Dr's Pies, Geppert, Komrad and Hanson respond.
Dear Colleagues,
First: nowhere in Buchbinder’s analysis is there any discussion of whether PAS is ethically justified, or consistent with the values of Hippocratic medicine. Many prominent medical organizations have repeatedly said it is not. [2,3,4]
Furthermore, it is a morbid irony to assert that an "unintended benefit" of MAID laws is to help "…start new conversations about what matters most to patients in the final stages of serious illness…” Does Buchbinder seriously believe that such intimate physician-patient conversations require legislation authorizing medically-assisted suicide on demand?
In truth, discussing MAID with a terminally ill patient narrows the conversation and orients the patient toward death as the preferred option. Responsible palliative care identifies options based on the patient’s actual goals and values [5]
Equally fallacious is Buchbinder’s reference to “this potential of MAID to control uncertainty” stemming from “the current historical moment.” The implication that a patient’s anxiety over “political unrest, economic instability, [and] climate change” is appropriately addressed by offering medically assisted suicide is stunning in its perversity.
As medical ethicist Dr. Leon Kass has observed, “We must care for the dying, not make them dead.” [6]
Respectfully,
Ronald W. Pies, MD
Cynthia M.A. Geppert, MD, PhD, MA, MPH, MSBE, DPS, MSJ
Mark S. Komrad, MD
Annette Hanson, MD
References
1. Buchbinder M. The Paradox of Medical Aid in Dying. NEJM 395;5 July 30, 2026 [attached]
2. Snyder Sulmasy L, Mueller PS; Ethics, Professionalism and Human Rights Committee of the American College of Physicians. Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Ann Intern Med. 2017 Oct 17;167(8):576-578
3. American Medical Association Code of Ethics. https://code-medical-ethics.ama-assn.org/ethics-opinions/physician-assisted-suicide
4. WMA Declaration on Euthanasia and Physician-Assisted Suicide. (2019). https://www.wma.net/policies-post/declaration-on-euthanasia-and-physician-assisted-suicide/
5. Geppert CM. Futility in Chronic Anorexia Nervosa: A Concept Whose Time Has Not Yet Come. Am J Bioeth. 2015;15(7):34-43. doi: 10.1080/15265161.2015.1039720. PMID: 26147264.
6. Kass L. Dehumanization Triumphant. First Things. Aug. 1, 1996. https://firstthings.com/dehumanization-triumphant/
1 comment:
Excellent reply. The last point you raise is particularly interesting. It directs us towards the larger suicidal currents which are now evident across Western society. For at least fifty years there has been terrific pressure towards ideologies which basically portray human life (or at least modern human life) as negative in and of itself. I usually avoid these connections, because they lead to political entanglements which detract from my immediate purpose of combatting medical homicide. However, these connections are very real.
Most importantly, when our government establishes the satisfaction of suicidal desire, for a small, atypical slice of the patient population (and does this over the competing need of protection for those who do not wish to die), then we see that our rulers (taken in the broadest sense) are unambiguously weighing in on the side of death. Collective death. And that, in the end, is our real adversary.
On the positive side: the future belongs to survivors, and their offspring. Hence, if we can survive this particular historical moment, we will prevail.
Best,
Gordon Friesen
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