Recently, Dr. Arthur Caplan of NYU, on the Medscape service (subscription required), took on the question of whether physician-assisted suicide (PAS) should be allowed for old folks just because they are old, or because they want to die together. There have been reports of just that. While he supports PAS for terminal illness but objects that PAS for “suffering” in general is just too fuzzy, and therefore rejects broadening it. An accompanying poll of doctors reported: 64-36% against PAS for old age, but 69-31% in favor of PAS for terminal illness. As some advocates of PAS, like the editors of The Economist, have pointed out in the past, however, this distinction is highly difficult to sustain: if someone is suffering “intolerably,” who are we to overrule that person’s wishes based on a diagnosis of the cause of said suffering?
Better is to recognize, as Neil Skojdlal noted this week, that real palliative care is not PAS, but is the ethical alternative. And as Mark McQuain noted this week, changing the terminology confuses, rather than clarifies, the issues. At least Dr. Lo, whose New England Journal of Medicine editorial Mark reviewed, accepted that not all physicians will accept PAS or be willing to offer it or refer for it. He seemed to make room for that—unlike some advocates.
In a related item, Hastings center president Mildred Solomon “Calls for ‘Moral Leadership’ to Improve End-of-Life Care.” In essence, she argues that over-emphasis on “autonomy” can be a way for doctors to abdicate their responsibility, and leave patients out to dry without guidance in end of life decision making. She argues for a more relational approach, rethinking social supports to provide people with broader help in late life. Makes sense. She doesn’t address PAS in the brief piece I’m citing here, but I would certainly leave that out of the list of recommendations.