At its recent House of Delegates meeting, the American Medical Association voted to continue to study the principled stance against physician-assisted suicide that has been part of its Code of Ethics since 1994: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”
Advocates of assisted suicide have tried for two years to change this stance to one of “neutrality.” With this vote for delay and further review they will surely continue to do so. But as the AMA’s Council on Ethical and Judicial Affairs (CEJA) rightly said after an intensive study of the issue, such “neutrality” can be read as “little more than acquiescence with the contested practice.”
It has been read exactly that way wherever a state medical society has decided to go “neutral” on a proposal to legalize the practice. It sends the signal that there is no serious problem with doctors prescribing lethal drugs so their patients can kill themselves.
At a personal level, neutrality means indifference. As a patient, I’m not sure which statement from my doctor would be more upsetting: “In case you ever ask, I’m willing to help you kill yourself,” or “I simply don’t care whether you kill yourself or not.”
And as the AMA council observed, this is not an issue for indifference. Every thoughtful physician must care about the fundamental meaning of his or her profession. Even if all agree on “the sacredness of ministering to a terminally ill or dying patient,” there are “irreducible differences in moral perspectives” as to what that means (citation: CEJA report). Does it mean keeping company with the patient, addressing medical and psychological problems as they arise, and alleviating suffering? Or does it mean endorsing the patient’s hopeless feelings and enabling suicide? Should I commit myself to ending the pain, or ending the patient?
The healing arts will look radically different depending on our answer to that question. As anthropologist Margaret Mead once said, in the ancient pagan world most doctors were neutral on how to use their skills. You went to the doctor for an antidote to poison, or for poison itself.
Hippocrates charted a different path: The physician would “do no harm,” instead committing these skills only to healing and relief of suffering. That vision was taken up by Western civilization as a model consistent with Christian insights into the innate dignity of every individual, including the weakest and most vulnerable. This has made medicine a profession: Not a mere technical specialty for dispensing products, but an art that “professes” a commitment to life and health. Modern medicine turns aside from that vision at its peril.
The ethics council has also recommended that the AMA keep calling this practice “physician-assisted suicide,” rather than using vague euphemisms like “aid in dying” or “death with dignity.” The latter phrases, said the council, could mean anything from active euthanasia (direct killing by the doctor) to responsible hospice and palliative care.
As usual, social engineering is preceded by verbal engineering. But to have a serious debate we need at least to be clear what we are talking about.
This year, in my home state of New York, our highest court also concluded that what proponents call “aid in dying” is exactly what the laws in New York and most other states have long called assisting a suicide. Giving someone a drug overdose for the purpose of killing himself or herself is not magically transformed into something else because the culprit wears a white coat, or the victim has an illness.
The law does not treat attempted suicide as a crime, realizing that people with depression and despair need support and care rather than punishment. But it promotes suicide prevention, and it allows others to use force if necessary to stop a suicide attempt. It forbids assisting a suicide because that involves deliberately helping to cause someone else’s death. And unlike the victim, the person who “assists” is not generally acting from mental duress or disturbance.
Recent tragic suicides by celebrities have drawn renewed attention to what The New York Times calls our “public health crisis” of suicide.
The U.S. Centers for Disease Control report that suicide rates have risen almost 30% since 1999, which happens to be the year when Oregon issued its first report on legally authorized physician-assisted suicides.
According to the CDC, suicidal feelings are often driven by depression and other mental illness — and a diagnosis of terminal illness is simply one of the “stressors” that may lead someone to act on such feelings.
So it is appalling that in Oregon and Washington, the first states to legalize assisted suicide, 96% of the patients given lethal drugs do not even receive a psychological evaluation. And from 2014 to 2016, the overall suicide rate in Oregon (not counting what it calls “death with dignity” cases) was 37% higher than the national average.
The highest rate of all, almost twice the national average, was in Montana, where a state supreme court ruling has left the state with no clear law forbidding physician assistance.
Desperate people tempted by suicidal feelings may see something “aid in dying” proponents try to hide from themselves and others: Suicide is suicide. You can’t prevent suicide among some people by declaring that suicide is a valid way to solve other people’s problems. Those problems — all of them — have better and more life-affirming solutions.
The AMA’s decision to continue studying the issue leaves in place its longstanding, life-affirming policy, for now. That policy against physician-assisted suicide is also affirmed by the American College of Physicians, National Hospice and Palliative Care Organization, American Academy of Pediatrics, American Nurses Association and World Medical Association.
Nor are lawmakers or judges surrendering wholesale to the pro-suicide campaign. California’s Oregon-style law was recently invalidated, because courts found it was enacted by an unconstitutional process. Since Oregon’s law took effect in 1997, 10 states have passed new laws against the practice, joining 31 states that already had such laws and have rejected attempts to change them.
As the AMA ethics council has said, all medical professionals should be willing to engage in difficult conversations with concerned and frightened patients, responding creatively to their needs “other than providing the means to end life.”
I know that Catholic and other faith-based health care organizations will be eager to assist in providing and promoting this excellent care, as they have in the past. Next year, when it has looked more deeply at this issue, I hope the AMA will join us and so many others in wholeheartedly supporting patients’ right to live with dignity for as long as they are with us.
In recent years, proponents of physician-assisted suicide have tried to create an impression that the debate on this issue is over, that our society will accept death as a solution to patients’ problems. But perhaps the debate has just begun.
Cardinal Timothy Dolan is the archbishop of New York
and the chairman of the U.S. Conference of Catholic Bishops’ Committee on Pro-Life Activities.