Helping patients kill themselves runs up against Hippocratic Oath

John B. Kelly makes a strong case for opposing physician-assisted suicide, pointing out the potential for “misdiagnosis, coercion, and abuse’’ of vulnerable individuals (“Say ‘no’ to assisted suicide,’’ Opinion, Jan. 16). But there is a larger ethical point to be made: Helping patients kill themselves is a direct violation of the Hippocratic Oath and the ethical responsibilities of the physician. The oath requires of the physician that “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.’’ It has served as the most fundamental ethical document for physicians over the past 2,500 years.

We can all support the right of mentally competent terminally ill patients to refuse futile or so-called heroic treatment during their final days. But this right is a far cry from asking the physician to participate in the patient’s suicide.

As medical ethicist Dr. Leon Kass has observed, “We must care for the dying, not make them dead.’’

Dr. Ronald W. Pies

Lexington

The writer is a psychiatrist and medical ethicist affiliated with Tufts University School of Medicine.

Data point to move toward medical aid in dying

I take issue with a number of the contentions John B. Kelly made in his op-ed “Say ‘no’ to assisted suicide.’’

The American Medical Association is reconsidering its position on medical aid in dying after an AMA committee noted “many states have proposed or adopted legislation to legalize the practice, introducing a potential conflict for our members in those states.’’

A New England Journal of Medicine report concluded that medical aid in dying “is not likely to save substantial amounts of money in absolute or relative terms, either for particular institutions or for the nation as a whole.’’

Videos of medical aid-in-dying opponents Dr. Brian Callister and Stephanie Packer fail to provide documentation of their allegations.

A Journal of Medical Ethics report about the 1994 Oregon medical aid-in-dying law concluded, “Rates of assisted dying in Oregon . . . showed no evidence of heightened risk for the elderly, women, the uninsured, . . . people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations.’’

I am proud that the Massachusetts Medical Society listened to its members and patients and committed to supporting the option of medical aid in dying if the End of Life Options Act becomes law.

Dr. Eric J. Ruby

Taunton

The writer cosponsored the Massachusetts Medical Society’s resolution to conduct a survey of its members that showed a plurality supported medical aid in dying. He also cosponsored the society’s house of delegates’ resolution supporting the option of medical aid in dying if it becomes law.

More to end-of-life care than lethal medication

The debate on the Globe’s Jan. 16 Opinion page about one particular form of medical aid in dying — the act of a physician writing a prescription for a lethal dose of medication, to be used by an adult with a terminal illness at such time as the patient sees fit — shows how complex a topic this is.

As a physician, I know both professionally and personally the value and importance of end-of-life care, and appreciate how emotionally intensive such times are for both the patient and the patient’s family. But the people of Massachusetts should know that there is more to end-of-life care than lethal doses of medication, and that patients can play a role in the palliative or hospice care they receive in the future.

We all should fill out a Medical Orders for Life-Sustaining Treatment form. This document will communicate to physicians the level of care that each of us accepts or rejects. Moreover, everyone over age 18 should designate a health care proxy — a trusted individual who will be a voice in our behalf during a serious illness if we no longer can express our wishes.

Shared decision-making is important across the spectrum of patient care, and the end of life is no exception.

It’s true that we at the Massachusetts Medical Society withdrew our historic organizational opposition to what was previously called “physician-assisted suicide.’’ But in so doing, we also reaffirmed the value of palliative and hospice care in helping our patients have a say at the end of their lives.

Dr. Henry L. Dorkin

President

Massachusetts Medical Society

Waltham

It’s appalling to suggest insurers would push people toward death

John B. Kelly implies that health insurance companies will withhold payments for life-saving treatments, forcing people to choose suicide instead. This is an appalling misconception. As a longtime physician, I am painfully aware of problems with insurance companies, but I doubt that this has ever happened.

The bill before the Massachusetts Legislature that permits medical aid in dying applies to those people who have exhausted all curative treatment possibilities and are at a stage of their lives where only palliative care is relevant. The real question is whether, then, such a patient should be allowed to take control, if they want to, of the circumstances of their own death. It is an option that empowers dying patients who might otherwise feel helpless. No one is compelled to do anything. Is it decent to deny this kindness to those who want it?

As for his several other objections, considerable data from the experience of Oregon and other states reassure us that dangers and abuses with this law are rare.

Dr. Carl N. Brownsberger

Belmont