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
Langley

References

1.    Canadian Society of Palliative Care Physicians. CSPCP position statement: The practice of euthanasia and assisted suicide, 2013. Accessed 10 December 2014. http://www.cspcp.ca/wp-content/uploads/2014/02/EuthanasiaPositionStatementFINAL-June142013.pdf.
2.    National Hospice & Palliative Care Organization. Commentary and resolution on physician assisted suicide, September 2005. Accessed 10 December 2014. http://www.nhpco.org/sites/default/files/public/PAS_Resolution_Commentary.pdf.
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. www.epcc.ca/wp-content/uploads/2014/12/Affidavit-of-Etienne-Montero.pdf.
4.     Hendin H, Foley K. Physician-assisted suicide in Oregon: A medical perspective. Mich Law Rev 2008;106:1613-1645.