COMMENTARY

Should You Help Depressed People End Their Lives?

Arthur L. Caplan, PhD

Disclosures

March 02, 2017

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I am Art Caplan at the New York University (NYU) Langone School of Medicine in the Division of Medical Ethics.

If you follow politics (and it is hard to avoid this year), you may have noticed that Colorado became the fifth state—and the District of Columbia became the sixth jurisdiction—to allow physician-assisted dying. California, Vermont, Oregon, and Washington have had physician-assisted dying for some time. Other states, undoubtedly, are going to follow. Soon enough, the idea will come to your state by referendum, court decision, or legislation. That said, there are some very disturbing developments in other parts of the world regarding physician-assisted dying.

Belgium and Holland do not use terminal illness as the trigger to avail oneself of a doctor's help in dying. In the United States, our laws say that two doctors have to pronounce a patient terminally ill before the patient can request lethal medication. In Belgium and Holland, the standard they have been using is: Are you suffering and is it irremediable? That is, is it suffering that cannot be done away with and cannot be controlled?

"Terrible suffering" is a very loose standard. During the past year, people in Belgium and Holland have been given access to lethal doses of medication by doctors for things like a bitter divorce, losing their job, going blind, and very severe depression. People who are not dying and healthy persons are requesting help in dying from a doctor—and getting it—on the grounds that their life has lost meaning or that they do not want to go on because of their suffering.

It is hard to see where terrible suffering would end. I know that "slippery slope" arguments have their critics and that people will always say, "It does not mean that they are going to go down the slope." There is a lesson from Belgium and Holland that we need to be attentive to. It is one thing to help people who are going to die anyway—the terminally ill—manage their death in the way they might choose to do so with physician-assisted dying. It is another thing to take people who are otherwise not dying with mental problems, disabilities, emotional upsets, or who are just very unhappy and help them to die with what I would call physician-assisted suicide.

You can make the moral case for the legitimacy of physician-assisted dying for the terminally ill. The question is: Are we going to head where Belgium and Holland are now, which is to expand the right to physician-assisted suicide to people who are otherwise not dying? This is not a place we should go.

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

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