“First do no harm.” That is part of the oath that all physicians take as we graduate medical school. I graduated in 1995, and I went off to Oregon to start my residency. Oregon had just passed a death with dignity law. As a result, my residency placed a large emphasis on making sure the end of life was treated appropriately and that pain was treated appropriately.
But, gratefully, it was blocked. (A federal court lifted an injunction against the law in 1997, allowing it to go into effect) How could I as a physician help someone take their life? How could I be sure they were not suicidal? As physicians, we try to stop suffering absolutely. In fact, we became so good at that we started an opioid crisis in this country.
We already often hasten death. We adjust medication doses to breathing rates when people are near death and sometimes give just a bit too much. Did our treatment hasten their death? Probably. It is a question that haunts us as physicians. That is vastly different than handing someone a fatal prescription. That last dose is usually given in hospice or home hospice by loving caregivers who have been at the bedside. Sometimes this occurs in the hospital. Either way, this is appropriate use of medication because we are treating the suffering in front of us. Opioids suppress breathing — that is how overdoses occur — and at the end of life that can be a welcome respite. For me, having taken the oath to “do no harm,” that is as close to euthanasia as I am willing to ever get.