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February 1997
PEP Pioneers
Second Wind
Torrance, California
Dear Friends:
The present debate over what is incorrectly termed
Athe right to assisted suicide has doubtless caught the attention
of most if not all readers of the Second Wind. Quite frankly,
the Supreme Court debate on this subject troubles me greatly.
The facts are that there is no one on the Supreme Court qualified
to make a judgment about how to deal with suffering in the
case of terminal illness, for the simple reason that no one
on the Supreme Court is a physician. None of the nine justices
have had the experience of dealing with pain, misery, hopelessness,
and the intrinsic wish of those near death or with intolerable
suffering to enter the eternal sleep that is guaranteed to
all of us. The only true guarantee is the fact of death. How
this death occurs is a matter to be determined between patient
and physician.
There are some basic ethical principles involved, which I
have not seen discussed in the media recently. These are:
1) the autonomy of the individual; and 2) beneficence to the
individual. It is a fact that in medical decision making today,
that we have medical care that can extend life, but it also
can extend death and suffering. Thus we have a technical ability
which allows us to do things, yet an ethical component of
what ought to be done. Hopefully, both components can be reconciled.
In addition we have established guarantees which include the
right to privacy, which is a guarantee of the United States
Constitution and the right to bodily self determination which
is established by the common law. It is interesting that in
1891, the U.S. Supreme Court did say, "No right is held
more sacred or is more carefully guarded by the common law
than the right of every individual to the possession and control
of his own person, free from all restraints and interferences
by others unless by clear and unquestionable authority of
law". It is a fact that the United States Constitution
never mentions the word suicide, nor does it have any statement
which could be construed as a guiding principle as to how
patients should be cared for when their quality of life is
gone and they are suffering.
The President's Commission on making health care decisions
and decisions to forego life-sustaining treatment, which has
been widely quoted, clearly states, There is no significant
moral (or legal) distinction between withholding and withdrawing
therapy from patients in a hopeless condition, such as a permanent
vegetative state. This statement, however, does not deal with
the situation of individuals who are unable to express their
wishes, but here's where the Living Will and Durable Power
of Attorney can provide surrogate decision making. Indeed,
the personal physician can be a surrogate decision maker in
conjunction with family members or even friends who understand
what form of treatment the patient would want.
The Supreme Court has no right to interfere with the practice
of medicine. It cannot determine what drugs or devices are
used, such as morphine to relieve painful suffering or horrible
anxiety. Today physicians legally, morally, and ethically
give morphine and related drugs when they are required for
pain and other miseries, recognizing that the use of such
drugs may suppress bodily functions including respiration
resulting in death. This is not assisted suicide; this is
assisted relief of suffering as a result of an illness, which
is the proper role of the physician.
Somehow the Supreme Court has endowed itself with the power
of creating social change and determining rights of human
beings including the unborn which, in my judgment as a physician,
go far beyond the role of the Supreme Court and the Constitution
it is charged to interpret. Whatever decision the Supreme
Court makes in the current debate will have no meaning to
the practice of medicine or the relief of suffering and, in
my opinion, it would have been better if the Supreme Court
had refused to hear the arguments at all.
The only principle involved when patients are suffering, dying,
and miserable, is the principle of reason. It is highly unlikely
that reason will emerge from the polarized debate we are now
facing and the decisions of nine lawyers who know absolutely
nothing about the practice of medicine. For these lawyers
to decide about death and the care of dying would make about
as much sense as nine doctors attempting to rewrite the Constitution.
I will be in touch next month.
Your friend,
Thomas Petty, MD
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