Physician-Assisted Suicide in the ICU: Experts Debate Ethical Issues

Controversial topic gets spotlight at Critical Care Congress

Physician-assisted suicide and euthanasia (PAS/E) is a topic of intense debate in society, not least among critical care medicine specialists, who treat many patients at or near the end of life. Core ethical issues involved in PAS/E will be discussed and debated in a panel discussion at the Society of Critical Care Medicine’s (SCCM) 46th Critical Care Congress, to be held on January 21–25 at the Hawaii Convention Center in Honolulu, Hawaii. The issues are also discussed in the February 2017 issue of Critical Care Medicine, the SCCM’s official journal. The session will be broadcast live at www.sccm.org/live.

“We describe major alternative perspectives on four questions central to the ethical analysis of PAS/E in the form of a dialogue between those who favor the legalization of PAS/E and those who oppose it,” according to the article by Ewan C. Goligher, MD, of the University of Toronto, and his coauthors. They present a “collegial” perspective on these difficult issues by a panel of critical care medicine clinicians and other experts.

New laws and legal decisions have sharpened the focus on PAS/E and its implications for critical care medicine. Physician-assisted suicide refers to the prescription of lethal medications to be voluntarily self-administered. Voluntary euthanasia refers to the direct causation of death by a physician at the patient’s “specific, consistent, and thoroughly considered request.”

The four ethical issues to be debated include:

  • Are there patients for whom death is beneficial? One group of authors “find[s] it sometimes justifiable to accelerate a patient’s death deliberately as a means of ending suffering.” But the other group responds that the benefit from intervening to cause death is “unknown and unknowable to medicine.”
  • Is PASE/E morally equivalent to withholding or withdrawing life-sustaining therapy (WWLST)? Authors on the “pro” side believe that PAS/E is equivalent to WWLST, the latter widely regarded as morally acceptable. But those on the “con” side point out notable ethical distinctions between PAS/E and WWLST that reflect differences in intent.
  • Is it morally acceptable for physicians to cause death intentionally? Supporters of PAS/E see no “sufficient rationale” why patients should be allowed to consent to passive plans that will lead to ending life (such as WWLST) but not to active plans. Those opposed believe that intentionally causing death “runs counter to ... the moral foundation of medicine.”
  • What is a reasonable accommodation? Both sides agree that physicians have a right of conscientious objection to PAS/E. Patients should expect that many physicians will be unwilling to provide PAS/E. At the same time, physicians who object should be willing to transfer the patient’s care to colleagues who are willing to consider PAS/E.

Discussions on PAS/E have become increasingly prominent in health care and in society at large, according to the SCCM. PAS/E is now legal in six U.S. states and Canada.

Goligher and his colleagues write: “We hope that our discussion enables readers to reflect critically on their own position on PAS/E in order to care for critically ill patients and their families with ever greater compassion and humanity, and to discuss these issues among colleagues with clarity and respect.”

Sources: EurekAlert; January 18, 2017; and Critical Care Medicine; February 2017.