{"id":11174,"date":"2018-01-27T00:11:15","date_gmt":"2018-01-27T00:11:15","guid":{"rendered":"http:\/\/www.lifeandnews.com\/articles\/?p=11174"},"modified":"2018-01-28T00:15:27","modified_gmt":"2018-01-28T00:15:27","slug":"how-does-assisting-with-suicide-affect-physicians","status":"publish","type":"post","link":"https:\/\/www.lifeandnews.com\/articles\/how-does-assisting-with-suicide-affect-physicians\/","title":{"rendered":"How does assisting with suicide affect physicians?"},"content":{"rendered":"

Ronald W. Pies<\/a>, Tufts University<\/a><\/em><\/span><\/p>\n

When my mother was in her final months, suffering from a heart failure and other problems, she called me to her bedside with a pained expression. She took my hand and asked plaintively, \u201cHow do I get out of this mess?\u201d <\/p>\n

As a physician, I dreaded the question that might follow: Would I help her end her life by prescribing a lethal drug?<\/p>\n

Fortunately for me, my mother tolerated her final weeks at home, with the help of hospice nurses and occasional palliative medication. She never raised the thorny question of what is variously termed \u201cmedical aid in dying\u201d or \u201cphysician-assisted suicide.\u201d<\/a> <\/p>\n

As a son and family member who has witnessed the difficult final days of parents and loved ones, I can understand why support for MAID\/PAS is growing<\/a> among the general public. But as a physician and medical ethicist, I believe that MAID\/PAS flies in the face of a 2,000-year imperative of Hippocratic medicine: \u201cDo no harm to the patient.\u201d<\/p>\n

Studies point out that even many doctors who actually participate in MAID\/PAS remain uneasy or \u201cconflicted\u201d<\/a> about it. In this piece, I explore their ambivalence.<\/p>\n

Assisted suicides<\/h2>\n

In discussing end-of-life issues, both the general public and physicians themselves need to distinguish three different approaches.<\/p>\n

MAID\/PAS involves a physician\u2019s providing the patient with a prescription of a lethal drug that the patient could take anytime to end life. In contrast, active euthanasia or \u201cmercy killing\u201d<\/a> involves causing the death of a person, typically through a lethal injection given by a physician. Finally, the term \u201cpassive euthanasia\u201d refers to hastening the death of a terminally ill person by removing some vital form of support. An example would be disconnecting a respirator.<\/p>\n

Increasing international acceptance<\/h2>\n

In the U.S. some form of legislatively approved MAID\/PAS (but not active euthanasia) is legal<\/a> in five states and the District of Columbia. In my home state \u2013 following a passionate debate \u2013 the Massachusetts Medical Society recently decided to rescind its long-held opposition<\/a> to the practice. MMS has taken a position of \u201cneutral engagement,\u201d<\/a> which it claims will allow it to \u201cserve as a medical and scientific resource \u2026 that will support shared decision making between terminally ill patients and their trusted physicians.\u201d <\/p>\n

\n \"\"
\n Physician-assisted suicide is finding more acceptance.<\/span>
\n Ocskay Bence<\/a><\/span>
\n <\/figcaption><\/figure>\n

In a few countries, MAID\/PAS has grown increasingly common. In Canada, for example, MAID\/PAS was legalized in 2016<\/a>. In Belgium and the Netherlands, both active euthanasia and physician-assisted suicide <\/a> are permitted by law, even for patients whose illnesses may be treatable, as with major depression; and whose informed consent may be compromised, as in Alzheimer\u2019s disease. In the Netherlands, a proposed \u201cCompleted Life Bill\u201d<\/a> would allow any persons age 75 or over who decide their life is \u201ccomplete\u201d to be euthanized \u2013 even if the person is otherwise healthy. <\/p>\n

U.S. physician response<\/h2>\n

Among U.S. physicians, MAID\/PAS remains controversial, but national data point to its increasing acceptance. A report published in December 2016 found 57 percent of doctors agreed that physician-assisted death<\/a> should be
\navailable to the terminally ill \u2013 up from 54 percent in 2014 and 46 percent<\/a> in 2010. <\/p>\n

Perhaps this trend is not surprising. After all, what sort of physician would want to deny dying patients the option of ending their suffering and avoiding an agonizing, painful death? <\/p>\n

But this question is misleading. Most persons requesting PAS are not actively experiencing extreme suffering or inadequate pain control. Data from the Washington and Oregon PAS programs show that most patients choose PAS<\/a> because they fear loss of dignity and control over their own lives.<\/p>\n

Some physicians feel conflicted<\/h2>\n

Physicians who carry out assisted suicide have a wide variety of emotional and psychological responses. In a structured, in-depth telephone interview survey<\/a> of 38 U.S. oncologists who reported participating in euthanasia or PAS, more than half of the physicians received \u201ccomfort\u201d from having carried out euthanasia or PAS. <\/p>\n

