Whatever Happened to the Instinct that ‘Doctors Must Not Kill’?

In a 1992 article in the Journal of Clinical Ethics titled, “Doctors Must Not Kill,” renowned physician and bioethicist Edmund Pellegrino reminded fellow physicians—with incisive logic and strong passion—of their historic duty to be healers, not killers. As one who is not a physician but will one day be a patient facing the end of his life, I would take comfort in knowing that my physician was committed to heal me and, if healing were not possible, to provide me comfort and care to the day of my natural death. Pellegrino’s plea that “doctors must not kill,” however, evidently is falling on the deaf ears of more and more physicians.

The notion that mercy can entail ending the suffering of a patient by ending his or her life, combined with an almost uncritical acquiescence to patient autonomy, seem to be the major factors behind the increasing acceptance by physicians of PAS (physician-assisted suicide). According to the Medscape Ethics Report 2016, 57% of physicians believe PAS should be available to terminally ill patients who request it, up from 54% in 2014 and 46% in 2010. This aligns with the increasing public acceptance of PAS. A 2016 Gallup Poll found that 68% of Americans support the legalization of PAS, up 10% from the previous year.

What happened to the instinct that “doctors must not kill?” One would hope that this instinct runs deeper than even the historic commitment of physicians to be healers first and foremost. One would hope that it is, at its most basic and fundamental level, a human instinct.

I personally know a young police officer who recently resigned because he experienced this instinct not to kill. Facing numerous tense situations over the course of five years, he had drawn his service weapon dozens of times but, thankfully, had never been forced to fire. That nearly changed when he was charged by a machete-wielding man sky-high on drugs. “Sir, drop your weapon,” he repeated again and again to no avail, as the man quickly closed the distance. For the first time in five years, he exerted pressure on the trigger of his Glock. Two more steps by the man and two more pounds of trigger pressure by the officer, and both lives would be altered forever. One would be dead and one would have to answer for a split-second decision to use lethal force. Fortunately for both, the man loosened his grip on the machete and it fell to the ground. The officer breathed a sigh of relief.

“Dad,” my son told me, “I wasn’t afraid. I would have pulled the trigger if he had taken two more steps. I knew I would have been justified in doing so. But he wasn’t a murderer, a rapist, a bank robber, or a terrorist. He was just a crazy fool out of his mind on drugs. And though he was an imminent threat to my life, I didn’t want to shoot him.” Waxing philosophic, he added, “In that moment, I realized how unnatural it is to take the life of another human being. The instinct not to kill was overwhelming. Yes, I would have shot the man had he taken two more steps. But then I’d have to live with that decision the rest of my life.”

Granted, the case of a police officer deciding whether to shoot is different in many important respects from the case of a physician deciding whether to prescribe lethal drugs where PAS is legal. What intrigues me now, however, is that very strong instinct my son felt that night; that taking the life of another human being – even when legally justified – went against the very grain of his humanity. What does it say, then, when physicians who have sworn historically to be instruments of healing are now willing to be instruments of death? What happened to that instinct and commitment that Dr. Pellegrino so forcefully affirmed, “doctors must not kill”?

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