Do No Harm… Unless It Helps?
- Anisa Chandra
- Sep 10
- 6 min read
By: Anisa Chandra
Would you rather help someone commit their own suicide or wake up every day knowing that someone you vowed to take care of is in pain? It’s this question that doctors worldwide are forced to question when a patient requests physician-assisted suicide. According to the American Medical Association, “Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act"¹. In contrast, euthanasia, another form of assisted death, involves someone else performing the action that actually kills the patient, in contrast to the patient doing it themselves. While both have sparked worldwide debate, physician-assisted suicide has created more controversy as the medical professional is directly allowing the patient to take their own life.
The idea of physician-assisted suicide isn’t a new one – in fact, it pre-dates the Library of Alexandria, the creation of the Roman Empire, and the origins of the Great Wall of China. In book three of Plato’s “The Republic”, it was written that those who live their lives in the face of illness should be left to die, as they suffer so much that their general quality of life is diminished. In fact, the physician Herodotus was condemned for prolonging death through excessive treatment, prolonging the suffering of a sick person. It leaves the patient dependent on a variety of medical equipment, leaving them in a state where they are too sick to live fully, but too well to pass on. However, even before the Common Era, this was a controversial issue. After all, Hippocrates formally took note of the idea that all doctors should protect the lives of patients through medicine. And many agreed with him – Pythagoras, Aristotle, and Epicure, as well as their followers, were all strong opponents of physician-assisted suicide. ²Throughout history, different geographical sects and religious groups have all had their own respective beliefs regarding this controversial topic; while the Romans believed that those who were terminally ill and committed suicide had a reason to do so, early Catholics believed that those who died by suicide should be deprived of a burial in the ground. Additionally, anyone who attempted to reduce their physical capabilities in any manner was stripped of their properties, expelled from their city of residence, and was seen to have rejected their lineage. In more modern times, physician-assisted suicide is legal in a number of states and countries worldwide, including Canada, Belgium, the Netherlands, and various US states. In fact, 1 in 5 Americans now have access to this option. ³Before we examine both sides of this controversial debate, however, it’s important to recognize that the ability to even consider physician-assisted suicide is a privilege. According to the Psychiatric Times, “A demographic analysis of the 76% of patients who chose to ingest their prescribed lethal medication shows that 51% of them were male, 95% of them were white, 72% of them went to college, and 89% of them had health insurance… As in the rest of health care, only the most privileged are accessing this service"⁴.
To begin: if it goes against the Hippocratic Oath, one of the founding documents of medicine as we know it, why do 58% physicians worldwide and 72% of the American public support physician-assisted suicide? One of the most convincing arguments is that of patient autonomy. According to the National Library of Medicine, “It is often argued that assisted dying is permissible because it allows the patient to autonomously control the circumstances of her own death"⁵. After all, if we have the ability and right to control every other aspect of our lives and health journeys, why shouldn’t that apply to our death? Additionally, just as Plato believed, physician-assisted suicide relieves terminally ill patients, as well as patients with psychiatric illnesses, of their pain. But perhaps the most controversial argument is that of dignity; if a patient is simply looking to hasten an already inevitable death, and through that attempting to salvage their last shreds of dignity, why deny them that right? If it’s up to a patient to either choose to exit this life on their own terms or watch the last of their dignity be replaced with ventilators and feeding tubes, many believe that it’s morally right to allow the patient to make this last choice.
Just as this topic was controversial almost 2500 years ago, the controversy remains. To start, many question whether “death with dignity” is even possible. Renowned ethicist Paul Ramsey famously claimed in 1974 that “there is nobility and dignity in caring for the dying, but not in dying itself"⁶. Ramsey believed that the act of dying contains no dignity, and that holds true regardless of whether or not we choose to accept it. However, as previously stated, the origins of this debate started much earlier than 1974; instead, it started over two millennia ago with the creation of the Hippocratic Oath. To quote it, “I will give no deadly medicine to anyone if asked, nor suggest any such counsel…”⁷. If all of those who go into medicine do so fully expecting to take and obey this sacred script, then the question of physician-assisted suicide shouldn’t exist to begin with. There’s also the question of mental health and safety. Though many American states require mental health scans to ensure that a patient actually has either a terminal psychiatric or physical illness, these screenings often aren’t completed. In fact, according to the Psychiatric Times, just four percent of cases in Oregon had these “mandatory” scans. This created thousands of preventable deaths, especially for those who could’ve found other solutions through modern medicine, therapy, and rehabilitation programs. But if not physician-assisted suicide, what is the best way to care for terminally ill patients in pain? Though it may seem more gruesome, many patients prefer the voluntary stopping of eating and drinking, otherwise known as VSED. According to Dr. Ronald Pies, “those who stopped eating and drinking were rated by hospice nurses as suffering less and being more at peace in the last 2 weeks of life.” This is most likely because VSED is fundamentally different from starvation - the body of a person with a terminal illness is shutting down, and therefore doesn’t require heavy amounts of calories. This causes them not to experience hunger or thirst in the same manner that a healthy person would. ⁸Additionally, methods such as palliative care, hospice, or nursing homes have been used for centuries, and allow those with terminal illnesses to die surrounded by loved ones.
To better examine this issue, it’s important to look at real stories from both patients and physicians. One of the most controversial cases took place in 2018 and describes the story of 29-year-old Aurelia Brouwers. ⁹She’d been suffering from a variety of mental illnesses since the age of twelve, which caused her to commit suicide several times. To her, physician-assisted suicide was a method to escape the madness she had been living in. However, critics across the world continue to question whether a rehabilitation program, therapy, or another alternative could’ve allowed her to successfully recover. This story perfectly encapsulates the dilemma that is physician-assisted suicide: Is it the role of a doctor to do everything they can to allow a patient to live, even if it’s in a life of misery? Or do patients deserve autonomy regarding their own death? It’s also important to look at the perspectives of physicians in this situation. To quote “Pat”¹⁰, a pseudonym for an M.D. who has committed plenty of assisted suicides, “as health care professionals, and even as human beings, we’re just not used to doing this sort of thing”, which led to her feeling stressed and unable to focus for the days following her patient’s death. However, she felt positive feelings as well. Due to the amount of time she had spent with the patient, she knew how much pain they were in. Death was how they were able to free themselves, and she found knowing that gratifying¹⁰.
To conclude, the idea of physician-assisted suicide has continued to remain controversial. Beginning with Plato and Hippocrates during the time of the Ancient Greeks, it brought up ideas of the true role of a doctor, autonomy regarding death, and what it means to be terminally ill. This centuries-long debate forces us to confront what it truly means to live – and how to die with dignity.
9.10.2025
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