How Does Assisting With Suicide Affect Physicians?


Published:

Photo by Hush Naidoo on Unsplash

When my mother was in her final months, suffering from a heart failure and other problems, she called me to her bedside with a pained expression. She took my hand and asked plaintively, “How do I get out of this mess?”

As a physician, I dreaded the question that might follow: Would I help her end her life by prescribing a lethal drug?

Fortunately for me, my mother tolerated her final weeks at home, with the help of hospice nurses and occasional palliative medication. She never raised the thorny question of what is variously termed “medical aid in dying” or “physician-assisted suicide.”

As a son and family member who has witnessed the difficult final days of parents and loved ones, I can understand why support for MAID/PAS is growing among the general public. But as a physician and medical ethicist, I believe that MAID/PAS flies in the face of a 2,000-year imperative of Hippocratic medicine: “Do no harm to the patient.”

Studies point out that even many doctors who actually participate in MAID/PAS remain uneasy or “conflicted” about it. In this piece, I explore their ambivalence.

Assisted Suicides

In discussing end-of-life issues, both the general public and physicians themselves need to distinguish three different approaches.

MAID/PAS involves a physician’s providing the patient with a prescription of a lethal drug that the patient could take anytime to end life. In contrast, active euthanasia or “mercy killing” involves causing the death of a person, typically through a lethal injection given by a physician. Finally, the term “passive euthanasia” refers to hastening the death of a terminally ill person by removing some vital form of support. An example would be disconnecting a respirator.

Increasing International Acceptance

In the U.S. some form of legislatively approved MAID/PAS (but not active euthanasia) is legal in five states and the District of Columbia. In my home state – following a passionate debate – the Massachusetts Medical Society recently decided to rescind its long-held opposition to the practice. MMS has taken a position of “neutral engagement,” which it claims will allow it to “serve as a medical and scientific resource … that will support shared decision making between terminally ill patients and their trusted physicians.”

In a few countries, MAID/PAS has grown increasingly common. In Canada, for example, MAID/PAS was legalized in 2016. In Belgium and the Netherlands, both active euthanasia and physician-assisted suicide are permitted by law, even for patients whose illnesses may be treatable, as with major depression; and whose informed consent may be compromised, as in Alzheimer’s disease. In the Netherlands, a proposed “Completed Life Bill” would allow any persons age 75 or over who decide their life is “complete” to be euthanized – even if the person is otherwise healthy.

U.S. Physician Response

Among U.S. physicians, MAID/PAS remains controversial, but national data point to its increasing acceptance. A report published in December 2016 found 57 percent of doctors agreed that physician-assisted death should be available to the terminally ill – up from 54 percent in 2014 and 46 percent in 2010.

Perhaps this trend is not surprising. After all, what sort of physician would want to deny dying patients the option of ending their suffering and avoiding an agonizing, painful death?

But this question is misleading. Most persons requesting PAS are not actively experiencing extreme suffering or inadequate pain control. Data from the Washington and Oregon PAS programs show that most patients choose PAS because they fear loss of dignity and control over their own lives.

Some Physicians Feel Conflicted

Physicians who carry out assisted suicide have a wide variety of emotional and psychological responses. In a structured, in-depth telephone interview survey of 38 U.S. oncologists who reported participating in euthanasia or PAS, more than half of the physicians received “comfort” from having carried out euthanasia or PAS.

“Comfort” was not explicitly defined, but, for example, these physicians felt that they had helped patients end their lives in the way the patients wished. However, nearly a quarter of the physicians regretted their actions. Another 16 percent reported that the emotional burden of performing euthanasia or PAS adversely affected their medical practice.

For example, one physician felt so “burned out” that he moved from the city in which he was practicing to a small town.

Other data support the observation that MAID/PAS can be emotionally disturbing to the physician.

Kenneth R. Stevens Jr., an emeritus professor at Oregon Health and Science University, reported that for some physicians in Oregon, participation in PAS was very stressful. For example, in 1998, the first year of Oregon’s “Death with Dignity Act,” 14 physicians wrote prescriptions for lethal medications for the 15 patients who died from physician-assisted suicide.

The state’s annual 1998 report observed that:

“For some of these physicians, the process of participating in physician-assisted suicide exacted a large emotional toll, as reflected by such comments as, ‘It was an excruciating thing to do … it made me rethink life’s priorities,’ ‘This was really hard on me, especially being there when he took the pills,’ and ‘This had a tremendous emotional impact.’”

Similarly, reactions among European doctors suggest that PAS and euthanasia often provoke strong negative feelings.

Why The Discomfort?

As a physician and medical ethicist, I am opposed to any form of physician assistance with a patient’s suicide. Furthermore, I believe that the term “medical aid in dying” allows physicians to avoid the harsh truth that they are helping patients kill themselves. This is also the view of the very influential American College of Physicians.

I believe that the ambivalence and discomfort experienced by a substantial percentage of PAS-participating physicians is directly connected to the Hippocratic Oath – arguably, the most important foundational document in medical ethics. The Oath clearly states:

“I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.”

In 5th century BC Greece, Hippocrates was something of a revolutionary in this respect. As the classicist and medical historian, Ludwig Edelstein has pointed out some non-Hippocratic physicians probably did provide poisons to their dying patients, in order to spare them protracted suffering. Hippocrates opposed this practice, though he did not believe that terminally ill patients should be exposed to unnecessary and futile medical treatment.

Palliative care specialist Ira Byock has observed that:

“From its very inception, the profession of medicine has formally prohibited its members from using their special knowledge to cause death or harm to others. This was – and is – a necessary protection so that the power of medicine is not used against vulnerable people.”

