Last Saturday, the Wall Street Journal carried an excellent op-ed piece, “Dr. Death Makes a Comeback” (subscription required), by Dr. Paul McHugh, former chief psychiatrist at Johns Hopkins Hospital. In it, Dr. McHugh opposes physician-assisted suicide (PAS), making three key points:
- The practice will tend to spread beyond terminally ill people to those who are “treatable but mentally troubled.” He appeals to the experience in the Netherlands, Belgium, and Switzerland, but does not offer specific statistics.
- A “right to die” will become a “duty to die,” and payers, including the government, will refuse to pay for costly treatments but will pay for suicide drugs instead. In 2008, a case in Oregon made a move in this direction—abortive, I believe. (Note, however, that this argument can be tenuous in the case of treatments that are minimally effective or ineffective, but the financial pressure to deny effective treatment is real, I believe.)
- Most importantly, in my view, Dr. McHugh appealed to Hippocrates, writing that “assisting in suicide hollows out the heart of the medical profession…the vocational commitment of doctors to care for all people…means doctors will not hold back their ingenuity and energies in treating anyone, rich or poor, young or old, prominent or socially insignificant—or curable or incurable.”
This is exactly what Margaret Mead said in a statement that I learned of in Nigel Cameron’s The New Medicine: Life and Death After Hippocrates, and which I have repeated several times in past posts over the last couple of years: “…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 who had the power to cure would necessarily also be able to kill.” The Greeks made it clear, she said, that physicians “were to be dedicated completely to life under all circumstances, regardless of rank, age, or intellect…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…[It is] the duty of society to protect the physician from such requests.”
I sent that quote in a letter to the Journal, hoping they would print it, where their large readership could see it. They didn’t run it. Seven of the nine letters they did run (Wednesday, Jan 28 edition) supported PAS either explicitly or implicitly. I suppose that’s how their mail ran. One writer appeared tepidly to oppose PAS, while another—the only physician whose response was published—thought that energy would be better spent figuring out “why every new estimate of needless hospital deaths has been greater than all previous estimates for the past 25 years.” As if the two were mutually exclusive.
For me, the most troubling statement was this one: “[T]he focus [of the conversation about PAS] should be about the needs of the dying and suffering patient—not the needs of the righteous doctor” (emphasis mine).
So that’s it? Asserting the soul of medicine is pharisaical? If that is the majority report of our society then medicine as a profession is beyond dead—it’s a pile of dry bones spread abroad in a desolate valley. Can these bones live?
I return to a statement of Dr. Atul Gawande that I cited in my November 27, 2014 comments about his book Being Mortal: “The fact that, by 2012, one in thirty-five Dutch people sought assisted suicide at their death is not a measure of success. It is a measure of failure. Our ultimate goal, after all, is not a good death but a good life to the very end…we damage entire societies [emphasis mine] if we let providing this capability [for PAS] divert us from improving the lives of the ill. Assisted living is far harder than assisted death, but its possibilities are far greater, as well.”