Physicians’ role in assisted dying

In a recent Perspective article in the 7/12/12 issue of the New England Journal of Medicine, Julian J.Z. Prokopetz and Lisa Soleymani Lehmann take an interesting perspective on what physicians’ role in assisted dying should be. Although they admit that assisted dying, in which patients acquire a lethal dose of medicine with the explicit intention of ending their life (also known as assisted suicide), is generally illegal, they take the position that assisted dying is a desirable way for terminal patients to express their autonomy. They see anything that would hinder patients from being able to do this as a barrier that needs to be removed. They mention several of the objections that have been raised against assisted dying, but do not give much credence to any of them including the concern that participating in the intentional ending of a human life goes against the sanctity or inherent value of human life.

What is most interesting, particularly for Lehman who is a physician, is how they regard the objections to allowing assisted dying that are made by physicians. They note that in a 2003 survey of AMA members 69% objected to physician assisted suicide, and that there are national and state medical associations (including the AMA) that are officially opposed to physician assisted suicide. They note that those physicians “believe it’s inappropriate or wrong for a physician to play an active role in ending a patient’s life.” Their response to that is to suggest that physicians be relieved of the role of providing the lethal dose of medicine to those who request assisted dying. They propose that physicians be limited to determining the patient’s prognosis so the patient can take that information to a government agency to prescribe the lethal medication.

This proposal has some interesting implications. It assumes that the majority of physicians who are opposed to physician assisted suicide have no good reason for why they are opposed. It says that when those who care for the dying say that they do not think that helping those who have a terminal illness kill themselves is the best way to care for those patients we should pay no attention to them. It takes respect for autonomy to the extreme that says the physician should just provide diagnostic and prognostic information and the patient should get their treatment from a technician who simply does what the patient asks, even if that is to help kill the patient.

It is correct that one of the objections to participation in physician assisted suicide that physicians and physician organizations have is that it runs counter to the fundamental principles of the medical profession which is focused on providing care that is in the best interest of their patients and not doing harm to those patients by helping them kill themselves. Rather than suggest that physicians who have those principles should be circumvented, it would be good to recognize that the underlying principles of the medical profession which make assisting in suicide incompatible with the profession are good principles for anyone who is caring for those who are ill or dying. It is not just that assisted dying is incompatible with the medical profession; it is incompatible with caring for those who are dying in a way that respects the value of their lives as human beings.

Finding a way around those physicians who want to protect their patients by not participating in assisted suicide is like finding away to drive around those pesky crossbars at a railroad crossing that keep me from going where I want to go. Both are assertions of autonomy that fail to understand that there are good reasons that there are some things we should not do.

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John Kilner
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John Kilner

Good insight, Steve. The common response to assisted suicide initiatives is that physician autonomy should be valued as much as patient autonomy. But this argument in the NEJM sidesteps that by removing physicians from the equation. You are right to suggest that battling over whose autonomy trumps whose is the wrong way to go–that we are, first and foremost, engaged in health CARE, not health autonomy.

James Leonard Park
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James Leonard Park

Physicians already take part in most end-of-life decisions.
And some of these are explicitly life-ending decisions:
increasing pain medication, terminal sedation, ending curative treatments and disconnecting life-supports,
& terminal dehydration. See my Internet essay:
“Four Legal Methods of Choosing Death”:
http://www.tc.umn.edu/~parkx032/CY-L-END.html