The only way I survived the agonizing uncertainty of the years after getting stuck with an HIV-infected needle was with the knowledge that I could commit suicide should I ever reach that special terminal point.
I had seen dying AIDS patients beg for death's mercy and be denied this compassion by physicians afraid of the legal consequences. I was lucky, I did not get infected. But my thinking about death and dying certainly changed.The Hippocratic Oath was invented long before the persistent vegetative state, the respirator, the heart-lung machine and the surgical transplant. I now believe we physicians are misguided when we try to control modern technological medicine with an ancient ethic.
Therefore, to the question of whether physicians should assist euthanasia, I must say yes. From humanitarian, social, ethical, medical and political points of view, I believe this is the direction in which society must move.
Yet when Dr. Jack Kevorkian assisted 54-year-old Janet Adkins to take her own life in June 1990, shock waves reverberated across the nation. The incident fueled a smoldering public policy debate over euthanasia and the role physicians should be allowed to take in helping patients die.
Eventually, murder charges were dropped against Dr. Kevorkian since it is not considered illegal in the state of Michigan to commit suicide or to assist with another person's suicide. Dr. Kevorkian has, however, been stripped of his medical license, and has recently been indicted again for aiding two other suicides.
Then in November 1991 the Death with Dignity Initiative came before the voters of Washington state. This would have created the world's first law sanctioning physician-assisted suicide by allowing physicians legally to perform active euthanasia without criminal sanction on a "conscious and mentally competent, qualified patient."
Though Washington's Initiative 119 was defeated, a similar signature-gathering campaign is now under way in California, and New Hampshire and Michigan soon may consider the issue.
In the meantime, the medical profession is in a quandary over how to handle the persistent vegetative state patient who is incompetent to make decisions and has provided no living will or medical power of attorney. An estimated 5,000 to 15,000 people in this country are in such a state at any given time. A Virginia woman has been in this state since October 25, 1951.
Then, there are the dying, chronically ill. Critics note that there is a fine line between withholding or withdrawing treatments that sustain life vs. treatments that directly end life. Once physicians step over this line, the critics say, they go beyond their traditional role to "first, do not harm." In fact, the role of the physician has already changed.
Consensual termination of life by a mentally competent terminally ill patient is morally justified because it provides for individual choice about matters of vital and exclusive importance: the timing, manner and circumstances of one's own death.
Far from being a cowardly act, suicide is heroic when death is viewed as a part of life, a terminal end of the great circle. Logic and fairness dictate an extension of these rights to all categories of patients - the dying, the chronically ill and those in a persistent vegetative state.
For physicians not to help their patients die, if dying is the patients' considered choice, is, in my view, the act of cowardice.
American physicians must be prepared to extend their ethic, to meet death with their patients. This would contribute to the physician's stature as healer, not diminish it.
(Dr. Dittman is a surgeon at the University of Texas Health Center in Houston. This is excerpted from the summer issue of Priorities, a quarterly magazine of the American Council on Science and Health.)