Finding Meaning in Suffering: The Value of Helping Patients

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This article is in response to the series, “The Case for Medical Aid in Dying” by Douglas W. Heinrichs, MD.

Douglas W. Heinrichs, MD, builds his case for medical aid in dying (MAID) on respect for autonomy, and the duty to relieve suffering, while criticizing religious or metaphysical arguments against MAID as beyond the reach of discussion. However, the shift in the US of religious attitudes toward same sex relationships suggests that many of those holding metaphysical convictions are capable of modifying their views. In addition, the belief that individual autonomy has priority over other principles is itself a metaphysical conviction about the nature of moral reality.

A number of conceptual and practical concerns regarding legalizing MAID are not religious. For example, Daniel Sulmasy, in his response to Norman Cantor’s request to be allowed MAID in the face of dementia, expresses his reservation about taking on as a physician the role of deciding problems in living, as distinct from recognizing the limits of medicine when allowing someone to die.¹ He further points out that that the devaluing of basic human dignity inherent in deciding that a life is no longer worthwhile is the reason individuals living with disabilities have been so fearful of legalizing MAID, and that taking one’s life never affects only that individual. The ethicist Daniel Callahan has also probed thoughtfully how we can decide when suffering is meaningless, whether avoiding suffering or promoting self-determination should be our highest goals, and what the costs would be of ratifying MAID as social policy.²

My clinical work as a psychiatrist in a cancer center for over 40 years has convinced me of the value of helping patients find meaning in their suffering, rather than agreeing with them that their lives are no longer worth living.³

Dr Peteet is the Psychosocial Oncology Fellowship Site Director in the department of psychosocial oncology and palliative care at Dana-Farber Cancer Institute and Brigham and Women's Hospital.

References

1. Sulmasy DP. An open letter to Norman Cantor regarding dementia and physician-assisted suicide. Hastings Center Report. 2018;48:28-29. http://bioethics.pitt.edu/sites/default/files/publication-images/CEPResources/October2018/Sulmasy-2018-Hastings_Center_Report.pdf

2. Callahan D. Reason, self-determination and physician-assisted suicide. In: Foley K, Hendin H, eds. The Case Against Suicide: For the Right to End-of-Life Care. Johns Hopkins University Press; 2004.

3. Peteet JR. Patients who request assisted suicide: a closer look at the physician's role. Arch Fam Med. 1994;3(8):723-727.