After reading your article, Accessing Death With Dignity, posted on the front page of Sunday’s (March 11th) newspaper, I feel compelled to send in this response.  As a New Hampshire physician practicing in the fields of pain medicine and primary care, I am familiar with the intense agony people experience from a variety of health related conditions, including cancer, especially as they approach the end of their lives.  I can also appreciate the frustration people feel when they and their loved ones continue to suffer despite our best efforts from a medical standpoint.  A growing response to this difficult dilemma in our society has been to allow those considered competent the legal means to end their lives with the aid of prescribed medication.  This is, of course, what is known as physician assisted suicide.  As noted in the article, Vermont made this legal in 2013, making it the fifth state to do so through legislation.

While some consider the right to this act humane in the setting of intractable misery, I present a differing opinion.  As a member of the New Hampshire Guild of Catholic Healthcare Professionals, I suggest that the basis for our thoughts and actions be formed by the Eternal Law of God.  According to the mandates of our Creator, physician assisted suicide is an intrinsically evil act that is always contrary to His commandment: thou shall not kill. I recognize that suffering from terminal cancer can be both protracted and relentless, and for both the victim and their loved ones.  I speak from personal experience as well as professional.  In addition, I realize there are significant restrictions in the state laws concerning eligibility for those seeking medical aid in dying, making those who qualify few in number.  Nevertheless, no matter how good the intention, or dire the circumstance, the act of taking one’s own life should never be permissible. It is violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity.

To those who respond that this way of thinking is antiquated, a remnant of a bygone era, and no longer in keeping the modern view of autonomy and personal choice, I offer a word of caution.  A life lived in opposition to God’s law only leads to destruction and profound unhappiness.  A society that places itself above or outside the decrees of the Divine is destined for a state of dissonance and fragmentation.  The paradox is that adherence to God’s law does not reduce, much less do away with human freedom; rather, it protects and promotes that freedom.  Efforts have been and continue to be made in New Hampshire to prevent the legalization of physician assisted suicide, and I support those in Vermont who seek to repeal the current legislation.

I wish to add that opposition to physician assisted suicide is not unique to members of the Catholic Church.  Both the American College of Physicians and the American Medical Association have made clear their stance against physician assisted suicide.  While they certainly advocate the physician’s obligation to aggressively respond to the needs of patients at the end of their lives, the AMA specifically describes physician assisted suicide as, “fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks”.  Along the lines of dangers to the community, assisted suicide reflects a bias against persons with disabilities, serious illness and the elderly, and facilitates an environment in which their destruction is deemed preferable to compassionately addressing their health problems.

Finally, I believe it is important to address the issue of the obligation of doctors and other healthcare professionals specific to patients inquiring about physician assisted suicide, which was emphasized in your article.  Of course, it is always appropriate for doctors to thoroughly discuss patient concerns and reasons for requests for physician assisted suicide.  Compassionate and supportive care are highly likely to result in fewer inquiries about the subject.  In the situation where a patient persists in asking about physician assisted suicide, medical providers who are opposed to this practice are under no further obligation than to acknowledge that the Vermont law exists, and that there are resources available for further information (such as can be found on the internet).  This consistent with the same position quoted by the White River Junction, VA Medical Center's spokesperson.  Evidence for this position can be found from a case presented to the U.S. District Court for the District of Vermont in April, 2017.  The plaintiffs (the Vermont Alliance for Ethical Healthcare, Inc, and the Christian Medical and Dental Associations) expressed concern over the possibility of being subject to professional disciplinary action or other criminal or civil action against them from a refusal to inform patients of the choices available under the provisions of Vermont's Patient Choice and Control at End of Life Act (Act 39).

The case was ultimately dismissed on April 5th, 2017, and ironically served to support the position of the plaintiffs.  The ruling judge (Geoffrey W. Crawford) dismissed the case, stating that the briefing and oral argument presented, "demonstrate unequivocally that there is no credible threat of prosecution of Plaintiff's members by Vermont's medical regulators.".  As such, the plaintiff's concerns were greatly reduced as the possibility of disciplinary action was considered highly unlikely.  This stance was further supported by the Vermont Attorney General, who represented the defendants in this case (members of the Vermont Medical Board) and expressed the view that the life ending measures under Act 39 do not represent medical care and are not subject to the informed consent provisions. The Attorney General was quoted as saying, "the Act 39 process is not palliative care as the term is used in the patient's Bill of rights – it is an option for hastening death, not medical treatment such as pain management that improves quality of life...Act 39 does not give patients a "right" to "request" and "expect and receive" aid in dying from their healthcare provider, but, instead, expressly provides that healthcare providers and facilities are not obligated to participate in the Act 39 process.".  Ultimately, it was agreed upon by both sides in this case that a referral to a website in response to a patient's positive inquiry is sufficient to satisfy Vermont's informed consents requirements.

I conclude in the hope that we will continue our efforts in providing comprehensive and compassionate medical treatment for those stricken with terminal illnesses, and do our best in meeting their physical, psychological, emotional, and spiritual needs.  I pray we that we come to acknowledge the truth that genuine love and care for a person should never include supporting and participating in physician assisted suicide. 

Respectfully submitted

Paul Sansone, M.D.
Member, New Hampshire Guild of Catholic Healthcare Professionals