NEJM publishes powerful essay against physician-assisted suicide

By Dave Andrusko

Editor’s note. I wrote this post a couple of years back. However with a powerful tide rolling in to “empower” the mentally ill (and therefore  unable to give genuine consent) by giving them the “right” to assisted suicide, I believe it is more relevant than ever.

Paul Appelbaum, MD

Although I do scan relevant articles, I don’t profess to be a regular consumer of the New England Journal of Medicine(NEJM). However you don’t need to read it cover-to-cover to know that, by and large, this prestigious medical journal is no friend of the pro-life movement or what we stand for. And that includes a lack of sympathy for our staunch, unyielding resistance to physician-assisted suicide.

So I was pleasantly surprised when I read a very thoughtful article that appeared March 8th written by Franklin G. Miller, Ph.D., and Paul S. Appelbaum, M.D. The title tells you their perspective: “Physician-Assisted Death for Psychiatric Patients — Misguided Public Policy.”

Here are just three of the many important insights.

First, we have often quoted a trenchant observation from the late, great Fr. Richard Johnson Neuhaus who once wrote, “Thousands of medical ethicists and bioethicists, as they are called, professionally guide the unthinkable on its passage through the debatable on its way to becoming the justifiable until it is finally established as the unexceptionable.”

In the first paragraph Miller and Appelbaum write

Should physician-assisted death be available to people with psychiatric disorders? Although it was once unthinkable, physicians, primarily in the Netherlands and Belgium, have helped a small but growing number of patients with mental illness but no terminal condition to end their lives.

One day something is unthinkable, and before you know it, it’s “unexceptionable.” To their great credit, Miller and Appelbaum are striving to prevent that easy acceptance of the unthinkable.


The standard rationale for allowing physicians to aid patients in dying by prescribing or administering lethal doses of medication is that autonomous persons facing death or severe suffering should have the right to negotiate with willing physicians to determine the timing and circumstances of their death.

They layout the absurdity of applying the autonomy argument to people with mental illnesses:

People who seek to end their lives because of persistent suffering from severe mental illness are likely to experience, as a manifestation of the illness itself, intense feelings and distorted cognitions that their lives are worthless and their situations hopeless. Even if it is possible for patients with mental illness who are not terminally ill to make an autonomous decision to seek physician-assisted death, it is difficult, if not practically impossible, for clinicians to be reasonably certain that such a request is not related to the effects of the disorder.

Given that many psychiatric disorders are sensitive to changes in a patient’s environment, there is also virtually no way for clinicians to be assured that the patient’s suffering is irremediable — that there is no reasonable prospect that further treatment or care, including psychosocial interventions, could restore the patient’s will to live. [My emphasis.]

Third, there is the wider societal impact, which proponents just brush aside:

From a societal perspective, we believe providing a legal option for mentally ill people who are not terminally ill to receive medical assistance in ending their lives is misguided public policy. Such an option cannot be squared with the established societal responsibility to prevent suicides by people with mental illness, under which police officers and clinicians are legally authorized to intervene to prevent people from killing themselves. Endorsement of physician-assisted suicide as an option for people with mental illness would appear to contradict — and may discourage —other efforts to discourage suicide.

It is mind-blogging, cognitive dissonance on steroids, to rightly place the emphasis we do on preventing suicide and then say, somehow, people whose “autonomy” is seriously lacking ought to be able to ask a physician to “hasten their death.”

A fine essay which ends with exactly the right conclusion:

We believe a policy that embraces physician-assisted death for patients with mental illness who are not terminally ill is not compatible with physicians’ professional commitment to preserve life and promote health, including mental health — nor is it compatible with our societal responsibility to prevent suicide and protect and care for people with mental illness.