This discussion must consider “how” as well as “whether.” One of the questions Downar and colleagues1 set out for consideration contains the phrase “to consent to physician-assisted death.” This phrase assumes a physician-dominated framework for responding to a suffering person’s request (even plea). It should be framed as the physician giving consent. The patient’s “complaint” has traditionally been the starting point in the doctor–patient relationship. The patient states the problem; the physician offers medical diagnosis and controls access to possible interventions. When the cure for the “complaint” is futile, one can turn to palliation and acceptance of dying. But when palliation proves futile and help to die is requested, where can a suffering person turn? The means of easy dying are tightly controlled and only in the hands of physicians. Who else could “consent?”
Precipitating death is repugnant to physicians, as to most people, but there are instances in which that act may be the only compassionate and acceptable response to a request for release from suffering.
Questions around the “how” of physician-assisted death must be framed as a response to a request. Framing discussion in terms of “consent” is an insult to a person’s desperate initiative to end suffering.