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Nuland wrote in the context of an editorial favoring a right for physicians to engage in euthanasia — an act explicitly prohibited by the Oath. That is disturbing enough. But to see just how radical a departure Nuland's proposed "individual conscience" standard could take medicine away from thousands of years of professional wisdom and tradition, just read "Costing an Arm and a Leg" written by Carl Elliott for Slate. Elliott writes about a bizarre new mental illness called "Body Integrity Identity Disorder," or as it is commonly known, "amputee wannabe." Yes, you read right, we are talking about disturbed people who want their arms or legs cut off. Worse, there appear to be at least a few doctors whose "individual consciences" allow them to amputate these patients' healthy limbs — most notably Dr. Robert Smith of Scotland — who has admitted to acceding to the desires of amputation-obsessed patients. According to Elliott, there are even psychiatrists willing to prescribe amputation as the "only" available therapy to their patients' obsessions even though, "no formal research studies on treatments for wannabes have ever been undertaken." While it remains exceedingly rare for physicians to be willing to amputate healthy arms or legs, the idea of facilitating patient suicides — once just as beyond the pale as unnecessary amputations — has gained steam in the mental-health professions as well as among a minority of physicians. Indeed, there is a new theory being promoted in psychiatry, psychology, and social work known as "rational suicide." According to rational-suicide proponents, the mental-health professional's duty to a suicidal patient is not necessarily to prevent death. Rather, if after exploring the reasons a patient wishes to commit suicide the mental-health professional believes that the decision "to suicide" — some advocates use the word as a verb — is "rational" and appropriate to the patient's personal circumstances, then not only should the decision be accepted, but perhaps even facilitated. Indeed, once the professional decides that the reason for committing suicide is rational, his primary job is not to engage in prevention but to ensure that the patient goes through a proper decision-making process, such as ensuring that he has considered the impact of the planned suicide on loved ones, before doing the deed. As far as I know, professional associations have not yet formally accepted rational suicide. Still, "model rules" for "permitted suicide" have already been published in the October 2001 Journal of Mental Health Counseling, in an article written by Elliot D. Cohen, Ph.D. According to Cohen, a "permitted suicide" exists when a "counselor validates the client's decisions to commit [rational] suicide and obtains at least one independent qualified, confirmatory assessment." Providing the mental-health
profession's imprimatur to self-destruction does not end the duty of the
permitted suicide practitioner, according to Cohen. Counselors are also
required to become "knowledgeable about the various methods of self-administration,
including types of drugs, lethality of dosages, and efficacy of methods"
for suicide, so that the patient can be instructed on how to do the job
right. Above all, mental-health professionals are urged not to be judgmental
about suicide. Indeed, Cohen analogizes committing rational suicide to
refusing life-sustaining medical treatment. Since the suicidal person
can't pull the plug in order to die, he asserts, the rational suicide
"warrants the same legal protection afforded other groups of rational,
competent persons against involuntary hospitalization, detainment, surveillance,
and other forms of coercive practice." Think about the implications of this decision: Regardless of the individual or societal consequences, absent extraordinary exigencies such as preventing a plague, virtually anything may be allowable medically in Montana if it can be construed to involve obtaining "medical care from a chosen health care provider." Indeed, the decision was so radical that two justices dissented. They worried that the court had stripped the Montana legislature "of any role in matters relating to health care to be provided to the people of Montana" and that rule of law enunciated in the case was so broad that it could "encompass and decide such issues as the right to physician-assisted suicide and other important health and medical-related issues." If the dissenters were correct that almost anything goes medically in Montana so long as a patient wants it and a health-care professional is willing to do it — a reasonable interpretation considering the expansive language and philosophical thrust of the majority's decision — then it could very well allow doctors to amputate healthy limbs upon request and permit psychiatrists to participate in the "rational suicides" of despairing patients If medicine and mental-health counseling are to remain truly professional, "anything goes," cannot be their creed. Rather, health-care professionals need to energetically revive and defend the venerable Hippocratic principle that doctors are duty-bound not to harm any patient — even if that is what the patient desperately wants. To do otherwise is to abandon those who are least capable of protecting themselves to the horrors of self-abuse and destruction. — Wesley J. Smith is a senior fellow with the Discovery Institute and an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide. His revised and updated Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder was recently released by Spence Publishing. |
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he "Hippocratic Oath" sniffed Dr. Sherwin Nuland dismissively
in the February 24, 2000 New England Journal of Medicine, "has
been embraced over approximately the last 200 years far more as a symbol
of professional cohesion than for its content…Ultimately, a physician's
conduct at the bedside is a matter of individual conscience."
