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

January 21, 2019

Minutes after midnight the Leo Moon is Full. This is a complex, powerful Supermoon, when the Moon is closest to earth in its orbit. The Moon’s gravitational impact on tides as well as emotions is maximized. Expect shocking revelations, sudden endings and…
Edit ModuleShow Tags

Alternative Health Directory

Browse all listings »

Edit ModuleShow Tags
Edit ModuleShow Tags

Calendar

January 2019

Join acupuncturist and eastern medicine specialist Linda Davis to: 1) Learn and practice a simple method to access your pendulum’s divination powers; 2) experience various types of...

Cost: $20–$25

Where:
Portal Crystal Gallery
489 Massachusetts Ave
Arlington, MA  02474
View map »


Telephone: 781-859-5373
Website »

More information

Once used as a diagnostic tool for physicians, the palms and hands give us insight into physical health and emotional well-being. Learning to decipher the differences in hands and the meanings...

Cost: $250

Where:
The Soul Purpose
1225 Gar Highway
Swansea, MA  02777
View map »


Sponsor: The Soul Purpose
Telephone: 774-264-1329
Contact Name: Jessica Kozak
Website »

More information

Celebrating the new year, the new you!  Come detox, relax and get your new year readings while you recharge in our sanctuary! We have a fun line up of readers and healers providing...

Cost: $60- 3 Service package special; $25 - single service

Where:
Healing Power of Flowers - Heaven and Earth
68 Stiles Road
Suite A
Salem, NH  03079
View map »


Sponsor: Healing Power of Flowers - Heaven and Earth
Telephone: 603-275-7688
Contact Name: Stacey Smith
Website »

More information

Did you know that forgiveness heals? It can reduce depression, ease anxiety, increase our well-being, and facilitate the body's natural healing response. Many of us may get the concept of...

Cost: $60

Where:
private office
North Andover, MA  01845


Sponsor: Diana Harris
Telephone: 978-973-6637
Contact Name: Diana Harris
Website »

More information

The most powerful things in the universe are invisible. Energy which is the most powerful of physical and spiritual forces is invisible. The most precious and important things that matter in...

Cost: Free

Where:
Inner Space Meditation Center & Gallery
1110 Massachusetts Ave.
Cambridge, MA  02138
View map »


Telephone: 617-547-1110
Website »

More information

Show More...
Show Less...

Show More...
Show Less...

MBSR: Mindful Based Stress Reduction Mindfulness, as taught in the MBSR program, is recognized worldwide as the gold standard in mindfulness training and is one of the greatest...

Cost: Free

Where:
Life Care PT
38 Southwest Cutoff
Northborough, MA  01532
View map »


Sponsor: The Center for Resilient Living
Telephone: 508-556-7022
Contact Name: Ginny Wholley
Website »

More information

Show More...
Show Less...

“Master your breath, let the self be in bliss, contemplate on the sublime within you.” —Krishnamacharya Join us for an evening of deep exploration and transformation using...

Cost: $30 (limited hardship rates available)

Where:
Spontaneous Celebrations
45 Danforth Street
Jamaica Plain, MA  02130
View map »


Telephone: 617-233-6410
Contact Name: Allen B. Howell
Website »

More information

Show More...
Show Less...

Listen as Lauren channels messages from loved ones to prove you are never alone. An intimate event with tested and endorsed research medium.  Visit website for tickets. Doors open at 6:30...

Cost: $50

Where:
The Spiritual Path with Lauren Bortolami
129 N. Main Street
Mansfield, MA  02048
View map »


Sponsor: Lauren Bortolami Robbins
Telephone: 508-339-8111
Contact Name: Lauren Robbins
Website »

More information

With Sherri Snyder-Roche. This yoga workshop will explore self-compassion, self-love and pushing through discomfort to help your recovery process. Recovery from divorce, eating disorders,...

Cost: $95 for 6 weeks or $17 drop in

Where:
State of Grace Yoga and Wellness Center
104 E. Hartford Avenue, Unit A
Uxbridge, MA  01569
View map »


Telephone: 508-278-2818
Website »

More information

Show More...
Show Less...

Women Rising Together—Women’s Workshop This workshop is designed for women who are facing a challenge and would like to come together with other spiritually minded women to explore...

Cost: $25

Where:
Apple Tree Arts
1 Grafton Common
Grafton, MA  01519
View map »


Contact Name: Christine Johnson

More information

Intuitive medium Laura Wooster is honored to present this evening of spirit messages from your loved ones on the other side. She will deliver evidential messages of love, hope, and comfort from...

Cost: $25

Where:
Circles of Wisdom
386 Merrimack Street
Suite 1-A
Methuen, MA  01844
View map »


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

More information

Holistic Problem-Solving with Dr. HermanSJr. Tired of missing opportunities that could further your life, your education, even your work? Tired of missing threats that continue to hold back your...

Cost: $100

Where:
Caffe Nero
368 Congress Street
Boston, MA  02210
View map »


Telephone: 321.30.PSYCH(7792)
Contact Name: Soni
Website »

More information

Show More...
Show Less...

Instructor: Stacey Piwinski Adult Level Spend half a winter’s day working with warm, cozy, and colorful yarn! Each participant will learn to weave their own circular weaving, starting...

Cost: $65

Where:
Creative Spirit
80 Washington Street
Marblehead, MA  01945
View map »


Sponsor: Creative Spirit
Telephone: 781-797-0389
Contact Name: Peyton Pugmire
Website »

More information

Start this intensive January 26 This is an excellent series for those who are on a healing journey of any sort, as we access the Akashic field of energy to clear your path and...

Cost: $860 or three payments of $366

Where:
, MA


Telephone: (978) 835-0005
Contact Name: Nancy

More information

Holistic Problem-Solving with Dr. HermanSJr. Tired of missing opportunities that could further your life, your education, even your work? Tired of missing threats that continue to hold back your...

Cost: $100

Where:
Caffe Nero
368 Congress Street
Boston, MA  02210
View map »


Telephone: 321.30.PSYCH(7792)
Contact Name: Soni
Website »

More information

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