At Georgetown, a Jesuit and Catholic university, the most cogent argument against physician-assisted suicide for those who espouse our values is that it is morally wrong, a clear violation of the commandment not to kill oneself or others. But, as befitting an academic environment, the case can be made without the necessity of a religious argument. Assisted suicide sets a new and perilous precedent for patients who might seek it out, for those who rightfully fear it and for the medical profession that is supposed to administer it.
Physician-assisted suicide awaits Mayor Muriel Bowser’s signature of the Death with Dignity Act, passed last month without a referendum of those who will be affected. Desperate patients who are terminally ill will be empowered, under the act, to request a lethal prescription from a willing physician. The law requires that they take it voluntarily and self-administer the drugs. However, no witness and no physician are required to be present at the bedside to ensure that no coercion occurs.
This early death is supposedly needed to keep such patients from dying in pain. Yet, in Oregon, the first state to approve PAS, the primary reasons patients give for seeking assisted suicide are not pain, which palliative care experts say should be controllable, but fear of being a burden, fear of loss of control and possibly even the depression associated with these. All were listed before fear of pain — except depression, for which neither the Oregon nor D.C. law requires psychiatric evaluation or support.
Those with a superficial familiarity of the issue may wonder why it is so controversial. If you do not like it, do not do it — is it not just a matter of autonomy? The unfortunate answer is that PAS is much more complex than just a matter of autonomy, or compassion, and will create an uncontrollable conflict between the two.
This option will create more than just a theoretical danger. To fully respect autonomy, we cannot justify arbitrary requirements such as terminal illness or the ability to self-administer the drugs. Any claim of intolerable suffering should qualify, or we fail in the duty of compassion. Society will have accepted that suicide is an acceptable response to anyone’s suffering. This will now acknowledge that some lives are no longer worth living, or preserving, and we give tacit approval to their assessment that they are better off dead. This is an egregious failure of true compassion toward the dying, as well as others with chronic medical conditions.
If this is not disconcerting enough for the terminally ill, what will be the effect on those who are not seeking an early death? Many are already frightened by this tectonic shift in attitudes of care. This is why the law was opposed at the Council hearings by organizations concerned for the disabled, the mentally ill and, especially in the District of Columbia, for those people of color who have never had adequate access to medical care. They all understand that if someone’s life can be labeled as “not worth preserving” it becomes a danger for us all.
In Belgium and the Netherlands, where assisted suicide and euthanasia have been practiced longer than in the United States, arguments based on autonomy and compassion could not maintain adequate restrictions on the practice of PAS and euthanasia. Accordingly, they now compassionately euthanize those who suffer from non-terminal diseases, and those who suffer without the ability to end their own lives or even request it. Acceptable indications now include chronic depression, anorexia nervosa, alcoholism and the intractable loneliness of aging.
Finally, the role of physicians has always been, “to cure, sometimes to relieve often and to care always.” This is why the American Medical Association still holds that assisting in suicide “is incompatible with the role of the physician.” Such a change in the physician’s commitment inevitably changes the doctor-patient relationship and the trust that it requires. Will patients always be able to believe their doctors work only to provide comfort and prolong their lives to their benefit? Or will they perceive that some doctors will look at some patients as “lives unworthy of living”?
Add to this the deception that this law also demands from physicians. They may not list suicide or assisted suicide on the death certificate, but must certify that the death occurred from the underlying illness that was anticipated as the future cause of their demise. Even the term “death with dignity” is a deceitful euphemism in comparison with the more accurate physician-assisted suicide. Creating such societal changes, such risks for the vulnerable and permanently altering the role and nature of the medical profession is a burden that a favored few should not be able to impose on the rest of society.
G. Kevin Donovan is a professor at the Georgetown University Medical Center and director at the Pellegrino Center for Clinical Bioethics.
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