COMMENTARY

Physician-Assisted Suicide Vote Coming Up: A Help or a Danger?

Arthur L. Caplan, PhD

Disclosures

October 25, 2012

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Hi. I am Art Caplan, from the Division of Medical Ethics at the NYU Langone Medical Center in New York City.

I want to talk about a policy issue that has come up in the state of Massachusetts. It will be a big issue in elections this November. It is the attempt to legalize physician-assisted suicide.

Should doctors ever intentionally hasten the death of one of their patients? This question is enormously ethically controversial. Obviously, medicine has codes of ethics, including the Hippocratic oath, "Do no harm." Many professional organizations, including the American Medical Association, the American College of Physicians, and many other groups, say that you absolutely cannot do anything that would hasten the death of the patient. And there has been a lot of opposition to this legislation by groups such as the Massachusetts Medical [Society].

That said, Oregon and Washington State already have enacted physician-assisted suicide laws. In both of those states, the ability to help someone die is severely restricted. It applies only to people who are deemed terminally ill. The patient has to have an assessment of their competency by the doctor. And obviously, [the physician] can call in a psychiatrist or psychologist if the physician thinks that is necessary, because perhaps the person is depressed. There is a waiting time for the patient, and ultimately the doctor prescribes the pills, but the patient must take them.

That is what makes these laws different from euthanasia, which is when the doctor kills the patient without permission, without discussion, saying, "I think your life is miserable; I am going to end it." That is what Jack Kevorkian did many years ago.

[Physician-assisted suicide] is also not the same as withdrawing treatment, when people might say, "I think it is time to back off the dialysis; I think it is time to shut off the ventilator." Those are areas where something becomes burdensome to the patient, and while the physician may remove life support knowing that the person is going to die, it is not the same as assisting in their suicide because the patient is already on the road to death.

Taking an active step to hasten death is what assisted suicide is all about, but it is something that the patient, who is judged competent, must request.

What are the objections? One objection is that doctors should never be involved in something like this. But I think that can be overcome by giving the right of conscience. Some doctors will say, "I cannot deal with that. I am not going to do it, and I do not want to be involved in it." Others will say, "I could do it if the patient is terminally ill and in a lot of pain, suffering a lot, and meets the conditions that the proposal in Massachusetts includes and the laws in Oregon and Washington contain."

Another objection: People may feel compelled or coerced into choosing this option because their care is expensive or because relatives are thinking that they do not want to spend the grandchildren's college tuition to keep grandpop going. That is a concern, but it is one that has to be handled as part of the informed consent, making sure that the person really is voluntarily choosing this, really understands that they do not have to do this and is not in a position of feeling pressured or bullied. That certainly cannot be part of an assisted-suicide request.

Last, people worry about abuse of people who are perhaps poor or feeling isolated and alone, people who do not have family support. Are they going to end their lives because they basically are despairing, rather than because they have pain that could be controlled by good palliative care?

What we know is that in Oregon and Washington, although there are requests for those [lethal] pills, almost no one takes them. The interesting thing is that people find it more empowering to have the ability to end their lives when they want and choose not to do so, not that people are being rushed to take pills, perhaps under suspicious circumstances. I think the worries about abuse, hastening death, and rushing people [to end their lives] before they really want to are not borne out by the evidence that comes to us from Washington and Oregon.

With the appropriate restrictions, I think there is a case for enactment of this legislation. I understand that many physicians will not want to participate. Certainly many would say that with the right palliative care, the right hospice care, we would not even need this legislation.

But what I see, ironically, is that more people may actually live longer and fight harder when they know they can end their lives but choose not to, rather than feeling that they are trapped and there is no way out. Ironically, by making assisted suicide possible, the law may actually be more empowering and prevent these suicides.

I am Art Caplan from the Division of Medical Ethics at the NYU Langone Medical Center. Thanks for watching.

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