Opinion

Why American doctors need to hold the line on physician-assisted suicide

Physician-assisted dying is a deeply divisive issue in the medical community. Photo courtesy of Creative Commons

(RNS) — The American Medical Association’s official opposition to physician-assisted suicide is admirable and clear: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

The AMA currently insists, in other words, that health care providers focus on killing the pain, not the patient.

But in June, at their annual meeting in Chicago, the AMA’s House of Delegates voted to continue to review the policy, with assisted-suicide supporters arguing for the group to take a neutral stance. In a move last month that was called “startling” by the president of the Catholic Medical Association, the American Association of Family Physicians — whose New York chapter already supports the practice — changed its official position on physician-assisted suicide from opposed to neutral.

Then, this week at the AMA House of Delegates’ interim meeting, the discussion over assisted suicide was so vociferous that it “could split the association,” reports say. The debate was so divisive that delegates, while at least temporarily leaving the current opposition to physician-assisted suicide intact, were forced to yet again refer the discussion back to committee, thus setting up an even more disruptive battle for next summer’s meeting.

The trend has been running in this direction for several years. Eight U.S. states have now passed laws permitting physician-assisted suicide, and a younger group of resident physicians appears ready to abandon the wisdom of nearly every professional code of medical ethics going back to the Hippocratic oath.

The intense debate on this issue touches the very foundations of the profession. What counts as health care? What does it mean to be a professional physician? Should eminent medical organizations bend their views to provide access to what a handful of states have legalized? What do patients have a right to demand of medical teams?

Much of the opposition to physician-assisted suicide comes from religious health care providers. A huge number of Catholic hospitals and clinics see their religious vocation and mission as totally incompatible with killing. They are committed to nonviolent health care that models the love of a God-man who commanded Christians to see his face in the sick.

It is anything but surprising, then, that professional groups such as the Catholic Medical Association, Ascension Health and the Christian Medical and Dental Associations did their best to activate their members against changes in the AMA’s view.

But as the AMA’s current code demonstrates so well, opposition to physician-assisted suicide need not be explicitly religious.

A patient receives medication. Photo via Shutterstock

Many of us are sympathetic to end-of-life cases where someone is wracked with terrible pain. According to Oregon’s public health department data, however, physical pain doesn’t make even the top five reasons people request physician-assisted suicide:

  1. Loss of autonomy (91.4 percent)
  2. Decreased ability to engage in enjoyable activities (86.7 percent)
  3. Loss of dignity (71.4 percent)
  4. Loss of control of bodily functions (49.5 percent)
  5. Becoming a burden on others (40 percent)

A study of Canadian practices found something similar. People who requested relief “tended to be white and relatively affluent and indicated that loss of autonomy was the primary reason for their request. Other common reasons included the wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life.”

It is no surprise that, unmoored from a Hippocratic understanding of health care, younger physicians would support assisted suicide. Like other privileged populations, they disproportionately consider the loss of autonomy and bodily function — along with becoming a burden on others — to make life so undignified as to be unlivable.

Disability rights groups such as Not Dead Yet are leading efforts to educate people to see how legal assisted suicide affects the value of the lives of the disabled. Indeed, disability rights groups have been the most effective opponents of the practice worldwide.

Sick and disabled people despairing of life in an ableist, consumerist, youth-worshiping consumer culture are already made to think they don’t matter — that they are “takers rather than makers.” Paving the way for them to kill themselves is diabolical. We should instead provide nonviolent physical and mental health care and attempt to become a culture that welcomes rather than discards our most vulnerable.

Traditionally marginalized groups tend to understand this better than privileged populations. The overwhelming majority of those who request physician-assisted suicide are white — 96 percent in Oregon.

Overall, 53 percent of whites support legal physician-assisted suicide, compared with only 32 percent of Latinos and 29 percent of African-Americans, according to Pew Research.

More study needs to be done, but it is likely that racial minorities’ well-placed distrust of the medical community plays a significant role. Georgetown Law professor Patricia King argues that racial minorities have a justified fear of becoming “throwaway people” in medical contexts.

