Ask the Bioethicist

Physician-assisted suicide

Question: Do you believe there are any situations in which physician-assisted suicide — deliberately helping to kill a patient (as opposed to vigorously relieving suffering) — is justified?

By David Magnus, PhD

Until we fix the underlying problems that lead people to pursue suicide and until we provide access to health care to everyone, the risks for abuse outweigh the benefits.

Here’s a look at a few of the biggest risks: In a society where not everyone has access to health-care insurance, patients might feel pressure to end their lives to ease their families’ financial and care-giving burdens. This is a good reason to provide better health coverage for everyone, not a reason to end a life. In addition, many physicians ask themselves, how would actively assisting in a patient’s suicide affect physicians as individuals, and how will society view the profession if it becomes common?

So, when a patient asks for help in ending his or her life, ask not whether it is ever ethical to help — ask yourself why the patient is asking. Many patients and families are in situations where the normal goal of medicine, attempting to prolong life, no longer makes sense. Trying to help them live longer just prolongs suffering. In these cases we often shift our goal to comfort care. We hope to make patients as comfortable as possible as they face the end of life. In these cases, we typically offer medicine to make them comfortable, but not to help them live longer — even if we could.

What would make someone want to move beyond comfort care, waiting for her condition to kill her, to actively end her life? Some patients are depressed (often with good reason). Some are afraid of losing control of their lives. Others fear dependence on strangers and machines. Above all, people want to avoid suffering without dignity or control or hope.

Usually these patients will die on their own if we stop aggressive treatment. But not always. Many proponents of physician-assisted suicide see something incoherent in the fact that we will allow these patients to refuse simple life-saving treatments, such as a dose of antibiotics, but draw a line at taking active steps to help them end their lives. Proponents also argue that providing patients with the power to end their life at a time of their own choosing provides a rare and precious sense of control that can be more important than actually ending their suffering.

These are persuasive arguments. But in our social context they’re insufficient. Physician-assisted suicide isn’t the answer — improving the practice of medicine is. There is no reason for patients to be in pain. We need better palliative, “comfort,” care throughout the country. We need adequate counseling to deal with depression. We need to place patients into hospice care much sooner than we currently do. And we need to provide more equitable access to these health-care services. If we provide better care and earlier referral to hospice care, suicide will no longer be a desired option for the vast majority of patients.

David Magnus, PhD, co-directs the Stanford Center for Biomedical Ethics. Send your questions to or Ask the Bioethicist, Stanford Center for Biomedical Ethics, 701 Welch Road, Suite 1105, Palo Alto, CA 94304, and include an e-mail address or phone number.

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