Friday, September 4, 2009

Physician-assisted Suicide: Constitutional Right or Just Plain Wrong?

This past week, the Montana Supreme Court heard a right-to-die case where the plaintiff argued that there is a constitutional right to physician-assisted suicide. A Montana physician had refused this request from a terminal cancer patient, who died in December 2008 without medical assistance. No state in the union currently has a constitutional right to die, although physician-assisted suicide is a legal practice in Oregon and Washington. In 1997 the U.S. Supreme Court ruled that there is no fundamental constitutional right to physician-assisted suicide, although it did not prohibit the practice entirely. Once the balance of the U.S. Supreme Court shifts leftward in the coming years, perhaps a constitutional right to medical euthanasia will be ‘discovered’ in the U.S. Constitution.

If the Montana plaintiff’s view prevails, would physicians there be breaking the law by refusing to assist a patient who requested a doctor-assisted death? Would such principled doctors be denying a patient a newly established constitutional right? We are all familiar with lawsuits alleging wrongful death. Would the term wrongful life be invoked by a patient who claimed physical and psychological damages because a doctor wouldn’t facilitate his demise?

While the courts can opine on these controversies, this is a moral question for society and the medical profession, not a legal issue. Just because an action or behavior is legal, doesn’t make it right. Physician-assisted suicide is wrong and no court decision can make it right.

I expect some to claim that my categorical view against this practice is callous and dogmatic. I reject these arguments. There are some moral lines that simply must not be violated. The medical profession is sworn to relieve suffering and to comfort those who cannot be healed. This is our mission. Our patients trust us with preserving and protecting their lives. If we were to hasten or cause death, regardless of the motive, we squander this trust and sacrifice the essence of what it means to be doctors. It would change how we physicians view our own profession and would certainly change how society view us. Euthanasia would conspire with overzealous organ procurement in intensive care units and nursing homes as forces that distort how we view these human beings. If physician-assisted suicide were to become accepted, then it will inevitably enter the minds of physicians, nurses and family members who are caring for dying, or even chronically ill patients. Once this becomes an option, then it becomes legitimatized. It’s easy and frightening to extrapolate where this could lead us. The medical profession must remain guardians of life, not expediters of death. We need to keep our mission pure.

Sadly, there are patients who are suffering miserably, and we must do all that we can to help them. They have a right to effective pain control. They have a right to receive expert palliative care. They have a right to refuse treatment. They have a right to pray to the Almighty for final relief. They don’t have a right, however, to expect me to answer their prayers. While I might pray for their eternal rest also, I can’t push them forward on this journey. If I did, then I will have crossed a moral and ethical boundary with no way back.

All sides to an issue claim rights. In ethics, like law, the rights of all players are weighed against each other. These analyses can be vexing as competing parties argue persuasively that their rights are paramount. Depending upon the circumstances of the ethical dispute, one right will prevail. No right, however, is absolute. The right to free speech does not permit us to scream ‘Fire!’ in a crowded theater. Similarly, if a desperately ill individual has a right to a doctor-assisted death, then it is outweighed by society’s right to life.

If the Montana Supreme Court decides for the plaintiff, then this state will become the ethical Wild Wild West.


Anonymous said...
This comment has been removed by a blog administrator.
Anonymous said...

Legal is moral is ethical. There is absolutely no distinction among them. Intentionally separating them by degrees is what has caused all the problems and greased all the slopes. The way it is now is that legal is for public interest (an insidious creature that changes all the time depending on lobbyists), moral is for religions (tools of CULT-ivation) and ethics is for business (sell people what they say they want and make them responsible for it). These sub-categories need to be joined up as "fair play" one to another.

As far as right to die is concerned, we already have a right to die. It happens sooner or later to everyone. Studies show that most people don't want to hasten their deaths. Death is a process and there are plenty of painkillers. I think this lawsuit is a load of tosh designed to usher in the murder of languishing patients and free up beds etc. Remember that cases are chosen like articles in a newspaper. It's the public interest thing I mentioned above.

Anonymous said...

Stephen Drake said...

Thanks - I've posted an excerpt and a link to your post on my blog, suggesting that my visitors read it in its entirety.

One quibble - I'm not sure that medicine's mission has ever been "pure" - or at least there probably hasn't been a time when a significant minority have held some strong feelings on what lives are worthwhile - and what ones aren't. Some of those have acted on those feelings - with or without the permission or request of the individual.

Michael Kirsch, M.D. said...

Thanks, Steve, for the posting. I'll concede that the medical profession may not reach a state of purity, but we must aspire to do so. Falling short of this goal, however, is quite different than deliberately abandoning it. Medical ethics must resist forces that aim to use it as a tool to justify their beliefs and practices. I invite readers to visit Steve's blog ( his point of view on this issue is thoughtfully presented.

Anonymous said...

There is a lawsuit underway over the death of Gregory Jacobs at Hamot Medical Center. The teenager was killed by organ removal in 2007. Here is an excerpt from the suit:

42. Mark Hogue, Psy.D. met with Gregory’s father on March 10, 2007, and discussed Gregory’s prognosis, “brain death” protocols, and “end of life issues.”
43. Dr. Hogue stated that it would be “better” for Gregory to die rather than survive with the injuries he had sustained. He informed the parents that he interacts with numerous brain injury survivors, who, though they cannot talk, communicate that they wanted to be dead.

This is one to watch...

Link to Washington Post story about how cool doctors are said...

physician assisted suicide is an oxymoron. It's BS that phrase! Suicide means death caused by the actions of yourself! Anything else is a heady blend of murder and sucide.

A free market for drugs would solve all this... unless the person was like paralyzed or something...

In that case, you're screwed.

If you merely can't talk, but you can still walk, there is the nearest tall building.

I don't think the blog author has an accurate view of how respected his profession is... there is very little left for your profession to compromise...

Your profession was instrumental in the holocaust, forced sterilization of those with psychiatric labels, continues to this day to support forced drugging and forced electroshock, continues to perform psychosurgery, continues to perform late term abortions,

I fear doctors as much as I fear getting sick.

But the government is the most fearful thing of them all.

I long for a day when I can buy all drugs freely, and contract with an expert for advice, and hire a surgeon if need be too.

Anonymous said...

Maybe the person just states they are donating organs.

Michael Kirsch, M.D. said...

Here's the latest on this issue.

John Lofton, Recovering Republican said...

FYI...might be interested in the radio show I did recently re: Dr.-Assisted Self-Murder in Montana;comments welcome.

John Lofton, Editor,

Communications Director, Institute on the Constitution

Host, “TheAmericanView” radio show

Recovering Republican

Michael Kirsch, M.D. said...

John, thanks for the link. You run an engaging radio show!

buy viagra said...

Well I think that if a person is only alive because of a machine or is in extremely amount of pain in bed maybe dead is not a bad option.

Add this