The coronavirus pandemic has forced us to adapt the way we access health care, and telehealth is now widely used to overcome many hurdles related to receiving in-person attention. But there are some contexts in which relying on telemedicine can be dangerous — even deadly. Telemedicine should never be used in the context of assisted suicide because it increases the dangers of a practice already ripe for abuse.
The American Clinicians Academy on Medical Aid in Dying recently put out guidelines (acamaid.org) for doctors to prescribe lethal drugs remotely. Their reckless recommendations include establishing the diagnosis, prognosis and decision-making capacity of patients to “legally establish the patient’s first verbal request and the start of the waiting period.” Following the waiting period, the required second verbal request for assisted suicide can be made “by telephone without visual contact.”
Eligibility for assisted suicide depends upon a six-month or less prognosis and the patient’s mental competence. Would you trust a doctor you have never met in person if they told you you had less than six months to live without getting a second opinion? Is one telehealth appointment enough to accurately diagnose depression or determine mental competence? Proponents of assisted suicide say yes. But the expansion of telehealth sheds light on how the so-called safeguards of assisted suicide can be easily circumvented.
One example is “doctor shopping.” A patient or caregiver who engages in doctor shopping is not interested in professional medical advice but obtaining a predetermined prognosis or prescription. The goal with doctor shopping in the context of assisted suicide is to achieve death regardless of the circumstances that would legally prevent it.
With telemedicine, finding an unscrupulous doctor who will prescribe lethal drugs no longer depends upon geography. A virtual visit suffices. Nothing prevents clinically depressed or suicidal patients from doctor shopping until they find someone willing to prescribe them death rather than the mental health care and suicide prevention they need.
On top of that, without doctors knowing the patients’ caregivers or family, there is greater risk for coercion from greedy heirs or abusive caregivers. Vulnerable patients are in grave danger when abusers can shop on their behalf for telehealth doctors known to bend the rules when it comes to assisted suicide.
Even when patients are seen in-person, it is difficult for a physician or psychiatrist in a single session to diagnose depression, incompetence or other factors which could impair judgment. In one documented case (dredf.org), a psychologist outsourced the psychiatric test to the patient’s family members, who had no medical credentials.
Such unprofessional standards should never be allowed to replace vital in-person care, especially when results literally determine whether the patient will live or die. Thankfully, the psychologist in this case concluded that the patient was depressed and did not qualify for assisted suicide. This demonstrates, however, how easy it is to flout the legal requirements for confirming mental competency.
Assisted suicide laws also require a terminal illness diagnosis of six months or less. Properly diagnosing a patient as terminal is difficult enough in-person, but even more so virtually. In fact, any patient’s life expectancy is a doctor’s educated guess at best.
My husband, J.J. Hanson (usatoday.com), was diagnosed with terminal brain cancer and given just four months to live. With that prognosis J.J. could have easily sought and qualified for assisted suicide in places where it is legal. Amazingly, J.J. didn’t listen to his doctors’ predictions and outlived his prognosis by three-and-a-half years. Our experience is not uncommon and underscores the inability of physicians to accurately predict how long someone has to live.
Assisted suicide always endangers vulnerable patients and has no place in our society. Allowing telemedicine to play any role in the prescription of lethal drugs, though, will further breakdown the few “safeguards” that exist to protect patients.
• Kristen Hanson is a community relations advocate with the Patients Rights Action Fund [patientsrightsaction.org].