Voluntary Euthanasia and the Art of Practicing Medicine

Elizabeth

By Elizabeth
Barry University School of Podiatric Medicine
Class of 2019

“I will remember that there is an art to medicine, as well as a science”. This excerpt from the Hippocratic Oath reminds physicians of our duty to share warmth, empathy, and compassion when treating patients. It is not only our intellectual knowledge that is a factor in care, but also our societal and ethical obligations that should govern the actions we take as doctors. It is the ethical and moral obligations felt by physicians that creates the debate regarding voluntary euthanasia. Specifically, in the United States, this is termed “Physician-Assisted Suicide”.

Physician-assisted suicide is legal in 18 countries and in 5 states of the United States (2). There are several qualifications within the legalized states that mandate when a patient is able to receive physician-assisted suicide. First, the patient must be at least 18 years old and reside in one of the 5 states. The patient must also be mentally competent to make their own decisions about their healthcare and life. The patient must be diagnosed with a terminal illness that will lead to death within at least 6 months, based on standard medical judgment. The medication must also be self-administered. Finally, there must be two physicians that agree upon this decision, justifying that all criteria are met (2).

There are several strong arguments for the support of this practice. One of the main endorsing arguments is that physicians wish to end the suffering of terminally ill patients. According to patient surveys, physician-assisted suicide helps the patients retain autonomy, dignity, and relieves the mental burden of not being able to live their desired lifestyle or enjoy their lives in this state (2,3). Surprisingly, pain is usually not a significant factor in a patient’s decision.

It is argued by those opposed to this practice that “susceptible” populations are more likely to utilize this option because they feel less accepted by society because of qualities, characteristics, diseases, or disabilities. However, physician-assisted suicide has not been shown to jeopardize specific patients or cause any population to feel vulnerable when making this decision. Legislative safeguards to protect patients in these populations can be implemented and, research conducted in the Netherlands discounted the argument (1). They concluded that vulnerable populations, in general, were not at risk for increased use of physician-assisted suicide, and the only population at risk for increased use were AIDS patients with terminal complications (1). This negates the opposing argument that disabled and vulnerable populations are more likely to use or feel pressured to undergo this procedure.

Ultimately, each physician must weigh both aspects of the debate and decide for themselves whether this is a procedure they want to support or oppose. Both arguments have valid concerns, and the art of medicine is as unique to physicians as a thumbprint. Whether a physician supports or opposes the practice, it is just one brushstroke in our medical practice as we, as physicians, try to support and heal our patients with our knowledge, experience, kindheartedness, and understanding.

References:

1) Battin, M, Van der Heide, A, Ganzini, L, van der Wal G, Onwuteaka-Phillipsen B.D.  “Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups”. Journal of Medical Ethics. October 2007. 33 (10): 591–7.

2) OREGON DEATH WITH DIGNITY ACT: 2015 DATA SUMMARY. Oregon.gov. Oregon Health Authority. Retrieved 4 October 2016.

3) Snyder Sulmasy L, Mueller PS. Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Ann Intern Med. 2017;167:576–578. doi: 10.7326/M17-0938