COMMENTARY

Physician-Assisted Suicide: Only As a Last Resort

Arthur Caplan, PhD

Disclosures

September 24, 2014

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

Physician-assisted suicide -- I have certainly heard a lot about it. The United Kingdom will soon be taking a vote to decide whether it wants to legalize physician-assisted suicide. Other countries, such as The Netherlands and Belgium, have done so, and several states in the United States, including Washington, Oregon, and Vermont, have also voted to allow physician-assisted suicide.

Physician-assisted suicide remains seemingly ethically controversial, although in a Medscape survey not too long ago, nearly half of all physicians who responded said they favored legalization, and a significant number [13.5%%] said maybe, depending on the circumstances. A lot of doctors, at least in that survey, showed some sympathy and some support for legalization.

I favor legalization but I believe that it has to be done with careful restriction. I am not sure whether the British law is regulated or restricted enough to prevent it from being abused. Oregon, Washington, and Vermont have in place a couple of conditions that are essential to preventing abuse of patients who are terminally ill. One is that you have to be sure that the person is not depressed or psychiatrically impaired. You do not want people ending their lives when they have treatable depression. Certainly people who are terminally ill may well be depressed, but you can often help them. Once out of depression, they may not necessarily want to take their lives.

You also need to be able to give people a waiting period after they express these wishes. You do not immediately say, "Okay, you want to end your life. That will happen in the next 12 hours." That was one of the problems with Jack Kevorkian, who used to dispatch people who came to him for assistance in dying with what I believe was unseemly speed. A person needs to think about it, reflect on it, talk with other people, and make sure that it is an authentic choice.

Offer Effective Palliative Care First

The other restriction I would look for with respect to assisted suicide is to first offer people palliative care, hospice -- options that do not involve taking the person's life. If they say, "I'm in pain"; if they say, "I'm spiritually upset," then we ought to try to address that first before we say, "Here's a pill; goodbye." It does seem to me that good palliative care and good hospice care are crucial as fundamental components of what assisted suicide should be about. We do not want to encourage people toward assisted suicide. We may want to include it as an option but absolutely the option of last resort.

Interestingly enough, in Oregon and Washington, not many people actually take their own lives. Many do ask for the pills, but once they have that parachute or safety net, they often decide to try to live on. In addition, both states have tried to do better with palliative care, to control pain and suffering.

Assisted suicide may work but only with adequate protections, adequate controls, adequate oversight, and adequate regulation to make sure that people do not think, "I better do this because I am a burden to others" or "I am going to do this because nothing else out there can help me with my pain, suffering, or depression." Those are not adequate ethical circumstances to support someone ending his or her own life.

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

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