\u201cComfort\u201d was not explicitly defined, but, for example, these physicians felt that they had helped patients end their lives in the way the patients wished. However, nearly a quarter of the physicians regretted their actions. Another 16 percent reported that the emotional burden of performing euthanasia or PAS adversely affected their medical practice.<\/p>\n

For example, one physician felt so \u201cburned out\u201d that he moved from the city in which he was practicing to a small town. <\/p>\n

Other data support the observation that MAID\/PAS can be emotionally disturbing to the physician. <\/p>\n

Kenneth R. Stevens Jr.<\/a>, an emeritus professor at Oregon Health and Science University, reported that for some physicians in Oregon, participation in PAS was very stressful<\/a>. For example, in 1998, the first year of Oregon\u2019s \u201cDeath with Dignity Act,\u201d 14 physicians wrote prescriptions for lethal medications for the 15 patients who died from physician-assisted suicide.<\/p>\n

The state\u2019s annual 1998 report observed that:<\/p>\n

\n

\u201cFor some of these physicians, the process of participating in physician-assisted suicide exacted a large emotional toll, as reflected by such comments as, \u2018It was an excruciating thing to do \u2026 it made me rethink life\u2019s priorities,\u2019 \u2018This was really hard on me, especially being there when he took the pills,\u2019 and \u2018This had a tremendous emotional impact.\u2019\u201d<\/p>\n<\/blockquote>\n

Similarly, reactions among European doctors suggest that PAS and euthanasia often provoke strong negative feelings<\/a>. <\/p>\n

Why the discomfort?<\/h2>\n
\n \"\"
\n Feeling conflicted.<\/span>
\n Robert Kneschke<\/a><\/span>
\n <\/figcaption><\/figure>\n

As a physician and medical ethicist, I am opposed to any form of physician assistance with a patient\u2019s suicide. Furthermore, I believe that the term \u201cmedical aid in dying\u201d allows physicians to avoid the harsh truth that they are helping patients kill themselves. This is also the view of the very influential American College of Physicians<\/a>. <\/p>\n

I believe that the ambivalence and discomfort experienced by a substantial percentage of PAS-participating physicians is directly connected to the Hippocratic Oath \u2013 arguably, the most important foundational document in medical ethics. The Oath clearly states<\/a>: <\/p>\n

\n

\u201cI will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.\u201d <\/p>\n<\/blockquote>\n

In 5th century BC Greece, Hippocrates was something of a revolutionary in this respect. As the classicist and medical historian, Ludwig Edelstein<\/a> has pointed out<\/a> some non-Hippocratic physicians probably did provide poisons to their dying patients, in order to spare them protracted suffering. Hippocrates opposed this practice, though he did not believe that terminally ill patients should be exposed to unnecessary and futile medical treatment.<\/p>\n

Palliative care specialist Ira Byock<\/a> has observed<\/a> that:<\/p>\n

\n

\u201cFrom its very inception, the profession of medicine has formally prohibited its members from using their special knowledge to cause death or harm to others. This was \u2013 and is \u2013 a necessary protection so that the power of medicine is not used against vulnerable people.\u201d <\/p>\n<\/blockquote>\n

Indeed, when patients nearing the end of life express fears of losing control, or being deprived of dignity, compassionate and supportive counseling<\/a> is called for
\n\u2013 not assistance in committing suicide.<\/p>\n

To be sure, comprehensive palliative care, including home hospice nursing, should be provided to the subset of terminally ill patients who require pain relief. But as physician and ethicist Leon Kass<\/a> has put it<\/a>:<\/p>\n

\n

\"The\u201cWe must care for the dying, not make them dead.\u201d<\/p>\n<\/blockquote>\n

Ronald W. Pies<\/a>, Emeritus Professor of Psychiatry, Lecturer on Bioethics & Humanities at SUNY Upstate Medical University; and Clinical Professor of Psychiatry, Tufts University School of Medicine, Tufts University<\/a><\/em><\/span><\/p>\n

This article was originally published on The Conversation<\/a>. Read the original article<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ronald W. Pies, Tufts University When my mother was in her final months, suffering from a heart failure and other problems, she called me to her bedside with a pained expression. She took my hand and asked plaintively, \u201cHow do I get out of this mess?\u201d As a physician, I dreaded the question that might […]<\/p>\n","protected":false},"author":44,"featured_media":11175,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[2450],"tags":[3924,3929,3922,3925,3546,3923,3927,3928,3926],"_links":{"self":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/11174"}],"collection":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/users\/44"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/comments?post=11174"}],"version-history":[{"count":1,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/11174\/revisions"}],"predecessor-version":[{"id":11176,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/posts\/11174\/revisions\/11176"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/media\/11175"}],"wp:attachment":[{"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/media?parent=11174"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/categories?post=11174"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lifeandnews.com\/articles\/wp-json\/wp\/v2\/tags?post=11174"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}