Physician Assisted Suicide
Physician Assisted Suicide
It was late at night as I made my last rounds at the Navy hospital where I was working to fulfill my military duties during the waning years of the Vietnam War. I had been in the operating room most of the day and was finally getting to see each of my patients to assess their care and make plans for the coming day. I was anxious to check on the status of one particular patient I knew had been in considerable pain and was close to death.
Anticipating my return, she was still awake awaiting my evening rounds. She needed something stronger for her pain. Having long suffered with metastatic cancer of the uterus, she was at the end stage of her illness and was seeking to die comfortably and peaceably. With labored breath, she told me of increasing pain in her back and neck and that the medication we had been giving her was not working any more.
I ordered more narcotics in hopes of bringing her some relief, though I was doubtful that the increased dosage would do the job. We'd gotten to know each other over the three weeks she had been in our hospital, and I was feeling frustrated that we had so little to offer this charming and gracious woman.
As the nurse handed me the syringe, I knew I was walking on thin ice. If I gave her too much narcotic medication I would suppress her breathing centers and cause her to go into respiratory arrest and die. If, on the other hand, I under medicated her, the pain would persist.
The exact amount had a significant chance of bringing her temporary comfort and sleep. I hesitated as I held the plunger to the syringe in my hand, and my thoughts went back to a dictum I had been taught as a medical student many years earlier, first, do no harm. insurancerate.com
It was, and still is, a rule physicians live by as we go about our daily chores of attempting to heal and comfort the sick. I questioned whether I was doing harm or bringing comfort to my dying patient.
Twenty-five years later that question is still being asked. In the summer of 1990, 54 year old Janet Atkins, suffering from Alzheimer's Disease, committed suicide by pressing a button that released a deadly poison into her veins and quickly and painlessly ended her life. She did this with the aide of a physician, Dr. Jack Kavorkian.
Since this case reached the front page of most newspapers it created quite a debate in the lay and medical communities. While many physicians accept the view that terminally ill patients should not be kept alive by unusual or technological invention, most however, draw a sharp line between artificially prolonging life and deliberately helping it end.
There is considerable difference between cessation of treatment and overtly causing a patient's death. Physician assisted suicide, however, seems to be gaining support. A poll by the Hemlock Society, found that 64% of Americans favor the concept of medically assisted suicide for the terminally ill. In 1988 an American Bar Association survey noted that more than half of the lawyers questioned on the subject found that giving lethal injections to terminally ill patients who requested it should be legal.
In addition, for many years physicians have been quietly helping terminally ill patients die in peace and with dignity. There seems, however, to be an enormous ethical difference in making a patient more comfortable by injecting a pain reliever which could inadvertently cause the death of a patient, and injecting a patient with a substance with the primary intent causing death.
Physician assisted suicide is not only focused on the act of injecting overdoses. Reporting in The New England Journal of Medicine in 1991, Dr. Timothy E. Quill told of his experiences in giving one of his terminally ill patients oral medication and the information necessary to end her life when she chose.
The article initially was more positively received by many in medicine than was the Kavorkian/Atkins case. In the first place, Dr. Quill knew his patient for an extended period of time and was her primary physician (Dr. Kavorkian had only met Ms. Atkins the day before and had not been involved in her illness or treatment).
Secondly, Dr. Gill wrote of his experience with the sensitivity, compassion, concern, and consideration all of us would want from our physician, while Dr. Kavorkian appeared to may to be cold and heartless.
Yet, I question if there really a difference in what Kavorkian and Quill did. Despite enormous differences, both assisted in a patient's suicide.
I believe the assisted suicide issue should be left in other hands. A physician should not be involved with assisting a patient in committing suicide. It cuts against the grain of our reason for being. Obviously, many agree since in the summer of 1991, a book entitled Final Exit: The Practicalities of Self-deliverance In Assisted Suicide for the Dying made its' first appearance in the New York Times best seller list in the Category of Advice, How-To and Miscellaneous.
The author, Derek Humphrey, founder of the Hemlock Society (a right-to-die organization) knew his book was needed and put together this work on ways to end one's life.
My terminally ill patient had told me on more than one occasion how she wished to die rather than continue her suffering. She had often asked if I would help her end her life peaceably and with dignity.
I knew this as I pushed the plunger to the syringe and injected the narcotic into her vein. Two hours later she died of respiratory arrest never gaining consciousness again.
I believed then and still do today that my intent in medicating my patient was to bring pain relief not death. Herein lies the difference between what I feel is the discriminating factor between a physician assisting suicide and performing an ethically defendable act. A patient may ask me each month for more sleeping medication and I may comply in an attempt to help my patient sleep. Should she choose to save these capsules until she has enough to commit suicide is her decision. However, I could not in good conscious give her "extra" pills to assist in this act.
Our health care system is moving closer to a process that concentrates less on the high technology that prolongs dying and more on making death more comfortable. Physicians will not, however, be able to handle this ethical dilemma alone. It will require guidelines and directions and this can only be achieved through societal consensus and legal acceptance.
Then perhaps, the very question of the ethical propriety of physician assisted suicide will be unnecessary.