Map of life expectancy at birth from Global Education Project.

Friday, November 18, 2005

No, I don't have a definite opinion about everything

Long time readers may remember that I'm somewhat ambivalent about legitimizing physician-assisted suicide, in part because of an aspect of the issue that is not much considered in the public discussion, specifically the burden it places on physicians. It is easy for me to decide that terminally ill people should be able to choose the time and manner of their own deaths if they wish to -- with the very important proviso that there should be equal access to excellent palliative care, including nursing care, pharmaceutical relief from suffering, social support, and counseling; and very strong assurance that suicide is freely chosen and that there truly is no better option. Limited experience in Oregon and Europe, fortunately, has seemed to show that the people who avail themselves of the option are not poor, disadvantaged, or socially isolated. Rather, they seem to be relatively empowered people for whom everything is being done that can be done.

Of course, people can find ways to take their own lives without the help of a physician. But doctors have technical expertise to make sure they succeed painlessly, and the prescription pad to supply the means. However, many doctors are averse to the idea, fear the responsibility of having to decide on individual cases, or have moral objections to it. They feel uncomfortable about the prospect of a legal and cultural regime in which patients are likely to come to them with requests for assisted suicide, and so physcians are quite divided on this issue.

A rather disturbing case from Switzerland, where assisted suicide is legal, calls attention to these concerns. A German woman approached the organization Dignitas, which assisted terminally ill people in taking their own lives, with a medical report showing she had terminal cirhhosis of the liver. A Dignitas physician gave her a lethal prescription, which she took. It then turned out that the medical report was a fake, which she had obtained from another physician under a pretext, and that she had been depressed but not terminally ill. Upon learning these facts, the physician who had given her the prescription took his own life.

While this is a highly unusual event -- one out of hundreds of suicides that Dignitas has assisted -- it certainly should give us pause. It might be argued that the physician who gave her the false medical report was most to blame, but that is beside the point. I still feel that we should proceed very cautiously with proposals in this area, and that at the least, very carefully designed safeguards are needed. The Oregon experience has appeared to be alright so far, but it is still very limited. When I posted about this issue before I asked for comments, but didn't get any. I understand -- it's a tough one, and as I say, I'm not sure how I feel about it myself. But I'd still like to know what others think. (In polls, most people do support it, but that's not enough reason to go ahead, in my view.)

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