The debate over physician–assisted suicide is very important to physicians and patients. Both groups favor easing the dying process, providing adequate pain control and avoiding unwanted over–treatment and protracted suffering. Patients and physicians may find it difficult at times to distinguish between the need for assistance in the dying process and the practice of assisting suicide.
Physician–assisted suicide occurs when a physician provides a medical means for death, usually a prescription for a lethal amount of medication that the patient takes on his or her own. In euthanasia, the physician directly and intentionally administers a substance to cause death. Physicians and patients should distinguish a decision by patients or their authorized surrogate to refuse life–sustaining treatment or an inadvertent death that occurs during an attempt to relieve suffering from physician–assisted suicide and euthanasia. Laws concerning or moral objections to physician–assisted suicide and euthanasia should not deter physicians from honoring a decision to withhold or withdraw medical interventions in appropriate situations. Fears that unwanted life–sustaining treatment will be imposed continue to motivate some patients to request assisted suicide or euthanasia.
In the clinical setting, all of these acts must be framed within the larger context of good end–of–life care. Many patients who request assisted suicide are depressed, have uncontrolled pain or have potentially reversible suffering or fears. In the setting of providing comfort to a dying person, most physicians and patients should be able to address these issues. For example, with regard to pain control, the physician may appropriately increase medication to relieve pain, even if this action inadvertently shortens life (the “Double effect”).
Physician–assisted suicide may be legalized in some states, although no consensus currently exists among patients or physicians or within the College. Many fear that physicians are inadequately trained to arrive at such a conclusion with patients. Concerns focus in particular on vulnerable populations–poor persons, persons with costly chronic diseases, demented persons, disabled persons and very young children. Physicians and patients must continue to search together for answers to these problems without violating the physician’s personal and professional values and without abandoning the patient to struggle alone. For now, the policy debate continues to evolve rapidly and physicians should urgently strive to greatly improve the quality of end of life care.
