Doctors as Healers

There are concerns that one of the first casualties of euthanasia and physician assisted suicide (PAS) will undoubtedly be the doctor/patient relationship.
  • Doctors enter medicine out of a desire to save lives and relieve suffering, not to have to kill their patients.
  • The WMA recommends that doctors refrain from practising euthanasia even if national laws allow or decriminalise it..
  • There are fears that economics and healthcare rationing will dictate who can live and who must die.
  • Many of those who are labelled by bioethicists as "non-persons" are also those whose medical care would be the most expensive.
The drive by bioethicists to have euthanasia become part of medical practice is unwelcome to many doctors and is seen as sinister by opponents of euthanasia.
  • One of the fears is that it will undermine the doctor patient relationship and corrupt the character of doctors
  • Medical associations around the world have taken a firm stance against euthanasia, calling it unethical
  • There are fears that economics and healthcare rationing will dictate who can live and who must die
  • Doctors enter medicine out of a desire to save lives and relieve suffering, not to have to kill their patients
  • Doctors may feel pressured to agree to a patient's wish for euthanasia even when they know they can alleviate pain or treat depression

Research indicates that the psychological effect for doctors providing physician-assisted death is profound. 1

Bioethics is a relatively new field of philosophy that engages in debate in the areas of morality in the context of health care and biotechnology. Bioethicists have enormous influence over policy makers in medicine, law and government who try to grapple with highly complex moral issues.

John Harris, a director of the Institute of Medicine, Law and Bioethics at the University of Manchester in England and a leading voice in the bioethics movement wrote:
"Many, if not most of the problems of health care ethics presuppose that we have a view about what sorts of beings have something that we might think of as ultimate moral value. Or, if this sounds too apocalyptic, then we certainly need to identify those sorts of individuals who have 'the highest' moral value or importance (emphasis added): a moral value or importance comparable to that to which we believe ourselves entitled."
Wesley J. Smith is a senior fellow at the Discovery Institute of Seattle, Washington, an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide, an award winning author, and a special consultant to the Center for Bioethics and Culture. Smith points out:
"Had Harris written that health-care ethics presupposes a view about "which race has the highest moral value or importance, " he would be dismissed as a mindless bigot. Mainstream beliefs in bioethics are just as discriminatory -- they merely threaten different victims.

Here's the nub of the problem: Many bioethicists believe that basing moral value and legal rights solely upon being human is capricious, religion-based and irrational. Many go so far as to contend that granting special status to humans simply because they are human is itself an act of discrimination against animals, a concept that has been given the bizarre name "species-ism."

To avoid the odour of 'species-ism,' bioethicists often assert that what counts morally is not being "human" but being a "person," a status earned by possessing identifiable mental capabilities such as being self-aware or having the ability to engage in rational behavior.

While the exact criteria for determining who is and who is not a person are still being debated, most bioethicists agree that there are human beings who are not persons."
Many of those who are labelled by bioethicists as "non-persons" are also those whose medical care would be the most expensive. In a day and age when most hospitals are facing budget blow-outs and are calling for cost-cutting measures, bioethics poses a danger not only for the terminally ill, but also for the elderly, those with physical or mental disabilities, and the chronically ill.

Doctor patient relationship
One of the first casualties of euthanasia and physician assisted suicide (PAS) will undoubtedly be the doctor/patient relationship. Dependent on mutual trust this bond will become increasingly fragile as doctors find their boundaries in the issue over life and death changing.

Doctors worldwide are against euthanasia and PAS this statement from the World Medical Association (1992) outlines their position.
“Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient."
Further the WMA recommends to National Medical Associations and doctors to refrain from practising euthanasia even if national laws allow or decriminalise it.

