Tuesday, January 19, 2016

Why Physicians Should Oppose Assisted Suicide

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Journal of the American Medical Association (JAMA), in its current edition, published a series of articles concerning palliative care, end-of-life treatment and assisted suicide.

Dr. Y Tony Yang and Dr. Farr A Curlin offered their insights as to Why physicians should oppose assisted suicide. Dr. Yang is affiliated with George Mason University and Dr. Curlin is affiliated with Duke University.

In their article, Yang and Curlin focus on why people ask for assisted suicide and why physicians should not support or participate in assisted suicide. They begin their article with the following:
That we are debating this question of whether physician-assisted suicide is ever justifiable shows how far medicine has shifted toward redefining the role of the physician. If the medical profession accepts physician-assisted suicide, it will be declaring decisively that "physicians" are mere providers of services to be guided only by the desires of the individual patient, the will of the state or other third parties, and what that law allows.
They continue by examining the difference between palliative care and assisted suicide:
While acknowledging that death may come sooner as a side effect of palliation, physicians pledge never to intentionally hasten the patients' death. ... Yet with physician-assisted suicide, the physician is to disregard what is perhaps the most universal moral injunction - do not kill (emphasis is mine) - and wrtie a lethal prescription with the express intent of helping patients kill themselves.
Yang and Curlin then explain why people in Oregon ask for assisted suicide:
Evidence, nevertheless, indicates that calls for physician-assisted suicide are not mainly driven by the experience of pain or other refractory symptoms. ... reports from Oregon that found patients requesting physician-assisted suicide reported being concerned about "losing autonomy" (91.5%), being "less able to engage in activities making life enjoyable" (88.7%), "loss of dignity" (79.3%), "losing control of bodily functions" (50.1%) and being a "burden on family, friends/caregivers" (40%). Only 1 in 4 (24.7%) even reported "concern about" inadequate pain control.
They continue by examining what options already exist for patients and what assisted suicide actually represents:
Patients already have the right to refuse life-sustaining treatment. They have the right to proportionate palliation, even if death is hastened as a side effect. They also have the liberty to end their lives by all manner of methods that do not involve physicians. With respect to physician-assisted suicide, the "right to die" is a euphemism for the putative "right to have a physician help me kill myself." (emphasis is mine)
The writers then examine the issue of the trust relationship between patients and physicians:
"Physician-assisted suicide is fundamentally inconsistent with the physician's professional role." (emphasis is mine) If the physician were solely service providers who accomodated the self-determining choices of patients, then physician-assisted suicide would be logical, if assisted suicide were justified. ... Rather the physicians professional role is to attend to those who are sick and debilitated ... There would be no profession of medicine but for human beings' shared vulnerability to illness. There can be no practise of medicine if patients do not trust physicians to care for them when they cannot care for themselves.
Yang and Curlin continue by showing how the physicians role extends in society:
And herein is the conflict. Insofar as physicians enjoy societal trust, it is because since Hippocrates, physicians have maintained solidarity with those who are sick and disabled, seeking only to heal and refusing to use their skills and powers to do harm. This is why Doctors Without Borders treats injured Taliban soldiers. It is why physicians have refused to participate in capital punishment, or to be active combatants, or to cooperate with torture. It is why physicians have refused to help patients commit suicide.
They then re-examine the trust relationship between patients and physicians:
The boundary against intentionally causing the patient's death, however, gives patients a reason to trust physicians while also giving physicians the freedom needed to perform their duties and responsibilities... Rather than posing an obstacle to compassionate care, this boundary creates a space in which physicians can act freely and decisively to palliate distressing symptoms. (emphasis is mine) Without this commitment, patients have good reason to be concerned that morphine that leads to sedation is dosed not in proportion to the pain but in an effort to hasten death.
Yang and Curlin conclude:
In sum, physician-assisted suicide is never justifiable. It is never justifiable because it always violates the injunction not to kill. It is never justifiable because it unjustly patronizes the desires of the few who request physician-assisted suicide over the needs of the much larger number larger number... Physician-assisted suicide contradicts the physician's professional role and undermines the distinctive solidarity with those whose health is diminished that makes the practise of medicine possible. ... physicians should oppose the legalization of physician-assisted suicide and steadfastly refuse to condone or participate in it.
JAMA simultaneously published an opposing point of view titled: Responding to patients requesting Physician Assisted Death.

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