Deadly Business: MDs Report Experience With Assisted Suicide
But Johanna H. Groenenwoud, MD, and colleagues from the Netherlands -- where
both physician-assisted suicide and euthanasia are allowed under strictly
controlled circumstances -- report that plans for a peaceful assisted suicide
can sometimes go awry, and physicians may have to step in to ensure that
patients do not suffer.
In a study of more than 100 cases of intended assisted suicide and more than
500 cases of euthanasia, complications included a longer than expected time to
death and failure to induce coma. In 7% of suicides, patients awakened from
their comas. This happened in 16% of euthanasia cases.
Technical complications included difficulty in finding a vein for lethal
injection of medication, trouble swallowing pills or vomiting them up once they
had been swallowed, or loss of consciousness before the drug could be
administered. In 18% of cases where the physician's intent was to help the
patient with suicide, the doctor felt it necessary to intervene by
administering a lethal drug, either because of problems with completion or
because the patient was unable to take medication.
The studies pick a tentative and delicate path through the minefield that
lies between the camps of right-to-die extremists such as Jack Kevorkian on one
flank and right-to-life zealots on the other, says Sherwin B. Nuland, MD,
clinical professor of surgery at Yale University School of Medicine. Nuland
wrote an editorial accompanying the studies.
"Opponents of physician-assisted suicide will look at these
complications as evidence to support their viewpoint, and they are justified in
doing so. But those who believe that in certain, carefully controlled
situations, providing assistance with suicide is an ethical responsibility
should see the findings in an entirely different light," Nuland writes.
He says that physicians must decide for themselves if, when, and how they
should help dying patients find relief from unrelenting suffering, and that
those who choose to take concrete steps must do everything in their power to
ensure as peaceful and untroubled a death as possible.
"You have to remember that there will probably be a relatively small
proportion of physicians whose conscience allows them to participate in
[physician-assisted suicide and euthanasia]," Nuland tells WebMD. "But
I think for those people there should be training, and I think the natural
trainers are anesthesiologists and clinical pharmacologists." He emphasizes
that training in physician-assisted suicide should be readily available but
totally voluntary, and it should not be part of the standard medical school
A medical ethicist who was not involved in the studies but supports
protection of private decisions between dying patients and their doctors tells
WebMD that our society is not ready to publicly support either
physician-assisted suicide or euthanasia.
"Doctors have a legal, moral, and ethical obligation to keep their
patients out of pain, and if that involves giving them lethal prescriptions and
risking that [patients] take them to kill themselves, that's perfectly fine.
Even the U.S. Supreme Court says that's fine," says George J. Annas, JD,
MPH, an Edward R. Utley professor, chairman of the health law department at
Boston University School of Public Health, and a professor in the Boston
University schools of Medicine and Law. "If you've got to kill your patient
to keep them out of pain -- as long as you don't intend to kill them but intend
to keep them out of pain -- that's the practice of medicine."