The Issue of Physician Motive in Physician-Assisted Suicide

Two responses to my June 8th post provide useful points of departure for further discussion about physician-assisted suicide (PAS). The first respondent argued that the Hippocratic Oath states that physicians should not give a “poison,” as opposed to stating that they should not give a “deadly drug.” The respondent’s claim was that inherent in the term “poison” was malintent, which would make the causation of death an act murder and not PAS, which could be an act of compassion.

I believe that in fact “deadly drug” is the more accurate translation of the original Greek. Regardless, I would ask how the definition of the word “poison” differs substantively, in either a linguistic or ethical perspective, from the term “deadly drug.” Even if the respondent’s claim were correct, it would be interesting to see how one would argue that Hippocrates would disapprove of a physician giving a “poison” while not disapproving of giving a “drug that causes death.”

It is useful to cast light on the attempt to use terminology to give a deed a hue of credibility by taking advantage of connotations. What seems to be happening in the debate over PAS is that the deed is cast as morally permissible if the motive of the physician is one of compassion. Therefore, the language supporting PAS is molded to convey that sense.

In fact, the Oath does not take physician motive into account. This is an important distinction, and I believe that this omission by Hippocrates was deliberate. He would have known that regardless of claims of PAS proponents, there is no possible way to ascertain or guarantee physician motive. Physicians performing PAS might sincerely believe they are performing a compassionate act, or they could have a grotesque fascination with death, as did the infamous Dr. Kevorkian. Given the intense interpersonal dynamics present in medical care, to permit PAS is to permit undesirable motives that then in subtle or flagrant ways will influence patients (as all of us are influenced by the beliefs of those around us).

Finally, I would argue that it is not clear that physician motive is all that relevant to those desiring PAS. We can draw from the example of pro-abortion advocates, who have moved to the claim that abortion should be available on demand, and that the moral position of physicians is irrelevant. So would it be with PAS: should the movement follow this predictable course, the physician would be relegated to a position of a mere provider of a service demanded by a customer.

If legalization of PAS continues, I predict that as with abortion, physicians will likely divide into three groups: those that are vehemently opposed, those that embrace it as part of their medical practice (out of compassion, we’d hope, but could never be certain), and those who do not express vehement objections but sense that it is contrary to the logic and coherence of their view of their participation in the profession.

This brings us to the question raised by the second respondent to my post, who asked why it was necessary to involve physicians at all, as suicides don’t usually seem to require them. I will discuss this in my next blog post.

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Barry Orvell, MD
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Barry Orvell, MD

The value of Hippocratic Oath is more ceremonial and an updated versoin by a Dr. Louis Lasagna, 1964, contains a this re interpetation: ” If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.” But then Dr. Lasagna is not Hippocrates. I don’t think we need to dwell on what Hippocrates intended since it can distract us from the real issues . What is… Read more »