Physician Assisted Suicide

Posted by on Mar 29, 2009 in Letters to the Editor

Dear Editor, Ottawa Citizen.
Re: Physician Assisted Suicide

Dear Sir:

Physician Assisted Suicide (PAS) for those with incurable illness sounds like a good idea.  With a smile on their face and hardly a tear among those who came to watch old dad depart after his courageous battle with cancer, there were self-congratulations all-round.  “Well I am so glad that’s over.  I could not have taken watching him suffer any more.  Besides, I couldn’t afford to spend any more time at his bedside.  And after all, he never was good to me.  I sure hope he recognized how much I did for him in the will”

For many this seems so logical, there is hardly any real consideration of one of life’s most important events.  Maybe these thoughts from a physician who has been in practice for almost ½ a century are worth considering.

  1. After 50 yrs, almost everyone has an incurable illness, (hidden cancer, arteriosclerosis, brain cell loss, depression) and most will die of an incurable illness, so who is this for?  Isn’t life itself an incurable illness?
  2. In times of economic distress, there is pressure to save health care dollars at the expense of those considered to have poor quality of life by the young and healthy taxpayers.  A young couple with new baby and shaky income, need the estate money badly and the elders know they are trying to keep their money earnings well hidden.
  3. Prior to Hippocrates, physicians had a dual mandate, to cure if they could or to hasten death with a poison, if they couldn’t.  As Margaret Meade wrote, we now have a priceless heritage with Doctors commit to only treat, but this could easily revert to the old system of doctors deciding who they should treat and who kill, especially if the suicide assisting doctors were well paid.
  4. Being able to trust doctors will always treat except in very unusual circumstances, has made it possible to believe doctors will try their best to help you keep living better, not hasten your dying.  It is the fail-safe position everyone assumes of his or her own doctor.  It saves huge amounts to money because distrust provokes more diagnostic tests, second opinions, prolonged explanations etc.
  5. Almost every human is ambivalent about living.  On a good day, “I hope I go on living to a ripe old age and die quietly in my sleep”.  On a bad day of disappointments and fighting, “I sure would like to get off this stupid globe.  I would give anyone $ 1000 to quietly send me on my way, right now”.  For many it is an hourly fluctuation depending on pain, frustration and hope.  So how can anyone know the real intent of a person with “incurable illness”
  6.  Their thinking clouded with medications, toxic products of cancer and pain, who is able to determine whether any consent or desire is freely given with full awareness of the implications.
  7. Dying is one of life’s most important events.  There are at least 12 vitally important tasks to accomplish before the dismissal of one’s spirit.  Probably the most important and difficult activities are in reconciling with all those the dying person has hurt and all those who have hurt him/her. Depending on their availability of family, friends and enemies, this could take many weeks.  In this respect there are advantages to prolonged dying.
  8. In this tight bundle of life, what we do to others is done to us.  When we kill the helpless we lose our sensitivity to helpless cries of the suffering, wounded and frightened.  As physicians lose their sensitivity, they are less able to empathize with the suffering of patients and diagnose their ailments.
  9. When we contribute to the death of a helpless person, we progressively interfere with our Species Specific Restraint to Aggression.  Those who lose this preconscious restraint have difficulty restraining their anger and lethal disgust of old people and handicapped babies.
  10. All those who contribute to the death, passively or actively, of a family member, close friend or revered colleague, are more inclined to feel guilt.  A guilt-encumbered grief is more difficult to resolve, more often becomes pathological grief and eventually a difficult to treat depression.

When all these factors, (and there are others) are considered, it seems clear to this senior psychiatrist that Physician Assisted Suicide will do more harm than good.  Maybe our elders were wise in limiting the opportunity of the healthy to prey on the helpless.  Maybe what is really at stake is human survival made possible by encouraging compassion instead of rhetoric.

                                 Philip G. Ney  MD  FRCP(C)