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.