But law shapes culture for us all, and physician-assisted suicide is bound to shape culture in ways that are not good for the most vulnerable. Countries like the Netherlands and Belgium began with strict limits on assisted suicide, but uncritical respect for patient autonomy now has legalized it for patients who are not dying, including those who have mental illness. Even for children.

Physicians have a professional obligation to uphold an objective standard of what counts as health care. The AMA has refused to blindly support multiple procedures that have been legalized by U.S. states. The organization has insisted, for instance, that physicians must not participate in the death penalty.

So it should remain with physician-assisted suicide. Physicians are not Burger King cashiers from whom you “have it your way.” The professional practice of medicine requires a coherent and nonviolent commitment to patients’ health, one that bears with them in ways that refuse to conclude anything other than it is good they exist.

(Charles C. Camosy is associate professor of theological and social ethics at Fordham University. A board member of Democrats for Life, he is author of Too Expensive to Treat? Finitude, Tragedy, and the Neonatal ICU. The views expressed in this commentary do not necessarily represent those of Religion News Service.)

About the author

Charles C. Camosy

Charlie Camosy, though a native of very rural Wisconsin, has spent more than the last decade as a professor of theological and social ethics at Fordham University. He is the author of five books, including, most recently, "Resisting Throwaway Culture." He is the father of four children, three of whom were adopted from the Philippines.

58 Comments

Click here to post a comment

  • Dr. Camosy is advocating a position for the American Medical Assocation to consider rather than attempting to manage other people’s lives.

  • Which really is not relevant to what Dr. Camosy advocates.

    He wrote nothing about you choosing to end your own life.

  • Dr. Camosy is advocating a position for the American Medical Assocation to consider rather than attempting to manage other people’s lives… himself.
    FIFY.

  • Dr. Charles C. Camosy is an associate professor of theological and social ethics at Fordham University, a board member of Democrats for Life, a published author on ethical issues, particularly healthcare:

    http://www.charlescamosy.com/healthcare

    If you actually read the article he does not take a position on whether YOU or any other particular person should choose to kill him or herself.

    What he suggests is that is incompatible with medical profession to assist in suicides.

    If you are a physician, and a member of the American Medical Assocation, you will have your chance to have your own voice heard.

    If you are not, it would probably behoove you to stop attempting to manage other people’s lives, in this case Dr. Camosy’s.

  • He is attempting to restrict the ability of other people to make their own choices. In this case he wants to restrict physicians from making their own choice about whether they should assist in a suicide. And by doing that, he is attempting to manage the life of the person who seeks assisted suicide – by making it impossible for a physician to say “yes.” Yes, there will be physicians who will abuse this, assist in a situation someone else would refuse that assistance. But Camosy’s gives no quarter for a situation when a physician really does think it would be the right thing to do.

    I think Camosy makes some important points that we need to really think about enhancing the life of people with disabilities.
    And he makes an important point about helping those despairing of life, who no longer find joy in life or a reason to live.

    But it is charity that does that and not communities supporting it with their time, their dollars. We don’t have that culture. Those who need the help don’t get it. Do we just let them suffer as the example of what we should be doing – for how long, how many? Do you really see a majority of people in the U.S. voting for care homes for the desperately ill, paying for doctors, nurses, care givers? Do you see thousands of people volunteering to visit the sick, the old, those in need? Have you or Camosy given your last dollar and the dedication of your free time to visiting those in despair?

    I fear physician assisted suicide being misused. But I also fear it not being available when it may be truly needed. I want physicians to be able to make their own decision. Camosy can help finance some “how to make moral choices in impossible situations” seminars for doctors and for those who seek assisted suicide from them. Include the family and friends of the person seeking suicide. Put it down to the people who are affected and can act in the particular situation.

  • “He is attempting to restrict the ability of other people to make their own choices.”

    Absolutely NOT.

    He writes nothing about you, Ben, or Ms. Humphreys choosing to off yourselves.

    “In this case he wants to restrict physicians from making their own choice about whether they should assist in a suicide.”

    Of course not.

    In states where physician-assisted suicide is in place – Oregon for example – some physicians are in fact assisting suicides.

    He restricted himself to commenting on what the official position of the American Medical Association should be.

    “And by doing that, he is attempting to manage the life of the person who seeks assisted suicide – by making it impossible for a physician to say ‘yes.’”

