COMMENTARY

Should Doctors Help People Die Just Because They're Elderly?

Arthur L. Caplan, PhD

Disclosures

May 16, 2018

Hello. I am Art Caplan at the Division of Medical Ethics at New York University (NYU).

George and Shirley Brickenden, Canadians, 95 and 94 years old and married for 70 years, recently passed away together in a Canadian hospital. They were allowed to die under Canada's law that permits physician-assisted dying. The interesting question about how they died, in terms of ethics, is: Where should the United States, Canada, and other countries be headed with respect to physician-assisted dying?

In the United States, we've recently seen activity in Washington, DC; California; and Hawaii moving towards legalization of physician-assisted dying. What that means is that a terminally ill person, with less than 6 months to live, can request pills that will cause them to die. They have to have a waiting period. They have to report it to the authorities. They have to be competent to do this. They have to have a diagnosis from two physicians, and there are other safeguards.

It's a practice that has also been around in Oregon and Washington State for some time. It doesn't seem to have been abused; that is, we're not taking poor people and rushing them off or taking people who don't really want to die and making them do so. In fact, of the people who make the request—and relatively few do in Oregon and Washington where it's been policy for many years—many of them don't take the pills. They like knowing that the pills are there, but they don't take them.

In Canada, the policy is a little different. You're supposed to restrict the practice of assisted dying to people whose death is predictable and whose suffering seems to be severe. In Canada, you don't have to be "terminally ill"; you have to be headed towards a course that indicates that you're going to die no matter what but maybe not in 6 months.

Despite the attraction that a story about a loving couple dying together has, the fact that the Canadians here used assisted dying still raises an important question. Is old age a sufficient reason to help somebody die? Both of these people who used assisted suicide technically did not have a terminal condition.

The other question is: If one of them was sicker than the other, and they wanted to die together, is that a kind of suffering in which medicine should intervene and say, well, if your wife is going to use assisted dying, then we'll help you, too? I think that the answer to that is no. It's too slippery a slope.

Once you start saying that it's suffering, you get into a subjective definition. What does suffering mean? Depression, I lost my job, I got divorced. There are a lot of reasons that people could give and legitimately say that they are really suffering a lot. First, before I help someone die because their spouse of 70 years is passing, I would want to counsel them. I'd try to support them, but I wouldn't see medicine's job as being to kill them.

I'm not against assisted suicide for the terminally ill. I'm not against trying to help somebody die the way they want, if we know that they're going to die in 6 months or less. I am worried when we see behavior, such as we saw in this case, where a country starts to say, "You're old, and you're going to be lonely, and you're going to be sad, and you're going to be grieving; those are good enough reasons to help you die." I think that's going too far, and if we're going to have assisted dying by physicians, we need to have a clear, bright line. Otherwise, that slope could be taking both Canada and other countries to places that we really don't want to go.

I'm Art Caplan at the Division of Medical Ethics at NYU. Thanks for watching.

Talking Points: Should Doctors Help People Die Just Because They're Elderly?

Issues to consider:

  • Some healthcare professionals believe that older people have the right to end their lives with dignity when they decide they have "completed life."

  • Others are concerned that physician-assisted dying for people who are needy or lonely is wrong, and that combating loneliness and helping older people live with dignity is better than enabling them to die.[1]

  • Some healthcare professionals contend that some healthy older people might want to end their lives because they are afraid of being a burden to their families.

  • Still others question: If a law were passed to help older healthy patients die, would there need to be a minimum age of patients under which the law could be applied?[1]

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