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 McQuainBarry Orvell, MDCarol EblenSteve PhillipsTom Garigan Recent comment authors
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Mark McQuain
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Mark McQuain

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… Read more »

Carol Eblen
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Carol Eblen

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… Read more »

Barry Orvell, MD
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Barry Orvell, MD

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… Read more »

Tom Garigan
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Tom Garigan

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
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Mark McQuain

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