PHYSICIAN-ASSISTED SUICIDE AND THE HIPPOCRATIC OATH
Originally written: July 18, 2017
Physician-assisted suicide is sometimes called physician-assisted death. Suicide is the more accurate word. It is not voluntary active euthanasia. This means a patient asks a physician to kill him or her with a lethal injection. In physician-assisted suicide, the physician’s act is necessary but not sufficient for the patient’s death, whereas in active euthanasia, the act of the physician is both necessary and sufficient. Active euthanasia is not legal in the United States. Physician-assisted death is legal in 6 states and DC, comprising 20% of US citizens. Opponents of physician-assisted death are fearful that it will lead to voluntary active euthanasia, as has occurred in the Netherlands and in Belgium. There, active euthanasia is done more frequently than physician-assisted-death. Furthermore, in the Netherlands, as in the United States, patients who have chronic and nonterminal diseases, including psychiatric diseases, can receive either physician-assisted death or active euthanasia.
In the United States, patients must be terminally ill, which is defined as a fatal disease with prognosis of 6 months or less to live. Do the Dutch value life less than Americans do? Are they less religious? Or do they believe that physicians have a duty to respect patients’ autonomy and the right to determine what constitutes their best outcome? This approach obviously conflicts with the Hippocratic Oath, which simply says do no harm.
In many cases, suffering, both physical and emotional, can be reduced by symptom palliation and treatment of depression. These measures would not, however, solve the problems of a patient’s financial worries, pressure from family members, health insurers, and hospitals.
It goes without saying that some physicians’ religious beliefs preclude them from participating, and indeed, in all states, participation is voluntary, and the American Medical Association and American College of Physicians are opposed to legalizing physician-assisted death. The American Academy of Neurology is formulating a policy, not yet available.
See Neurology, 2017, volume 88, an editorial with lead author Bernat. Also see the wonderful novel by Ian McEwan called Amsterdam. It is also distinguished by being short and safe to drop on your foot.