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Jeff Jacoby

What about do no harm?

Suicide is not health care, and prescribing death is not a doctor’s role

ISTOCKPHOTO/H. HOPP-BRUCE/GLOBE STAFF

If Hippocrates, the “father of Western medicine,” were alive today, would he favor Question 2, the Massachusetts ballot initiative to authorize doctor-prescribed suicide?

Presumably not: The celebrated code of medical ethics that bears his name, which physicians for centuries took an oath to uphold, flatly forbids assisted suicide. “I will not give a lethal drug to anyone if I am asked,” the Hippocratic oath avows, “nor will I advise such a plan.”

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Some things never change, and one of them is the beguiling idea that doctors should be able to help patients kill themselves when incurable disease makes their lives unbearable. The advocates of Question 2 speak feelingly of the anguish of the terminally ill, suffering from awful symptoms that will only grow worse, and desperate to avoid the agonies to come. Not all of those agonies involve physical pain: Even worse for many people is the loss of autonomy, the mortifying collapse of bowel and bladder control, the intense unwillingness to be a burden to others, the existential despair of just waiting for death.

Question 2’s supporters call their proposal the “Death with Dignity Act.” As a matter of compassion and respect, they argue, we should allow dying patients to choose an early death when they decide their suffering is more than they can endure. “People have control over their lives,” says Dr. Marcia Angell, the former editor of the New England Journal of Medicine and lead petitioner of the Massachusetts ballot measure. “They ought to have control over their deaths.”

There is nothing new about this contention. The claim that assisted suicide can be an appropriate aspect of patient care, especially when the alternative is drawn-out misery inexorably ending in death, has been made since antiquity. Hippocrates heard the arguments too; then as now they exerted an undeniable emotional pull. There is a reason the Hippocratic oath obliged new doctors to stand firm against it.

Civilized societies do not encourage people to commit suicide, or seek ways to make it easier for them to do so. Individuals may choose, out of pain or heartache or hopelessness, to end their lives; tragically, thousands of Americans do so every year. But “tragically” is the operative word. A libertarian purist might insist that human beings have the right to dispose of their lives as they see fit. That doesn’t change the fundamental principle that life is precious and suicide is a tragedy.

Only a moral cretin yells “Jump!” to the man on the high bridge who wants to end it all. No matter how compelling and genuinely desperate that man’s reasons are — even if he is suffering from an incurable disease, with just months to live and only physical pain, nausea, and the loss of bodily control awaiting him — we don’t seek ways to facilitate his suicide. On the contrary, we seek ways to avert it. “High bridges often have signs encouraging troubled individuals to seek help rather than jump,” writes Greg Pfundstein in an essay at Public Discourse, the Witherspoon Institute’s online journal. “Suicide hotlines are open 24 hours a day because we hope to prevent as many suicides as possible.”

Question 2 would turn that premise inside out. Massachusetts voters aren’t just being asked to authorize doctors to prescribe fatal drugs for the terminally ill. They are being asked to endorse a view that our ethical culture at its best has always abhorred: that certain lives aren’t worth living. That there are times when people should jump — indeed, that there is nothing wrong with making it easier for them to do so.

Question 2’s provisions are highly arbitrary, as even its proponents acknowledge. It allows only one kind of suicide to be prescribed: drugs that can be swallowed, but not a lethal injection — let alone a bullet or a noose. It requires a prognosis of no more than six months to live. It is available only to patients who can both speak and write — thereby excluding, for instance, a paralyzed victim of Lou Gehrig’s disease.

Why such capricious line-drawing? Because, says Angell, that is the only way to make assisted suicide “politically acceptable.” Her candor is admirable. But it doesn’t extend to Question 2, which provides that death certificates for patients who commit doctor-prescribed suicide will falsely list the underlying disease as the cause of death.

Suicide is not health care, and prescribing death is no role for a doctor. Hippocrates would reject Question 2. Massachusetts voters should too.

Jeff Jacoby can be reached at jacoby@globe.com. Follow him on Twitter @Jeff_Jacoby.
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