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Physicians Should “Assist in Suicide” When it is Appropriate

Published online by Cambridge University Press:  01 January 2021

Extract

In my career as a primary care physician and as a palliative care consultant, I have assisted many patients to die with their full consent. None of them wanted to die, and all would have chosen other paths had their disease not been so severe and irreversible. To a person, none of these patients thought of themselves as “suicidal,” and they would have found that label preposterous and demeaning. In fact, the kind of personal disintegration that the label implies is just what is trying to be prevented by those choosing this possibility. So on behalf of patients who have chosen this option, I reject the title of this debate as it unnecessarily tars the discussion with the suggestion of mental illness. In my primary care practice, I have also met many patients who were “suicidal” in the mental health sense of the word, and rest assured I have assisted none of them to die. In fact, I have at times had them involuntarily hospitalized to prevent them from carrying out their wishes.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2012

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References

Cassell, E. J., “The Nature of Suffering and the Goals of Medicine,” New England Journal of Medicine (1982): 639645.CrossRefGoogle Scholar
Quill, T. E. Lo, B. Brock, D. W., Doctor “Palliative Options of Last Resort: A Comparison of Voluntarily Stopping Eating and Drinking, Terminal Sedation, Physician-Assisted Suicide, and Voluntary Active Euthanasia,” JAMA 278 (1997): 10992104.CrossRefGoogle Scholar
Quill, T. E., “I Want to Die. Will You Help Me?” JAMA 270 (1993): 870873.CrossRefGoogle Scholar
Morrison, R. S. Meier, D. E., “Clinical Practice. Palliative Care,” New England Journal of Medicine 50, no. 25 (2004): 25822590.CrossRefGoogle Scholar
Gazelle, G., “Understanding Hospice - An Underutilized Option for Life's Final Chapter,” New England Journal of Medicine 357 (2007): 321324.CrossRefGoogle Scholar
See supra note 1.Google Scholar
Quill, T. E. et al., “The Debate over Physician-Assisted Suicide: Empirical Data and Convergent Views,” Annals of Internal Medicine 128 (1998): 552558.CrossRefGoogle Scholar
See supra note 3.Google Scholar
Quill, T. E. Cassel, C. K., “Nonabandonment: A Central Obligation for Physicians,” Annals of Internal Medicine 122 (1995): 368374.CrossRefGoogle Scholar
Tolle, S. W. et al., “Characteristics and Proportion of Dying Oregonians Who Personally Consider Physician-Assisted Suicide,” Journal of Clinical Ethics 15 (2004): 111118.Google Scholar
See Quill, , supra note 3.Google Scholar
See Quill, et al., supra note 2; Quill, T. E. Coombs-Lee, B. Nunn, S., “Palliative Options of Last Resort: Finding the Least Harmful Alternative,” Annals of Internal Medicine 132 (2000); Quill, T. E. Byock, I., “Responding to Intractable Terminal Suffering: The Role of Terminal Sedation and Voluntary Refusal of Food and Fluids. ACP-ASIM End-of-Life Care Consensus Panel,” Annals of Internal Medicine 132 (2000): 408414.CrossRefGoogle Scholar
Quill, T. E. Dresser, R. Brock, D. W., “Rule of Double Effect: A Critique of Its Role in End-of-Life Decision Making,” New England Journal of Medicine 337 (1997): 17681771.CrossRefGoogle Scholar
See supra note 12.Google Scholar
Jansen, L. A. Sulmasy, D. P., “Sedation, Alimentation, Hydration, and Equivocation: Careful Conversation about Care at the End of Life,” Annals of Internal Medicine 136 (2002): 845849.CrossRefGoogle Scholar
