Physicians, the morality of euthanasia, and the Hippocratic Oath

In his post on Monday, Tom Garigan suggested that one of the primary reasons that those who favor physician-assisted suicide propose that physicians be the ones providing the means of death is that the involvement of physicians gives moral certification to what is being done. I think this is a very important insight. As I have thought about what he wrote I have been thinking about what makes the medical profession a moral enterprise and how that relates to physician-assisted suicide and other forms of euthanasia.

A key thing that distinguishes a profession, and particularly the medical profession, from a trade or association of technicians is the idea that a profession has a set of moral standards which helps to define the profession. Historically, the Hippocratic Oath was the thing that set physicians apart as a profession. There are several things about that historic oath which led to physicians being seen as part of a profession that was respected for its moral standing. One of those was recognizing a higher moral authority before which the oath was sworn. Another was a commitment to doing what was best for the patient. There was also a specific list of things which the Hippocratic physician would not do, the things that were ethically prohibited. This included administering poison (euthanasia), abortion, surgery (which the Hippocratic physician was not trained to do), and taking advantage of anyone in the household of those being treated (particularly sexually). Those prohibitions make it clear that there are moral standards which take precedence over the individual physician’s judgment. It seems to me that this submission to moral standards which are grounded in a higher moral authority is the thing that has traditionally given the medical profession a unique moral standing in society.

It is the moral standing of the medical profession in society that makes it important for those who support physician-assisted suicide and other forms of euthanasia to propose that physicians play a key role in the administration of death. The involvement of physicians appears to transfer the moral standing of the medical profession to the action being done. The problem with this is that by taking on the authority of deciding who will die by physician-assisted suicide or euthanasia the physician is violating the key thing that gives the medical profession its moral standing. By making the decision to provide lethal medication for the person requesting physician-assisted suicide or administering lethal medication to the person receiving active euthanasia the physician has taken on the authority of being able to determine that another person’s life is not worth living. By doing so the physician is saying that there is not a higher moral authority to which physicians are subject and there are not distinct boundaries which a physician should not cross in doing what seems to the physician to be best for the patient. Since it was the acceptance of a higher moral authority and specific boundaries that has given the medical profession its moral standing in society, the abandonment of those things and the assumption of unlimited moral authority by the physician undermines the basis for society’s moral respect for the medical profession. In the end, the involvement of physicians in physician-assisted suicide and other forms of euthanasia does not give moral certification to those actions, but instead leads to the loss of moral standing for the medical profession.

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Mark McQuain
Mark McQuain
5 years ago

Along those same lines, I have sensed a shift in my patient’s perception of medical doctors over my 25 years in practice in that patients seem to view doctors presently more as technicians with a skill set rather than a member of a profession submitting to a higher moral standard. Since a growing portion of people do not recognize any transcendental source for moral authority, do we just have vestigial moral authority (much like a taboo or trust in a witch-doctor)? And if that is the only remaining basis to any moral authority physicians have, can that moral authority be transferred to an act like euthanasia as Tom Garigan suggests? Or will it be further eroded by committing the act as you suggest?

Even if other people do not believe in a transcendental source for moral authority, is it sufficient that those same people at least believe that I believe there is such a source for physicians like me to retain some of that sense of moral authority or trustworthiness?

Carol Eblen
Carol Eblen
5 years ago

The matter of unilateral passive euthanasia of the elderly/disabled/poor/mentally ill on the public safety nets of Medicare/Medicaid is ignored by government and the AMA and the bioethicists who hide their heads in the sand because of MONEY and PROFITS that are involved when patients are treated as “product” for “profit” in the Medical Industrial Complex —- instead of being treated by physicians as the children of God, the transcendental source for moral authority for Christians.

It becomes more difficult for physicians to take the high ground as they become employees of hospitals and as hospitals and insurance companies are consolidating to protect their current “record” profits.

