Doctors Describe Their Toughest Ethical Dilemmas

Shelly Reese


February 23, 2017

In This Article

Physician-Assisted Dying

Support for physician-assisted dying (also called "physician-assisted suicide") is growing. More than one half (57%) of the survey respondents believe that physicians should be allowed to help terminally ill patients end their lives, up from 46% in 2010 and more than one quarter (28%) believe that assisted dying should be allowed for irremediable suffering.

Even as support grows, the issue remains fraught. Many physicians describe assisted dying cases as the most difficult ethical challenges of their careers. They describe their struggles with "defining that line between assisted dying and providing comfort anesthesia"; "wrestling with the desire to assist dying in a suffering terminal cancer patient because of how I would be viewed"; and "denying physician assisted suicide for a terminal patient in the intensive care unit."

Both physicians who have participated in assisted dying and those who have declined to do so struggle. One immunologist recalls a gut-wrenching decision to withhold life support "from a newborn with a disease that was terminal but who could possibly have lived months to a few years with limited support," and an addiction specialist recounts declining to deliver a fatal bolus of opioid to a terminally ill young man. "His grandmother asked me to just empty the syringe in the IV. I explained that the end of Rhett's life was not my call, but it was very hard to not accede to the grandmother's wishes."

Once again, physicians' mandate to do no harm lies at the core of the issue. "Physicians are trained to do no harm, and killing seems like harm no matter what the circumstances," says Caplan. "So there's a tension." Difficult as that ambivalence may be for physicians, he notes, "It's a good thing. You don't want physicians to be too eager to do this."


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