Should Doctors Help you Kill Yourself?

Exploring the Ethics of Euthanasia

Male doctor with his patient. Credit:Jacob Wackerhausen

Is euthanasia an appropriate option for people coping with terminal illness and/or chronic pain? Should doctors assist patients to kill themselves?  

I have mixed feelings on this issue. I have worked with many suicidal clients over the years, and I have had a former client commit suicide. When I was in college I worked at a psychiatric hospital and I found a patient who killed himself. I place a high value on life, and I have trouble seeing suicide as a legitimate alternative for most people.

The Supreme Court of the U.S. refused to establish a right-to-die, and left many of the issues in the hands of the various states. Other countries have different traditions. The Netherlands is sometimes called euthanasia's home. Their medical system has allowed assisted suicide for at least the last 20 years, in spite of the fact that it remains technically illegal.

In her article, Diane Hunter asked:

What happens to the person in chronic pain who is not receiving sufficient pain medication or has no hope for a future without pain and simply can't take it any longer?

The implication seems to be that physician-assisted suicide might be a solution for that person. How about giving them sufficient pain medication instead? I can't agree with euthanasia as an option for chronic pain. Too many patients are able to make an excellent adjustment to their pain with medications, physical techniques, and/or cognitive and behavioral techniques.

Doctors are often caught in a bind with chronic pain patients. There is support in the literature for giving opioid analgesics to chronic pain patients if other modalities of treatment have been tried, and if these medications allow them to lead a normal life. Some state licensing boards have been critical of this practice, however.

This has led to doctors withholding these medications from many patients. Physiological dependence on these medications occurs with long term use - but this is not considered "addiction."  Addiction includes the concept of "compulsive use despite harm" which is not the case when these medications are used as prescribed.

I have also seen such patients labeled "drug-seeking" by staff members. The implication is that they have a drug problem. While this is sometimes true, and care needs to be taken with these medications, many of these patients are actually "relief seeking." If the drug is what gives them relief, then that's what they will seek.

Pain impulses go to more than one part of the brain. They go to the sensory areas and to the emotional areas. Much of the negative impact of the pain is from the negative emotions which are triggered. Then we often begin to think about the pain, and we get even more of the brain involved. The above quote contains a good example of a pain thought. "I simply can't take it any longer" is a thought.

Pain patients can learn to calm down such thoughts and emotions, and eliminate two thirds of the negative experience of pain.  Mindfulness meditation is one approach to this process.

Conditions which are both painful and terminal are a different story. Hospice care is been becoming more popular, with the emphasis on patient comfort rather than high tech medicine. Terminally ill patients who are in pain should be provided with treatment to allow them to live out their final days in comfort, even if these pain medications shorten their life. This is certainly what I would want for my life under these circumstances.

Treatment for depression can be extremely effective, and I do not believe that assisted suicide should be considered for depressed patients. A person who is depressed has lost perspective on life. He or she often feels like life is hopeless in spite of overwhelmingly positive circumstances. If psychotherapy and medications are not effective for severe depression, then electroconvulsive therapy (ECT) is often an effective treatment. Only mild memory loss is associated with newer ECT techniques.

Should doctors be able to help you kill yourself? I'm skeptical. We need to carefully study countries like the Netherlands and learn from their experience. We need to closely follow the experiences of people in Oregon and learn from them. I can concede that assisted-suicide might be justified in the rarest of cases of extreme suffering.

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