Page 131 |
Previous | 138 of 497 | Next |
|
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
|
Loading content ...
occurred, they were clearly a means of avoiding capture and almost certain abuse and death at the hands of the Romans. But even if it is true that Jews committed suicide on Masada, and that modem Jews committed suicide rather than be sent to Holocaust concentration camps, generalizing from the particulars ignores the subtlety and complexity of these occasions. So one ought to inquire whether, and if so how, Masada or the Holocaust might qualify as exceptions to the general Jewish prohibition against suicide and the preference for life over death. An Ethical Quagmire My friends who are lawyers tell me that the answer to Dr. Carroll's query ("why were Dr. Kevorkian's trials held?") is not mysterious: the prosecuting attorney and a grand jury in Oakland County, Michigan, believed that there was sufficient evidence to believe that a Michigan statute had been violated, that a crime had been committed. Instead of acknowledging that these people knew their job and were doing it. Dr. Carroll declaims that "(t)hese new puritans are dangerous people, driven by the classically psychoneurotic puritan dynamic of unconscious reaction formation."' This argument ad hominem is not substantive. Inasmuch as autopsies and other evidence have shown that Dr. Kevorkian's subjects were not always in terminal stages of disease, and given the common knowledge that carbon monoxide is no medical treatment, a more interesting question is why the several juries have declined to convict. One answer comes from Methodist bishop Donald Ott, whose church is on record as opposing physician-assisted suicide: under questioning from the judge and lawyers during jury selecdon, he said "I told them that I believed that an individual should have the right to choose in a terminal situation their death...."' This revisionist view comports with Dr. Carroll's view of patient and physician autonomy. To be perfectly honest, I've never really thought of myself�or of the AMA!�as part of a "conspiracy of the puritan right to subvert the professions of medicine and the law in pursuit of their neurotic agenda." But that is Dr. Carroll's view�that all who disagree with him must be "neo-puritans [who] are so dangerous [because] they do not respect professional boundaries and codes of conduct because they regard themselves as agents of a higher cause."' In brief, he is saying that ethics is not so much concerned with describing a life of virtue as with providing an expedient approach to perceived moral dilemmas, that theistic and other accounts of the sanctity-of-life in Western medicine are now indefensible and can therefore be set aside, and that there is no morally relevant distinction between killing and medical attendance to the dying patient. Dr. Carroll does not argue these points; he merely declares them. It is true that, despite a burgeoning biomedical technology, no one can guarantee us relief from the pain and discomfort of irreversible illness or irremediable injury. Dr. Carroll's essay illustrates nicely how our modern resources for dealing with dying and death�maybe especially in the modem medical setting�are extraordinarily limited if not frankly impoverished. Unable to cure. Dr. Carroll declares we ought to help people kill themselves. But his mere declaration fails to persuade. And why thi s kind of killing ought to be "medicalized" requires much further thought. When lethal injection was first adopted as the means for capital execution, the Oklahoma state legisla-mre blithely assumed that the medical director in the state prison system would push the drugs. But he declined, asserting the same principle now affirmed by the AMA. If our society should decide to legitimate assisted-suicide, it must show why it is unreasonable or otherwise not feasible to put this practice into the capable hands of nonphysicians� rather like the executioners who push the drugs or throw the electric switches or release the trapdoors in capital executions. What the Past Told, The Future Holds I am not clairvoyant and only seldom given to prophecy, but because Dr. Carroll's case for physician-assisted suicide is built on the twin foundations of "mercy" and "patient autonomy," I think it highly likely that social and professional boundaries will stretch far beyond the situations he describes. When autonomy is honored above all else, and when the assessment that pain and suffering are unbearable is entirely subjective, distinctions between terminal and nonterminal conditions evaporate. Indeed, I believe that requests for "suicide-assistance" will eventually be made on behalf of incompetent patients who have executed an "advance directive" request for assisted suicide; I expect that incompetent patients will be put to death based on the "substituted judgments" of well-intentioned others who will elect "suicide" on their behalf. For those who wish to consider this point, I highly recommend Michael Burleigh's Death and Deliverance: 'Euthanasia' in Germany 1900-1945, which brilliantly shows how the National Socialist decision to kill people had complex origins in politics, economics, religion, and medicine. Santayana's aphorism is apposite here: those who cannot remember the past are condemned to repeat it. Dr. Carroll dismisses the dangers of the slippery slope, but we have inched out onto this treacherous moral terrain, although not ovemight. Indeed, our foray onto the greasy gradient has taken us from sanctiry-oi-Me to respect-for-Xdt to <7Ma//n'-of-life, and now invites us to embrace physician-assisted suicide; I suspect it will lead eventually to selective NCMJ Marcli/April 1997. Volume 58 Number 2 131
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1997 |
Identifier | NCHH-17-058 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 58 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-058.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-058 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 131 |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1997 |
Identifier | NCHH-17-058-0141 |
Form General | Periodicals |
