We’ve all heard of physician assisted suicide occurring in free democratic countries in Europe, primarily in the Netherlands. In socialized countries such as Europe, life and death matters are a concern of the state. Live patients who are sick consume valuable resources – tax moneys.  Dead patients no longer are costly—they no longer consume tax dollars or Euros. Sick patients were never a legal problem until socialized medicine came into vogue. This is when governments paid the cost of illness and all governments have a cash flow problem—not just Greece, Italy, and Spain—but also Oregon which implemented a Physician Assisted Suicide law. All governments just don’t seem to think taxes are high enough to pay for the public good. Many times what is considered the public good is really the public harm.

President Obama has been raising taxes since he became president. Every day the news is telling us of another tax gimmick that was found to raise taxes on a particular segment of society which is not large enough to create a resistance problem. We are near the point where President Reagan was when he became President and found the Marginal Tax rate was more than 90 percent. He reduced it to 35 percent and the federal income increased greatly as citizens no longer had to use tax shelters. The government had plenty of money again. And the citizens also had money again to live more comfortably.

Now as taxes are skyrocketing again, the government is looking for ways to save money.  Not as a benefit to its citizens but for the benefit of the government bureaucracy. We are seeing limits on life saving procedures as are common in Europe; age limits on life saving procedures such as Coronary Bypass surgery, kidney dialysis, and others so that the discussion of Physician Assisted suicide is raising its head again. “Why should the elderly lie in nursing homes year after year on Medicaid expense? Can’t we let the doctors just slip then a little more morphine or phenobarbital or digoxin than the heart and brain can handle, maybe turn off the cardiac monitor so no one can get excited as the heart goes into agonal rhythm and then flat lines so that all medical costs stop along with the heart beat.”  By having doctors, who always have had the highest ethical standards of any group anywhere, do this it won’t seem like mass executions—just a rational cost saving procedure.

A doctor in The Netherlands confided in me during a break in a medical meeting in Amsterdam that he once admitted an elderly lady to the hospital. She said she worried about being put to death while in the hospital. The doctor I was speaking with assured her that he would watch over her to make sure that didn’t happen. The next weekend, he signed her out to a colleague. When he came back on Monday, he looked for her and couldn’t find her. The nurse said she had “died.” He quickly summoned his colleague as to what happened. He was told, “We needed the bed and she looked pretty sick.” He said he now felt it was a horrible tragedy for physicians to be involved in assisted suicide. It is more often an execution.

Statistics in Oregon, the first state in which physicians are allowed to kill patients who request it, indicate that perhaps as many as half of these patients have not signed a valid request stating that they wanted to be executed. These hospital mistakes are completely permanent. They are not simple medication errors that the Institute of Medicine feels are so tragic. Many of those are inconsequential and can be reversed. Physician execution of patients can never be reversed.

Patients in our day have enough lethal medications in their possession that doctors never need to be involved. Many pharmaceuticals are now dispensed in 90-day lots. Essentially all patients have enough cardiac or hypertension medications or narcotics at home that they can do the deed on their own.  Even a 30-day supply of such medications can do the dirty deed. Why should we involve and corrupt a profession with high moral values.  We have been revered as having the highest ethical values after after ministers, priests and rabbis.

A patient with obstructive sleep apnea came in for his annual evaluation. He had been snoring for decades, but about six years ago, his wife noted that his snoring stopped abruptly in the middle of the night. She observed her husband and noted that his chest was still moving, as if he was breathing, but there was no snoring. She then put her hand over his mouth and nose and did not find any air movement. She woke her husband immediately and after a loud strider, he began breathing. She insisted he see his pulmonologist as soon as he could obtain an appointment. He was immediately placed on a Continuous Positive Airway Pressure (C-PAP) device to wear at night and was scheduled for a Polysomnogram (sleep study). This confirmed the diagnosis of sleep apnea (no breath) and determined the optimal pressure to set the device to assure continuous breathing while asleep.

As I was finishing my exam and writing his prescriptions, he casually mentioned that a friend of the family, who had sleep apnea, also had severe respiratory failure requiring oxygen. His C-PAP was powered by oxygen pressure rather than compressed air. The friend was getting increasingly depressed over his disability and told my patient that sometimes he thought that he would just turn the machine off and end it all. Although my patient tried to joke him out of this approach, he apparently decided one night that he’d had enough. He turned off the machine and the oxygen and quietly died during the night.

With all the emphasis on physician-assisted suicide, it is indeed unfortunate, if not absolutely heinous, that physicians should play the role of executioner. That such a proposition can be passed by public vote underscores the lack of basic medical knowledge we have been unable to provide to the public. Or perhaps not enough moral turpitude that it matters. They don’t need a physician acting as an executioner to write a lethal dose of barbiturates (or to turn off life support or just cut the oxygen line.) The patients have numerous ways or lethal doses already in their possession. Whether in The Netherlands, Oregon or Europe, we should never have to worry about whether our doctor is wearing the white coat of healing or the black cloak of an executioner.