'Death with Dignity' claims another victim

This article was written by Paul McHugh, a former psychiatrist in chief at Johns Hopkins Hospital. This article was printed on page A13 of the US edition of the Wall Street Journal on May 25, 2013

Now Vermont has joined the misguided movement toward assisted suicide.

Paul McHugh

By Paul McHugh, Wall Street Journal, May 25, 2013

Nearly 30 years ago, Arnold Schwarzenegger's "Terminator" character made famous the phrase "I'll be back," the implacable cyborg assassin's response to a setback. Today, similarly relentless terminators are among us, also with a deadly mission: to move America toward acceptance of physician-assisted suicide.

On Monday, the terminators gained a victory when Vermont Gov. Peter Shumlin signed into law the "Patient Choice and Control at End of Life Act." The bill had been passed by the state legislature the week before without consulting the electorate, possibly because the lawmakers had seen what happened last fall next door in Massachusetts, where voters rejected a similar initiative. Now Vermont doctors will be able to prescribe lethal medication to patients as the state joins Oregon, Washington and Montana in supporting the practice. (Assisted suicide is technically prohibited in Montana)

Hippocratic Oath

So the terminators are back. The reasons for opposing them and opposing physician-assisted suicide never went away. The reasons have been with us since ancient Greek doctors wrote in the Hippocratic oath that "I will neither give a deadly drug to anybody if asked for it nor will I make a suggestion to that effect." The oath is a central tenet in the profession of medicine, and it has remained so for centuries.

Dr. Leon Kass, in a brilliant essay on the Hippocratic oath in his 1985 book "Toward a More Natural Science," explains why this has been true. Medicine and surgery, he says, are not simply biological procedures but expressions, in action, of a profession given to helping nature in perpetuating and enhancing human life. "The doctor is the cooperative ally of nature," Dr. Kass writes, "not its master." It shouldn't need saying, but the exercises of healing people and killing people are opposed to one another.

Traditionally the public rests its trust in doctors on this understanding of medicine. Doctors occasionally remind the public of it when they explain why they do not participate in capital punishment or bear arms in military service.

But the terminators who champion physician-assisted suicide propose that, as seen in intensive-care units, contemporary medicine prolongs unnecessary suffering.

As a psychiatrist, I work with doctors on such units, and I can testify that all of them realize that human life itself is limited in duration and scope. These doctors regularly consider just how far they should go in sustaining a hope for recovery—cooperating with nature's resilience in treating advancing disease. They also consider when prolonging a futile effort should be replaced by comforting the person as his life naturally comes to an end. The judgment is delicate, though, and most families are justified in leaving it to skilled physicians.

Another argument for physician-assisted suicide is that many patients with cancer live too long in pain. The suffering could be reduced if their legitimate wish for death were fulfilled. These are the arguments pressed by Dr. Timothy Quill and many in the Oregon "death with dignity" group.

Dr. Kathleen Foley

But scientific publications from oncologists such as Kathleen Foley, who studies patients with painful cancers, reveal that, quite to the contrary, most cancer patients want help with the pain so they can continue to live. Suicide is mentioned only by those patients with serious but treatable depressive illness, or by those who are overwhelmed by confusion about matters such as their burden on loved ones and their therapeutic options. These patients are relieved when their doctors attend to the sources of their psychological distress and correct them.

In the nearly two decades that Oregon has permitted physician-assisted suicide, I became suspicious that just such depressed and confused patients number large among those who ask for and take life-ending poisons. Why suspicious? Because the law does not demand a psychiatric assessment before they take the fatal step.
Yet all efforts by psychiatrists anxious to read the medical charts of these patients after their deaths have been thwarted by the champions of their suicides, who have shrouded the patients' mental states in secrecy by raising the "privacy privilege." I believe that these doctors are killing patients of the sort that I help every day.

And then there is this talk about "death with dignity," as the Oregon and Washington laws are titled. Surely what we want is "life with dignity." Seeking life, we're ready to endure much in order to keep it going. Think of the life-saving and life-preserving colonoscopy—all dignity drops with your trousers.

The advance of the hospice movement has made a shambles of the terminators' insistence that medicine prolongs suffering and denies dignity. The doctors, nurses and social workers committed to hospice care demonstrate how an alliance with nature at life's end plays out in just the way that the medical profession intends. As hospice ways become more familiar, the public can overcome the fears that the terminators used to win over the Vermont legislature.

For you see, the terminators ultimately are not merely interested in killing people who are suffering the throes of a final illness. They have even others in mind, as history tells us. The drive to allow doctors to "assist" in suicide is not recent. Its roots are in the Progressive era of the early 20th century, when many Americans placed utter confidence in reform and in technocratic elites. Then the enthusiasts for euthanasia lined up with those clamoring for government intervention in the name of eugenics and population control.

Across the decades, Americans have fought off such dire temptations with reasoned arguments about the nature of medicine. Despite Vermont's unfortunate decision, Americans elsewhere likely will continue to defeat physician-assisted suicide at the ballot box and in the statehouse. But the enemies of life are terminators—they'll be back.


Dr. McHugh, former psychiatrist in chief at Johns Hopkins Hospital, is the author of "Try to Remember: Psychiatry's Clash Over Meaning, Memory, and Mind" (Dana Press, 2008).