Physician-assisted suicide and euthanasia (PAS/E) are contrary to the 2,500-year-old historic and vitally important professional ethic of caring and healing. The professional ethic of medicine is to care for the patient. Francis Peabody said in 1927, “The secret of caring for the patient is in caring for the patient.”1 This is not a tautology, but a truism. The proper response to a request for physician-assisted suicide or euthanasia is excellent end-of-life care.
The American Medical Association maintains an unequivocal position on this issue: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life … .”2
In both ancient and modern times some physicians have, on occasion, secretly assisted patients with suicide or have even administered lethal medication themselves when they felt extenuating circumstances justified an exception to the societal standard and the professional rule. Until Jack Kevorkian, MD, it was done in secret because this rule was recognized as valid.
Historically, there have been several periods of time when euthanasia was given serious public debate. But until 1984, when the Royal Dutch Medical Association took the revolutionary position that it was professionally acceptable for a physician to give a lethal injection to a patient under certain clearly defined circumstances, that debate was always silenced by returning to the professional ethic of healing and not killing.
Arguments in Favor of Physician-Assisted Suicide/Euthanasia
In the current debate about the legalization of assisted suicide, supporters offer three major arguments:
- A patient has a right to self-determination;
- It is the compassionate thing to do; and
- It is working in the Netherlands and in Oregon, so we should allow it elsewhere, too.
The first two arguments have remained the same for more than 200 years.3
The right to self-determination: Proponents maintain, correctly, that a patient has a right to accept or refuse any treatment—even if that refusal leads to death. They go on to maintain that the patient should then have the right to request any treatment they want, even medical assistance with bringing about death.
Though a patient has a negative right to be left alone, I believe this does not translate into a positive right (an entitlement) to whatever he or she wants. If that were the case, there would be no need for laws to regulate prescription drugs; a patient could just buy whatever he or she felt was appropriate. Patient autonomy is not absolute any more than is a generic right to personal freedom. The U.S. Supreme Court has found there is no constitutional right to assisted suicide.
Compassion: Supporters of PAS/E often point out that “we shoot horses, don’t we?” implying that our compassionate response to animal suffering should be extended to include human suffering. This is only tenable in a worldview that concludes that there is no moral difference between humans and animals. If you believe, as do most people in Western society, that a) we have a greater obligation to human beings than we do to animals, and that b) human life is special and should be respected and protected whenever possible, then we are obligated to find a better solution to terminal suffering in humans.
Compassion, while perhaps more compelling than self-determination, is still not determinative. As Pellegrino has said, “ … compassion is a virtue, not a principle. Morally weighty as it is, compassion can become maleficent unless it is constrained by principle.”4 Compassion means “to suffer with.” Compassionate patient care involves coming alongside patients who are suffering, being with them, and doing all we can to alleviate that suffering.