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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6 Comments on "Mahoney: First, do no harm"


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4 years 10 months ago

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.

4 years 10 months ago
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… Read more »
Paul Donovan
4 years 10 months ago
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… Read more »
Chuck Kletecka
4 years 10 months ago

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
4 years 10 months ago
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… Read more »
4 years 10 months ago
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… Read more »
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