As the practice of Medicine has been specialized and incorporated, the Hippocratic Oath takes a back seat to good business practices. However, patients still respect and value physicians above other “merchants” for their special knowlege and skills that save lives and relieve pain and that often are the difference between life and death.

I wonder if the physician who placed the unilateral DNR Code Status in my husband’s hospital chart was a Christian and if it bothered him that he commited a sin and a violation of Missouri law. .

I am still waiting for a new comment on unilateral Code Status in Hospital Charts from TIU, JH, and the view of TIU as to the reality of involuntary euthanasia of elderly/disabled/poor/mentall ill patients on Medicare and Medicaid insurance in service of fical expediency and profits.

Carol Eblen
Carol Eblen
5 years ago
Reply to  Steve Phillips

I’m sure that you are correct; i.e. that most physicians hold a strong sense of moral responsibility to do what is best for their patients. But, shouldn’t they also have a legal and ethical responsibility not to hasten the death/or shorten the life of a patient without the patient’s informed consent or the consent of the surrogate when the patient cannot give consent?

While I realize that physicians, themselves, have cooperated to have “passive euthanasia” which is the withholding or withdrawing of life-sustaining medical treatment treated differently by the law than “active euthanasia” — that becomes possible with the legal and lethal prescription when Physician Assisted Suicide (PAS) is sanctioned by the state. Isn’t this dangerous for patients in the REAL World? PAS, at under $1,000 is a solution to the problem of reduced reimbursement or no reimbursement from CMS/Advantage/Private Insurance for the treatment of Medicare/Medicaid patients —who have NO idea that they have become charity patients in their local hospitals.

It is Jon Holmlund of TIU who indicated that he was working on a paper concerning unilateral DNR that would be forthcoming. I am waiting. Thank you for engaging in conversation with me. You are a good man!

If the Hospital Ethics Committee had done its job in my case, I probably wouldn’t be out here on the Internet trying to expose the long-existing problem of the misuse of DNR Code Status to the public.

The Hospital Ethics Committees have a conflict of interest so often because, of course, they are going to protect the Hospital and the physician if wrong-doing is involved. I was promised a hearing with the Hospital Ethics Committee that, of course, never took place once my husband and I returned home from the hospital.

If you have some concern over the cost of care

Barry Orvell, MD
Barry Orvell, MD
5 years ago

My realization is how our basic assumptions need to be brought to light. If we assume that morality comes from a belief in God, then we may never agree on PAS.
And if we are suspect of anyone whose says they are just as moral without a belief in God, then we may never understand each other
The thought that doctors also take their morality from an authority on high, Hippocrates, is an extension of the same religious paradigm.
Secular morality derives from earthly experience. Yet both arrive at very similar answers on right and wrong. I find this to be so interesting,
The debate over PAS brings out these two ways of thinking. It calls for a stretch on each side, I think.

Barry Orvell, MD
Barry Orvell, MD
5 years ago
Reply to  Steve Phillips

I agree that morality is embedded. If we agree that non religious also have a respect for the highest values, then we can communicate. There is a need to do good, as much as to breath.
Euthanasia to me is wrong, killing the innocent, the helpless is wrong. I don’t see Physician assisted suicide as similar because the patient is requesting it, he is in sound mind, he can change his mind, and he is close to dying and his suffering can not be palliated.
Moreover there must not be coercion of doctors or patients to take part.
The California law was crafted with safeguards so that agency resides with the patient and never with doctor or insurer.
In Oregon there are 300,000 deaths/yr, and 70-80 deaths/yr from PAS. It must be selective and the rationale must be clear.

Tom Garigan
Tom Garigan
5 years ago

Just in case my intent was not clear (in my post two days ago): I do not believe that physician involvement in an act actually gives it moral certification. Instead, that is just the hope of proponents of PAS. There may be a patina of moral certification initially, but at its core the act of assisting suicide does not rise in moral value just because of involvement of any particular group.

Mark McQuain
Mark McQuain
5 years ago
Reply to  Tom Garigan

I, too, understood your point as Steve’s reply stated