A doctor’s view on assisted suicide
By John R. Peteet | November 11, 2015, 6:13 EST
Should physician-assisted suicide be legal in Massachusetts?
Last month, the Massachusetts Joint Committee on Public Health heard testimony on H1991, which if passed would add our state to the growing list of those that permit physician-assisted suicide.
Advocates of assisted suicide contend that patients deserve the right to die with the means provided by their physicians and that there is little evidence of abuse.
Opponents express concerns that there will be societal pressure for disabled individuals to “exit gracefully” and that, over time, our country will follow Belgium and the Netherlands in extending the logic of assisted suicide to include euthanasia of individuals suffering from mental illness.
Although physician opinion has not been unanimous, the Massachusetts Medical Society has opposed physician-assisted suicide as fundamentally incompatible with the physician’s role as healer, as it did in 2012 when a ballot initiative legalizing assisted suicide was narrowly defeated by the state’s voters.
Dying and the loss of control it represents are frightening prospects. The impressive growth of palliative care and the sensitivity of well known physicians like Atul Gawande in “Being Mortal” have not allayed the fears of many that an increasingly scientific, impersonal medical system will fail and even abandon them in the end.
As a psychiatrist in a cancer center for more than 35 years, I have seen hundreds of patients who, at times, wanted to die. I recall a CEO who was devastated by learning that his lung cancer was no longer responding to treatment, especially so since he had recently lost his wife to cancer.
At first, unused to failing to achieve his goals, this CEO lacked any idea what he could do next. But with the help of his treatment team, he found ways he could take charge of his dying – arranging appointments with his friends and colleagues to tell them what he appreciated about them and to say goodbye, putting his affairs in order, and providing for his daughter’s needs.
Studies show that most individuals who request physician-assisted suicide do so not to escape intolerable physical symptoms, but to re-establish a sense of dignity and control. Their plight underscores the importance of the physician’s role in going beyond the relief of physical suffering to helping patients take charge of the time they have left.
Our responsibilities have their roots in the ancient but increasingly relevant traditions of beneficence, virtue, and patient autonomy, understood as mastery rather than freedom from influence. Physicians’ inability to meet all of their patients’ needs does not detract from the importance of the psychological, personal, and pastoral aspects of the doctor-patient relationship.
As doctors, we can help our patients establish realistic hopes by expanding their possibilities. We can help them to bear suffering, by assuring them that their pain is understood and by remaining with them. And we can help them to achieve perspective, by reviewing their lives and their priorities.
If Massachusetts legalizes physician-assisted suicide, we will be sending a message to patients that their lives may no longer be worth living. This will make them less likely to trust that their doctors will be there for them when they need them most. And it will make us less able, as a society, to offer hope that suffering has dignity and can be made more bearable.
John R. Peteet, M.D. is an Associate Professor of Psychiatry at Harvard Medical School.