Physicians Are Talking: Why Should We Assist in Suicide?

Nancy Terry


September 24, 2014

In This Article

Does Assisting Patients in Dying Constitute Harm?

Legislation making its way through the United Kingdom's House of Lords has drawn international attention to the issue of physician-assisted suicide for terminally ill adults.[1]

Physicians and healthcare practitioners are conflicted on the topic, if the more than 80 comments on a recent Medscape perspective by Dr. David Kerr are any indication. "I find this area increasingly challenging," writes a critical care physician. "I would find it very difficult to prescribe a death pack to a patient, yet are doctors focusing on their patients or are we protecting ourselves from challenging decisions?"

Individualized treatment is now the byword in medicine. A patient's genetic profile and personal preferences for methods and extent of treatment increasingly guide the course of care. Is a terminally ill patient's preference for assistance in dying all that different? Apparently it is.

Medscape commenters cite the Hippocratic Oath and the injunction to do no harm as reasons why physicians should not involve themselves in assisted dying. "Medical care and alleviation of pain is our responsibility," says a rheumatologist. "Assisted suicide is not our role."

Yet, others argue that some form of harm frequently accompanies therapy, even when the intention is curative. "Any time a doctor prescribes a medicine or a procedure, he is subjecting the patient to its side effects," says one commenter. "During the end-of-life decision, no matter what a physician does or does not do, some harm is done to the patient, physically or psychologically."

"Sometimes the harm comes precisely from our giving of care and therapy, and not granting our patients the important right to simply say 'no more,'" says an anesthesiologist. "By invoking the tenet of primum non nocere (first do no harm), we avoid examining this dilemma and making difficult choices."

Several Medscape commenters were uncertain about what assisted suicide entails. One commenter asks, "Does physician-assisted suicide mean the Kevorkian method? The physician actually administers the injection or dose of drugs to end a life, as in euthanasia? Or does it mean that the physician participates by writing a script but the administration of the drug is totally the patient's choice and responsibility? I am in favor of the latter, where the process is controlled by the patient's choice with the 'assistance' of the physician being completely hands off."

According to the World Federation of Right to Die Societies,[2] physician-assisted suicide refers to the physician providing the means for death (most often with a prescription) that the patient, not the physician, administers. Euthanasia is generally the result of a physician acting directly, such as giving a lethal injection, to end the patient's life. Terminal sedation, withholding or withdrawing of life-sustaining treatments, and pain medication that may hasten death are practices that right-to-die societies distinguish from physician-assisted suicide.

But these distinctions sometimes become blurred. In Belgium, writes a critical care physician, euthanasia is no different from assisted suicide. "In both cases, the patient requests and chooses the day and hour of death. Voluntarily, consciously, the choice is made and death is shared with family and friends."

Several commenters contend that whether a physician assists by writing a prescription or administering a lethal injection, the result is the same: the patient's hastened death. Other commenters take issue with this view. One healthcare provider says, "Handing over a script for a potentially lethal dose of a drug is no more assistance than allowing the patient to drive away in a car, have access to a rope, or go near a cliff. All these things can be lethal if the patient wishes them to be."


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