Assisted Suicide: Who Should Assist? Should It Be Done?

Should there be laws in the United States that permit assisted suicide? Well, in a recent posting elsewhere, I expressed my views against physician participation and wrote: "I think that assisted suicide, if it is to be accepted by all states be accomplished by trained and certified technicians with legal access to specific death drugs. No physician participation should be involved except for diagnosis and prognosis."

Bob Koepp read that comment and wrote me the following:

I think all we know about human nature suggests that "certified technicians" who specialize in killing will demonstrate considerably less reticence about exercising their "craft" than would ordinary citizens in intimate relationships with those seeking death. Most friends and family members who are asked for such assistance try very hard to dissuade the "seekers."

IF the "seeker" was motivated by concerns related to medical questions, consulting a physician would be appropriate. But I think that people might have sound reasons for seeking death that are not medical in nature, which would not be reflected in a physician's diagnosis and prognosis.

I responded with:

What if there were regulatory laws as currently in Oregon by which the two physicians would have to screen the patient for depression and also to provide the technician (and patient of course) with a dx and prognosis and suggest any approaches to the symptoms without need for suicide. Finally, if all the I's are dotted and T's crossed, it would be up to the technician to make the final decision as to whether to grant the patient's request for assisted suicide. The main point here is that the final decision for prescribing the patient the deadly pills would not be up to the physician but up to the tech who will know and obey the law. ..Maurice.

And Bob responded with:


Someone should conduct the following experiment (please excuse the deception -- it's necessary). Take two groups of randomly selected physicians. Those in Group A are approached by patients who say they want to kill themselves, but don't ask for any assistance. Those in Group B are approached by patients who also say they want to kill themselves, but do ask for assistance. How do the physicians respond to these different patients?

Quite apart from such an experiment, I don't think physicians are all that good at diagnosis and prognosis, and setting them up as gatekeepers to "legitimate" assisted suicide invites problems. Physicians no less than the rest of us are prone to letting their prejudices influence their judgments. A physician who believes strongly in the "rightness" or the "wrongness" of assisted suicide will be inclined to interpret signs and symptoms in a way that comports with his/her prior convictions. Word gets out about which physicians are more likely than others to support requests for assisted suicide, and it is to these physicians that people seeking such assistance will turn. Where's the objectivity in such a system?

I understand and share your concern with preventing suicides, the vast majority of which seem to me to reflect serious depression or desperation born of ignorance about viable alternative courses of action. Only a very few suicides seem to me to be likely candidates for classification as "rational suicide," and only a few of these few involve any sort of request for assistance. And then, as I mentioned in my previous message, even among these "few of the few," those approached for assistance are often unwilling to provide such assistance, even though the person making the request might have good reasons for wanting to die.

I would actually go further, and suggest that the mere fact that a would be suicide seeks material assistance should often be interpreted as a call for help of a different sort, since it is very rare indeed that such assistance is actually necessary to the performace of the deed. For how many of the suicides so far "assisted" in Oregon, the Netherlands, Belgium, Switzerland... was the person actually incapable of killing him/herself? How many people, whether or not they actually _needed_ assistance, when once supplied with effective means to end their lives have then not put them to their "intended" use? With respect to those who don't use the means provided, I think the natural conclusion is that they didn't want to kill themselves so much as they wanted to feel some sense of control. Did the physicians who screened them misdiagnose?

In short, I think there are very, very few cases where assisting in a suicide could withstand critical scrutiny. But in recognition of those very, very few cases, I think assisted suicide should be decriminalized.

Creating a new body of law to "legalize" and "regulate" the "practice" of assisted suicide, provides a patina of respectability to "following the rules" in an area that probably is beyond the reach of general rules. And I persist in my belief that when we explicitly recognize a separate class of "workers" with a special "expertise," those workers become _more_ inclined than the rest of us to engage in the activity in question, and _less_ reflective and _less_ critical of their own actions. Rather than regulating assisted suicide, I think every purported assisted suicide should be critically scrutinized for any evidence that those providing assistance have negligently endangered another's welfare, or worse, have intentionally acted contrary to the interests of another. We already have laws against such behavior, whether it involves suicide or other activities.

Bob Koepp

I would like to read what other visitors think about assisting a suicide attempt either in the context of a suffering patient or in any other situation. Specifically, should any assistance be necessary? As Bob noted: “I would actually go further, and suggest that the mere fact that a would be suicide seeks material assistance should often be interpreted as a call for help of a different sort, since it is very rare indeed that such assistance is actually necessary to the performance of the deed.” Well, except for a quadriplegic who wanted to die, I suppose that is true. Anyway, what do you think? ..Maurice.