The “Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia on Participating Physicians”
Dr. Kenneth R. Stevens, Jr., MD – September 16, 2016
When new things are developed in medicine, they are scrutinized to determine if there are harmful effects with them. Physician-assisted suicide and euthanasia deserve to be evaluated regarding their adverse effects. Instead of focusing on the involved patients, this report focuses on the reported effects on the doctors who are involved in assisted suicide and euthanasia. All of the following information and quotations are documented in: Stevens, KR, Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia on Participating Physicians, Issues in Law & Medicine, 2006; 21:187-200. The full article is available online at www.pccef.org/articles/art44.htm.
From participating Dutch doctors:
“Many physicians who had practiced euthanasia mentioned that they would be most reluctant to do it again.”
“To kill someone is something far reaching and that is something that nags at your conscience.”
“You will never get accustomed to killing someone. We are not trained to kill. With euthanasia your nightmare comes true.”
“It is not a normal medical treatment. You never get used to it.”
“Because doctors find the [euthanasia] request so difficult – the most difficult request you can get as a doctor.”
“It is emotionally draining.”
Dutch doctors opposed to performing euthanasia find it more difficult to get a job.
“I know from physicians who are opposed to performing euthanasia that they are afraid of saying so when applying for jobs and trying to find a post as a physician. In certain circumstances, that will make it much more difficult for them to get a job.”
Euthanasia inhibits the development and advancement of palliative medical care because everything will be solved with euthanasia:
Dr Zylicz, Dutch euthanasia expert: “I was giving consultations in several situations like this, when the GP was calling me about a patient with gastrointestinal obstruction. He said, ‘The problem is that the patient is refusing euthanasia.’ I said, ‘What happened?’ He said, ‘In the past,, all these kinds of situations, when people were intractably vomiting, I solved by offering euthanasia. Now this patient does not want it, and I do not know what to do.’
That was really striking. Providing euthanasia as a solution to every difficult problem in palliative care would completely change our knowledge and practice, and also the possibilities that we have. This is my biggest concern in providing euthanasia and setting a norm of euthanasia in medicine: that it will inhibit the development of our learning from our patients, because we will solve everything with euthanasia.”
From participating Oregon doctors:
“I have to admit, I am blown away by how different this felt that a natural death. And I am still not clear on what to make of that…Just the suddenness of it. It’s shocking to have somebody go from telling a family story to being dead. It’s a strange, strange, strange transition.”
The first annual report of Oregon’s Death with Dignity act reported: “For some of these physicians, the process of participating in physician-assisted suicide exacted a large emotional toll, as reflected by such comments as, ‘It was an excruciating thing to do…it made me rethink life’s priorities,’ ‘This was really hard on me, especially being there when he took the pills,’ ‘This had a tremendous emotional impact.’ Physicians also reported that their participation led to feelings of isolation.”
From others in Oregon:
“This was a monumentally difficult experience for a doctor early on, even considering changing the direction of care from preserving life and extending life to helping someone end it. For many, they have done it maybe for one patient and cannot reconcile that they have don’t it and they are very uncomfortable with it.”
“Sometimes they are overwhelmed by the impact of this which is contrary to what they normally do.”
Fewer Oregon physicians are present now at the time of ingestion/death than in earlier years.
During the first four years of legalized assisted suicide in Oregon, the prescribing physician was present when the patient took the lethal drugs for 52% of the assisted suicides. However since that time most physicians have not been present with the patient at that time. During the past seven years, prescribing doctors have been present at the time of death only 11% of the time. Is that decrease a reflection of the adverse impact on the physician of being there at that critical time? The emotional effect of only writing the prescription is probably less than when the doctor is also present for the suicide. The term “vending-machine medicine” has been coined for such doctors’ medical care.
Leon Kass: “The psychological burden of the license to kill (not to speak of the brutalization of the physician-killers) could very well be an intolerably high price to pay for physician-assisted suicide.”
New York State Task Force on Life and the Law (1994):
“Many physicians and others who oppose assisted suicide and euthanasia believe that the practices undermine the integrity of medicine and the patient-physician relationship. Medicine is devoted to healing and the promotion of human wholeness; to use medical techniques in order to achieve death violates its fundamental values. Even in the absence of widespread abuse, some argue that allowing physicians to act as ‘beneficent executioners’ would undermine patients’ trust, and change the way that both the public and physicians view medicine.”
Physicians and their organizations should support the integrity of medicine and the patient-physician relationship by continuing to strengthen opposition to assisted suicide and euthanasia.