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Letters

When and how to die

J. Donald Boudreau
CMAJ November 06, 2012 184 (16) 1814; DOI: https://doi.org/10.1503/cmaj.112-2075
J. Donald Boudreau
Department of Medicine, McGill University; Arnold P. Gold Foundation Associate Professor of Medicine; Core member, Centre for Medical Education, McGill University, Montréal, Que.
Roles: Associate Professor
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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.

References

  1. ↵
    1. Flegel K,
    2. Fletcher J
    . Choosing when and how to die: Are we ready to perform therapeutic homicide? CMAJ 2012;184:1227.
    OpenUrlFREE Full Text
  2. ↵
    Hippocratic Oath [reproduced and translated by Ludwig Edelstein]. In: Temkin O, Lilian C, editors. Ancient medicine: selected papers of Ludwig Edelstein. Baltimore (MD): Johns Hopkins University Press; 1967.
  3. ↵
    1. Cane W
    . Medical euthanasia. A paper, published in Latin in 1826, translated and reintroduced to the medical profession. J Hist Med Allied Sci 1952;7:401–16.
    OpenUrlPubMed
  4. ↵
    1. Boudreau JD
    . Physician-assisted suicide and euthanasia: Can you even imagine teaching medical students how to end their patients’ lives? Perm J 2011;15:79–84.
    OpenUrlPubMed
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In this issue

Canadian Medical Association Journal: 184 (16)
CMAJ
Vol. 184, Issue 16
6 Nov 2012
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When and how to die
J. Donald Boudreau
CMAJ Nov 2012, 184 (16) 1814; DOI: 10.1503/cmaj.112-2075

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When and how to die
J. Donald Boudreau
CMAJ Nov 2012, 184 (16) 1814; DOI: 10.1503/cmaj.112-2075
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