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‘Pain a minor reason patients choose PAS’

Compassion for individuals confronting a terminal illness drove the efforts to legalize physician-assisted suicide, or PAS (also known as medical aid in dying), in Colorado in 2016.

Compassion is again the motivation behind an attempt by legislators to loosen the requirements and increase access to physician-assisted suicide through Senate Bill 068. Despite admirable intentions, the bill could actually increase suffering, and cause serious unintended consequences for vulnerable individuals and communities.

When the End-of-Life Options ballot initiative was passed, many Coloradans assumed they were voting to give options to patients with intractable pain and suffering –especially for those with terminal cancer. The reality is that fear of pain or actual pain is a minor reason that patients choose PAS in jurisdictions where it is legal. Colorado’s law doesn’t require physicians to submit the reason why their patients choose PAS, but other states have more robust data collection and safeguards.

In Oregon, which has the longest PAS program in the country, only 28% cited inadequate pain control or anticipation of pain as a contributing factor to their decision. In fact, when assessed prospectively, the amount of pain and suffering endured by patients who choose PAS is no different than for those who don’t pursue PAS.

Coloradans may be surprised to learn some of the factors which are more commonly cited in the PAS decision. Being a burden on families (48%), loss of dignity (72%), and losing autonomy (90%) all are more important than pain, according to the Oregon report from 2022. These feelings aren’t inevitable at the end of life and could be a reflection of the growing ableist mentality in our country. They also highlight the inadequacy of our social safety net.

When I change my 1-year-old grandson;s diaper, I never think that he has no value or dignity. Similarly, when I helped my 96-year-old father near the end of his life with personal hygiene tasks, I never thought he was less a man because he had the inability to independently perform some activities of daily living.

Being dependent does not deprive a person of value and dignity. However, that is exactly the message that is frequently portrayed by PAS advocates and the compliant media. In public testimonials to PAS, the term “dignity” is frequently invoked. Choosing PAS is often characterized as “courageous.” Equating disabilities and dependency with value and dignity quickly becomes a message that reverberates in vulnerable Coloradans.

By making access to PAS easier, we will be promoting this ableist message. Senate Bill 068 expands the universe of people who can prescribe PAS to nurse practitioners. It allows patients from other states to participate in PAS. And it decreases the time that a patient is required to wait to receive their PAS drugs from 15 days to 48 hours or less.

As assisted suicide is normalized, the explicit or implicit message to consider it will increase among vulnerable Coloradans. What starts out as a “right” becomes an obligation nurtured by the medical community and changing public attitudes.

What is often overlooked, if not purposely ignored, is that a significant percentage of people seeking PAS are depressed. The End-of Life Options Act required that PAS participants be “mentally capable.” The reality is that fewer than 1% of people in Colorado prescribed PAS drugs have been referred for mental health consultation.

Since conservative estimates suggest that at least 8% and as many as 47% of patients who request PAS have clinical depression, we are likely treating clinical depression with state-sanctioned suicide.

Suicide is a serious problem in Colorado and has been a focus of private and public scrutiny, and preventative efforts. Colorado’s public health posture provokes cognitive dissonance. On the one hand, we are doing everything in our power to prevent suicide, especially in vulnerable teens. On the other hand, we are promoting suicide for the sick, elderly and disabled through PAS. And with Senate Bill 068, even when their natural death is imminent.

We should redirect our compassion. The bill does nothing to address the issue of depression that drives some to pursue PAS. It could increase deaths in vulnerable (non-terminal) populations, including at-risk teens. For all these reasons, Coloradans should let state senators and representatives know that this bill doesn’t have a place in Colorado.

Thomas J. Perille of Englewood is a medical doctor and the president of Democrats for Life of Colorado. He contributes to The Colorado Sun, a nonpartisan news organization based in Denver.