British Medical Association Makes a Stand for Doctor/Patient Relationship
From BMA report from the select committee on medical ethics: Relationship between doctor and patient

  • 102. The existence of a trusting and open relationship between doctor and patient is of particular importance when the patient is terminally ill and decisions must be made for care towards the end of life. The VES (Voluntary Euthanasia Society) suggested that "any change making it easier for doctors openly to carry out their patients' wishes can only reinforce confidence on both sides". Some other witnesses agreed.

  • 103. More witnesses however felt that the relationship between doctor and patient would be undermined if the doctor was empowered to practise euthanasia, even under the strictest of controls. The BMA said "if doctors are authorised to kill or help kill, however carefully circumscribed the situation, they acquire an additional role, alien to the traditional one of healer. Their relationship with all their patients is perceived as having changed and as a result some may come to fear the doctor's visit".

  • 104. The Linacre Centre suggested that the practice of euthanasia would corrupt the character of doctors, and encourage them to view some patients as lacking inherent worth. This would undermine "a disposition indispensable to the practice of medicine: the willingness to give what is owing to patients just in virtue of their possession of basic human dignity."


  • Advances in medical science
  • 105. The VES cited developing medical technology as a factor fuelling support for euthanasia. "Having created the situation in which lives are routinely saved, transformed or prolonged by medical intervention, we can hardly pretend that the process of dying, and that alone, must be left to nature". Mr Ludovic Kennedy suggested that advances in medical techniques meant that “the dominant fear today is of being denied release from a prolonged period of painful, distressing and undignified dying". This point was supported by a number of individual members of the public who wrote to us, particularly those who had witnessed the difficult death of a family member.


  • "Slippery slopes"
  • 106. The so-called "slippery slope" argument was clearly put by the BMA. They said that "by removing legal barriers to the previously 'unthinkable' and permitting people to be killed, society would open up new possibilities of action". They said that "any moral stance founded on the permissibility of active termination of life in some circumstances may lead to a climate of opinion where euthanasia becomes not just permissible but desirable.

    Once active termination of life is a matter of choice for competent people, the grounds for excluding non-competent people from such treatment become harder to defend". A number of other witnesses made a similar point. Sir Robert Kilpatrick observed that "one of the great problems is always to work out the implications of a change, because they may be much more far reaching than one can see".

    He cited abortion as an example, saying that the number of abortions performed each year far exceeded that expected at the time legislation was passed. Dr David Cook made a similar point: "What began in 1968 as offering permission for doctors to perform abortions under certain restricted terms has now become an expectation ... that abortion is available on demand ... there has been a slippery slope when legislation about justified killing has been introduced". He also spoke of the human inclination always to go beyond any established limit.

  • 107. The Reformed Presbyterian Church of Ireland feared that voluntary euthanasia would lead to a descent of the "slippery slope" because of the need for concurrence by the doctor. "The ultimate decisive factor is the patient's perceived quality of life - ie that his life is not worth living - not his request for death... there is no logical reason, once voluntary euthanasia is allowed, why the practice may not be extended to cases where no request has been made, if in the doctor's judgement that is the best course of action for all concerned".


  • Euthanasia and medical practice
    In considering the argument heard that euthanasia and assisted suicide are perfectly compatible with the aims of medicine, author Daniel Callahan of The Hastings Center, states in When Self-Determination Runs Amok ,
    "I would note at the very outset that a physician who participates in another person's suicide already abuses medicine" (p.179).
    A doctor takes an oath to preserve life when he becomes a doctor, not to end it. Opponents of euthanasia claim that any doctor or medical professional who is involved with active euthanasia and assisted suicide is harming themselves and the whole medical profession.

    When discussing euthanasia, J. Gay-Williams stated,
    It could have a corrupting influence so that in any case that is severe doctors and nurses might not try hard enough to save the patient. They might decide that the patient would simply be "better off dead"...This would result in an overall decline in the quality of medical care (p.170).
    Reference:
    1. Mitchell K. Physician commitment in end of life care – perspectives from New Zealand and the Netherlands. Soc Sci Med. 2004 59; 775-785.