Learning to Kill with Confidence

The data are in for the first year of physician-assisted suicide in Oregon. In November 1997 the people of the state voted in a referendum to make it legal for doctors to help people kill themselves. Now, after one full year under the law, the data have been sifted through and analyzed in a supposedly objective, dispassionate, scientific fashion and reported in the New England Journal of Medicine. The proponents of physician-assisted suicide were delighted with the results and now make the claim that there should be no cause for concern among the public in the face of this “expanded medical service.”

There were no reports of adverse physical reactions to the drugs in terms of vomiting or convulsions, and no one had to help kill a loved one by tying a plastic bag over his head when the drugs failed, as some claimed would happen.

Most of the individuals were unconscious within five minutes, all within twenty minutes. Most died within one hour, although one lived on for almost twelve hours after taking the lethal drugs. “You see,” say the advocates of physician-assisted suicide, “it is all so easy, so clean — so efficient.”

It was thought by many who voted for physician-assisted suicide that those suffering from intractable pain would be the ones who would avail themselves of it. However, the New England Journal of Medicine study showed a much different motivation. People did not choose suicide because they were in pain but because they feared they would lose control of their lives as their illness advanced. Also, the suicides tended to be those who were never married or who were divorced. A sense of loneliness. Isolation. Fear of lack of control. Those are hardly medical factors requiring the intervention of a physician.

Only 23 people were given prescriptions for lethal drugs. Of those, only 15 managed to kill themselves. Six died from their underlying illness first. Rather small numbers in the estimation of some. Of course, those are only the numbers reported. In Oregon there are no penalties for not reporting the practice. Also, it was just the first year of the implementation of the law. Wait until people grow accustomed to the idea. The numbers may grow yet.

In Holland where euthanasia is technically illegal but seldom prosecuted, some 20% of those being killed by doctors have never requested it, according to the Journal of Medical Ethics. Indeed, the Journal reports that 59% of doctors do not even report euthanasia or physician-assisted suicide, as required by law.

In Oregon moral reservations on the part of doctors and patients kept the number of suicides from being higher. Six of the 15 people who sought lethal prescriptions had to go to two or more doctors.

The article in the New England Journal of Medicine reported the qualms of conscience which plagued many of the physicians who helped patients kill themselves. “It was an excruciating thing to do … it made me rethink life's priorities.” “This was really hard on me, especially being there when he took the pills,” and, “This had a tremendous emotional impact.”

This uneasiness should not be too surprising. After all, for more than 2,000 years physicians had been taking the Hippocratic Oath and pledging: “I will give no one a deadly potion even if asked, nor counsel any such thing.” It is not an easy matter to turn one's back on more than 2,000 years of a moral tradition of noble pagan origins. Or on more than 3,000 years of the Judeo-Christian tradition and its commandment: “Thou shalt not kill.” But many of our physicians are tremendously resilient these days. We adapt.

As I read the doctors’ remarks in New England Journal of Medicine, I thought of a religious education class I attended while I was a high school student. The teacher asked us if we wanted to kill our consciences. He then went on to tell us how. He told us to go into a store and simply take something we wanted. He said that we would immediately feel pangs of conscience. As soon as our conscience began to bother us, he said, we should steal again. As we repeated that behavior, he said, the pangs of conscience would eventually disappear altogether.

The physicians in the New England Journal of Medicine article expressed qualms about their behavior. But there is no reason to think such qualms will persist. Indeed, the proponents of euthanasia hope they will not. We just have to give our physicians and our dying neighbors in Oregon more time to kill their consciences before they begin feeling really comfortable about killing themselves and one another.

Dr. John Haas is director of the National Bioethics Center in Boston.