A debate on physician-assisted suicide.

Abstract

Dr. Hartmann: This debate is a small part of a large continuing American and international debate on physician-assisted suicide. I will argue that physician-assisted suicide should be legal, and Dr. Meyerson will argue that it should not. The state of Oregon now has a law called the Death With Dignity Act. It narrowly passed by referendum in 1994 with 51 percent of the vote and was then put on hold by legal challenges until October 14, 1997, when the U.S. Supreme Court removed the final legal obstacle to its becoming law. Energetic opponents attempted to repeal the law in a referendum in November 1997, but it was upheld by a vote of about three to two. Under the Oregon law, a mentally competent adult suffering from a terminal illness likely to result in death within six months may choose to receive a lethal dose of medication, after consulting with two doctors and waiting 15 days. I favor that law and others like it. Good values clash with good values in the area of physician-assisted suicide. People often hold on to some of these values with firm feeling and long-standing conviction— feeling and conviction not always fully reasoned or reasonable, and certainly not always stemming from advanced education and training. Part of our possible usefulness today in considering this area, as both citizens and psychiatrists or mental health colleagues, is not just to look at specific and legitimate psychiatric areas of special interest in physician-assisted suicide, such as, “Is the wish to die always a symptom of mental illness?” Part of our potential usefulness is also at what is probably a more general and preliminary level: to acknowledge and identify some psychological obstacles to discussion and to help clear some ground so that these emotion-laden areas can be open for reasonable discussion, as opposed to mere intellectual decoration on the surface of deeply held positions. Laws simply criminalizing physician-assisted suicide do not help clear such ground. Rather, the reverse. They do affect practice, powerfully if always imperfectly, but they also foster passionate premature closure rather than reasonable discussion, acknowledgment of complexity, learning, and evolution of varieties of decent, balanced, and caring solutions. Let me cite an issue that, at least temporarily, displaced physician-assisted suicide as a topic of medicalethical debate in 1997: cloning. A member of the medical-ethical panel immediately set up to deal with what to do about cloning said of the panel’s discussions, “Logic was air-tight, but it did not change anyone’s mind. . . . Logical arguments [were] only rationalizations for gut feelings or religious viewpoints” (1). So let us be a bit modest about the power of this debate. In physician-assisted suicide, there are many obstacles to real discussion, including people’s general reluctance to get anywhere near making any exceptions to “thou shalt not kill.” However, one large obstacle to discussion of physician-assisted suicide is that people have deep wishes not to be in conflict, to have one simple, clear guiding philosophy or value or commandment or model that will settle difficult dilemmas for us. We wish for the security and beauty of simplicity. We human beings— including physicians and Supreme Court judges— are, on the whole, uncomfortable with what is not perfectly resolved and with the idea that some conflicts are not wholly resolvable— that some of our own powerful values necessarily and inevitably clash with other of our own powerful values. Moreover, we are often uncomfortable even with acknowledging that this discomfort or conflict exists, so we tend to deny that there are major philosophical as well as emotional conflicts, and to deny that we often wish away conflicts by leaning unreasonably on authority and what seem to be familiar or simplifying solutions. At a level that I think is always in conflict with our most adult selves, we all Editor’s note: As part of the ongoing discussion at many levels of our society about physician-assisted suicide, a debate was held at the October 1997 Institute on Psychiatric Services in Washington, D.C. Dr. Hartmann argued in favor of physician-assisted suicide, and Dr. Meyerson argued in opposition. Alan A. Stone, M.D., was the moderator. This article presents the opening statements of the two debaters, slightly edited and updated to reflect subsequent developments.