“Montana physicians can feel safe that in providing aid in dying, they don't run risk of criminal prosecution,” she said. “We know aid in dying happens in every state, even where the legality is unclear. In Montana, this [decision] brings clarity to this issue.”
Ms. Tucker added that most medical care “is not governed by statute; it's governed by the standard of care and best practices. So most physicians will approach aid in dying in Montana as something regulated by the standard of care. I think what's going to happen with Montana [is that this case] will move aid in dying into normal medical practice that's governed by the standard of care, and we'll get away from the notion that there need to be elaborate statutes.”
How Much Do RA Patients Suffer?
Most rheumatologic disorders do not meet the standard of terminal diseases. However, they can involve a level of intractable suffering that leaves them on the ethical edge of consideration of assisted suicide.
A case presented by the University of Washington's Ethics in Medicine Web site discusses a recently divorced 55-year-old man with severe rheumatoid arthritis who comes in for a routine visit, complaining of insomnia. “He requests a specific barbiturate, Seconal, as a sleep aid, asking for a month's supply. On further questioning, he states that he wakes up every morning at four, tired but unable to go back to sleep. He admits that he rarely leaves his house during the day, stating that he has no interest in the activities he used to find enjoyable.”
The Web site ((
http://depts.washington.edu/bioethx/topics/pasc1.html
It then states that he falls outside the qualifying diseases: “The request for a specific quantity of a specific barbiturate suggests that this patient is contemplating suicide. This concern should be addressed explicitly with the patient. His sleep pattern (early morning awakening) and lack of interest in previously enjoyable pastimes (anhedonia) suggest major depression. This should be fully evaluated and treated. In addition, pain management and long-term care options should be fully revisited in a patient with complaints such as his.
“Even if the patient were fully competent, most proponents of [physician-assisted suicide] would object to aiding his suicide as he is not terminally ill. This said, rheumatoid arthritis can be a painful and debilitating chronic condition and it is unclear whether there is any relevant ethical or legal distinction between such a patient and one who is terminally ill.”
—Sally Koch Kubetin