Page Type | all; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed581997medi_0141.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 58 |
Issue Number | 2 |
Page Number | 131 |
Health Discipline | Medicine |
Full Text | occurred, they were clearly a means of avoiding capture and almost certain abuse and death at the hands of the Romans. But even if it is true that Jews committed suicide on Masada, and that modem Jews committed suicide rather than be sent to Holocaust concentration camps, generalizing from the particulars ignores the subtlety and complexity of these occasions. So one ought to inquire whether, and if so how, Masada or the Holocaust might qualify as exceptions to the general Jewish prohibition against suicide and the preference for life over death. An Ethical Quagmire My friends who are lawyers tell me that the answer to Dr. Carroll's query ("why were Dr. Kevorkian's trials held?") is not mysterious: the prosecuting attorney and a grand jury in Oakland County, Michigan, believed that there was sufficient evidence to believe that a Michigan statute had been violated, that a crime had been committed. Instead of acknowledging that these people knew their job and were doing it. Dr. Carroll declaims that "(t)hese new puritans are dangerous people, driven by the classically psychoneurotic puritan dynamic of unconscious reaction formation."' This argument ad hominem is not substantive. Inasmuch as autopsies and other evidence have shown that Dr. Kevorkian's subjects were not always in terminal stages of disease, and given the common knowledge that carbon monoxide is no medical treatment, a more interesting question is why the several juries have declined to convict. One answer comes from Methodist bishop Donald Ott, whose church is on record as opposing physician-assisted suicide: under questioning from the judge and lawyers during jury selecdon, he said "I told them that I believed that an individual should have the right to choose in a terminal situation their death...."' This revisionist view comports with Dr. Carroll's view of patient and physician autonomy. To be perfectly honest, I've never really thought of myself�or of the AMA!�as part of a "conspiracy of the puritan right to subvert the professions of medicine and the law in pursuit of their neurotic agenda." But that is Dr. Carroll's view�that all who disagree with him must be "neo-puritans [who] are so dangerous [because] they do not respect professional boundaries and codes of conduct because they regard themselves as agents of a higher cause."' In brief, he is saying that ethics is not so much concerned with describing a life of virtue as with providing an expedient approach to perceived moral dilemmas, that theistic and other accounts of the sanctity-of-life in Western medicine are now indefensible and can therefore be set aside, and that there is no morally relevant distinction between killing and medical attendance to the dying patient. Dr. Carroll does not argue these points; he merely declares them. It is true that, despite a burgeoning biomedical technology, no one can guarantee us relief from the pain and discomfort of irreversible illness or irremediable injury. Dr. Carroll's essay illustrates nicely how our modern resources for dealing with dying and death�maybe especially in the modem medical setting�are extraordinarily limited if not frankly impoverished. Unable to cure. Dr. Carroll declares we ought to help people kill themselves. But his mere declaration fails to persuade. And why thi s kind of killing ought to be "medicalized" requires much further thought. When lethal injection was first adopted as the means for capital execution, the Oklahoma state legisla-mre blithely assumed that the medical director in the state prison system would push the drugs. But he declined, asserting the same principle now affirmed by the AMA. If our society should decide to legitimate assisted-suicide, it must show why it is unreasonable or otherwise not feasible to put this practice into the capable hands of nonphysicians� rather like the executioners who push the drugs or throw the electric switches or release the trapdoors in capital executions. What the Past Told, The Future Holds I am not clairvoyant and only seldom given to prophecy, but because Dr. Carroll's case for physician-assisted suicide is built on the twin foundations of "mercy" and "patient autonomy" I think it highly likely that social and professional boundaries will stretch far beyond the situations he describes. When autonomy is honored above all else, and when the assessment that pain and suffering are unbearable is entirely subjective, distinctions between terminal and nonterminal conditions evaporate. Indeed, I believe that requests for "suicide-assistance" will eventually be made on behalf of incompetent patients who have executed an "advance directive" request for assisted suicide; I expect that incompetent patients will be put to death based on the "substituted judgments" of well-intentioned others who will elect "suicide" on their behalf. For those who wish to consider this point, I highly recommend Michael Burleigh's Death and Deliverance: 'Euthanasia' in Germany 1900-1945, which brilliantly shows how the National Socialist decision to kill people had complex origins in politics, economics, religion, and medicine. Santayana's aphorism is apposite here: those who cannot remember the past are condemned to repeat it. Dr. Carroll dismisses the dangers of the slippery slope, but we have inched out onto this treacherous moral terrain, although not ovemight. Indeed, our foray onto the greasy gradient has taken us from sanctiry-oi-Me to respect-for-Xdt to <7Ma//n'-of-life, and now invites us to embrace physician-assisted suicide; I suspect it will lead eventually to selective NCMJ Marcli/April 1997. Volume 58 Number 2 131 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-058.pdf |
Document Sort | all; nchh-17 |
Article Title | Physician-Assisted Suicide A Bad Idea, Carroll And Kevorkian Notwithstanding |
Article Author | Harmon L. Smith |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-058 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Tags
Comments
Post a Comment for Page 131