Physician-Assisted Suicide: There Are No Best Practices


I am an adult psychiatrist who has worked in public sector psychiatry in the US and the UK. In both countries, physicians struggle with the ethics and professional meaning of legalized or proposed physician-assisted suicide (PAS). I was recently asked by an organization to host a CME course titled “Best Practices in the End-of-Life Options Act.” Passed in 2016, the Act legalized the practice of PAS in California.

My response to the invitation

Thank you very much for your invitation to join in providing a CME about “Best Practices in the End-of-Life Options Act.”

I understand and appreciate your wish to institute best medical practices in the context of the very serious and complex ethical and legal issue of PAS.

At one point in my 14 years of examining and writing about PAS and euthanasia, I thought that, even though I found PAS to be unethical, in situations where it became legal, perhaps the best that psychiatrists and other physicians could do would be to provide thorough assessments and treatment options for individuals requesting PAS.

However, as I continued to weigh and evaluate the ethics of PAS, analyzing the logic, sociocultural context, and history of medical ethics has led me to this opinion: To facilitate an unethical practice—even with the best of intentions, even if legal, and even if one does a little good in the process—is to be unethical. Here are the logical arguments that point me to this conclusion:

Does making something legal make it ethical?

Medical ethics is not based on legality. The death penalty is legal in some states, yet it is recognized as unethical for doctors to participate in executing prisoners, even if the prisoner requests a doctor to assist by administering a drug.

Some forms of torture are legal, or have been legalized, yet it is recognized that it is unethical for physicians to participate in the process of torture, even indirectly. If doctors are required by law to do something unethical, that does not make it ethical.

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