First Do No Harm? Scottish Doctors Are Sounding The Alarm About Assisted Suicide

Medical euthanasia for humans, often branded “assisted suicide,” is quietly making its way around the developed world. New Zealand, Spain, and Canada are the most recent countries to legalize the practice, and other national parliaments are also in the process of weighing legalization in their own countries. In Scotland, a bill proposing to legalize human euthanasia was delayed following “unprecedented response,” with doctors from across the political spectrum saying that “no one should be deprived of life intentionally.” Still, Scottish politicians say they have enough public support that the bill may be viable once reintroduced. Is the world finally waking up to the ethical wrongs of euthanasia? Or will assisted suicide become the norm?

Duty of Care

The Hippocratic oath is one of the oldest examples of medical codes of ethics. Though it’s surrounded by myths and misconceptions (its content has changed over time and isn’t universally required by medical schools, for example), its role as an expression of medical ethical standards has remained constant. The original oath included the line “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion,” though the modern oath adds additional nuance, saying doctors must “tread with care in matters of life and death” and “must not play at God.”

Doctors say that although the oath’s wording has changed, their duty to patients hasn’t. In one survey, 95% of doctors said they’d refuse to participate in any part of the assisted suicide process. Seventy percent said they’d consider resigning from organizations that supported the program. Scottish clinicians are organizing under the name Our Duty of Care, or ODOC, against the assisted suicide lobby. The group has written a five-page dossier documenting their protests against the Physician-Assisted Dying (PAD) bill, which will be released in Parliament later this year. Their declaration says, “Physician-assisted suicide would fundamentally and irrevocably change the nature of medical practice and undermine the trust and confidence that patients ought to be able to have in their doctors.”

Much of the broader global medical community agrees. Many leading medical organizations oppose physician-assisted suicide, including the World Health Organization, Hospice Nurses Association, American Psychiatric Association, and dozens of others. The American Medical Association’s code of ethics calls assisted suicide “fundamentally incompatible with the physician’s role as healer.” Liam McArthur, the Scottish politician introducing the bill, said that bans on physician-assisted suicide caused needless suffering, but doctors say that killing patients is a more fundamental change than just a new form of care. Leon Kass, MD, explains, “The legalization of physician-assisted suicide will pervert the medical profession by transforming the healer of human beings into a technical dispenser of death. For over two millennia, the medical ethic, mindful that power to cure is also power to kill, has held as an inviolable rule, ‘Doctors must not kill.’”

For over two millennia, the medical ethic, mindful that power to cure is also power to kill, has held as an inviolable rule, “Doctors must not kill.”

Is Life Priceless?

Can we put a price on human life? Many policymakers think so. Even though some politicians argue for assisted suicide as a solution to end-of-life suffering, others are endorsing it for more sinister reasons. The more socialized a country’s healthcare system is, the more likely it is that the costs for patient care will be seen as zero-sum. When one more dollar for healthcare means one less dollar for infrastructure or education, then governments have a greater incentive to reduce the high costs of end-of-life care. 

Canada’s Medical Assistance in Dying (MAiD) program, one of the most extensive human euthanasia programs, has been praised in a report for its ability to save millions in healthcare spending. As the author of the report explained, “In a resource-limited health care system, anytime we roll out a large intervention ... cost has to be a part of that discussion. It's just the reality of working in a system of finite resources."

Using MAiD as a way to get patients to make sacrifices for public policy goals hasn’t stopped at cost cutting, either. Since legalizing MAiD, Canada has become a world leader in harvesting organs from euthanized patients, sparking mixed feelings from ethicists. One said he was “rather proud that Canada has done so well in terms of organ donation by MAID patients.” Others, noting that over one-third of MAiD deaths are from patients who felt they were "a burden on family, friends or caregivers,” fear that patients “who struggle with a lack of self-esteem and self-worth may be pushed to see this as an opportunity to mean something.” 

No ethical government makes suffering people feel like they’re worth more dead than alive. At its worst, socialized medicine teaches societies to think of care for vulnerable people as the state’s job, not the family’s. By building a medical system that sees the final years of life as a burden, we show vulnerable people that their lives aren’t worth as much because of their suffering, and teach them to see themselves as a burden to the people caring for them. 

No ethical government makes suffering people feel like they’re worth more dead than alive.

A Slippery Scope

While assisted suicide is still a proposal for Scotland, other countries offer a glimpse into the ways that the policy harms vulnerable people. Proponents of assisted suicide say that strict guidelines are key to making it an ethical system, but experience shows these guidelines get relaxed and even eliminated over time. Restricting euthanasia to adults, the terminally ill, or other dire situations often sounds like reasonable limitations, but it becomes less simple in practice. Eventually, the people who need the most help end up the most at risk for medical euthanasia.

Canada is already considering expanding its program to include children. Under the proposal, children as young as 12 could opt for assisted suicide without their parents’ consent. The group Dying with Dignity says that a child’s decision shouldn’t be limited by their “chronological age,” and that “mature minors” should be able to bypass their parents' objections when seeking lethal injection. Belgium is two steps ahead: The country updated its assisted suicide laws to include children in 2014.

Mental Suffering

Mental health issues offer a similar conundrum. Though many assisted suicide proponents say its purpose is only for the terminally ill, many laws end up expanding to include mental illnesses. Belgium’s laws already include “mental suffering” as a legitimate reason. In one case, this included an otherwise healthy woman with depression and PTSD due to a terrorist attack. She was only 23, but felt her depression medications weren’t working. Many ethicists agree that offering a legal way to commit suicide is dangerous for the suicide rate, and the statistics back them up: Legalizing assisted suicide increases the overall suicide rate.

Expanding human euthanasia to those with mental health issues also puts vulnerable people at risk. In one case, a 61-year-old disabled man was feeling suicidal and sought help at a hospital. He was killed shortly thereafter, with “hearing loss” as a justification on his euthanasia papers. “Somebody needs to take responsibility so that it never happens to another family,” said the family of the deceased. “I am terrified of my husband or another relative being put in the hospital and somehow getting these (euthanasia) forms in their hand.” U.N. human rights experts are beginning to call out Canada’s program for its “discriminatory impact” on disabled people, calling it “probably the biggest existential threat to disabled people since the Nazis' program in Germany in the 1930s.”

The majority of homeless individuals experience mental health issues, and, in some cases, completely healthy people in poverty are beginning to consider death their only way out. “We’re at the point where clients on these programs are telling us they’re considering medically assisted death or suicide because they can’t live in grinding poverty anymore,” a CEO of a Canadian food bank remarked. One man in Alberta said he was weighing assisted suicide for exactly that reason: “I want to live. I don't want to die. ... Sooner or later, it’s going to get to a point where I just won’t be able to afford to live.” He went on to say that if he couldn’t get medical care at home, “they're willing to do a house call to kill you.”

Closing Thoughts

Assisted suicide can’t be made ethical by public policy tweaks. Murder isn’t a solution to healthcare, poverty, organ donation, or any other challenge of running a country, and our policymakers are getting dangerously close to treating it as an easy way out. Medical professionals like those in Scotland are remembering an important truth that too many Western leaders have forgotten: Human life is a natural good with inherent dignity and worth. Suffering people deserve to be cared for, not discarded.

Love Evie? Sign up for our newsletter and get curated content weekly!