On September 12, 2015, the California Legislature passed a controversial bill legalizing physician-assisted suicide. California would become the fifth state to allow doctors to prescribe lethal medication to terminally ill patients who request it, after Oregon, Washington, Vermont and Montana. During the debate over the passage of the bill, everybody weighed in: patient’s rights advocates, dying patients and their advocates, religious groups. The one group that I didn’t hear about was what the frontline physicians — those practitioners who will actually prescribe the treatment — had to say. This is my attempt to add that viewpoint.
Death is a major event (to understate the obvious) in the cycle of life, and the decision to die must be left up to the individual, his/her particular physiology, and close family members. We should be counselors, and comfort providers, not terminators. If physicians assist in suicide we will truly be “playing God,” and entering onto a slippery moral slope from which we may not recover.
Irrespective of one’s religious beliefs there seems to be a universal morality that governs our behavior with respect to our fellow humans. Variations of the 6th Commandment (Thou shalt not kill or murder) exist in virtually all traditions; not just the Judeo-Christian one we’re all so familiar with. There must be a reason that traditions as widely divergent as Tibetan Buddhism and American Evangelical Protestantism carry the same proscription. Obviously, such a widely banned practice must reflect some underlying universal morality; or a hardwiring of the human nervous system, if one wishes to be totally materialistic about it. Granted, with the widespread incidence of “holy” war and religious murder, the bans are honored more in the breach than in reality. But still, the proscriptions are there.
No physician wishes to watch a patient beg to die, or be in excruciating pain. I’m sure that all of us have felt that death would be a release for certain patients. However, once we become personally involved in promoting death, we begin to undermine the moral contract that exists between patients and physicians, thereby undercutting our abilities to provide care to the living. We cannot be both physician and executioner. It is impossible to assume both roles at once, and should we become purveyors of suicide, it ultimately lessens our abilities as physicians.
Death is not the enemy. Our real enemy is pain, suffering, and loss of dignity; it is imperative for each of us to expend whatever efforts it takes to alleviate the pain (both physical and emotional). I don’t mean to imply that every one of our patients be put on high-tech life support (existence support, in actuality). In fact, that course, more often than not, prolongs the suffering. Our job, when dealing with the terminally ill, is to provide as much pain relief, emotional support and comfort as humanly possible to ease our patients’ transition from life to death. We have no moral right to hasten that process.
How can we, as physicians, wear both the mantle of healing and executioner? For although we may be performing a compassionate act, we still are acting as executioner. What effect will this have upon us? Curing a condition and healing are not necessarily synonymous, and while, when dealing with the terminally ill, we may not cure them of their condition(s), we certainly may provide healing in the form of emotional and physical support and achieving “closure.” Ultimately, I feel, physician-assisted suicide will lessen our effectiveness as healers, and, perhaps, make us a bit jaded and coarsen our own characters, to our professional and personal detriment.
Often, we facilitate a much longed for death by prescribing various medications that patients will take in conscious overdose. Obviously, many of the drugs we prescribe for comfort and pain relief are lethal when taken to excess, and if a person deliberately overdoses on those medications, that is their prerogative. We are fully cognizant of what they are doing, and give, at least tacit approval to their actions. But prescribing drugs that a person may or may not take is a long step from actually pushing the plunger on a syringe loaded with lethal drugs.
The cardinal implicit assumption of our Western society is that of individuals being responsible, and ultimately answerable, for their own actions. Our entire society is predicated upon people having control of their lives, and, in fact, this particular argument of physician-assisted suicide is about people taking control of their own deaths. If a terminally ill person wishes to hasten his or her demise, that is his/her decision, and we shouldn’t necessarily stand in his/her way. However, if we act as agents providing death for our patients, we are divesting them of their final and greatest responsibility.
We can attempt to rationalize assisted suicide as a matter of compassion. No matter how compassionate we may think we are by performing assisted suicide, we are taking the first tentative steps on a path that leads us away from healing, and into a future where the loss of moral distinctions erases the humanity from our profession.
Stephen Kamelgarn is a family physician who blogs at Code Blue Health Crisis.
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