    Since they are saying “yes” currently, that obviously is untrue.

    What YOU’RE trying to do is manage the life of a qualified ethical commenter and pundit by telling him what he may or may not advocate.

    “I think Camosy makes some important points that we need to really think about enhancing the life of people with disabilities.”

    Some people in the Netherlands have had “Do NOT kill me” tattooed prominently on their bodies so that some physician does not take upon her or himself to execute them.

    “Those who need the help don’t get it.”

    The topic, btw, is physician-assisted suicide.

  • A few comments:
    1) I think the main issue is that doctors are charged with preserving life. If they get to the point of taking life; they are no longer doctors but executioners. If people want someone to terminate their life; fine; just don’t call them doctors.
    2) I don’t agree with assisted suicide; but I can understand why someone would go that route as I have seen what cancer does to people.
    3) in my state, if one needs long-term care and doesn’t have a policy from an insurance company, the state takes their assets and they essentially live out their lives on the taxpayers dime ( healthcare and room provided). So, you are incorrect to ask if mark et. al. Is going to have the decency to pay to keep the infirm alive; he already is.

  • Much, much worse, yet more interesting to me, than the “physician-assisted suicide” pioneered by the “white and relatively affluent”, is the “Physician-[betraying] suicide” pioneered by Judas:

    For “when Judas, who had betrayed [Jesus the Physician], saw that He had been condemned, he felt remorse … threw the pieces of silver into the temple sanctuary and departed; and he went away and hanged himself.”

    What’s up (dangling) with that, ‘yo?

    Source: Matthew 27:3, 5.

  • Like the Catholic Church’s teaching on birth control, physicians will eventually ignore the AMA’s rule in huge numbers (if they keep it). People and doctor’s already do what they have to do in many cases – it’s just done under the table in the states where it’s not legal yet. Most people don’t want to be kept alive for decades hooked up to every machine imaginable with no hope of recovery. Nor do most people want to suffer for years on end in intractable never-ending pain. If their physician won’t help them, people will find one that will. There’s the unbending ideology of the author of this article, and then there’s the reality that people and physicians deal with every day in hospital rooms and doctor’s offices all across this country (and around the world).

  • Really lousy logic here. He is not writing directly to or about me right now but what he advocates as the “rule” could impact me or someone i love in the future. The AMA’s position right now is “we are studying it” but if they come out with a position in opposition to it, that could affect a willingness of doctors to do it or continue doing it. I am not sure if the AMA taking a position could also mean sanctions could be imposed or some action could be taken by the AMA that would affect the doctors ability to continue to practice medicine. So, yes, if the AMA comes out condemning it that could impact the freedom of physicians to make a decision based on the merits of a particular case and conditions of John Smith or Mary Doe who comes to him for help.

    While we worry about the person who may be wrongly allowed to commit suicide with the help of a physician, we are not talking about real cases where assistance in dying is a gift that ends a torment being experienced by a real person. I don’t like that willingness to spend the pain of one person to spare a mistake being made to another person. Believe in torture, do you? You may volunteer to spend your own pain to make a point but what gives you the right to require the pain of another?

    I am not trying to limit what Camosy or any other pundit may argue but to present another side, different points to be considered, and point out consequences not considered in the argument Camosy puts forward.

  • Ben evidently misses that his own comment is an attempt to manage someone else’s life, namely Mr. Camosy’s.

  • Really lousy logic there.

    The very first sentence in the article is:

    “The American Medical Association’s official opposition to physician-assisted suicide is admirable and clear: ‘Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.’”

    so you are in error asserting the AMA’s position right now is “we are studying it”, and since despite that opposition physicians in states where it is legal are doing it, we know that the willingness of sufficient doctors to do it or continue doing it is unimpaired.

    If you wish to put a pistol under your chin and pull the trigger, the AMA’s opinion is of no effect either.

    His point is that suicide is NOT a medical treatment, and that what’s left of the Hippocratic Oath after the legalization of abortion is worth preserving.

  • The Catholic Church, of course, really has nothing to do with it.

    Yes, it opposes suicide – period. But it is hardly alone in that.

    And when it was founded the entire world was ignoring its teaching.

