Doctors are sharply divided over the question of physician-assisted suicide.
In August-September 2010, Medscape electronically surveyed over 10,000 physicians representing all specialties. Respondents answered a series of ethics questions, including the following: "Are there situations in which physician-assisted suicide should be allowed?" Of the more respondents, 45.8% answered "Yes"; 40.7% answered "No"; and 13.5% said "It depends."
At either of the extremes, physicians who accepted the invitation to explain their position didn't mince words: "Kill yourself, but don't involve me," said one doctor opposed to physician-assisted-suicide. Another opponent said: "I am a healer, not an executioner."
Equally unequivocal were doctors who support the practice. Said one: "Did you ever watch a patient die a miserable death day by day? Thank God I live in Oregon, so that won't have to happen to me." Another said bluntly: "We treat animals more kindly than people. This should be an absolute right of a terminally ill person."
In between these 2 black and white extremes, physician respondents who are still uncertain about the issue expressed their continuing ambivalence in various shades of gray, a clear reflection of the competing ethical concerns they're struggling to balance. One doctor said: "As a physician, I do believe my job is only to keep a human being alive, but the quality of life is important as well." Another physician framed his ambivalence this way: "I think there are times when it may be justifiable, but I don't think it should be legal."
After more than a century of debate, physician-assisted suicide remains a relatively rare practice in this country. Currently, only 3 states -- Oregon, Washington, and Montana -- permit it, the first two through statutory law and the last via a trial court ruling.
Still Complex and Controversial
Despite its rarity, though, physician-assisted suicide or physician-assisted death, as some experts prefer, remains controversial, certainly within the public at large but also among practitioners. For physicians, the debate not only raises fundamental questions about the nature of the profession itself but also about doctors' ethical obligations to their patients at the end of life.
Further complicating the debate over physician-assisted suicide is that it has sometimes become entangled in the more general debate over end-of-life care.
On one side, there are opponents of physician-assisted suicide who nevertheless draw a bright line between this practice and providing the palliative treatment necessary in order to alleviate a patient's pain, even if that treatment ends up suppressing respiration and hastening death. One physician said: "Patient comfort is paramount. If death occurs but [it] is not the intent of [the] intervention, I do this."
Experts believe that this distinction between aggressive palliative care and physician-assisted suicide is crucial -- and one that that shouldn't be blurred.
"Palliative care and withdrawing life-sustaining support are legally and morally distinct from physician-assisted suicide," says Nancy Berlinger, PhD, Deputy Director and Research Scholar at The Hastings Center, an independent, nonprofit bioethics research institute in Garrison, New York. "While physician-assisted suicide is legal in only 3 states, palliative care is supported by a variety of measures in different states, where a legal and ethical consensus around its importance has formed."