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.

Have a reaction to this article? Write a letter to the editor.

One Comment

  1. Welcome to the Oregon experience.
    Some doctors coerce patients. The following classic letter from an Oregonian is an example.
    “Dear Editor, 
    Hello from Oregon. 
    When my husband was seriously ill several years ago, I collapsed in a half-exhausted heap in a chair once I got him into the doctor’s office, relieved that we were going to get badly needed help (or so I thought). 
    To my surprise and horror, during the exam I overheard the doctor giving my husband a sales pitch for assisted suicide. ‘Think of what it will spare your wife, we need to think of her’ he said, as a clincher. 
    Now, if the doctor had wanted to say ‘I don’t see any way I can help you, knowing what I know, and having the skills I have’ that would have been one thing. If he’d wanted to opine that certain treatments weren’t worth it as far as he could see, that would be one thing. But he was tempting my husband to commit suicide. And that is something different. 
    I was indignant that the doctor was not only trying to decide what was best for David, but also what was supposedly best for me (without even consulting me, no less). 
    We got a different doctor, and David lived another five years or so. But after that nightmare in the first doctor’s office, and encounters with a ‘death with dignity’ inclined nurse, I was afraid to leave my husband alone again with doctors and nurses, for fear they’d morph from care providers to enemies, with no one around to stop them. 
    It’s not a good thing, wondering who you can trust in a hospital or clinic. I hope you are spared this in Hawaii. 
    Sincerely,
    Kathryn Judson, Oregon”

    Doctors are human too. My brother had a stroke that left his right arm useless and his speech impaired. He asked me to contact his doctor to explain that he did not need the antidepressants that the doctor had prescribed for him because he was not depressed. The doctor’s response was “Would not you be depressed in his condition?”
    We trust our doctors but we do not want to tempt them with the power to coerce their patients to cut short their life with legal assisted suicide.
    All Oregon model laws including CA, DC and Colorado’s non transparent Prop 106 simply allow killing by forced euthanasia.

Leave a Reply

Your email address will not be published. Required fields are marked *

*