As a result of two cases currently before the BC Supreme Court, the question of legalizing assisted suicide is once again in the media. The legal argument is straightforward: if suicide itself is legal then assisting suicide should be legal as well. Otherwise, the law against assisted suicide is the only one on the books that makes assisting a legal act illegal. This I can understand, although the legal nuances escape me.
What I have difficulty understanding is the assumption by several groups supportive of assisted suicide that physicians would be the ones to assist. While assisting someone to commit suicide can result in a decrease of suffering for the individual, it certainly contradicts the tenet “above all else, do no harm,” which surely is the underlying principle of the practice of medicine. There can be no more harmful and irrevocable act done to an individual than killing that person, even though the person requests it.
Patients with progressive, debilitating, painful diseases require enormous courage to face each day. They also require and deserve compassionate and supportive care from their physicians. Where I have trouble is with the decision whether such care extends to helping them to commit suicide. This is not to suggest that such individuals do not have the right to take their lives—this I fully support. The really difficult question is who should (or should not) help them to die when they are no longer able to perform the act themselves.
If assisted suicide is legalized, care will need to be taken to make sure that there is no coercion applied to anyone involved in the process. This applies to the medical profession as well as to the patient, friends, and family. Some of my colleagues may feel comfortable assisting, but I would feel that I was breaking my oath of “do no harm.”
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
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