March 15, 2007 09:11 PM
Assisted Death: The Antithesis of the Healing Arts
March 8, 2007
Since 1994, when Oregon passed the Death with Dignity Act legalizing physician assisted-suicide, several state legislatures have entertained similar legislative proposals. Fortunately, to date, such proposals have not become law. However, currently legislative initiatives are underway in California and Vermont, to decriminalize physician assisted-suicide. If such proposals become law, there will be a dramatic reversal of the healing role of medicine in society.
"Assisted-suicide" usually refers to a professional prescribing a lethal dose of medication for self administration by the patient. It is not the refusal of treatment by a patient, or the withdrawal of treatment at a patient's request. The U.S. Supreme Court provides us with such a distinction between withdrawing life-support and assisting a suicide: "a physician who withdraws, or honors a patient's refusal to begin, life sustaining medical treatment purposefully intends, or may so intend, only to respect his patient's wishes and 'to cease doing useless and futile or degrading things to the patient when [the patient] no longer stands to benefit from them….' [A] doctor who assists a suicide, however, 'must, necessarily and indubitably, intend primarily that the patient be made dead.'.…" [Vacco v. Quill, 521 U.S. 793 (1997)]
Nor is assisted-suicide the administration of pain-relieving or sedating medication, even when the known but unintended side effect may be the hastening of death. Morally licit and legal provisions exist for those situations. Physician assisted-suicide is assisting by a professional in the direct taking of a human life. That medical professional has an obligation always to act in the best interest of the patient, even when the patient's own requests contradict that aim. Since the time of Hippocrates physicians have been charged to protect life under all circumstances. The legalization of physician assisted-suicide constitutes a dramatic shift in the life preserving role of the physician.
Proponents of legalized assisted-suicide claim that it is a humane method of preserving personal dignity for those who are near death or experiencing a severe, debilitating disease. What constitutes personal dignity? Is the one-year old in diapers more dignified than her 85 year old great grandfather, who has dementia and also needs assistance with activities of daily living? Does he deserve less of the family's and society's care and concern than younger members of society? Such abandonment is not only "ageism" but also constitutes the ultimate negation of one's innate dignity. For a compassionate society to survive, it cannot equate personal dignity with the potential to contribute to society. Furthermore, is assisted-suicide really humane for the ill person? Or is this a method to relieve others, including society at large, of personal and financial obligations to truly care for society's most vulnerable members - the frail elderly, infirm, disabled, poor, and underinsured, or those whose treatment regimes are deemed too costly? In the Netherlands, where assisted-suicide is the legal practice, even on neonates, non-voluntary euthanasia is now performed widely.
A study published by Duke University demonstrated that while the frail elderly are strongly opposed to assisted-suicide (only 39.9% supported assisted-suicide), 59.3% of their younger relatives favored it. (Koenig, et al., Archives of Internal Medicine, October 28, 1996). The U.S. Supreme Court has recognized the risks of subtle coercion that can occur. Chief Justice William Rehnquist wrote that "If physician assisted-suicide were permitted, many might resort to it to spare their families the substantial financial burden of end of life health care costs." [Washington v. Glucksberg, 521 U.S. 702 (1997)] Pope John Paul II affirmed that, "To concur with the intention of another person to commit suicide and to help in carrying it out through so-called 'assisted-suicide' means to cooperate in, and at times to be the actual perpetrator of, an injustice which can never be excused, even if it is requested." (Evangelium vitae, no. 66). The truly humane method of caring for such members of our society is not to help them eliminate themselves, but to do all in our power to eliminate their suffering, while affirming their innate dignity and worth through the manner in which we care for them: "Even when not motivated by a selfish refusal to be burdened with the life of someone who is suffering, euthanasia must be called a false mercy, and indeed a disturbing 'perversion' of mercy. True 'compassion' leads to sharing another's pain; it does not kill the person whose suffering we cannot bear." (Evangelium vitae, no. 66). Today, there is no reason for a patient to seek death as a method to control pain. In fact, most persons who request physician-assisted-suicide withdraw that request if their depression and pain are treated.
There is an unwritten social contract that society will care for its most vulnerable members. Extending the legalization of assisted-suicide not only will lead to more deaths among our most vulnerable members of society, it will be the death of society as we now know it: a society that affirms that the lives of the elderly, disabled, and terminally ill are no less valued than those of the young and healthy.
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