    And the majority have continued to do so on a variety of matters in a variety of conditions and a variety of circumstances.

    The point of the article is that the AMA should not gut the Hippocratic Oath.

    No one will stop you if you want to put a double-barreled shotgun in your mouth and decorate the ceiling with both barrels.

    However, a physician’s finger should not be on the trigger.

  • Sadly, this is coming to a state and town near you. The financial burden of caring for the sick elderly is astronomic. The evil big brother state will ultimately encourage early death just to manage the burden of Medicare and Medicaid. If the sickest are killed off there will be more resources for those who have a good chance at recovery and productive lives. Culture and society may force compliance as it is best for the state to have healthy working people. Sound’s eerily similar to China.

  • The culture of death, never gives up. Let’s hope the people of faith (and even some ethical Nones), likewise refuse to quit.

  • Indeed.

    Some seem to believe it’s just a really big aspirin:

    https://disqus.com/home/discussion/religionnews/american_doctors_vote_to_keep_their_opposition_to_assisted_suicidefor_now/#comment-4199238148

    “While we worry about the person who may be wrongly allowed to commit suicide with the help of a physician, we are not talking about real cases where assistance in dying is a gift that ends a torment being experienced by a real person. I don’t like that willingness to spend the pain of one person to spare a mistake being made to another person. Believe in torture, do you? You may volunteer to spend your own pain to make a point but what gives you the right to require the pain of another?”

    There’s a reason why people in the Netherlands have taken to having “Do Not Kill Me” tattooed prominently on their body or on a stainless steel tag on a wrist band or chain.

  • SING WITH ME. And a 1, and a 2 …

    Don’t try suicide
    Nobody’s worth it
    Don’t try suicide
    Nobody cares
    Don’t try suicide
    You’re just gonna hate it
    Don’t try suicide
    Nobody gives a d*mn
    You need help
    Look at yourself you need help
    You need life
    – QUEEN

    I don’t wanna suicide,
    I don’t want this to end
    I just wanna be your friend
    – GREEN DAY

    So long suicide
    Gone right out of sight, out of mind.
    Leaving me alone and abandoned
    Hello I’m alive
    I’m loaded alive and I know
    In my bones I know what I’m good for
    – DURAN DURAN

    Let us give our lives for the liberation
    And salvation of the black nation
    No longer dead, deaf, dumb and blind out of our mind!
    Brain-washed with the white men’s mind
    No more homicide!
    No more fratricide!
    No more suicide, infanticide and, genocide!
    – ICE CUBE

  • You make an excellent point about restricting choices. Is camosy concerned about doctors making choices he doesn’t approve of, or about ANYONE making choices he doesn’t approve, and making it as difficult, expensive, unpleasant, and potentially dangerous as he can— dangerous in the sense that a botched suicide may be worse for the survivor than death.

    Here’s an idea that might determine where camisy’s real intemtions lie. Let’s take this out of the hands of doctors, and put it all in the hands of private companies. Same criteria must be met, and legally defined. Private enterprise ought to be able to solve the problem.

  • Hear, hear.

    (“Decorate the ceiling”, though, is a bit PG-13 for me. Made me look up just now at my Art Deco high ceiling.)

  • “Ethical Nones”? What’s that, kinda like a collapsing bridge over The Blue Tsunami between Pat and Hetic?

    “Culture of Death”, though, is a poignant literary keeper, phrasing-wise. Kudos!

  • You didn’t strike me as a fundamentalist.

    You have struck me as someone without good reading comprehension, but since your normal haunt is JoeMyGod, there is no surprise there.

  • I certainly hope that I remain one of the few who have had to view the results of a suicide. It does tend to stick with you.

  • “Is camosy concerned about doctors making choices he doesn’t approve of, or about ANYONE making choices he doesn’t approve, and making it as difficult, expensive, unpleasant, and potentially dangerous as he can— dangerous in the sense that a botched suicide may be worse for the survivor than death.”

    I would try reading the article.

    If that is too much for you or the content is too complex, I would write him at:

    camosy(AT)fordham(DOT)edu

    Do share any response you receive.

  • (Raising my hand) Oh oh oh and uh – No “Ethical Nones” in Foxholes! Right? Right?

