From the Economist in October 2012 was an article on physician assisted suicide.  In the United States, terminally ill patients can apply for permission to end their lives with the guidance of a doctor in Oregon and Washington state.  Several safeguards are in place to prevent this from becoming the default death pathway (only 0.2% of total Oregonian deaths).  Also, I had no idea that Holland, Switzerland, and Belgium allow assisted suicide even in non-terminally ill citizens.  So you can be suffering from, say, severe acne vulgaris, in the Netherlands and be within your rights to seek immediate death from a certified death-administering professional.  Revelatory, indeed.  And heartwarming to read about on a Sunday.

My main interest is in the doctors who are contracted to carry out these ghoulish deeds.  By physician assisted, I think what everyone has in mind some sort of benign, humane, non-invasive mode of life sapping.  You lie on a table.  Calming eastern mystic yoga music plays softly in the background.  The room smells of lilac and aloe.  A soothing voice whispers in your ear, “it’s going to be alright, peace and love await you”.  And then a white robed man with a Francis of Assisian face of compassion slowly injects painless sedatives until you pass out and then the final killing agent is administered while you are in a state of blanked nothingness.

In general, this would be a job right up the ally of a motivated, profit-oriented anesthesiologist who has become disillusioned with clinical practice.  Pumping people full of mind altering, physiology warping drugs is what they do for a living.

But I was wondering how other professions could break into the market.  A general surgeon would not seem to be such a natural fit.  At least not when it comes to death by drug.  A general surgeon looking to make a few bucks on weekends killing people would have to offer a menu of alternatives along the following lines:

• The big red. Thoracotomy performed after induction of general anesthesia.  Aorta identified and sliced transversely.  Included in offer are free disposal of exsanguinated blood and chest closure.
• The double tap. Bilateral neck incisions made (either under local or general anesthesia, depending on patient financial situation), both carotid arteries dissected out and tied off.  Included is immediate EEG and consult from certified neurologist to confirm brain death.
• The gateway. Portal vein opened up after transecting the bile duct and hepatic artery.  Blood can either be suctioned off field or left inside abdomen.
• The strangler. Incision made as for tracheostomy.  Instead of tracheostomy, surgeon occludes trachea with fingers until death ensues.  Wound closed with absorbable suture in skin lines; lovely cosmetic result guaranteed for open casket viewing.

All kidding aside, I am not one to make judgments on a man’s decision to end his own life.  It seems like a ghastly option but I’ve never been in a situation where I was suffering horribly with months to live.

On the other hand, the idea that a physician would participate in the hastening of death strikes me as intellectually incoherent.  Whoever it is that would devote himself to such a career is not, nor could ever be, called a doctor.  Those, like Kevorkian, who perform these procedures are not doctors.  They have chosen to become something else.  Arguments about the morality of what they do can certainly be fostered.  But they are not doctors anymore.  Not if the word is to have any clear, common sense meaning in the English language.

Jeffrey Parks is a general surgeon who blogs at Buckeye Surgeon.