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The ethical debate over doctor-assisted dying

Photo: CC, Borya,

Sixty-eight percent of Americans support doctor-assisted death. But in a field dedicated to the mantra ‘do no harm,’ it can be tricky to define ‘right’ or ‘wrong’ in the debate.

“Doctor-assisted dying is a gray area that’s defined by personal values,” said John Song, M.D., M.P.H., associate professor in the Center for Bioethics and in the department of internal medicine at the Medical School.

The conversation picked up with media attention surrounding terminal cancer patient Brittany Maynard’s choice to end her life last fall. Doctor-assisted dying, which has been legal in Oregon since 1997, has popped up in state supreme courts and legislatures, most recently with approval in California. It is also legislatively-approved in Vermont, court-approved in Montana, and referendum-approved in Washington.

While it could be several years before the issue may appear in Minnesota courts, the discussion is a hot topic, particularly for medical school students who might choose to practice or continue post-doctoral education in other states.

“Doctors don’t talk about it as much here because it’s not yet legal in Minnesota and it causes a lot of moral distress,” Song said. “How can one practice his or her beliefs but also be responsive to patient autonomy, particularly where this is a legally protected right? It’s a difficult debate.”

Song outlined some other hypotheticals that raise concerns on both sides of the issue.

How do we define terminally ill?

Many people in the medical community worry about right-to-die legislation snowballing into elective deaths for essentially anyone. In order to qualify for doctor-assisted death, someone must be terminally ill. But what is considered terminally ill? And how do we measure suffering, Song asks, if that becomes rationale for death.

The answer is, there is no end-all-be-all answer.

“This becomes a judgment of quality of life, and quality of life can be a very subjective concept,” Song said.

What if someone could be saved?

Science and medicine are constantly evolving. New treatments or experimental procedures could become options for terminal patients.

“We’re able to keep people alive much longer than before,” Song said.

But that can also mean a long and painful decline to those facing an inevitable death, like Maynard.

“They want to die in a controlled way that manages symptoms, preserves a legacy and allows them pleasant memories with loved ones,” Song said.

Could this patient autonomy be abused?

Some worry this could become a way for people of power or authority to ‘eliminate’ the disenfranchised, like the elderly, children, people with disabilities or racial minorities.

That hasn’t been the case in states or countries that allow doctor-assisted death, though, Song says. On the contrary, it has been beneficial and accepted. Nonetheless, it highlights the importance of having a conversation about death and considering the potential implications.

“There is not always a right answer to this debate,” Song said. “People don’t want to die helplessly. They want to dictate the circumstance of their death, and if that minimizes harm, we as physicians should discuss ways we can help facilitate that.”