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Palliative Treatment of Last Resort and Assisted Suicide
- Lois Snyder, JD; and
- Arthur L. Caplan, PhD
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IN RESPONSE:
Dr. Gates provides an impassioned reaction to the papers on assisted suicide, which we edited for the Finding Common Ground Assisted Suicide Consensus Panel convened by the University of Pennsylvania Center for Bioethics. He calls the issue “an apology for physician-assisted suicide.”
The University of Pennsylvania series, in fact, takes no position on the morality of assisted suicide or physician-assisted suicide. The goal of the project was not to argue for or against. Instead, believing that legalization was coming, as it did in Oregon and as it may in other states, we sought to examine how to guide practices and create safeguards that would keep assisted suicide rare, voluntary, regulated, and an option of last resort. In doing so, we questioned the usual assumptions. One of the papers explicitly debates, for example, whether assisted suicide necessarily should mean physician-assisted suicide. Dr. Gates does not successfully make a case that there is an inherent bias or prejudice on the part of those who tried to do what is so rarely done with respect to this issue—engage in dialogue despite strong ethical differences of opinion.
As it happens, we are both opponents of the legalization of physician-assisted suicide, as were others who participated in the project and contributed to the papers in the series. The panel membership was national and multidisciplinary and was deliberately composed of individuals with diverse viewpoints. Panel membership, any dissents from a particular paper by a panel member, and the goals of the project were clearly identified. The preceding letter by Sulmasy and colleagues on palliative treatment of last resort implies otherwise. This letter also misrepresents several issues, most importantly by characterizing terminal sedation and voluntary refusal of food and fluids as measures recommended for standard practice when they were actually considered absolute last resorts for rare cases by the panel. The project was called Finding Common Ground because that is what we were attempting to do on the difficult issue of assisted suicide. As the abortion debate has demonstrated, avoiding polarization is not easy. Worse still, polarization of the sort reflected in these letters can be counterproductive to the positions that Drs. Gates and Sulmasy and others hope to advance.
The project we undertook tried to benefit from the diversity of opinion its members brought to the table in proceeding cautiously in an area of great controversy. But we wanted to proceed, to advance the debate. Groups in the past who have tried to write guidelines have failed when the discussion shifted from how to do so back to whether to do so. In the process, important policy considerations about how to keep physician-assisted suicide rare, alternatives to the practice, the implications for the patient–physician relationship, who should write guidelines, and how to regulate it were not getting addressed. The Annals papers help break this logjam—an important step now that physician-assisted suicide is legal.
Lois Snyder, JD
Arthur L. Caplan, PhD
University of Pennsylvania Center for Bioethics; Philadelphia, PA 19104
- Copyright ©2004 by the American College of Physicians
