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What Drives Physician Support for PAS?

On January 8, I wrote about increasing physician support for physician-assisted suicide (PAS)—up from 46% of surveyed MDs in 2010 to 54% now.  Only 31% were flatly against it.  The remaining 15% give qualified support—“it depends.”

Now, Medscape sends a follow up (registration required), regarding the reasons their surveyed physicians gave for their answer.  The title of this report:  “Is religion why docs are against assisted suicide/dying?”

They led with the four most commonly cited reasons for opposition:

  1. Belief in God.  Two of several quotes:  “The time of death is up to God,” and “A physician is not a murderer to let.”  Medscape notes that some theistic physicians supported PAS in their survey, some citing a “larger context” requiring doctors to alleviate suffering.  As I fretted in my post last week, the way opposition to PAS is described here makes it sound like such opposition is simply an example of self-righteous moralizing.  Treating the patient with regard to the whole person is construed as incompatible with limiting the physician’s calling by proscribing PAS.  At least the “murderer to let” comment offers a hint at a broader stance, resting on the nature of that calling.
  2. Support for palliative care.  Citing Dr Diane Meier, president of the Center to Advance Palliative Care at Mount Sinai Hospital in New York:  we need more physicians properly trained in palliative care.  See also my citation of Dr. Gawande in my post from last week.
  3. Maybe the patient has treatable depression.  This is a major concern, although PAS advocates will claim that “sufficient safeguards” are being built into assisted-death laws.  Here, the respondents might have added, “maybe someone is giving a vulnerable patient a push….”
  4. No prognosis is certain.  Anyone who has tried to project an individual patient’s life expectancy knows this.  Indeed, good hospice care sometimes prolongs survival beyond active anti-cancer therapy.

And the three chief reasons cited by physicians in favor of PAS, in the survey described in Medscape:

  1. Medication barely helps intolerable torment and prolonged misery.  I would hope palliative care doctors, and doctors in general, would beg to differ as intrinsic to their calling.
  2. We shouldn’t have to force patients to figure out how to kill themselves.  That is Medscape’s wording, not mine.  I am sure I am not alone in wondering whether the physician(s) who said this believe that “figuring out how to kill a patient” is a proper objective of the medical curriculum?
  3. Why shouldn’t we treat people as well as we treat animals?  Again, Medscape’s wording, not mine.  I think this question, and the tacit assumptions that are clearly behind it, are risible and incoherent.  I will leave further responses to readers of this blog, in the comments section or other posts.

  Respondents on both sides of the issue cited “First, do no harm” in their defense.

I will close with a reprise of the key points raised by Dr. Emanuel in his 2012 online New York Times piece, “Four myths about doctor-assisted suicide”:

  1. Psychological distress (depression, hopelessness, fear of loss of control), not pain, is the main motive behind requests for assistance in dying.
  2. A push to PAS is not driven by advanced medical care technology:  “If interest in legalizing euthanasia is tied to any trend in history, it is the rise of individualistic strains of thought that glorify personal choice, not the advances of high-tech medicine.”
  3. PAS is a large, looming injustice, offering only an apparent benefit to well-off, educated people.  The poor an poorly-educated, who pose a burden to their relatives, are most likely to be abused.
  4. Many things can (and typically will) go wrong with the actual execution of PAS—it will not guarantee a quick, painless, easy death.

In his 2012 essay, Dr. Emanuel concluded that “we should focus our energies on what really matters: improving care for the dying.”  In that, I take him to agree with Dr. Gawnde—and with me.

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