Assisted suicide is death knell to doctor ethics

0 Comments | Insight on the News, Feb 10, 1997 | by Nelson Lund

The Supreme Court recently heard oral arguments in two cases that could generate a constitutional right to physician-assisted suicide. Several justices seemed skeptical about the wisdom of creating such a right, and we all should hope that the court will resist the temptation to authorize doctors to kill their patients. Otherwise, we soon will witness a new and barbaric culture of euthanasia and bureaucratized death.

Why shouldn't patients be free to have their doctors help in using lethal drugs to end their suffering? The answer lies in the special nature of the doctor-patient relationship. Anyone who has been seriously ill knows something about the tremendous power that physicians exert over their patients. Physicians have a virtual monopoly over the information patients use to make decisions about their own treatment, and they are experts at presenting the options in a way that almost guarantees which choice the patient will make. This is not necessarily inappropriate. We hire doctors, after all, because they know more than we do about treating our illnesses. But it does require us to assume that doctors have our interests at heart when they make their recommendations.

For thousands of years, the medical profession has recognized that patients will not place the necessary trust in doctors who behave like ordinary tradesmen. With the Hippocratic oath, every doctor promises neither to give a deadly drug to anybody if asked for it nor to make a suggestion to this effect. The oath is an offer to make a bargain with patients: "In return for your placing more trust in us than you do in ordinary tradesmen, we promise to behave in a less self-interested manner than other tradesmen." This is a good bargain for both parties: Physicians get more business because sick people will be less inclined to practice home remedies, and patients get better medical care when they are treated by experts.

The bargain implicit in the Hippocratic oath, however, is not self-enforcing. Traditionally, state legislatures have promoted the medical profession's monopoly by restricting unauthorized medical practice and by giving physicians exclusive control over powerful drugs. In return, state laws have required physicians to abide by key tenets of the Hippocratic oath, including the ban on assisted suicide and euthanasia.

If the federal courts strike down the laws against assisted suicide, they will unleash legions of Jack Kevorkians, and worse. First some doctors will be manipulating seriously ill patients into agreeing to assisted suicide, and others will begin practicing euthanasia when they are confident the patient would agree to commit suicide if he or she could. Second, patients rightly will become much more distrustful of their doctors' advice, and this distrust will make it much more difficult to give appropriate care

If these predictions seem alarmist, consider the recent Dutch experience. After the taboo against assisted suicide was relaxed in the Netherlands 20 years ago, physicians quickly went straight down the slippery slope. A privately financed survey in 1989 showed that 40 percent of Dutch physicians had performed euthanasia without patients' consent. Other surveys have produced similar results. And what reasons did physicians give for these homicides? intractable pain was mentioned in less than a third of the cases. More commonly physicians mentioned "low quality of life, the relatives, inability to cope and no prospect for improvement."

Intractable pain, especially among the terminally ill, is a genuine problem, but only because the American medical profession has been scandalously negligent in dealing with it. Nor has an obsessive fixation with the dangers of drug addiction helped matters. But the way to deal with this problem is by encouraging the profession to take pain relief much more seriously than it now does. Killing the patient is cheaper, and it may be appealing to overburdened relatives and profit-seeking managed-care companies, but it is not the practice of medicine.

Replacing the clear ban against doctors Em their patients with detailed government regulations inevitably would increase intrusiveness into the doctor-patient relationship. It would not prevent abuses by doctors and their bureaucratic overseers, since it is relatively easy for doctors to kill their patients without getting caught. That is exactly why the clear professional ethic forbidding such conduct should be reinforced rather than undermined.