Indeed, when patients nearing the end of life express fears of losing control, or being deprived of dignity, compassionate and supportive counseling is called for – not assistance in committing suicide.

To be sure, comprehensive palliative care, including home hospice nursing, should be provided to the subset of terminally ill patients who require pain relief. But as physician and ethicist Leon Kass has put it:

“We must care for the dying, not make them dead.”

Ronald W. Pies is a psychiatrist and ethicist affiliated with SUNY Upstate Medical University, Syracuse, NY; and Tufts University School of Medicine in Boston. He writes on a variety of cross-disciplinary topics, ranging from mental health to philosophy of mind to spirituality. He has also authored the novella, The Late Life Bloom of Rose Rabinowitz; and the poetry chapbook, The Myeloma Year. His most recent books are, Don't Worry – Nothing Will Turn Out All Right!, and You Must Know Everything!

This article was republished from The Conversation.

See also:
Aid To Dying: What Jainism – One Of India’s Oldest Religions – Teaches Us
How Burnout Is Plaguing Doctors And Harming Patients

Edit Module
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags

Daily Astrology

May 27, 2018

The Scorpio Moon aligns with Venus, Jupiter and Neptune to form a heavenly triangle in the sky, a water sign Grand Trine. Spurred on by the waxing and nearly full Moon, emotions swell. Happily, the celestial harmony promotes deeply loving ties, blessed…
Edit ModuleShow Tags

Alternative Health Directory

Browse all listings »

Edit ModuleShow Tags
Edit ModuleShow Tags

Calendar

May 2018

Full Flower Moon - Healing herbs for women's health Part I Tonic herbs for hormonal balance: fertility, normal cycling, aging. Please email rjrcnm@gmail.com if interested. Attendees will...

Cost: Drop in Fee $10 includes all materials and handouts.

Where:
Jefferson, MA


Sponsor: Hillside Herbals
Telephone: 508-847-8615
Contact Name: Rachel Ross
Website »

More information

Show More...
Show Less...
No Events

With Lama Surya Das and Philip Goldberg featuring music by David Whetstone $10 • SVED Lama Surya Das and Philip Goldberg meet to discuss how a 200-year East-To-West transmission...

Cost: $10

Where:
Scottish Rite Masonic Museum & Library
33 Marrett Road
Lexington, MA  02420
View map »


Sponsor: Lexington Community Education
Telephone: 781-862-8043
Contact Name: Craig Hall
Website »

More information

Feel the bliss of opening your spine, while being totally supported and meticulously aligned. Great for sciatica and low back pain! Classes also held Saturday mornings.

Cost: $18 drop in

Where:
Bliss Through Yoga
484 Bedford St
East Bridgewater, MA  02333
View map »


Sponsor: Bliss Through Yoga
Telephone: 508-331-3564
Contact Name: Janice
Website »

More information

8 Week Mindfulness Based Stress Reduction Course with Erin Woo Tuesdays, May 1 - June 19, 6–8:30 pm *Includes an all day retreat on Saturday, June 9 from 9 am - 4 pm Come explore the...

Cost: $290

Where:
Balance Bethlehem
2087 Main Street
Bethlehem, NH  03574
View map »


Sponsor: Balance Bethlehem
Telephone: 603-869-2125
Website »

More information

Show More...
Show Less...
No Events

YogaLife studio would like to offer this opportunity to slow it down, step back, notice your breath and sit quietly in community. Join us Thursdays from 5:40-6:30 PM. No Yoga...

Cost: Free

Where:
YogaLife Institute
6 Chestnut Street
Suite A
Exeter, MA  03833
View map »


Telephone: 603-969-8968
Website »

More information

Show More...
Show Less...

June 1 - 3, 2018 Barbara Brennan School of Healing presents a Weekend Immersion Workshop in Brennan Healing Science: The Brennan Method of Energy Healing with Anne Hoye, BBSH School Dean Come...

Cost: $325

Where:
Doubletree Hilton Hotel
11 Beaver Street
Milford, MA  01757
View map »


Sponsor: Barbara Brennan School of Healing
Telephone: 508-893-9915
Contact Name: Anne Hoye, BBSH School Dean
Website »

More information

June 1 - 3 All cultures have created rites of passage in which the adolescent bids goodbye to dependency and becomes an adult. The Call to Adventure is for men and women ready to discover their...

Cost: $350/weekend

Where:
Earthlands Retreat Center
Glasheen Rd
Petersham, MA
View map »


Sponsor: Circles of Air and Stone
Telephone: 802-387-6624
Contact Name: Sparrow Hart
Website »

More information

Show More...
Show Less...

Early Bird Special! Save $15 if you register before May 24th! Class includes: An Infinite Possibilities workbook and certificate of completion. Must register in advance to ensure that...

Cost: $85

Where:
Circles of Wisdom
90 Main Street
Andover, MA  01810
View map »


Sponsor: Circles of Wisdom
Telephone: 978-474-8010
Contact Name: Cathy Kneeland
Website »

More information

Psychics, mediums, angel readers, spirit art. Reiki, chair massage, IET, Gaiadon Heart, crystal healings, etc. Sign yourself up for a few appointments and bring your friends! Appointments...

Where:
Women of Wisdom
118 Washington Street
North Easton, MA
View map »


Telephone: 508-230-3680
Website »

More information

Show More...
Show Less...
Edit ModuleShow Tags
Edit Module Edit ModuleShow Tags