Quill, T. E. et al., “Last-Resort Options for Palliative Sedation,” Annals of Internal Medicine 151, no. 6 (2009): 421424.CrossRefGoogle Scholar
Vacco v. Quill. 1997, Supreme Court; Washington v. Glucksberg. 1997, 117 S.Ct 2258.Google Scholar
See Jansen, Sulmasy, , supra note 16; Lo, B. Rubenfeld, G. D., “Palliative Sedation in Dying Patients,” JAMA 294 (2005): 18101816.Google Scholar
Quill, T. E., Death and Dignity: Making Choices and Taking Charge (New York: W.W. Norton and Co., 1993): 1255; Quill, T. E., “Death and Dignity: A Case of Individualized Decision Making,” New England Journal of Medicine 324 (1991): 691–694.Google Scholar
Meier, D. E. et al., “A National Survey of Physician-Assisted Suicide and Euthanasia in the United States,” New England Journal of Medicine 338 (1998): 11931201.CrossRefGoogle Scholar
Steinbrook, R., “Physician-Assisted Death - From Oregon to Washington State,” New England Journal of Medicine 359 (2008): 25132515.CrossRefGoogle Scholar
Baxter v State of Montana, 354 Mont. 234. 2008 MT 449.Google Scholar
Ventafridda, V. et al., “Symptom Prevalence and Control during Cancer Patients' Last Days of Life,” Journal of Palliative Care 6 (1990): 711; Coyle, N. et al., “Character of Terminal Illness in the Advanced Cancer Patient: Pain and Other Symptoms during the Last Four Weeks of Life,” Journal of Pain Symptom Management 5 (1990): 83–93.CrossRefGoogle Scholar
Schroepfer, T. A. Hyunjin, N. Kavanaugh, M., “The Myriad Strategies for Seeking Control in the Dying Process,” Gerentologist 49 (2009): 755766.CrossRefGoogle Scholar
Pearlman, R. A. Starks, H., “Why Do People Seek Physician-Assisted Death?” in Quill, T. E. Battin, M., eds., Physician-Assisted Dying: The Case for Palliative Care and Patient Choice (Baltimore: Johns Hopkins University Press, 2004): 91101; Back, A. L. et al., “Physician-Assisted Suicide and Euthanasia in Washington State: Patient Requests and Physician Responses,” JAMA 275 (1996): 919–925.Google Scholar
Lee, M. A. Tolle, S. W., “Oregon's Assisted Suicide Vote: The Silver Lining,” Annals of Internal Medicine 124 (1996): 267269.CrossRefGoogle Scholar
Hickman, S. E. et al., “Use of the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program in the Hospice Setting,” Journal of Palliative Medicine 12, no. 2 (2009): 133141; Meier, D. E., “POLST Offers Next Stage in Honoring Patient Preferences,” Journal of Palliative Medicine 12, no. 4 (2009): 291–5.CrossRefGoogle Scholar
See supra note 27.Google Scholar
See Jansen, Sulmasy, , supra note 16; Quill, T. E., “The Ambiguity of Clinical Intentions,” New England Journal of Medicine 329 (1993): 10391040.Google Scholar
See supra note 3.Google Scholar
Battin, M. P., The Least Worst Death Essays in Bioethics on the End of Life (New York: Oxford University Press, 2004).Google Scholar
See Quill, Dresser, Brock, , supra note 14.Google Scholar
Quill, T. E., “Principle of Double Effect and End-of-Life Pain Management: Additional Myths and a Limited Role,” Journal of Palliative Medicine 2 (1998): 333336.CrossRefGoogle Scholar
See supra note 30.Google Scholar
Rachels, J., “Active and Passive Euthanasia,” New England Journal of Medicine 292 (1975): 268277.CrossRefGoogle Scholar
See Quill, Cassel, , supra note 9.Google Scholar
See Gazelle, , supra note 5.Google Scholar
See Meier, et al., supra note 21.Google Scholar
Quill, T. E. et al., “The Big Chill: Inserting the DEA into End-of-Life Care,” New England Journal of Medicine 354, no. 1 (2006): 13.CrossRefGoogle Scholar
See Morrison, Meier, , supra note 4.Google Scholar
See Quill, Cassel, , supra note 9.Google Scholar