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Assisted Suicide Violates the Physicians' Oath
A patient falls ill in one of Voltaire's philosophical tales and the
author observes: "Despite the attention and ministrations of the leading
medical doctors of Europe, he survived."
This is the sardonic wit we should apply to a debate today: Should a
physician who has sworn to do no harm be allowed, legally, to help a
patient kill himself with prescribed lethal doses of barbiturates? This is
not about Dr. Kevorkian, the infamous Dr. Death, now serving a prison term
for murder. The courts finally would not accept his oxymoronic euphemism
of "assisted suicide." (You can wound the language as well as the person.)
Physicians in Oregon, however, can become doctors of death under state
law, having received the imprimatur of the people in a statewide
referendum. But such doctors still need the help of the feds. Federal law
trumps state law in the administration of drugs under the Controlled
Substances Act, which governs powerful prescription drugs like morphine
that alleviate pain, but which can also kill.
Loophole-lovers, aware of the problem, sought a federal accomplice for
"assisted suicide" in Oregon and found one in Janet Reno, the attorney
general in the Clinton administration. She gave them a pass, promising not
to prosecute. John Ashcroft, who replaced her, has reversed that, and a
federal judge has stayed his decision, at least temporarily.
There are two issues here. One is philosophical in its consideration of
life and death issues. The other is legalistic and constitutional, whether
a state's rights in this matter should supersede federal authority. Like
most of our most complex decisions, liberal and conservative attitudes
conflict and overlap. Black and white reasoning is simplistic and
inadequate. There are shades of gray in both arguments. (There's no
Certain professors of medicine argue that when a patient is dying in great
pain, and chooses to end both pain and life, a doctor in good conscience
should be able to relieve the agony and abide by the patient's wishes. But
even if the doctor doesn't intend for a patient to die, he can
accidentally kill if he administers dosages high enough to alleviate
Hence, John Ashcroft's policy could make doctors fear prosecution,
curtailing their ability even to prescribe the necessary dosages for pain
medication. Consider what you would want for your mother or father, your
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child or your husband or wife, or even yourself, when pain drains human
dignity in those last hours of life.
On the other hand, no one should be licensed to kill. This is the argument
of a coalition of groups that have contended vigorously against such laws
in state legislatures, and includes many doctors and nurses as well as
hospice workers, disability rights activists, pro-life supporters and
various defenders of the poor. They argue that the sanctity of life is
paramount and worry about the potential for abuse of patients who are most
vulnerable to pressures of family, the cost of care, psychological guilt,
and the work of "do gooders" who consider themselves to be saviors or
saints in reducing suffering.
The strongest argument against the Ashcroft decision, it seems to me, is
that doctors would be inhibited from prescribing necessary doses of
morphine to eliminate pain because they fear prosecution. The attorney
general has specifically said - and assured the Oregon Medical Association
- that excessive scrutiny of doctors' prescriptions for morphine use would
not be initiated by the federal government.
In states that have outlawed assisted suicide, such as Michigan, Louisiana
and Rhode Island, the evidence shows that doctors have actually increased
their use of morphine in alleviating pain.
There's a persuasive argument for states' rights, since Oregon voters
twice affirmed by wide margins their decision to approve of "assisted
suicide." But the attorney general based his decision on an 8-0 U.S.
Supreme Court decision (United States vs. Oakland Cannabis Buyers'
Cooperative) that California could legalize medical marijuana, but that
such legalization could not prevent the federal government from enforcing
federal law that disallows the use of marijuana. The court convincingly
backs up John Ashcroft's decision.
The specter of death hovers close over us as we mourn those who died at
the World Trade Center and the Pentagon, and now the hundreds of
Dominicans who died in the crash of another airliner in New York City.
Fear of death assumes a new urgency in the age of terrorism. The values
that sanctify life seem all the more precious.
Ultimately, "assisted suicide" is not so much the slippery slope as the
complete contradiction of the ancient physicians' oath to preserve life -
and to insure that death be not proud.