Opinions: Viewpoints

Should physician-assisted suicide be legalized?
Michael H. White, J.D.

Physician-assisted suicide should be a lawful medical procedure for competent, terminally ill adults, because it is a compassionate response to relieve the suffering of dying patients. Controversy about this stems from fear that vulnerable populations may be coerced into premature death, on the one hand, and from fear that dying and helpless patients may be either abandoned or subjected to unwanted and unnecessary medical treatments, on the other hand.

In a workable system, the option of physician-assisted suicide would arise only after all treatment options are exhausted, the best of hospice and palliative care has failed to relieve unbearable suffering, and if a mentally competent patient continues to request assistance in dying. Then, with outside opinion concurring, a physician would be permitted to prescribe medication that the patient could use to hasten death at a time of the patient's choice.

These safeguards would preclude abuse of the handicapped, the incompetent, minorities, the elderly, or other vulnerable populations. Patient and family anxiety about future suffering and death would be reduced; care and comfort at the end of life would be improved. The individual would be able to make this most private and basic of decisions personally, without unwarranted and unnecessary intrusion by the state or religious opposition.

A more rational law than the current ban on assisting a terminally ill patient who requests help in dying will extend the length of lives of those who are dying by preventing the suicide of those who will benefit from relieved suffering.

Tracy E. Miller, J.D.

The two most common reasons that lead people to think about or to commit suicide, whether they are terminally ill or not, are untreated pain or depression. Given treatment for pain and depression, most patients, even those with AIDS or cancer, choose to live longer, not to kill themselves.

Unfortunately, all too often, physicians are not trained to offer adequate treatment for pain or depression. As a result, many patients feel that they have only two possible options: to commit suicide or to suffer. But good medical care can give patients relief from pain and control over their medical destiny without creating the severe risks posed by assisted suicide.

Legalizing assisted suicide would be profoundly dangerous. The risks would extend to all who are ill, but would be greatest for patients who lack access to high quality medical care. The gravest danger is not that physicians or family members will be abusive. Other risks will be subtle and more common: elderly patients who worry about being a burden; physicians who are not ill-intentioned but hurried or insensitive; patients who feel that they have no other options. What will it mean to patients if physicians recommend suicide instead of treatment or care? A request for suicide is often a plea for help. How many doctors know their patients well enough to hear that plea?

As a society, we must commit ourselves to caring better for patients at life's end. Authorizing doctors to assist suicide is a simple, but far more dangerous, solution.

Michael H. White practices law in Los Angeles, California. He is past-president and member of the board of Death With Dignity Education Center, past-president of Americans for Death With Dignity, co-author of Proposition 161 (The California Initiative), and past-co-chair of the Los Angeles County Bar Association Bioethics Committee. Tracy E. Miller is a health-care attorney and has written widely about bioethical issues. From 1985 to 1995, she was the executive director of the New York State Task Force on Life and the Law, which has proposed four laws to secure the right to forgo life-sustaining treatment.
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