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Posted on April 3, 2015 at 1:02 AM

I’ve posted several times on physician-assisted suicide (PAS) over the last 3+ years, including this past January 15, January 22, January 29, February 5, February 12, and March 27.

Whew!  I hadn’t realized until I created that list how focused I’d been on the topic this year.  Of course, my thoughts are neither new nor my interest unique; others on this blog, for starters, have also been weighing in.  I also am reminded that on a blog like this, I am just an opinionated blogger—nobody “died and made me king,” as the saying goes. 

Still, some of the comments to my 2015 posts, and other writing on this blog recently, deserve, I believe, a bit of a summary response rather than just the back-and-forth-of the comments sections.

I will try to be succinct, then maybe move on to other bioethics topics for the next few weeks at least.

To begin with, Sarah Sawicki’s March 28 post asked, “What do you think are the best ways to approach [PAS] with sensitivity and grace while upholding the importance of the imago-dei in all humans?”   I would  venture the following points:

  1. Regarding the individual testimonial from a suffering, dying fellow human, like the late Brittany Maynard, other testimonials from similarly-suffering people, like Kara Tippetts, are perhaps best positioned.  (The current issue of World magazine reports that Ms. Tippetts is nearing death.)
  2. Medical professionals, most notably palliative care specialists, oncologists, and others who often care for dying patients, should focus on improving care at the end of life.  Physicians with Medscape access might be interested in an offering from March 24, “The Last Hours of Living: Practical Advice for Clinicians.”
  3. As I am starting to age, I find myself thinking more about preparing for death.  Christians should encourage each other to prepare for that better country, better inheritance, better resurrection offered in Christ.  In ministering to those not yet in Christ, we maintain faithful proclamation of the gospel, preferably before our friends are approaching the death bed.
  4. When it comes to public policy, testimonial is not enough, and should not necessarily be afforded a privileged position.  There is a critical role for argument, civilly but forcefully presented.  Opposition to PAS is not some article of religious faith.  It is grounded in the nature of medicine, meaning that physicians ought clearly to forswear PAS:  “We shall not.”

Now, in commenting on my post last week, March 27, Dr. Barry Orvell made what I take to be the best argument in favor of PAS; to wit, 1) respect for persons demands respect for their autonomy, and for giving them all possible options for dealing with end-of-life suffering; 2) often, what patients really want is the comfort of knowing they have options, and more people—maybe far more—have inquired about PAS in Oregon than have actually filled a prescription much less taken the pills; 3) the situation is rare, anyway.

My response would be, in part:  1) autonomy is not the whole story, and the nature of the healer’s art is central; 2) I take it that true quality palliative care provides comfort, symptom relief, and treatment of the whole person; 3) practices tend to spread and broaden.

The first point was one of four made by Dr. Emanuel, as cited in my February 5 post.  Space prevents me from re-writing here.  But, given the long history of medicine and the radical implications of PAS, I believe that PAS advocates bear the burden of proof in refuting those points.

Regarding the third point, that practices tend to spread, this is the “slippery slope” argument.  One hears that this is a “fallacy,” which is only the case if it is held that the slippery slope means that A logically entails B as a consequence.  But the same logic that supports A can often make B more plausible.  Witness, hence, the Belgian discussion about liberalizing PAS there, as I discussed on June 21, 2013, and the extension of PAS to the pediatric population in the same country.

As regards my second point—providing care without killing—I again appeal to the nature of medicine as an enterprise.  I repeat the statement of Dr. Gawande, who, although he wondered whether limited PAS might not be OK, answered his doubt, in my opinion, by writing, “The fact that, by 2012, one in thirty-five Dutch people sought assisted suicide at their death is not a measure of success.  It is a measure of failure.  Our ultimate goal, after all, is not a good death but a good life to the very end…we damage entire societies [emphasis mine] if we let providing this capability [for PAS] divert us from improving the lives of the ill.  Assisted living is far harder than assisted death, but its possibilities are far greater, as well.”

And, yet again, I return to Margaret Mead:  [With Hippocrates, “f]or the first time in our tradition there was a complete separation between killing and curing.  Throughout the primitive world the doctor and the sorcerer tended to be the same person.  He with the power to kill had power to cure…He who had power to cure would necessarily also be able to kill.  With the Greeks, the distinction was made clear.  One profession…were to be dedicated completely to life under all circumstances, regardless of rank, age, or intellect—the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child…but society is always attempting to make the physician into a killer—to kill the defective child at birth, to leave the sleeping pills beside the bed of the cancer patient.  [It is] the duty of society to protect the physician from such requests.”

I think the autonomy argument for PAS is really thin gruel, and it troubles me greatly that palliative care specialists will not take a stand against it.  The current arguments have the nature of commending PAS (or, if you must, physician-aid-in-dying) as if poor souls are being deprived of a public good.  At least some of the advocates seem to avoid invoking the dubious “right to die,” which would create an affirmative duty to kill.  And if bills like California’s become law—as I suspect more will, before long—how much longer will it be before the medical curriculum requires a course in how to kill your patient efficiently?

We shall not.

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