(1993), in his powerful book, How We Die, has spoken of the “rescue
credo of high-tech medicine” (p. 253). He uses this terminology
to refer to the devoted physicians who are uncompromising in their
fight against injury and disease. When patients are terminally ill
and at death’s door, however, the restorative and curative drive
of high-tech medicine needs to give way. The Karen Ann Quinlan case
is the prototypical example of such a scenario, and the Patient
Self-Determination Act of 1991 was a clear statement of the nation’s
wishes in this regard.
I would suggest
that there is also a rescue credo for professionals who wage a determined
fight to prevent suicide, and Dr. Robert Yufit is deservedly considered
in their ranks. These are deeply committed people who are prepared
to assail any suggestion that our commitment to this cause be weakened.
At this point,
I think that I have read a good deal of and have a reasonable understanding
of Dr. Werth’s work. In no way did I see his comments in the last
issue of this newsletter as suggesting that we, in any way, reduce
our efforts to prevent suicide that stems from mental illness. To
the contrary, he encouraged Section VII members to lobby Congress
for funding for suicide prevention and mental health services. I
read his remarks as clearly referring to the terminally ill who
are competent, not afflicted with a mental disorder, and suffering
intolerably from physical disease. These are patients for whom pain
management has failed (unless one wishes to put the patient into
a permanent state of sedation) and for whom the comfort of hospice
is inadequate. It is not that they see no options; it is that dying
could, in fact, be their best option. What can future time perspective
mean to such a patient?
have quietly helped to end the suffering and hasten the deaths of
patients such as these for centuries. Sigmund Freud was one such
patient. This, of course, is not to argue that assisted suicide
should be institutionalized or legalized in this country. Such an
event could have many undesirable ramifications, and I did not hear
Dr. Werth advocating it in his newsletter remarks.
learned professionals have taken very strong ethical positions on
both sides of this issue. I believe that is why the American Psychological
Association and the American Association of Suicidology made the
very wise decision to neither endorse nor oppose assisted suicide.
Their language was not “wishy-washy”. The issues involved are far
too complex, do not lend themselves to easy answers, and should
not be brought to closure prematurely.
Nuland, S. (1993). How we die: Reflections on life’s final chapter.
New York: Vintage Books.