martes, 21 de mayo de 2013

Se reabre un debate importante: el suicidio médicamente asistido

     El suicidio médicamente asistido, esto es, la colaboración y ayuda de un profesional médico para que una persona pueda, voluntaria, libre y autónomamente, suicidarse, es un tema importante que conviene pensar con cuidado. Se trata de determinar los límites de la intervención médica: curar, aliviar y acompañar, lo que puede significar retirar un tratamiento y dejar que la enfermedad siga su curso, pero no llegar a ayudar a provocar la muerte, como se considera de modo general. O bien incluir la colaboración al suicidio en esas posibles tareas de acompañamiento en el proceso de la muerte. Un tema que se reabre ahora con otro estado de Estados Unidos que acepta este planteamiento.
    Así se recoge en el blog de (



Craig Klugman, Ph.D.
Awaiting the governor’s signature, Vermont is poised to become the fourth state to legalize physician-assisted suicide. While Oregon and Washington legalized physician-aid-in-dying through public referendum and Montana through a court decision, Vermont’s is occurring through the legislative process.
The first U.S. aid-in-dying law was the Oregon 1994 Death with Dignity Act. The law faced a referendum to appeal it in 1997 and a Bush administration court challenge was ruled on in 2006.
The Vermont law mirrors those of Oregon and Washington. The patient must be at least 18 years of age, have a life-threatening condition and be a state resident. He/she must request aid-in-dying twice, with 15 days between each request. One request must be oral and one must be in writing. And the patient must be capable of taking the lethal drugs without assistance. Two physicians must verify the life-threatening nature of the condition. Health care professionals are not required to participate in any assisted death and must inform the patients of other available end-of-life options.
Where Vermont’s law differs is that after three years, this structured system sunsets, at which time the request and process becomes a private matter between physician and patient. And after 2016, physicians gain legal liability protection from professional misconduct charges.
Of course the concept of physician-assisted-suicide is highly controversial in the United States. Some opponents cite concerns of a slippery slope where the option for death becomes a requirement. One position holds that the state has an interest in the preservation of life and thus should intervene. Others argue that the professional role of the physician is to cure where possible and comfort always, but never to help patients die. The Hippocratic Oath even seemingly bans this practice with its precept: “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.”
Proponents say that if people are going to kill themselves because of the pain and suffering their disease causes (or may cause) then its better to have an expert who can make sure the patient does it effectively and compassionately. To do it wrong could lead to a person not dying but having severe morbidity such as being ventilator-dependent or severely brain damaged, exactly the situation that the patient wished to avoid in the first place. Another argument holds that competent and capacitated individuals have autonomy and that should extend to the right to end their lives with dignity. Still another perspective states that these decisions are private medical ones and the state should not intervene.
Vermont as a state has a strong libertarian tradition. That state elected one of the only 2 independent (belonging to neither the Democrat or Republican parties) members of the U.S. Senate (the other state is Maine). And Vermont was the first state to legalize same-sex marriage (which 12 states now allow). Thus, it is not surprising that Vermont would permit assisted-suicide, viewing such matters as between individuals and not the purview of the state.
What is surprising is the aspect of the law that removes all of the protections after the first three years of enactment. In other places such safeguards were necessary in order to achieve enough political support to pass the law and was seen as necessary to protect patients from themselves and potentially anyone who may be coercing them into suicide.  However, it is refreshing to see a state with the chutzpah to stand up and say that these are decisions among adults. As long as a patient is a competent and capacitated person who can give informed consent and as long as a physician is acting as a noncoercive professional who is willing to assist, then this medical decision belongs between them (or between them and the patient’s family). In other words, Vermont has said that the state should keep out of these personal, family medical decisions.
It is unlikely that Vermont’s move represents a sea change. Although opinion polls hold that 55% of American support physician-assisted-suicide, 41 states have explicit laws making such an act a crime.  However, other states could learn from this notion that medical decisions are between health care professionals and patients (and their families) and should not be used to further political careers.
This entry was posted in End of Life CareFeatured PostsPolitics and tagged . Posted by Craig Klugman.