When and how to die

I am concerned with the statement in the CMAJ editorial on “therapeutic homicide,” that the euthanasia debate has been theoretical because of the “tacit assumption that doctors do not kill people.”1 This is a less than forceful description of medicine’s mandate.

That doctors do not purposefully take lives is far from a tacit thing. This constraint has been an invariant truth for millennia. The Hippocratic Oath includes the injunction, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.”2 An 1826 manuscript states, “How can it be permitted that he who is by law required to preserve life be the originator of, or partner in, its destruction?”3 Innumerable examples exist where doctors are admonished not to kill. Qualifying this long-standing ethical interdiction as “tacit” saps its intellectual rigour and opens it to questioning. If it is to be disregarded, let it be on the basis of persuasive counter-arguments rather than on the notion that it is not explicit.

I am deeply concerned about potential damage to the medical profession were it to accept assisted suicide as a medical act. I have suggested elsewhere that responsibility for implementing assisted suicide could be mandated to a nonphysician group.4 This would respond to legislative demands while enabling doctors to fulfill the ancient mandate of healing. Euthanizing and healing are not miscible, nor can they be 2 sides of 1 coin. This is not a tacit assumption; it is the expression of a reverberating imperative.