Medical Aid in Dying: Defining “Treatment”

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This article is in response to the From Our Readers article, “A Medical Degree Is Not a License to Prescribe Death” by Susan Stefan, JD.

I thank Susan Stefan, JD, for her thoughtful comments. I totally agree that prescribing lethal medication is best done in the context of a longstanding relationship between patient and physician. However, the fact that it is currently most often provided by a physician with a special commitment to medical aid in dying (MAID) is likely an unavoidable transition. (The “agenda” is to give patients the option, not to having them choose it.) We can hope that over time more physicians will become comfortable discussing these issues with their established patients in a frank and nonjudgmental way, even if the physician prefers to have another physician do the actual prescribing should the patient opt for MAID.

She asserts that MAID should be opposed because “suicide is not ‘treatment.’” But what is treatment? If our task is solely to extend the time our patients are alive, MAID clearly is not. If it includes interventions to reduce suffering, support our patients’ autonomy, and maximize their dignity as they define it, it clearly is. An initial visceral response to terms like “suicide” or “prescribing death” can result in missing important distinctions. A soldier whose foot is blown off in battle and a person whose foot is cut off by a surgeon to prevent metastasis of an osteosarcoma have both been maimed; The former is not treatment, the latter is.

As to the concern that MAID is simply medicalizing a personal and philosophical decision, the whole point of MAID is to give that decision to the patient. The physician is just providing a humane means to facilitate the patient’s choice. And as to MAID giving the already too powerful medical profession more power, remember that withholding an intervention is as much an exercise of power as providing it.

Dr Heinrichs is a psychiatrist in Ellicott City, Maryland.