Physician-Assisted Suicide and Euthanasia Is Incompatible With Medicine: A Response From Medical Students

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We would like to respond to the article published in a recent issue of Critical Care Medicine by Goligher et al (1) discussing ethical issues on physician-assisted suicide and euthanasia (PAS/E), specifically to whether it is morally acceptable for physicians to intentionally cause death.
As medical students, we are concerned with PAS/E, because these proposed measures fundamentally change the physician-patient relationship. Physicians implicitly promise patients basic conditions of trust. These include protecting their confidentiality, not engaging in sexual relations with patients or third parties that are involved in their medical decision-making process, and not prescribing medications with the intention of killing patients. For centuries, the physician-patient relationship has been based on these basic tenets of trust, and PAS/E disrupts that fundamental bond.
We are entering this profession with the understanding that medicine must always be used to heal and treat the patient; central to our trade is to eliminate the disease, not the person. The medical profession was never meant to decide when a patient should die; rather, medicine is a profession focused on the art of healing, with the intention of pursuing the health of each individual as a human being, regardless of their medical diagnoses.
Doctors must not pretend that we can cure every disease. However, where we can no longer cure, we can still offer palliative care. Refractory pain is most often spoken about in the debates on PAS/E, but the reality is that medicine is able to offer a wide range of options to control refractory symptoms. In fact, data show that patients often seek PAS/E not because of intolerable pain but rather due to fears of the future, feelings of diminished independence, and loss of control (2). For the majority of the patients we care for, diminished independence and loss of control are inevitable aspects of their disease processes. Thus, by supporting PAS/E, we would implicitly affirm that PAS/E is appropriate treatment for many, if not all, of our patients. Furthermore, precisely because so many patients experience some degree of loss of control, it is in the best interest of doctors and patients to set clear roles for the physician: to accompany patients through the disease process, not prescribing medications causing death.
As students, we have continuously witnessed the power of a doctor’s affirmation, be it implicit or explicit. It can drastically change a patient’s decisions due to the authority that comes with holding the title of physician. In end-of-life care, we believe that the responsibility of the physician is not to offer a life-ending solution but rather to support the patient in living the best quality of life possible within the realities of their limitations. The proposed and existing laws supporting PAS/E, however, send a clear message that life is only worth living if a person is maximally functional and independent.
Over the past few years, the medical profession has increasingly been in the spotlight as an authority on many high-impact propositions, and we, as students, are concerned about where our profession is headed. We strongly urge our colleagues to shift the focus of our efforts to improve end-of-life care for patients and onto the enhancement of patients’ quality of life through robust symptom management and palliative care.
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