A new “Position Statement” by the American Academy of Neurology has abdicated (in my view) members’ professional obligation to protect the lives of all patients — including the terminally ill — by revoking the organization’s previous universal opposition to physician-assisted suicide.
Interestingly, the opinion acknowledges that the reasons people almost always commit assisted suicide are existential, not pain — which is also true for those people who kill themselves for reasons other than a serious illness. From the Position Statement (my emphasis):
The committee recognizes that palliative care interventions may not be universally effective for all terminally ill patients who may seek hastened death assistance from AAN members, particularly with spiritual or existential suffering.
Exactly so. Assisted suicide is sold as a safety valve for pain that can’t otherwise be alleviated. But that is not why it is usually carried out.
To the contrary, statistics from states such as Oregon demonstrate that prescribed suicide requests almost always are not predicated upon unrelievable physical pain. Rather, people ask for poison pills out of fears of being a burden, worries about losing the ability to engage in enjoyable activities, a terror of losing dignity, etc.
These are important — crucial — concerns that can often be substantially alleviated by the properly trained mental-health professionals and chaplains via suicide prevention interventions, prescribed anti-depressants, etc.
It is also worth noting that no law in the U.S. requires any objective showing of actual suffering. Rather, once the determination has been made of six months or less to live, assisted suicide becomes available regardless of the presence or absence of symptoms.
Moreover, if spiritual and existential concerns justify assisted suicide, there is no way logically to restrict lethal prescriptions to the dying. Many people experience such despair more deeply and for a far longer time than the dying.
If a neurologist’s terminally ill patient asks for suicide, the proper — and it seems to me, only — ethical approach is suicide prevention via referral to specialists in that field, just as the doctor should do for a suicidal patient who is not terminally ill.
Writing a lethal prescription instead of referring for specialized care is abandonment because it deprives the patient of essential medical services that could make all the difference between continuing to live or asking to die.