Saturday, June 11, 2005

Perils of physician assisted suicide...

The current issue of the American Journal of Psychiatry as a rather staggering case report involving physician assisted suicide in Oregon . It involves a depressed and suicidal man with advanced lung cancer who is eventually deemed mentally incapacitated by a judge but whose (pre-existing) lethal prescription is not removed from his house. The piece is a rather vivid example of perhaps unforeseen problems with the OR PAS law, of which the authors are--very reasonably--critical. However the report smacks of a personal dispute, aired publicly, between the authors and an unnamed "Dr. B." This Dr. B--a proponent of PAS--is never named, however the authors give sufficient literature references on him/her that presumably anyone who bothers to dig up some old copies of the Hastings Center Report could presumably identify him or her. Although I could not imagine myself being involved with PAS, I'm not a priori against it, but this case presents one of the perils created by explicitly making PAS legal. For me, a major issue is that it creates a mechanism for physicians who have no prior relationship with patients becoming involved with their suicides & how easy it is to act, then, without adequate knowledge of the patients' histories, psychiatric problems etc.--all vital elements of medical decision making--especially in this most extreme circumstance of medical decision making.

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