Nearly 30 years ago,
Arnold Schwarzenegger's "Terminator" character made famous
the phrase "I'll be back," the implacable cyborg assassin's response to a
setback. Today, similarly relentless terminators are among us, also with a
deadly mission: to move America toward acceptance of physician-assisted
suicide.
On Monday, the terminators gained a victory when Vermont Gov. Peter Shumlin
signed into law the "Patient Choice and Control at End of Life Act." The bill
had been passed by the state legislature the week before without consulting the
electorate, possibly because the lawmakers had seen what happened last fall next
door in Massachusetts, where voters rejected a similar initiative. Now Vermont
doctors will be able to prescribe lethal medication to patients as the state
joins Oregon, Washington and Montana in supporting the practice.
So the terminators are back. The reasons for opposing them and opposing
physician-assisted suicide never went away. The reasons have been with us since
ancient Greek doctors wrote in the Hippocratic oath that "I will neither give a
deadly drug to anybody if asked for it nor will I make a suggestion to that
effect." The oath is a central tenet in the profession of medicine, and it has
remained so for centuries.
Dr. Leon Kass, in a brilliant essay on the Hippocratic oath in his 1985 book
"Toward a More Natural Science," explains why this has been true. Medicine and
surgery, he says, are not simply biological procedures but expressions, in
action, of a profession given to helping nature in perpetuating and enhancing
human life. "The doctor is the cooperative ally of nature," Dr. Kass writes,
"not its master." It shouldn't need saying, but the exercises of healing people
and killing people are opposed to one another.
Traditionally the public rests its trust in doctors on this understanding of
medicine. Doctors occasionally remind the public of it when they explain why
they do not participate in capital punishment or bear arms in military service.
But the terminators who champion physician-assisted suicide propose that, as
seen in intensive-care units, contemporary medicine prolongs unnecessary
suffering.
As a psychiatrist, I work with doctors on such units, and I can testify that
all of them realize that human life itself is limited in duration and scope.
These doctors regularly consider just how far they should go in sustaining a
hope for recovery—cooperating with nature's resilience in treating advancing
disease. They also consider when prolonging a futile effort should be replaced
by comforting the person as his life naturally comes to an end. The judgment is
delicate, though, and most families are justified in leaving it to skilled
physicians.
Another argument for physician-assisted suicide is that many patients with
cancer live too long in pain. The suffering could be reduced if their legitimate
wish for death were fulfilled. These are the arguments pressed by Dr. Timothy
Quill and many in the Oregon "death with dignity" group.
But scientific publications from oncologists such as Kathleen Foley, who
studies patients with painful cancers, reveal that, quite to the contrary, most
cancer patients want help with the pain so they can continue to live. Suicide is
mentioned only by those patients with serious but treatable depressive illness,
or by those who are overwhelmed by confusion about matters such as their burden
on loved ones and their therapeutic options. These patients are relieved when
their doctors attend to the sources of their psychological distress and correct
them.
In the nearly two decades that Oregon has permitted physician-assisted
suicide, I became suspicious that just such depressed and confused patients
number large among those who ask for and take life-ending poisons. Why
suspicious? Because the law does not demand a psychiatric assessment before they
take the fatal step. Yet all efforts by psychiatrists anxious to read the
medical charts of these patients after their deaths have been thwarted by the
champions of their suicides, who have shrouded the patients' mental states in
secrecy by raising the "privacy privilege." I believe that these doctors are
killing patients of the sort that I help every day.
And then there is this talk about "death with dignity," as the Oregon and
Washington laws are titled. Surely what we want is "life with dignity." Seeking
life, we're ready to endure much in order to keep it going. Think of the
life-saving and life-preserving colonoscopy—all dignity drops with your
trousers.
The advance of the hospice movement has made a shambles of the terminators'
insistence that medicine prolongs suffering and denies dignity. The doctors,
nurses and social workers committed to hospice care demonstrate how an alliance
with nature at life's end plays out in just the way that the medical profession
intends. As hospice ways become more familiar, the public can overcome the fears
that the terminators used to win over the Vermont legislature.
For you see, the terminators ultimately are not merely interested in killing
people who are suffering the throes of a final illness. They have even others in
mind, as history tells us. The drive to allow doctors to "assist" in suicide is
not recent. Its roots are in the Progressive era of the early 20th century, when
many Americans placed utter confidence in reform and in technocratic elites.
Then the enthusiasts for euthanasia lined up with those clamoring for government
intervention in the name of eugenics and population control.
Across the decades, Americans have fought off such dire temptations with
reasoned arguments about the nature of medicine. Despite Vermont's unfortunate
decision, Americans elsewhere likely will continue to defeat physician-assisted
suicide at the ballot box and in the statehouse. But the enemies of life are
terminators—they'll be back.
Dr. McHugh, former psychiatrist in chief at Johns Hopkins Hospital, is
the author of "Try to Remember: Psychiatry's Clash Over Meaning, Memory, and
Mind" (Dana Press