    Love these Brainstorming Sessions Not on The “Silk” Roads, of ours!

  • Existentialism is more than mere existence. It is about having the freedom to act, to make choices, to think.

  • You don’t know your Existen[tialism]. So here let Wikipedia sort it for you: “The proposition that existence precedes essence (French: l’existence précède l’essence) is a central claim of existentialism, which reverses the traditional philosophical view that the essence (the nature) of a thing is more fundamental and immutable than its existence (the mere fact of its being).”

    ERGO: Existen[tialism] is all about “existence” – “the mere fact of its being” – hence, as you’ve phrased it derogatorily, “mere existence.” The prime thesis of Existen[tialism] is, in fact, and again to reuse your statement of denial, that “There is [really nothing] more … than mere existence.”

    AW SNAP.

  • Typical Camosy Catholic dogma cheer leading garbage where “concern for life” means ignoring lives and the personhood of others and forcing them to do as he commands.

    Treating others like property.

    Of course it would be nice if he supported life sustaining healthcare for all before worrying about end of life care

  • “The evil big brother state will ultimately encourage early death just to manage the burden of Medicare and Medicaid”

    We already have that with insurance corporations making such decisions based on their bottom line. The death panels Republicans talked about in fear mongering rhetoric against healthcare reform are the reality of their proposals.

    I would welcome government control there. At least they have an incentive to provide care besides profit margins. At least “Big Brother” government is answerable to voters needs.

    I have yet to see arguments against the way the rest of the developed world does healthcare which are rooted in reality.

  • Still another example of religious folks trying to control others. Maybe the time and effort spent opposing suicide can be better used preventing child abuse among the clergy. Think how many hundreds of millions of dollars in legal settlements might be saved. Is it any wonder that people are fleeing religious congregations?

  • Absolutely NOT an example, let alone another example, of “religious folks” trying to control others.

    In the instant case the very first sentence in the article is:

    “The American Medical Association’s official opposition to physician-assisted suicide is admirable and clear: ‘Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.’”

    The American Medical Association is not a religious organization, anymore than the authors of the Hippocratic oath were members of a religious organization.

    The author is a professor of ethics who writes on healthcare issues.

    He makes not a single religious argument.

    What I believe your comment represents is another datum in the conclusion that to every anti-religious individual, any suggestion that there should be limits of any kind on human behavior – unless that individual happens to like it for some reason – is “another example of religious folks trying to control others”.

  • The article doesn’t have anything to do with restricting the freedom to act, to make choices, or to think.

  • “He makes not a single religious argument.” Nonsense. The author teaches ethics for a religious institution. As Fordham explains, “a Jesuit education means living a life beyond self, helping to feed the hungry, clothe the poor, heal the sick. Service is a critical part of who we are – so much so that it’s built into our curricula.” https://www.fordham.edu/info/20089/faith_and_service

  • Oh, so if he works for Fordham University, he MUST be making a religious argument.

    Just skip what he wrote, eh?

    Speaking of course of Nonsense.

  • So you don’t believe that someone who teaches ethics at a religious school and has taken the time to form an organization to promote his views is in anyway influenced by religious belief? If that’s the case religious education is not doing a very good job.

  • Better reread your definition HpO . I wasn’t talking about essence of a person BUT the essence of existence!

  • I believe you applied your a priori anti-religious bias to an article where it did not apply.

    In addition in reading the article I see no evidence that the author is trying to control others.

    Who, precisely, is he trying to control?

    I always recommend reading the article before commenting.

  • Wow. Anyone who disagrees with you is “anti-religious.” I guess, then, that you think of yourself as representing organized religion or at least one small, narrow, segment of it.

  • No, anyone who wades in making unsupported claims of “religious folks” “controlling others” when there are zero religious claims in the article and zero controlling others in the article is anti-religious.

  • No Existentialist ever talks or argues like this that you do: “There is more to … mere existence. [Namely] the essence of existence!” No such phenomenon to them.

  • “The overwhelming majority of those who request physician-assisted suicide are white — 96 percent in Oregon.”

    So – the willingness to have a doctor kill you is the real “White Privilege?”

ADVERTISEMENTs