Physician-assisted suicide is a disaster for medicine

The Argument

Ten years of misguided zealots' efforts show that the death option brings out the very worst in doctors.

Books

March 17, 2002|By Paul McHugh | Paul McHugh,Special to the Sun

In 1991, Mary Ann Glendon, the Learned Hand Professor of Jurisprudence at Harvard Law School, wrote a discerning book, Rights Talk: The Impoverishment of Political Discourse (The Free Press, 218 pages, $22.95) in which she noted that contemporary American discourse over such issues as property, sexual activity, abortion, social welfare and the like was deteriorating into sound bites, slogans and the strident language of "my rights." In this process our opinions were becoming hyperpolarized, exaggeratedly absolute, coarsely self-centered and remarkably silent about personal, civic and collective responsibilities.

She demonstrated how "rights talk" especially impeded solutions to those political and social problems that needed "deliberation" -- i.e., "time, information, and forums where facts, interests, and ideas can be exchanged and debated."

Her book was published the same year that Dr. Jack Kevorkian burst onto the American medical scene proclaiming a new "right" never anticipated by Glendon -- a right of the sick to physician-assisted suicide (PAS). He called it "medicide," or "the termination of life performed by ... professional medical personnel (such as a doctor, nurse, paramedic, physician's assistant, or medical technologist). [Prescription: Medicide by Jack Kevorkian (Prometheus Books, 232 pages with illustrations)].

Simultaneously, Dr. Thomas Quill published a peer-reviewed, professionally sanctioned article in the New England Journal of Medicine (1991, Volume 324, Pages 691-694) titled "Death and Dignity: A case of Individualized Decision-making" in which he described and defended his practice of giving a cancer patient a cache of sedatives to kill herself because she feared the advance of her illness. These two publications -- and their fervent authors -- fired up a decade of ferocious "rights talk" that replicated in polarized, self-centered, irresponsible arguments, much of what Glendon described for other issues of the journal.

But now 10 years have passed. Kevorkian is in jail. Quill's practice is discredited. And, in part helped by a few crucial events, we have emerged better informed and better equipped, as both practitioners and interested witnesses, to support and care for terminally ill patients rather than killing them. All of this should give, as Glendon says, at least hope if not optimism for the continuation of the American experiment in self-government.

This good story is well told in a new book edited by Dr. Kathleen Foley, the neurologist director of the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center and Dr. Herbert Hendin, the psychiatrist director of the American Foundation for Suicide Prevention, [The Case against Assisted Suicide: For the Right to End-of-Life Care (Johns Hopkins University Press, 371 pages, $49.95)].

These editors are veterans of the PAS war. Foley is famous for teaching physicians to use pain killers for cancer patients -- demonstrating how ignorance about medication for the dying had often led to unnecessary suffering and requests for PAS. Hendin is distinguished for his eyewitness reports of the psychologically callous and negligent workings of PAS in Holland that he dubbed "the Dutch cure."

The book has four sections that knit together coherently. The first -- titled "Autonomy, Compassion, and Rational Suicide" -- explores the theoretical and legal issues raised by PAS. Leon Kass, America's preeminent bioethicist, leads off with a consideration of the Hippocratic tradition -- including that sentence in the Hippocratic Oath explicitly repudiating PAS more than 2,400 years ago: "I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect." This hallowed tradition characterizes doctors not by their powers but their goals -- not their means but their ends -- which are to benefit the sick and keep them from harm.

This first section closes with "The Rise and Fall of the 'Right' to Assisted Suicide" by Yale Kamisar, professor of law at Michigan, who presents a definitive history of the legal battles of the decade. Here one can find just why the U.S. Supreme Court in 1997 rejected the claim of a constitutional right to assisted suicide and "brought the momentum [for PAS] to a screeching halt."

The court, notes Kamisar, concluded that these were matters the states could decide in their legislatures and "point by point ... wiped out all the lower courts' very strong and very quotable language in favor of physician-assisted suicide." The follow-on surprise was that in state after state (with the exception of Oregon) the voters, when given an extended and thorough consideration of what is at stake, rejected PAS as unsafe for the depressed, isolated, and demoralized terminally ill.

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