Mahoney: First, do no harm

Editor’s note: Edward Mahoney is president of the Vermont Alliance for Ethical Healthcare and is a professor at St. Michael’s College.

In medical school, all physicians are taught as a first principle “primum non nocere,” or “First, do no harm.” The hundreds of Vermont physicians and nurses who comprise most of the membership of the Vermont Alliance for Ethical Healthcare are convinced that the act of writing a prescription so a patient may commit suicide is fundamentally inconsistent with this principle and thus with the ethical practice of medicine.

This week the Judiciary Committee of the Vermont Senate is hearing testimony on S.103, the latest version of a determined attempt by a national organization to use the Vermont Legislature to overturn “primum non nocere,” or at the very least re-interpret it to the point of being meaningless.

The Vermont way of caring for and supporting one another does not include assisting someone in the act of suicide. The excellent physicians and nurses who labor long for the welfare of their patients do not include a prescription for death among their duties. Vermont has an excellent system of both palliative care and hospice care available to patients throughout the state. We are becoming a national leader in that area, and VAEH has actively supported these efforts.

The VAEH encourages the Legislature to likewise “do no harm” to the many Vermonters at the end of life who need to know that their health care providers – their very link to life and comfort and dignity – are not compromised by any capacity to deliver death. End-of-life care is a co-operative process involving the patient, family and health care providers. If even one link in the chain is empowered to enable the patient’s suicide, the potential for abuses becomes widespread. Here are just three:

• Elderly Vermonters suffer from a relatively high incidence of elder abuse, according to the state’s social workers. Could the “option” of assisted suicide become a tool in the hand of the abuser?

• Depression among end-of-life patients is widespread but often difficult to diagnose. It is, however, relatively simple to treat. Our resources would be better directed at treating end-of-life depression with effective, compassionate care, rather than with a lethal dose.

• Vermont’s health care insurance system is undergoing radical change. The state’s insurance commissioner was quoted in an Addison County newspaper last year as saying that cost control of end-of-life treatment, including coverage for treatment, would have to become a greater priority. Although he has subsequently denied these statements, every thinking, informed Vermonter realizes that in the new state-run health care insurance system, the state of Vermont will be under extreme pressure to reduce costs in the most expensive areas of medical care – which, of course, includes end-of-life care as well as care for the severely disabled and chronically ill. In the state of Oregon, where assisted suicide is already legal, there have been several reports of end-of-life patients being denied payment of permitted medical expenses, but being offered full coverage for medication to end their lives by suicide.

VAEH members who are health care professionals also view with alarm any unintentional message that this legislation would send to Vermonters who are at-risk for suicide. Even if this bill could safeguard Vermonters at end-of-life from potential abuses – which it can’t – it cannot possibly keep suicide-prone Vermonters from thinking that the state of Vermont agrees that when life gets too hard, it’s OK to end it all.

The VAEH urges concerned Vermonters to leave a message for their state senators at the Vermont Statehouse during working hours at (802) 828-2228.

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  • In this country today the act of writing a prescription is almost always an act of harm. Prescription medications are designed to make you sick and keep you that way. The money is in sickness, not health. Follow the money and you find out this whole perverted system is a criminal conspiracy between the top executives at the chemical cartels and the administrators at the Federal ‘regulatory agencies’ who are THE SAME PEOPLE.

  • Where is the common decency in not allowing an individual a doctor’s guidance and assistance in leaving this world with peace?

    Sure we can treat a lot, and that fact is a huge part of the reason folks would like to get out from under the “let’s treat everything with full medical assaults until they die from our treatments” medical philosophy.

    There are plenty of folks who do not wish to become professional patients performing work at the demand of the medical system. There are plenty of folks who wish to let their lives end with a modicum of dignity instead of imposing hugely expensive medical bills on their children or society at large. There are plenty of folks who do not agree that a few extra weeks or months of life that is dependent upon medications (creating who knows what side effects) is worth the pain and struggle that doctors and others who lay claim to know ourselves better then we.

  • Paul Donovan

    I would suggest that the evaluation and counseling that accompanies the decision serves to mitigate the concerns expressed by Prof. Mahoney, which I already see as minimal. I think you can also make an argument that making the doctor’s ethical choices less difficult might not be in the best interests of the patient. There’s a logical flaw in “slippery-slope” arguments. Lastly, and maybe most importantly, keeping a suffering (or heavily drugged) patient alive against his or her will for months without hope – perhaps even unconscious – might constitute “doing harm”. I can only hope that if I find myself in such a position that I can protect myself from having my decisions made for me by strangers.

  • Chuck Kletecka

    The concept of “doing no harm” acknowledges the value of each individual, including their right of self-determination. Self determination is what this bill is all about. Other concerns are important, and I believe addressed in this bill, but respect and trust in individual patient choice matters most.

  • Bob Rottenberg

    My almost 96 year-old dad has been asking me for many months, “Isn’t there a way I can put an end to my life?” He lives in New York State, which has no legal provision for physician-assisted suicide. About the only option available (aside from his threats to jump out a window) is to stop eating — which would certainly work, but would take a long time, and is no fun. I think he would welcome being able to take some doctor-prescribed pills, or get a shot, and simply drift off into whatever comes next.
    Of course, there’s nothing medically “wrong” with him, so I’m not sure that he could be diagnosed as “terminal.” His vital signs are all fine. He’s just old and tired and ready to move on.

  • My father’s mother, my father, and my mother all decided how and when they would die – and none of them committed suicide. My mother’s mother died, after incredible suffering with bone cancer. Her doctor allowed her to self-medicate with codeine and morphine but, even though she pleaded with him to help speed up what she referred to as “dying by inches” he would not even tell her what the lethal dose of her medications was that would grant her wish. If he had had the compassion to do that, I certainly would not have ever called it suicide. I invite anyone who cares to read excerpts from the last 4 months her diaries at and if you can do that without crying, you should not even be involved in this discussion.

    The only mention of “suicide” in S.103 is in the following section

    Nothing in this chapter shall be construed to authorize a physician or any other person to end a patient’s life by lethal injection, mercy killing, or active euthanasia. Action taken in accordance with this chapter shall not be considered tortious under law and shall not be construed for any purpose to constitute suicide, assisted suicide, mercy killing, or homicide under the law.

    This bill is not about suicide – it’s about people deciding for themselves how to manage the how an when of their dying near the ultimate end of their lives. Dying is as much a part of life as birth. One way to do “harm” is to not allow them a reasonable option for control of that part of their lives. My father and his mother starved themselves to death. Believe me, that is not a reasonable option but it was the best option they had for control.

    And one of the things you can learn from my maternal grandmother is relieving pain with medication comes with dramatically changing the function of your brain in ways that separate you from reality – which is loss of control of who you are. Being in control of your life is an important part of dignity. That’s what this bill is about – not suicide. It’s about a small adjustment to the end date.

    My parents and my grandmother set a good example for me but they did not teach me to commit suicide.

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