Suicides or executions: Physicians should not participate

Maine voters rejected physician-assisted suicide. Doctors queried about physician participation in executions should have done the same.

Editorial. Dec. 4, 2000.

The presidential race isn't the only squeaker from the 2000 vote. Maine voters narrowly rejected -- 51.5% to 48.5% -- a ballot question that would have allowed physician-assisted suicide. That leaves Oregon as still the only state that allows the practice.

The margin of Maine's decision is a bit close for comfort. However, that physician-assisted suicide measures fail at all -- as they have in California, Michigan and Washington -- is remarkable.

The implicit pitch to voters on physician-assisted suicide is primarily one of self-interest. A yes vote holds out the notion that the option will be there for one's own painless exit, or for those one might be responsible for, when all other hope is lost and in the face of terrible pain.

If that weren't enough, supporters play the compassion card -- who would be so cold-hearted as to deprive a stranger whose personal values embrace a physician-aided death? No wonder that on first gloss, a yes vote might sound so appealing. Indeed, nearly three-fourths of Mainers supported the ballot question early on in the campaign.

Yet more than half of Maine voters, in a higher-than-average turnout, rejected the binding ballot initiative in favor of keeping the constraints on what a doctor can do, and by extension closed this option for themselves.

Those who voted no were willing to take a look down the slippery slope. They were aware of the pressures that could cause patients and their families to make unwise decisions. A no vote also rejected the dangerous compromise that such a law would bring to the notion of "first do no harm."

An intriguing contrast came a few weeks before the vote in the pages of the Oct. 23 Archives of Internal Medicine. An article examining physician attitudes toward involvement in the use of lethal injection in capital punishment revealed some interesting numbers.

In the survey, 482 doctors gave their opinions on eight actions regarding physician participation in execution explicitly prohibited by AMA ethical policy. The list includes administering lethal drugs, choosing an injection site and supervising prison personnel to do the work.

Of the eight actions, 80% of those doctors said at least one was acceptable for a physician to do, 53% said five were acceptable and more than a third said all eight were OK. AMA ethical policy prohibits active physician participation in any type of execution, but the increasing use of lethal injection makes the survey results especially timely and disturbing.

Neither suicide nor execution requires a physician's active participation. The techniques, the drugs, the equipment work quite as well in the hands of others -- it's not brain surgery. When a physician is brought in, something else is being borrowed, not to be returned -- the integrity of the medical profession.

That so many voters in Maine appear to understand this in the context of physician-assisted suicide is encouraging. The numbers from the physician survey on executions are not nearly so reassuring.