This past May, a bill titled, “The Voluntary Assisted Dying Amendment (Telehealth and Other Matters),” was introduced in Victoria, Australia, which has already legalized assisted suicide and euthanasia.  This bill to permit assisted suicide and euthanasia using telemedicine is not only dangerous to patients, but could accelerate already rising rates of assisted suicide in the Australian state. 

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In 2017, Victoria’s parliament passed the Voluntary Assisted Dying Act to legalize assisted suicide as well as euthanasia. The law took effect on June 19, 2019. It requires that patients wishing to end their lives obtain a death permit. They then either self-administer lethal drugs [assisted suicide] or have a medical provider do so [euthanasia].

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According to an article in the Christian Post Reporter by Emily Wood, “Assisted suicide deaths soar in Victoria, Australia as euthanasia becomes 'normalized' globally,”

 

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A recently released report details the increasing rate of voluntary assisted suicide in Victoria, Australia, as hundreds have ended their lives following the state’s legalization of euthanasia in 2019. The [biannual] report shows that in the last six months of 2020, voluntary assisted suicide rates have increased in Victoria. A total of 581 people in Victoria applied for voluntary assisted dying since June 2019… and 446 individuals sought information on voluntary assisted suicide in the last six months of 2020 alone, according to the data.

 

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In addition to rising rates of Victoria residents seeking assisted suicide or euthanasia, the number of doctors seeking to participate has also risen by 31.6%.[1]  The number of confirmed euthanasia deaths from practitioner administration increased by 81.8%.[2] This is a shocking statistic. 

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Even amidst a world-wide pandemic and widespread lockdowns, physicians’ rates of participating in active euthanasia still jumped markedly.  If euthanasia via telemedicine became legal, doctor shopping would become inevitable and easily accessible.

 

 

U.S. Experience

In the U.S., nine states and D.C. now legalize physician assisted suicide including California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Washington, and Vermont.  A Montana Supreme Court decision, while not legalizing the practice, found that a physician would be able to raise the defense that the patient consented if sued.

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Typically, most states make it a crime to assist in a suicide, but these sorts of laws carve out an exception for a physician to prescribe lethal drugs to end the life of a patient if certain criteria are met. The patient then takes the lethal drugs at home.

 

There is mounting evidence that any so-called “safeguards” are woefully inadequate. This was documented by the National Council on Disability (NCD)—an independent federal agency that advises the President and Congress-- in its 2019 study titled “The Danger of Assisted Suicide Laws.” 

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The NCD cited numerous failures including the fact that “Insurers have denied expensive, life-sustaining medical treatment, but offered to subsidize lethal drugs, potentially leading patients to hasten their own deaths; misdiagnoses of terminal disease can cause frightened patients to hasten their deaths; financial and emotional pressures can distort patient choice; and patients may “doctor shop” limitlessly to find a physician who will obtain a colleague’s concurrence and prescribe a lethal dose.”[3]

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Expanding an already broken system of “hastening death” to include an even less monitored scheme of telemedicine would be a grave mistake.

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Kristen Hansen, in Washington Times op-ed, “When telemedicine can be dangerous — even deadly” from July 14, 2020 writes,

 

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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.”[4]

 

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.

 

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While the COVID-19 pandemic led to a spike in telehealth, there are some services that simply cannot be delivered virtually.  One of the leading prognoses that prompt people in legalizing jurisdictions to seek assisted suicide is a diagnosis of cancer. 

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It is now commonly understood that the pandemic has led to major disruptions of treatments, for cancer patients in particular.  According to a recent study, “COVID-19 has had a catastrophic effect on healthcare systems compromising the treatment of cancer patients. It has an increased disease burden in the cancer population.”[5]

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However, the prognosis of terminal illness is often inaccurate, a problem sure to be compounded if permitted on the basis of a virtual visit alone.

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The National Council on Disability goes on to state,

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Implementation of assisted suicide laws has demonstrated that even the current “safeguards,” which are modest at best, are easily circumvented…. Examples from other countries have also demonstrated that once assisted suicide seems “safe,” then euthanasia and assisted suicide for nonterminal diseases becomes a reasonable next step. Thus, there is no reason to believe that better laws, training of physicians, data collection or safeguards will provide real protection from harms and abuse in any meaningful way.[6]

 

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In a law laden with multiple dangers and scant “safeguards” there ought to be a moment of pause for countries abroad, and for us here in the U.S, before we forge ahead into expanding assisted suicide using telemedicine.

 

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[1]https://www.bettersafercare.vic.gov.au/sites/default/files/2021-02/VADRB_Report%20of%20operations%20Feb%2021_FINAL.pdf

[2] Id.

[3] Available at: https://ncd.gov/sites/default/files/NCD_Assisted_Suicide_Report_508.pdf

[4]https://www.washingtontimes.com/news/2020/jul/14/when-telemedicine-can-be-dangerous-even-deadly/

[5] Shirke, M. M., Shaikh, S. A., & Harky, A. (2020). Implications of Telemedicine in Oncology during the COVID-19 Pandemic. Acta Bio Medica: Atenei Parmensis, 91(3), e2020022.

[6] Available at: https://ncd.gov/sites/default/files/NCD_Assisted_Suicide_Report_508.pdf

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