Physician-Assisted Suicide Should Not Be Legalized

Nearly 95 percent of those who kill themselves have a psychiatric illness diagnosable in the months before suicide. The most common mental illness in these suicides is depression, which can be treated. This is particularly true of those over fifty, who are more prone than younger victims to take their lives during the type of acute depressive episode that responds most effectively to treatment.

Like other suicidal individuals, patients who desire an early death during a serious or terminal medical illness usually suffer from a treatable depressive condition. Although pain and other factors such as lack of family support contribute to their wish for death, depression is the most significant factor, and researchers have found it is the only factor that predicts the desire for death.

Both patients who attempt suicide and those who request assisted suicide often test the affection and care of others, confiding feelings like "I don't want to be a burden to my family" or "My family would be better off without me."

Such expressions usually reflect depressed feelings of worthlessness or guilt, and may be a plea for reassurance. They are also classic indicators of suicidal depression in patients who are in good physical health. Whether physically healthy or terminally ill, these patients need assurance that they are still wanted; they also need treatment for depression.

Most of the indignity of which patients justifiably complain is associated with futile medical treatments. Doctors are learning to forego such treatment although patients are only beginning to learn that they can refuse them. On the other hand patients are also afraid of being abandoned by their doctors while they are dying. There is basis for these fears since only in the past decade have we begun to educate physicians that caring for patients they can not cure is an integral part of medicine.

There are patients who find it hard to be dependent on others. Yet serious illness usually requires this. Dependency is hardest for patients when their families do not want that responsibility. A change in family attitudes, however, can modify the outcome in cases where patients wish to die. A 1989 Swedish study showed that when chronically ill patients attempted suicide, their overburdened families often did not want them resuscitated. But when social services stepped in and relieved the family's burden by sending in home care helpers, most patients wanted to live and their families wanted them to live, too.

Awareness of the dangers of physician-assisted suicide must be coupled with comparable awareness of the dangers of the unbridled use of life-prolonging medical technologies. It is now accepted practice—supported by the American Medical Association, the courts, and most churches—that patients need not be kept alive by invasive, artificial means, such as by feeding tubes.

Public Opinion on Physician-Assisted Suicide

Many people have seen others suffer terribly while dying. When asked, "Are you in favor of euthanasia?" most people reply "yes," meaning that they would prefer painless death over suffering. But when asked, "If terminally ill, would you rather treatment make you comfortable, or have your life ended by a physician?" their responses might be different.

People confuse their support for the right to refuse medical treatment—a right supported by law and by civil and religious leaders—with support for the right to die by assisted suicide or euthanasia. The more people know about the care of people who are terminally ill and the pros and cons of legalizing euthanasia, the less they support legalization. Yet the public is still grossly misinformed. A recent poll indicates that only 61 percent of people are aware that under current law, patients may refuse any and all unwanted treatments. Ten percent of the population believe that the law requires a patient to accept whatever treatment a doctor wants to provide....

A More Humane Option

Patients who request assisted suicide or euthanasia are usually asking in the strongest way they know for mental and physical relief from suffering. When that request is made to a caring, sensitive, and knowledgeable physician who can address their fear, relieve their suffering, and assure them that he or she will remain with them to the end, most patients no longer want to die and are grateful for the time remaining to them.
Euthanasia advocates have come to see suicide as a cure for disease and a way of appropriating death's power over the human capacity for control. In the process, they have derailed constructive efforts to better manage the final phase of life. Our social policy must be based on a larger and more positive concern for people who are terminally ill. It must reflect an expanded determination to relieve their physical pain, to discover the nature of their fears, and to diminish suffering by giving affirmation to the life that has been lived and still goes on.