When a person is suicidal, it is standard to get a psychiatric or psychological evaluation to help treat the suicidal person-except in states that have physician-assisted suicide laws. In those states when a suicidal person wants assisted suicide, there is only a so-called “safeguard” that leaves it up to the opinion of the assisted suicide doctor as to whether or not such an evaluation is necessary.
Not surprisingly, very few such consultations are done since assisted suicide advocates insist that suicide is rational when a person is terminally or incurably ill.
But even if such an evaluation is done, would it be done according to the same standards as the evaluation of a suicidal person not seeking medically assisted suicide?
In my opinion, probably not.
In a recent Psychiatric Times article “Death and the Psychiatrist”, editorial board member and ethics writer Dr. H. Steven Moffic struggles with the topic of medically assisted suicide:
The role of the psychiatrist is generally to determine whether psychiatric illness is contributing to the decision to die. The assumption is that the mental illness is treatable if it is diagnosed. Another related role is to assess competence to make a decision.
However, data indicate that psychiatrists are seldom called in by other physicians when they should be. Moreover, in the Netherlands and Belgium, physicians can now be called on to help mentally ill patients die.2 (Emphasis added)
Dr. Moffic goes on to note that:
Polls indicate that like the public, physicians and psychiatrists have mixed and ambivalent opinions about euthanasia, and—for moral reasons—few of us want any involvement.5” (Emphasis added)
There are obvious financial considerations as Baby Boomers age and become ill. End-of-life medical costs are high and physician-assisted suicide offers a cheap, quick solution to conserve health care resources. (We in psychiatry know this all too well, since we were an early target of for-profit managed care cost savings.)13 (Emphasis added)
Yet he concludes:
Beyond the personal, what do I believe professionally about euthanasia? I lean toward the AMA position—that physician-assisted death could take us too far away from our healing role. Perhaps, though, a special cadre of physicians can be trained and dedicated to this role. (Emphasis added)
However, ambivalence does nothing to stop or even limit medicalized suicide.
The traditional Hippocratic Oath was routinely taken by graduating medical students and promoted the standard of incorruptible virtue in the practice of medicine. In the 1960s, that began to change and new Oaths were promoted as more up to date and relevant.
Significantly, one of the first parts of the Hippocratic Oath to be eliminated was:
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion. (Emphasis added)
Now we have medicalized deaths actually promoted as civil rights.
Without strong ethical standards, enforceable laws and honorable health care providers, how can we be expected to just automatically trust our health care system?