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Assisted Suicide: A Decision-Making Guide for Health Professionals

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Stephen Jamison
Assisted Suicide:
A Decision-Making Guide for Health Professionals

(San Francisco, CA: Jossey-Bass Publishers, 1997)
(ISBN: 0-7879-0873-8; hardcover)
(Library of Congress call number: R726.J357 1997)

Almost all doctors and nurses who work with dying patients
get asked from time to time to assist their patients to die.
This book directly addresses this dilemma:
What should the doctor or nurse do
when asked to assist a dying patient
to achieve a peaceful and painless death?

Assisting suicide is still officially a crime almost everywhere.
But this book reports that such laws have never been used
against a health-care worker who has helped someone to die.

This book does not explore the reasons for death
as seen by the patient who is dying.
Those issues are in the background.
And it is assumed that the nurse or doctor
would not assist a patient to die
unless it was in the best interests of the patient.

Rather, the focus is on the decision-making process
within the health-care professional--the doctor or nurse--
who must decide how to respond to a request for help in dying.

The doctor is first supposed to do no harm.
And sometimes assisting a patient to die is a help rather than a harm.
But the doctor does not want to get a reputation
as someone who helps people to die.

Does the doctor plan to be present when the patient takes the gentle poison?
The doctor should not recommend death as a treatment option.
But when the patient brings it up,
the doctor needs to think deeply about what is best for the patient
and how best to protect all the people who might become involved
--including, of course, the doctor himself or herself.

Good communication between the doctor and the patient
should make explicit all the reasons the patient wants to die
--both valid reasons and invalid 'reasons'.
Here are some of the invalid reasons for choosing death:
Some patients want to die because they fear they will lose the power
to choose death at a later phase of their disease.
Some patients are emotionally exhausted by the whole process.
Some patients suspect they have additional medical problems
they have not been told about.
Some patients do not want to be an emotional
or financial burden on their loved one.
Some worry about isolation as they die.
Others feel in despair.

There are two extreme ways of responding:
(1) Absolutely refuse to assist the patient to die.
(2) Grant the wish for death immediately.
Every health-care worker has a right to refuse to help the patient die.
But when they refuse to help, they should refer the patient
to someone else who feels more open to choosing death.

In some complex cases, where various doubts might arise,
it could be wise to call in a psychological consultant,
who will assess the patient's state of mind
and abilities to make wise life-ending decisions.

Families of the dying often complicate the process.
Some family members might be opposed to any chosen death.
Some relatives feel guilty for having neglected the patient.
Sometimes parents did not know their sons were gay
--much less dying of AIDS and now asking for assistance in dying.

Before agreeing to assist a patient in dying,
the doctor should make certain
that pain and other forms of suffering
have been addressed in the best possible ways.

What methods of assistance in death are available to the doctor?

1. The doctor can order increased pain medication,
but when the amount of medication is out of line with general medical practice,
the nurse will notice that a secondary purpose is to bring death.

2. The doctor can discontinue the life-support systems.
Jamison does not call this a method of assisting death.

3. The doctor can cooperate with the patient
who decides to give up food and fluids.
This method of achieving a voluntary death is completely legal.

4. The doctor can order terminal sedation
--enough pain-killers to keep the patient unconscious until death occurs.
And the drugs will probably shorten the process of dying.

Because assisting a patient to die is still illegal,
90% of the assisted deaths Jamison studied were reported as natural death.
The other 10% were reported as (unassisted) suicides.

Even tho many assisted deaths have been reported in the media,
almost no one has been prosecuted or sued.
But there is a small risk,
which suggests that knowledge of the real cause of death
should be confined to a small circle of people who can be trusted.

Assisted Suicide should be read by all health-care workers
who might ever be asked to help a patient to die.
In general, it does favor the right-to-die.
But most of the book is taken up with cautions
that doctors and nurses should heed
when responding to requests for aid in dying.

If you would like to read reviews of other similar books,
search the Internet for this precise expression:
"Books on Helping People to Die".

James Leonard Park, advocate of the right-to-die with careful safeguards.