By: FRANCIS KANE
March 8, 2015
In the ancient oath of Hippocrates that physicians at one time swore by, the central promise reads thus: “I will neither give a deadly drug to anybody if asked for nor will I offer counsel for it.” Since the oath is about 2,500 years old, it seems that the controversy over physician assisted suicide has been around for a long, long time.
Recent stories and commentaries in The Daily Times have reported on the introduction of a law allowing the practice of assisted suicide here in Maryland. Maryland law now prohibits it but proposed new legislation (SB 0676 and HB 1021) would enact it.
The articles have focused on the decision our new state delegate, Carl Anderton, will have to make — and have captured, I think, the conflicting feelings many citizens have about the proposed practice. Is it unjustified killing or legitimate relief of suffering? There are sincere proponents on both sides of this issue; but, if we are going to overturn an age-old practice, we should at least listen to some reasons why the ancient physicians promised not to assist in killing.
So, here are some arguments that might make us think twice about this “new” direction in, I trust, the spirit of “civil conversation” that The Daily Times editors have called for,
Every profession professes something; that is, after all, the meaning of the word. Standing for something means conversely standing against whatever would violate the purpose of that profession.
Teachers ought not assign grades arbitrarily; lawyers ought not violate justice even for the good of their clients.
Every profession has a “bottom line” below which its practitioners ought not go. So physicians and other health care professionals profess the sacredness of life and the concomitant duty not to kill their patients.
You can indeed eliminate suffering by eliminating the patient, but that is hardly what the ancient tradition of health care stands for. Neither can you provide deadly drugs without being complicit in the act; all the demands for physicians’ involvement in the proposed law makes that clear.
It is true no physician is forced in to assist in suicide, and that’s a good thing. Nonetheless, the profession’s bottom line becomes quite smudged. If health care practitioners are permitted to provide lethal drugs, why not administer them to the patient?
It will be a difficult line to draw.
A greater worry might be that the practice makes us so dependent on assisted death, we diminish or neglect the efforts needed to make a person’s life with a terminal illness both comfortable and meaningful. That point has been made convincingly in these pages by Coastal Hospice president Alane Capen, on March 2 and in the latest, best-selling book by Atul Gawande, “Being Mortal.”
Gawande cites the Netherlands where, in 2012, an astonishing one in 35 Dutch adults sought assisted suicide while that country’s record in end-of-life care has lagged behind other countries. That, Gawande avers, is not a record of success but of failure. While providing for assisted living is harder than assisted death, it is more in keeping with the mission of health care.
With assisted suicide permitted, though, aren’t legislators less likely to support efforts like hospice? After all, suicides cost a lot less!
My own hesitations go a bit further because of a crucial distinction I see often overlooked in the debate — that is, the difference between an act and a practice. It is one thing to respond to an individual, isolated act of assisted suicide by a loving if misguided friend or relative. The law almost always treats that with restraint and mercy.
But by legalizing a practice throughout the state, we the citizens in a real sense own it. Not just individual patients and health care professionals but now we the people “profess” that innocent life is not unqualifiedly sacred. We become accomplices in the suicide of dying patients. Shouldn’t that make us uncomfortable?
And then what might come next: the right to suicide even if not terminally ill? What about comatose patients who are a “drain” on health resources? The oath, old as it is, still speaks to us across the centuries with its underlying call: What do we as a people stand for?
In this brief reflection, I have focused on the impact such legislation has upon the profession of health care. There are other arguments dealing with some disturbing details of the bill, all of which persuade this old liberal to oppose this supposed new “right” to die.
I think we should not pass such a law and, if passed, Gov. Larry Hogan should veto it.
Francis Kane is professor emeritus at Salisbury and taught medical ethics for more than 40 years.