George A. Sprecace M.D.,
J.D., F.A.C.P. and Allergy Associates of New
Out End-of-Life Refusal Orders in a 'Culture of Refusal'
self-determination...NOT euthanasia or physician assisted suicide
ZENIT, The world seen from Rome
Do No Harm? Should Patients Still Trust Their Doctors?
Medical Journals Show Increasing Support for Euthanasia
By Denise J. Hunnell, MD
WASHINGTON, D.C., AUG. 22, 2012 (Zenit.org).- Primum non nocere. First
harm. This edict has been part of medical ethics since the time of the
Greek physician, Hippocrates, in the fifth century B.C. It is
the Hippocratic Corpus, a collection of medical writing attributed to
Hippocrates. The original Hippocratic oath includes:
I will apply dietetic measures for the benefit of the sick according to
ability and judgment; I will keep them from harm and injustice.
For millennia the physician has been charged with being an advocate for
patient. Part of the impetus for the original Hippocratic oath was to
that doctors would not be paid by an enemy to give poison instead of
Patients should be able to come to their doctor when they are sick and
weakened, and have no fear that their vulnerability will be
Unfortunately, the sacred trust of the doctor-patient relationship is
strained by a new ethical model. Physicians are being urged to place
greater good above the needs of their individual patients. A disregard
sanctity of human life as well as a utilitarian philosophy that judges
value of a patient to society is becoming more mainstream in the
profession. This is evidenced by the increasing number of articles in
medical journals that call for approval of assisted suicide and
euphemistically called assisted dying.
The British Medical Journal (BMJ), a publication distributed to the
the British Medical Association, devoted much of its June 14, 2012,
endorsing voluntary euthanasia and physician assisted suicide. Raymond
emeritus professor of geriatric medicine at the University of
argues in this issue that respect for patient desires and autonomy
irrelevant any opinion on the matter by the Royal College of Physicians
British Medical Association. Therefore, all opposition to euthanasia is
inappropriate paternalism and should be dropped.
In this same issue, Tess McPherson relates the difficult last days of
mother, Ann McPherson, and uses this painful experience as a call for
physician assisted suicide and euthanasia. Rather than seeking better
control, she argues that death is the best option for those suffering
end of their lives.
Finally, Fiona Goodlee, editor in chief of the BMJ, rounds out the
declaring that legalization of assisted dying is not a medical
rather a societal question. She argues that the role of the physician
compatible with providing euthanasia or assisted suicide and if society
it, they should get it.
Amid these scholarly endorsements of euthanasia come the claims of
physician Patrick Pullicino that the National Health Service (NHS) is
effectively killing 130,000 patients every year when doctors place
patients on the Liverpool Care Protocol (LCP) and deny them nutrition
hydration. According to the Daily Mail:
Professor Pullicino claimed that far too often elderly patients who
longer are placed on the LCP and it had now become an 'assisted death
rather than a care pathway'.
He cited 'pressure on beds and difficulty with nursing confused or
difficult-to-manage elderly patients' as factors.
Professor Pullicino revealed he had personally intervened to take a
the LCP who went on to be successfully treated.
The medical literature from the United States also shows an increasing
acceptance of physician assisted suicide and euthanasia. The July 12,
issue of the New England Journal of Medicine (NEJM) included an article
Lisa Soleymani Lehmann and Julian Prokopetz that suggested physician
to assisted dying was an unreasonable barrier to patients seeking
They recommended that all patients who met the legal criteria for
suicide as outlined in the state laws of Oregon, Washington, and
be able to obtain the drugs necessary for suicide without a physician's
prescription or approval.
Perhaps the most chilling example is the enthusiastic endorsement in
Journal of the American Medical Association (JAMA) for the book Death,
and Organ Transplantation: Reconstructing Medical Ethics at the End of
Drs. Franklin Miller and Robert Truog. This book seeks to do away with
principles of medical care. The first is that a physician cannot
cause the death of his patient. The second is that donors of vital
transplantation must be dead before the organs are harvested.
Catholic health care ethics, in accordance with natural law, holds that
the burden of life-sustaining extraordinary care such as a ventilator
greater than the benefit it provides, such care can be withdrawn. This
seen as causing the death of the patient, but rather allowing the
die from his underlying illness. Miller and Truog disagree and assert
an act directly causes the death of the patient. They then begin their
down the slippery slope by claiming that if causing death by
life-sustaining care is acceptable, then active voluntary euthanasia by
injection should also be acceptable. Further, if voluntary euthanasia
injection is acceptable, then voluntary euthanasia by removal of vital
to be used for transplantation should be equally acceptable. This
argument could be disregarded as fringe thinking had it not been so
and positively recommended in JAMA.
It is reasonable to say that the notion that physicians should not kill
patients is still widespread among medical professionals. Indeed,
the aforementioned authors take their colleagues to task for opposing
euthanasia and physician assisted suicide. The growing numbers of
medical journals that are routinely publishing support for all forms of
assisted dying are, however, a clear indication that this approach to
life care is making significant inroads in mainstream medical ethics.
foundational principles of health care that date back to Hippocrates
This has serious implications for patients. No longer can a patient
his physician has his best medical interests at heart. Now physicians
urged to consider the cost to society of a patient's care and judge
patient is worthy of such expense. Instead of seeking to provide
authentic compassion at the end of life, there is increased support for
hastening death as an expedient solution to suffering.
It is now incumbent upon every patient to explore the ethical
principles of his
doctor. Does he uphold the sanctity of life from conception to natural
Does he understand that treatments can be deemed burdensome, but human
never burdensome? Does he view nutrition and hydration as ordinary care
as a patient can derive a benefit from it? Does he reject all
for intentionally causing the death of his patients?
If your physician does not answer unequivocally yes to each of these
can you really trust him with your life?
* * *
Denise Hunnell, MD, is a Fellow of HLI America, an educational
of Human Life International. She writes for HLI America’s
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