“Nor shall any man's entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so.”
–Hippocratic oath
Since ancient Greece, the guiding principle of medical ethics has been, above all, a respect for human life. Accordingly, the Hippocratic oath blatantly forbids euthanasia (when a doctor directly administers a lethal drug with the patient’s consent) and physician-assisted death (when a doctor allows the patient access to a lethal drug that can be self-administered) on the grounds that deliberately ending a life violates the professional role of a physician.
However, thousand-year-old regulations are not fit to guide a modern world, and the Hippocratic oath is no exception. Medical ethics has evolved to place increasing value on patient autonomy. Abortion, for example, explicitly forbidden by the Hippocratic oath, is now an autonomous choice that a woman can make about her own body. We now acknowledge that while a doctor has a duty to improve a patient’s physical health as much as possible, this can conflict with a patient’s personal desires and happiness. In the end, the decision is up to the patient.
But what if the patient wants to die?
This was the case of Brittany Maynard, who ended her own life two weeks ago. After surgery failed to curb her aggressive brain cancer, she was told she had six months left to live. Rather than deteriorate painfully over time with futile medical treatments, she chose to maintain her quality of life for as long as she could. Brittany finally passed away of her own accord, peacefully and painlessly, by taking a medication prescribed to her by her doctor.
Brittany was not the first person to decide that it just wasn’t worth it to prolong a disease that would certainly kill her. But Brittany is unique because she was 29 years old. Had she been 50 years older, no one would have batted an eyelash. Elderly patients opt out of procedures that are too expensive, too much of a burden or unlikely to succeed, all the time. When they come to terms with their illnesses, we understand. They’ve lived their whole lives already. They wouldn’t have much time left anyway. But in Brittany’s case, because she is young, active and energetic, we find it harder to rationalize why she would choose physician-assisted suicide. We expect her to fight for life.
Why? Because suicide is a dirty word. It makes people uncomfortable. Its automatic association with mental illness, which itself is unfairly stigmatized in society, as well as our basic value of life elicits a knee-jerk reaction—There is no excuse for wanting to die. There is something fundamentally wrong with having the gift of life and choosing to throw it away.
But terminally ill people, candidates for physician-assisted death, don’t have the same gift of life as you or I. Brittany Maynard was already at the end of her life. She didn’t choose that.
Today, the World Medical Association’s official stance on physician-assisted suicide is: “Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.”
You can’t kill them, but you can let them die.
I don’t see much of a difference. In the case of life-threatening illness, isn’t the right to decline medical treatment equivalent to the right to die? The physician has given up his duty to heal, putting the patient's life in the patient's own hands. At this point, why shouldn’t the physician help the patient make the safest, most comfortable decision about their remaining days?
For terminally ill patients, death is a decided fate. If physicians can be involved in managing other symptoms to improve comfort, they can also help manage the ultimate one. Doctors already offer hospice and at-home care as humane alternatives to staying in the hospital. I guess the logic is, with painkillers and a homey environment, we can improve someone’s quality of death. Yet going above and beyond that, guaranteeing a painless, peaceful passing is unthinkable?
I do understand that not all physicians want to provide the service of assisted death, as it might counter their personal values. That is their choice. But an outright ban makes physician-assisted suicide completely inaccessible to those who are suffering. They deserve the choice too. Some people, like Brittany, don’t want to lose their independence, gradually wasting away in a bed, causing even more sadness for family members who have to witness the changes. Why is it wrong to improve her quality of death by letting her choose when she wants to go?
I believe that the right to die is an inherent part of patient autonomy. Hopefully, if physician-assisted death loses some of its stigma, terminally ill patients won’t have to move to Oregon just to exercise their right to die with dignity. Hopefully, the choice can one day be there for those who need it.
Pallavi Shankar is a Trinity sophomore. Her column runs every other Friday.
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