For patients suffering from terminal illnesses, the extent of pain and hospitalization can become unbearable. Some consider physician-assisted suicide to be an option of ending life comfortably, while others believe it contradicts the very nature of a physician’s humanitarian responsibilities.
Both sides discussed the issue at length at “Physician-Assisted Suicide or Physician-Aid in Dying?” hosted by Harvard Medical School’s Veritas Forum at Tosteson Medical Education Center Friday evening.
Veritas Forum discussions began at Harvard University “to facilitate deeper questions of meaning and purpose in life,” said Nathan Nakatsuka, a fifth year MD/PhD student at Harvard Medical School, who spearheaded the event.
The “Death with Dignity” bill, which supports medically-assisted suicide, returns to Massachusetts legislature in 2018. In 2012, a ballot question supporting the bill failed to pass with a 51 to 49 percent vote.
Nakatsuka said he wants people to “be informed on all levels, not only on political and clinical, but also on moral, philosophical and spiritual.”
Moderated by Dr. Alexandra Cist, M.D. at Massachusetts General Hospital, the event’s speakers included Dr. Daniel Sulmasy, a professor of biomedical ethics at Georgetown University and Dr. Lachlan Forrow, a professor of medicine at Harvard Medical School.
During the first hour, Forrow and Sulmasy presented the reasoning behind their stances on medically-assisted suicide. Forrow, who supports euthanasia, said physician-assisted suicide protects a patient’s autonomy.
“[Patient suicide] happens anyway … It’s just hidden and we don’t know whether it’s done with proper safeguards, making sure the patient knows all the options,” he said to the audience.
Forrow shared a clip with the audience of Brittany Maynard, a former California resident who relocated to Oregon after being diagnosed with terminal brain cancer to undergo physician assisted suicide.
“Once [Maynard] knew that [her illness] got to be too bad, she could and she ultimately did take the prescription that allowed her a sense of confidence and freedom,” Forrow said. “[She] was enjoying life with a vividness … right up to the end because she had this choice.”
Forrow closed with a question. “Was writing that prescription about death or was writing that prescription a profoundly pro-life thing that she did with her doctor?”
Sulmasy, who opposes euthanasia, disagrees with Forrow about the nature of patient autonomy.
“Autonomy is not absolute and it should never be absolute,” Sulmasy said during the talk.
When asked about this concept of patient autonomy, he said a patient’s self-determination in medical care doesn’t mean a patient has a right to demand certain treatments.
“There is certainly, in my view, no duty to provide sleeping pills just because the patient asked for them. I don’t think we should be practicing Michael Jackson medicine,” Sulmasy said.
In an interview with The Daily Free Press, Sulmasy said his degree in philosophy led him to think more carefully and profoundly about all the factors involved, including the key differences between “killing” and “allowing to die,” and in general, the meaning and goals of medicine.
“The principle of respect for autonomy needs to be balanced with other kinds of principles that guide medical ethics, such as our duty to do good for patients, our duty not to harm patients, our duty in justice,” Sulmasy told The Daily Free Press.
Zaev Suskin, who attended the event, is a medical student at Georgetown and pursuing masters degree in bioethics at Harvard Medical School. While studying at Vanderbilt University, Suskin wrote his undergraduate thesis on physician-assisted suicide.
“I think that what’s often lost in these talks is that the focus here … is on compassion,” Suskin said. “If my last act for that patient could be one of compassion, then I am definitely comfortable helping a patient in [this] way.”
While the speakers had opposing viewpoints, Suskin said, both focused on human relationships.
“I really do think a message from both of [the speakers] is to consider the role that another human plays in our lives,” Suskin said, “especially for people who may not value their own life, [we must] consider what roles that confers to [physician’s] to play in their lives.”
As medicine’s capabilities to extend life continue to grow, Suskin said, it’s important to consider the potential weight of longer lives.
“We really are advancing to the point where we can keep patients alive like never thought possible,” Suskin said. “So now more than ever [this discussion] seems important, as we get better and better at … extending life, but also at extending a life that contains a lot of misery.”