The assisted-suicide bill in Hawaii was just deferred. We may see it threaten patients again in coming years. I offer my comments as a psychiatrist, and as a clinical expert on suicide.

Assisted-suicide is, at the very least, a medical procedure unlike any other. A surgeon hopes that his patients will wake up again, and be alive to critique him. A living patient is a complaining (and perhaps a litigious) patient.

A dead patient is a patient who by definition cannot complain — a point never lost on pirates (“Dead men tell no tales”) or on the Mafia. In fact, there is probably something profound in the old Jewish idea of glorifying God through our kvetching.

To bring the point back to doctoring: Imagine, if you will, a procedure where a patient cannot complain afterwards. Picture a procedure whose purpose is to end complaining, precisely by taking away a patient’s ability to complain.

A living patient is a complaining (and perhaps a litigious) patient.

Such is an assisted-suicide. How convenient for the doctor. His patients are so satisfied with their outcome … they’re practically speechless.

Assisted Suicide: The 21st Century Lobotomy

In my own field of psychiatry, for many decades we had another such procedure, one which obviates complaint. Almost no patient ever complained about his lobotomy. Patients who were lobotomized were docile. They hardly complained about anything.

Today, we do not allow lobotomies. Patients may request it, as they sometimes used to. But it isn’t available. We consider it barbaric and inhumane. Doctors have said NO. We have imposed our value system on our patients. 

We’re Ashamed to Say “No”

These days, doctors can be very uncomfortable saying NO. Look no further than the opioid epidemic we are facing as a country. It’s largely caused by the unwillingness of doctors to say NO. Like you and everyone else, doctors do not like being characterized as callous or cruel.

Doctors are, perhaps, in their wish for moral esteem, even more sensitive to these accusations than the average person. Especially in our touchy moral climate.

A doctor who facilitates an assisted-suicide may be touted as a doctor who looks squarely at his patient’s suffering. But he might be, on the contrary, a doctor unwilling to sustain the professional burden of having failed a patient.

Patients Who Feel They’ve Failed Their Doctors

On an unconscious level, a minority of cancer patients may actually feel guilty for not responding to treatment. They may equate their illness with personal failure. The patient may also perceive his suffering as causing the doctor to suffer.

The patient may have an unconscious wish to preserve, at all costs, his own belief in the doctor’s omnipotence to heal. Some patients may imbue their doctor with childhood feelings, the sorts of feelings in which mommy can kiss away any boo-boo, and no matter what, daddy will find a way to fix it.

For these patients, the thing that absolutely cannot be endured, is not their suffering per se, but to see a doctor turn and throw up his hands.

To a doctor with no other moorings than “I’m good, science is good,” a lethal prescription may be quite appealing.

These emotional factors in interplay can create a perfect storm. To a doctor with no other moorings than “I’m good, science is good,” a lethal prescription may be quite appealing. The finality of it may be especially so.

An Unholy Communion Wafer

On a deeper and more perverse level, the sacramental aspect of it may resonate. A lethal prescription may be prescribed by mouth, like a Satanic wafer, or like a coin on the mouth for Charon the ferryman. 

What are the chief duties of physicians? They are “to cure sometimes, relieve often, and comfort always.” To sit with our patients. To admit our failings. To say NO if necessary. And to continue to offer our help.

Emphatically, it is not among our duties to ship our patients off to some unknown shore, a shore from which they can never return, and wash our hands of the whole thing.

We saw this mindset in the unique history of the leper colony in Kalaupapa, Hawaii. We saw it especially in the doctors who sent patients there, but who refused to go there themselves.