The Colorado law that legalizes physician-assisted suicide for the terminally ill requires certifiers to classify such deaths as natural. The cause of death must be the terminal illness, not drug toxicity.
If a dying person chooses suicide over suffering, I don’t object. I’m not entirely opposed to giving doctors the option to prescribe life-ending medicines, though there are plenty of ways to commit suicide without physician assistance. I’m appalled that the Legislature would require that death certificates be falsified.
On Colorado’s death certificate, coroners and doctors respectively certify that “in my opinion,” or “to the best of my knowledge, death occurred ... due to the cause(s) and manner as stated.” Certifying the death of someone who died from a prescribed drug overdose as a natural death from lung cancer would be a false statement reflecting neither my professional opinion nor my best knowledge.
Legally mandating a false statement doesn’t make it true. I couldn’t sign such a certificate, and I wouldn’t have to because Colorado removes assisted-suicide deaths from the coroner’s jurisdiction.
I question whether oversight will be adequate without the safeguard of an independent review.
The Department of Public Health and Environment is required to “annually review a sample of records … to ensure compliance,” but “the information collected by the department is not a public record and is not available for public inspection.”
In other states, death-with-dignity laws are even less rigorous. Dr. Katrina Hedger of the Oregon Department of Human Services said, “We are not given the resources to investigate (assisted-suicide cases) and not only do we not have the resources to do it but we do not have any legal authority to insert ourselves.”
Opponents of assisted suicide legislation worry that a “slippery slope” will make it increasingly likely that life-ending drugs will be prescribed for the depressed, the elderly, the disabled, the incompetent or others outside of the law’s original intent. Nobody wants that, but the slippery-slope concern is valid.
Assisted suicide and medical euthanasia have been legal in the Netherlands since 2002 for people who aren’t necessarily terminally ill but who experience “unbearable and hopeless suffering.” I recently read several British newspaper articles reporting on a trend toward applying this law to people with mental health problems:
The request for death by a woman who was sexually abused as a child was granted when doctors and psychiatrists decided her post-traumatic stress disorder manifested by anorexia, chronic depression and hallucinations was hopeless and her suffering unbearable.Another approved request came from a man with long-standing alcoholism who said he could no longer live with his addiction. The man’s brother supported the request because the denial of a “good death” would make some messier means of suicide inevitable.I’d be surprised if these were the kinds of cases a majority of the Dutch envisioned when they adopted the “unbearable and hopeless suffering” language. It’s likely the Netherlands is on a slippery slope.
Terminally-ill people and their families don’t deserve the societal opprobrium that typically accompanies suicide. But calling assisted-suicide deaths “natural” masks that problem without solving it.
I hate euphemisms. Assisted-suicide deaths are suicides. Coroners and medical examiners should review them. If a majority of the public thinks a suicide classification is too harsh, add a “death with dignity” check box to the death certificate so vital statisticians can track these cases, researchers can report on them and the public can see whether, over time, the law continues to fulfill its original intent.
Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland. Email her at email@example.com.