Should doctors be legally permitted to help kill their patients?

It’s a contentious and heartbreaking question that 18 state legislatures and the District of Columbia will ask later this year, as they consider passing physician-assisted suicide (PAS) legislation similar to that already passed in Oregon.

The case against PAS as bad public policy has been ably advanced by Ryan T. Anderson in his recent report, which analyses how PAS endangers the weak, corrupts medicine, compromises the family, and violates human dignity and equality.

From a patient perspective, beautiful testimonies from Kara Tippets and Maggie Karner on their commitment to living and dying with grace challenge the narrative put forth by the likes of Brittany Maynard, who recently ended her own life in Oregon, where PAS is legal.

But what about the doctors? Regardless of any legal decision surrounding PAS, what would it mean for the medical profession to abandon one of the central components of the Hippocratic Oath sworn by physicans for the past 2500 years: “Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so”?

Dr. Farr A. Curlin, M.D., Josiah C. Trent Professor of Medical Humanities at Duke University School of Medicine, addressed this question with Ryan Anderson in a recent Washington, DC panel event on “Living Life to its Fullest.”

Pointing to this section of the Hippocratic Oath, Dr. Curlin identified three reasons doctors have always committed not to help kill their patients, and why the future of medicine depends on preserving this commitment:

1) “It’s an essential guard against the temptation to get rid of patient suffering by getting rid of the patient who suffers.”

Watching people suffer is hard. Really hard. It’s not just the about the pain, but the disability, dependency, sadness and loss. It isn’t just hard on the families, but on the doctors and nurses as well. And so in some respect, it’s natural to want to get rid of that suffering by any means possible — even if it means ending the life of the sufferer. “By committing not to help kill their patients from the outset,” Dr. Curlin explained, “doctors are able to hedge against this natural temptation.”

2) “It gives doctors the freedom they need to treat the symptoms that afflict their patients.”

Dr. Curlin, who administers palliative care, detailed how his commitment to his patients that he will not actively seek their death allows him to focus all his efforts on aggressively and effectively alleviating their symptoms.

For example, a patient with advanced respiratory failure and constant shortness of breath often requires morphine to alleviate the extreme pain and discomfort. His advance commitment allows him to prescribe morphine to alleviate the pain in good faith and good medicine, while acknowledging that the side-effects of such treatment might hasten the death process.

3) “It protects the trust between doctors and patients.”

A patient’s trust rests on the belief that the doctor always has the patient’s best interest in mind. This is particularly important for patients from marginalized classes — the poor, disabled and elderly — who in Dr. Curlin’s experience have expressed little interest in PAS, yet are the most susceptible to its abuses.

In fact, some patients have even foregone palliative care out of fear that their doctor might be trying to intentionally kill them, a misunderstanding that reveals how the corrosive nature of PAS is already eroding the trust between doctors and their patients.

 What Should We Do?

How then should we — not just doctors, but all of us — approach the pending death of a loved one? We would to well to take our cues from the Little Sisters of the Poor, a religious order entirely devoted to accompanying the elderly.

Sister Constance Veit, a member of the Little Sisters of the Poor who also joined the panel, spoke of the process in their homes when a resident enters the dying stage.

Then, the sisters begin a 24/7 watch and vigil, often alongside family members. During these “spiritually and humanly intense” times, the Little Sisters provide the dying resident with all the best the home has to offer — from the finest bed linens and fresh flowers to peaceful music and careful attention to every detail.

Residents of their homes, Sister Veit explained, do not look upon “with fear or dread, but with hope filled expectation” — the hope of being reunited with those who have gone before them.

As much as the future of medicine depends on continued commitment from doctors towards the life and well-being of their patients, so too does the future of our society depend on our commitment — as sons and daughters, as husbands and wives, as friends and neighbors — to follow in the footsteps of the Little Sisters of the Poor and accompany our loved ones toward death with hope, peace and purpose.