Letter to the Editor
To the San Diego Physician Editorial Board
[Re: the September 2006 edition of the San Diego Physician’s lead articles about physician-assisted suicide] Unlike Dr. Liner of San Francisco, we are delighted that the California Compassionate Choices Act died in the Senate Judiciary Committee. There is plenty wrong with AB 651. If indeed the bill requires a patient to be “competent adults”, patients wanting to commit suicide are by definition, not mentally, emotionally, psychologically, or morally competent. Suicide is choosing to kill oneself. To assist someone to commit suicide is to support the ultimate pathological delusion.
“Terminal sedation” used in palliative care is compassionate and certainly not “clandestine and unregulated.” The “double effect” in terminal sedation is not a “dilemma” when the dying process is from the underlying cause of death, and not the sedation. There is no “risk of a criminal act” when palliative care is given; whereas, deliberately prescribing a lethal dose in PAS (physician-assisted suicide) is, for certain, criminal. (See the American Medical Association (AMA) website statement on Medical Futility in End-of-Life Care, Section E-2.037 and Quality of Life, Section E-2.17.)
Additional considerations are the following documented by the American Psychiatric Association (APA):
Section 1-C
Question: Can an ethical psychiatrist participate in the legal execution of a prisoner by injecting a lethal dose of a sedative?
Answer: Section 1 (AMA) says: A physician shall be dedicated to providing competent medical service with
compassion and respect for human dignity.
Section 1, Annotation 4 (APA) states:
A psychiatrist should not be a participant in a legally authorized execution. One could argue that death by injection of a sedative is more compassionate and more dignified than death by gas chamber, firing squad, or the executioner's noose. Nevertheless, the overriding meaning of this principle is that the physician-psychiatrist is a healer, not a killer, no matter how well purposed the killing may be. (See Opinion 2.06, AMA Council Opinions, 2000-2001.) (July 1977)
Consider also the AMA policy on Capital Punishment (Section E-2.06) which also supports the position of the psychiatrists.
We physicians are here to heal, comfort, educate, support, and give compassionate care. We are not here to harm, as clearly stated in Dr. Herbst’s informative essay. We are certainly not gods to decide who lives and who dies. And we should never assist anyone in harming or killing himself/herself. We believe that life is to be treasured. We believe in not prolonging life when care is futile, honoring patients’ advance directives. We believe that the doctor-patient relationship is privileged and based on trust. We must not forfeit that trust.
If AB 651 “specifically prohibits euthanasia”, just try to explain the difference in principle between actively killing someone versus actively helping someone kill himself/herself. Really caring means going beyond just accepting a patient’s choice and request to do harm to himself/herself; it means exploring life-saving options that may include psychiatric intervention, adequate pain management, community resource referrals, spiritual help, pastoral consultation, family counseling, palliative care, hospice involvement, and compassionate end-of-life care. (See the AMA definition of Euthanasia (Section E-2.21) and PAS (Section -2.211).)
We strongly urge the CMA to hold its position against PAS. Don’t weaken. Don’t be neutral. Being neutral is how Oregon and its physicians lost the battle to oppose PAS.
Respectfully,
Eva Leonard, MD
Joseph F. Leonard, MD