Why Doctors Must Not Kill

I finished Chapter 9 in the book, Leading a Worthy Life: Finding Meaning in Modern Times by Leon R. Kass. In this chapter, Kass makes a strong argument against euthanasia and physician-assisted suicide. This is a topic that I have thought about in the past but not deeply. This chapter helped me to clarify what I believe on this subject. It’s important to mention that this chapter puts aside the topic of refusing medical treatment and focuses on the more controversial topic of physician-assisted suicide and euthanasia. In recent years, it appears that public opinion has shifted towards a more favorable/accepting view of physician-assisted suicide and euthanasia.

Autonomy and compassion are the two reasons used to justify the killing of patients and these ethical orientations reflect the values of the larger American society. The thinking behind both of these rationales is opposition to the belief that medicine is intrinsically a moral profession – they assume that the medical profession is amoral. For the ethical school of compassion, “all acts – including killing the patient – done lovingly are licit, even praiseworthy. Good and humane intentions can sanctify any deed.” (p.205)

The author believes that the practice of medicine is an ethical activity in which technique and conduct are ordered in relation to an overarching good, the naturally given end of health. “Being a professional is more than being a technician.” (p.206) It engages not only one’s mind and hands, but one’s character. The virtues required for practicing medicine are moderation, self-restraint, gravity, patience, sympathy, discretion and prudence. The positive duties are demands for truthfulness, instruction, and encouragement. The fundamental negative duty is that a doctor must not kill. “Doctors may and must allow dying, even if they must not intentionally kill.” (p.207)

“In view of the obvious difficulty in describing precisely and “objectively” what categories and degrees of pain, suffering, or bodily or mental impairment could justify mercy killing, advocates repair to the principle of volition: the request for assistance in death is to be honored if it is freely made by the one whose life it is, and who, for one reason or another, cannot commit suicide alone. How free or informed is a choice made under debilitated conditions?” (p.209) “With patients thus reduced – helpless in action and ambivalent about life – someone who might benefit from their death need not proceed by overt coercion. Rather, requests for assisted suicide can and will be subtly engineered.” (p.210) By making euthanasia or assisted suicide an option available to gravely ill persons, some might come to see this right to choose this as an obligation or duty.

“Thus in actual practice, physician-assisted suicide and euthanasia will be performed by physicians not out of simple deference to patient choice, but for reasons of mercy: this is a “useless” or “degrading” or “dehumanized” life that pleads for active, merciful termination, and therefore deserves my medical assistance.” (p.210)

“But once assisting suicide and euthanasia are deemed acceptable for reasons of “mercy”, then delivering those whom illness or dependence have dehumanized will also be acceptable, whether such deliverance is chosen or not.” (p.211)

The legalized practice of physician assisted suicide and euthanasia will damage the doctor-patient relationship. Once a doctor has license to kill, how can you trust him/her to act in the interest of preserving your life? Trust is a critical factor in the relationship and the healing process. Mistrust produces stress, anger and resistance to treatment. Also, having the option to kill will alter the physician’s attitude toward his/her patients. Setting limits to the use of dangerous powers is very important. Also, human life in living bodies should command respect and reverence by its very nature.

“Can wholeness and healing ever be compatible with intentionally killing the patient? Can one benefit the patient as a whole by making him dead? To intend and to act for someone’s good requires his continued existence to receive the benefit.” (p.220) Medicine owes patients assistance in their dying process but it has never had the mission to produce or achieve death itself.

Medicine can provide adequate relief of pain and discomfort. Also, physicians can keep learning how to withhold or withdraw interventions that are only burdensome or degrading. But, to stop medical intervention is fundamentally different from mercy killing – the physician who stops treatment does not intend the death of the patient. However, with physician-assisted suicide or euthanasia, the physician must intend the patient’s death and take on an “angel of death” role.

What the dying need most is our presence and encouragement. Withdrawal of affection, contact and care is the greatest cause of the dehumanization of dying. “The treatment of choice is company and care.” (p. 225) We should try to reverse dehumanization by not allowing doctors to be the dispensers of death.

This summary doesn’t do justice to all the arguments and detail that the author provides to support his position. This chapter (and book) is worthy of your reading and evaluation.

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