Issue Position: Assisted Suicide by Physicians
Issue Position
Doctors already assist Death, Should they also assist Suicide?
My patients are confused; an intelligent lawyer friend of mine is confused; and so I think that the public must be confused too. My patients tell me that "death with dignity" is the best end to pain and suffering, but we physicians are already offering that.
I have patients tell me of terrible suffering or horrendous medical expenses that one of their relatives has endured. I ask them, "Did your relative want to try to live or to die?" The answer is always, "Well, he (she) wanted to live, but if I'm in that position I want to be able to die comfortably and not suffer like they did."
This sort of humane treatment is available right now. Today any patient who doesn't want to battle until the last moment after expensive, heroic, life-support's pain and exhaustion ends in death can insist on peacefully "letting nature take its course." I have seen this happen as a pathologist, as a close relative and as a treating physician.
As a former practicing forensic pathologist and medical examiner for three Michigan counties I have reviewed numerous charts of victims of violence from all the big hospitals in the city close to my rural counties. These were charts of persons fatally injured but surviving to the metropolitan hospitals.
Routinely, when the victims became brain dead the treating physicians instituted these humane procedures: They first make certain of the brain death. They then explain the situation to the family and obtain the family's permission to discontinue life support. This decision usually involves the advice of the family's minister, priest or rabbi and a social worker. Life-support systems are then discontinued with the family's approval. Once the patient is first noted to be brain dead the entire process rarely takes more than two days.
Thirteen years ago tragedy engulfed me in the a melodrama to which I had previously been only a spectator.
My 69 year old father had been "successfully" resuscitated after a heart attack in a large, city hospital while under the care of one of my friends. When I visited him later that evening he was on a ventilator. My cursory examination indicated that he was brain dead. By mutual agreement his attending physician and I had a brain perfusion test done the next day. There was no circulation in the brain anymore. The brain had swollen from the interruption of blood during the heart attack, and now it was dead from lack of oxygen for the previous twenty-four hours. A repeat confirmatory test was done the next day for safety's sake.
My mother, brothers and I knew what dad had always wanted if such a situation occurred, and we agreed completely. Hours later the nurse "pulled the plug." My two brothers and I stood by the bedside to attend our father's last, unassisted heart beats while our mother sat tearfully in the waiting room.
No fuss, no court orders, no prolonged hospital stay, no horrendous bills.
In my family practice I diagnose a patient with a fatal, terminal disease about once or twice a year. These patients often tell me that they don't want to prolong the agony with treatments and all the expense. I explain to them what to expect, and that I will give them whatever and however much pain medication they need. They usually enroll in Hospice, an organization that offers home health nursing for terminally ill patients.
Invariably I receive a phone call or two from a relative during the final days. The relative tells me: "He's not eating!" or "He's not drinking!" or "He's just wasting away!" I explain to the anxious relative that this is nature's way of weakening the patient so that he will die sooner, and so that he will feel less pain as he slowly becomes obtunded. I offer advice, encouragement and consolation. The patient dies easily, comfortably and with little expense.
These relatives are some of the most caring and brave people I have met. They also have the satisfaction of knowing that they have "cared to the end" when they bury their loved one. Usually other family members pitch in and assist during the last week or two. Being able to offer as much to the patient as professionals, these families have earned Christ' commendation: "I was sick, and you visited me." (Mathew 25:36). This terminal care is touching; healing for the grieving family; and it brings the family together.
When I explain this to patients they then start wondering what this "death with dignity" option is anyway. And why is it needed?
Simply put, it is murder unopposed by the victims, and it is not needed. In fact, it is one more deviation from a philosophy that holds human life sacred, to a philosophy that deigns human life to be no more valuable than animal life. I say one more deviation because the first departure was the legalization of abortion.
The Christian, Jewish and Islamic religions condemn assisting a person who wants to kill himself since they condemn suicide itself.
This philosophy of the sanctity of human life is also found in Greek cultures as expressed 2,400 years ago by the famous father of medicine, Hippocrates. His Hippocratic oath has served as the guide of medical ethics in Western culture since then. Concerning suicide it states, "To please no one will I prescribe a deadly drug, nor give advice which may cause his death."
Note that the same Hippocratic oath next promises "Nor will I give woman a pessary to procure abortion." The "safe" abortifacient of the day a pessary, was also prohibited. Having stepped onto the slippery slope of abortion-on-demand for the "unwanted child" our society now plunges into the "assisted suicide" solution for its next perceived problem. At this rate Hitler's final solutions for "problem" classes of people will soon be hailed as being ahead of its time.
Our culture's traditions are its collective memory, a memory that spans literally thousands of years. If for no other reason than practical ones the traditions should not be discarded lightly.
But there is an additional, plain, easily-seen reason to keep unopposed patient murder from the practice of medicine: physicians have too much power over patients to be given this new "therapeutic modality."
You see, knowledge is power and practicing physicians actually have a monopoly on functional medical knowledge. Few people, including many physicians, realize what volume of facts they know in addition to the skillful manipulation of those facts in treating patients.
Let me explain why that is true. The knowledge needed for the practice of medicine comes only after four years of intense 80 hour per week or more study in medical school, two to eight years of an intense 80 to 100 hour per week residency training and then a few more years of individual patient management and care. The individual patient care teaches the physician how to develop patient trust, convince the patient to endure the expense and misery of diagnosis and then motivate the patient to accept the best treatment.
Only physicians pay the price to master this knowledge, and its skillful manipulation. Therefore they alone have a virtual monopoly on it and the power which it endows. This power gains the patient's trust.
Indeed, a patient must trust his doctor. This fact became intimately clear to me when I, myself, needed surgery by a specialist. I didn't have five extra years to learn his field thoroughly enough so that I could have the knowledge of all the ramifications of my problem. In the stillness of the night before surgery I came to recognize that my trust in his knowledge and integrity was the sole reason I would surrender my body to his surgery
If a physician has his own agenda to fulfill, he can convince his patient to fulfill it for him. With the patient's trust assisting the doctor, the doctor can then withhold information, emphasize one facet of information over another, skillfully discern the patient's emotions and direct them in the paths the physician wants to go. When the final desired therapeutic effect is death, no patient can or will complain about the outcome.
As a physician I am alarmed to see the news media essentially promoting unopposed murder. Many polls show the public favoring this innovation. Oregon's law allows it. But as far as I can tell, the public doesn't even understand it.
If unopposed murder is legalized where must it lead? We need only to look to the Netherlands where it is estimated that thousands are put to death each year without their consent and almost certainly against their will. In addition, tens of thousands succumb to the pressures from family and the establishment. Remember that a person who is sick succumbs to pressure much more quickly than a person who is healthy.
What will it do to the essential doctor-patient relationship of trust? Can you trust a doctor who will have pressure from your heirs to conserve your estate? Can you trust a doctor who is being pressured by the government, insurance companies and the hospital to contain costs by making you dead sooner? Will you be able to trust your doctor when you know he is allowed and maybe encourage to convince you to ask for an "assisted suicide?"
Our society has already taken one step from the tried and true by legalizing abortion. We should retrace our steps to protect human life, not stumble still further into the culture of death by essentially legalizing euthanasia and all that will surely follow.
We physicians already assist you in death. Don't give us the power to assist you in murder.
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