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PAS: Unwise, Uncontrollable, and Unnecessary

BY G. KEVIN DONOVAN, MD, MA

 


 

Proponents of physician-assisted suicide point to real and tragic stories of suffering in individuals at the end of life. I’ve heard the stories and found them heartbreaking, making me and others want to do something to alleviate such situations. Unfortunately their solution would not make for a better society; they offer a cure that is worse than the disease. Their plan would be to change the laws governing suicide in every state. Currently, suicide is not illegal in any of the states or the District of Columbia. What they would change is the prohibition of assistance from an outside party, specifically in this case, a physician. This would result in a profound shift in the doctor-patient relationship, and the profession of medicine. For 2 millennia, physicians have striven to separate themselves from those who would deliberately cause harm. The Hippocratic oath, still taken in some form by most medical school graduates, states specifically “I will give no deadly medicine to anyone if asked, nor suggest such counsel.” The American Medical Association still states that participating in assisted suicide or euthanasia is incompatible with the role of the physician. Given this tradition and the importance of the doctor-patient relationship, it is unclear why proponents of PAS seek to legislate the involvement of physicians in assisting with the patient’s suicide. It is likely because of the trust relationship that exists between patients and their doctors, a trust that would be eroded in many cases by even so much as an offer from the physician to bring about their patient’s death.

Those who would like to see physician-assisted suicide (PAS) legislation passed assert that it would only be done with appropriate restrictions and protections. In fact, the only real protections are for the physicians who would involve themselves, with the law protecting them from any consequences of their involvement, short of felonious behavior. It also protects from discovery the records of the activities surrounding PAS – reports are to be sent to the Health Department, which collates them, issues an anonymized report, and destroys the originals. What is missing here is the adequate protection for patients. Although the law would initially restrict PAS to those with a terminal disease with six months to live, these restrictions, if viewed closely, can be seen to be indefensible. Changing the law to legalize PAS is based on an appeal for autonomy for the patient; it redefines medical care to include, as a medical good, aiding in the death of the patient. But if we enshrine this new medical good with the power of law, we will make it logically impossible to deny that good in multiple other cases.

Why should a patient have to be expected to die in six months, rather than 12? Why must they be terminally ill rather than suffering from chronic incurable illness? Why must they be able to take the medicine themselves -what if they are too weak, too debilitated, too demented – why can’t someone else give them a lethal dose? Why even should we restrict this new “benefit” to those over 18; we know children can suffer from terminal or chronic conditions. Shouldn’t this new medical benefit include them as well?

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When a legislature undertakes to change the law, they change the moral fabric of society as well. What was previously unthinkable is now legal, and soon becomes the norm. This places all patients at risk, not solely those whom society has disadvantaged by reason of poverty, color, or physical disability. An elderly grandmother, seen by those she loves to be suffering, may hear the suggestion of assisted suicide as something she would never have considered before now. But, now that it’s legal, it must be all right, and perhaps should be considered, not so much because it is her strong desire, but because she does not want to see her loved ones or their financial resources further exhausted.

Legislators should always be cautious when considering revolutionary changes in societal norms. They should certainly have a clear and strong understanding of the effects on the majority of the citizenry. This is particularly true in PAS when so many long-term consequences are still uncertain. It is even truer when the change in the law is designed to privilege the few at the risk of many. We are repeatedly told that only a few patients would likely seek the solution annually, and some of the data from other states suggest this may be the case, at least at first. We must ask ourselves if such a drastic change in the legal landscape for such a small number is wise or is necessary. We now know that we have long suspected: patients have already been obtaining assisted suicide from physicians willing to provide it, without any legal sanction. It appears that those who want assistance in their suicides can find it, even in places where it has not been authorized by law. It would be more difficult in all likelihood, and would give people pause before proceeding. Would this be such a bad thing, if someone had to consider that step carefully and with all due deliberation?

I do not think that assisting in suicide meets the deepest and most fundamental needs of the suffering patient. I think they need physical and emotional support, the reassurance that they are never considered a burden, and a loving presence to their very end. I know that there are those individuals who would disagree, and might want to proceed with their self-inflicted deaths whether it were legalized or not. They should not be judged, they should never be prosecuted for the attempt. As a society, we shouldn’t change the law in a way that might encourage their deaths, we should not take their hand and lead them towards that, and certainly shouldn’t make them feel they are subtly being pushed into it. But overall, the sick, the vulnerable, the suffering, and dying deserve so much better, and a truly caring society would provide them with no less.


 

ABOUT THE AUTHOR

G. Kevin Donovan, MD Director G. Kevin Donovan, MD, MA

G. Kevin Donovan, MD, MA is the Director of the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center. He is also a professor in the Department of Pediatrics at Georgetown University School of Medicine.

 

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Reference:

Emanuel, Fairclogh, et al. “Attitudes and Practices of US Oncologists regarding Euthanasia and Physician Assisted Suicide, Ann Intern Med2000; 133:527-532,www.annals.org.

Images: Creative Commons

3 thoughts on “PAS: Unwise, Uncontrollable, and Unnecessary”

  1. Dear Dr. Donovan,
    I appreciate your blog being up to date. This article on PAS was pretty convincing at the end when you brought up the emotional support aspect. You said PAS would erode the trust in doctor patient relationship. Would you please speak more about this and give an example? Lastly, you said there are only very few patients who seek this solution. What do you mean by this and would you please name the example. Again thank you for your time to educate the readers like me.

    1. Dear Peter Le,

      Thank you for your comments. I would reply as follows: In fact, there are only very few patients who seek this solution, as evidenced by the data coming from Oregon, where only 40 – 70 patients seek PAS annually, as compared to the large number of those who died there every year. This is a relatively small number given the far greater number of people who are potentially affected by the adverse consequences of such a law.
      As for the erosion of the doctor-patient relationship caused by PAS, I don’t think anyone has described it better than the anthropologist Margaret Mead, when writing several decades ago, in anticipation of this very problem:

      “For the first time in our tradition there was a complete separation between killing and curing. Throughout the primitive world, the doctor and the sorcerer tended to be the same person. He with the power to kill had the power to cure, he who had the power to cure would necessarily also be able to kill. … [With Hippocrates] the distinction was made clear. One profession, the followers of [Hippocrates], were to be dedicated completely to life under all circumstances, regardless of rank, age or intellect—the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child…”“[T]his is a priceless possession which we cannot afford to tarnish, but society always is attempting to make the physician into a killer—to kill the defective child at birth, to leave the sleeping pills beside the bed of the cancer patient. … [I]t is the duty of society to protect the physician from such requests.”

      Anthropologist Margaret Mead, Quoted by Maurice Levine in Psychiatry and Ethics, pp.324-325

      -Dr. G Kevin Donovan

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