Physician-Assisted Suicide

To the Editor: Reasoning by analogy can be misleading. In their November 1998 article discussing developments in the Netherlands concerning physician-assisted suicide in psychiatry, Schoevers and associates state that "a comparison with the death penalty may not be as far-fetched as it seems; the death of an innocent person is always one death too many." The authors thus suggest an analogy between the death penalty and physician-assisted suicide in psychiatry, at least as far as it concerns the deaths of "innocent persons." This presumed analogy, however, is defective for a number of reasons.

First, leaving exceptional cases aside, persons who are confronted with the death penalty have no wish to die. Psychiatric patients who have an enduring wish for assistance in suicide, on the other hand, want life to end because they consider themselves to be suffering unbearably, with no prospect for relief.

Second, presume for the sake of argument that the taking of the life of a guilty person by the state can be justifiable under specific conditions. The legal standards of evidence that can justify the death penalty in an individual case are not necessarily the same standards of evidence that ought to be applied to morally or legally justify physician-assisted suicide. The implication of the analysis by Schoevers and associates seems to be that the standards of evidence in cases of physician-assisted suicide should at least be comparable to the standards for a death penalty sentence. But it is not at all evident what the right standards in physician-assisted suicide should be.

Reasoning by analogy can be dangerous. If such reasoning takes place for rhetorical reasons, we should be particularly cautious. Taking the life of an innocent person who is believed to have committed a serious crime is not comparable to assisting in the suicide of a mentally ill person who is considered incurable, but who might in fact have been curable if his or her life was not ended, perhaps because a new treatment eventually was developed. In the latter case, we will not even be able to make a valid statement about "innocent" patients: in retrospect we can never be sure that the patient would have been curable.

For some, this uncertainty is precisely the ultimate argument for categorically opposing physician-assisted suicide. Indeed, only when certainty is assured will we be able to totally rule out "innocent" candidates for assisted suicide. As a consequence, however, mentally ill but competent patients who suffer severely and hopelessly are left alone.

The morality of physician-assisted suicide in psychiatry needs a different weighing of values, norms, and interests than the morality of the death penalty.

Dr. Berghmans is a senior research associate at the Institute for Bioethics in Maastricht and is affiliated with the department of health ethics and philosophy at the University of Maastricht in the Netherlands.