Re: Physician-assisted suicide

In the October issue of the BCMJ, Dr Bill Cavers commented on physician-assisted suicide [BCMJ 2014;56:381]. Physicians on both sides of this matter can certainly appreciate the import of the pending Supreme Court of Canada decision. 

However, when considering this serious issue, it is vital that the stance of each side is accurately represented for proper understanding and clear communication. Dr Cavers presented a false dichotomy when he conflated the principled stance of doctors opposed to physician-assisted suicide (often sealed by oath) with “preserve life at all costs” while only those in favor are deemed to uphold the obligation to ease suffering, which is clearly within the rich and noble tradition of medicine.

Physicians and palliative care associations opposed to participation in patient suicide are not in favor of preserving life at all costs.[1,2] Withdrawal of medically futile care that is merely prolonging suffering is good medicine, but it is not the same as helping a patient commit suicide or inflicting death with a lethal injection.

Dr Cavers’ phrase “an individual’s right to an assisted death” is also problematic. By referring to it as a right, Dr Cavers is effectively marginalizing the convictions of those who see physician-assisted suicide as not only unethical, but fraught with well-documented dangers of expansion and abuse, as seen in Belgium and the Netherlands.[3,4] Once something is deemed a right, then there are difficulties in allowing freedom of conscience to deny that right. There are already circumstances where a physician’s right of conscience is effectively denied, when activist groups demand purported rights. 

Those who support physician-assisted suicide are seeking a service that could be, if legislated permissible, provided by someone outside the medical profession with minimal training. The hands of healers; however, should continue to be used to cure when possible, and to comfort always, with effective palliative care.
—Zoltan Horvath, MD


1.    Canadian Society of Palliative Care Physicians. CSPCP position statement: The practice of euthanasia and assisted suicide, 2013. Accessed 10 December 2014.
2.    National Hospice & Palliative Care Organization. Commentary and resolution on physician assisted suicide, September 2005. Accessed 10 December 2014.
3.    Lee Carter, et al v. the Attorney General of Canada and the Attorney General of British Columbia. Affidavit of Professor Etienne Montero submitted to Supreme Court of Canada 23 April 2014. Accessed 5 January 2014.
4.     Hendin H, Foley K. Physician-assisted suicide in Oregon: A medical perspective. Mich Law Rev 2008;106:1613-1645.

. Re: Physician-assisted suicide. BCMJ, Vol. 57, No. 1, January, February, 2015, Page(s) 8 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
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.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply