An Open Letter to Representatives of the World Medical Association

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COMMENTARY

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I am writing to representatives of the World Medical Association (WMA) who may be going to the WMA General Assembly in Reykjavik, Iceland. I would like to communicate my concern about the current effort of the Royal Dutch Psychiatric Association to try and influence the WMA to “go neutral” on the issue of medical euthanasia and physician-assisted suicide. This is an effort by elements in the WMA that have been normalizing a remarkably slippery slope for over 16 years. It is an attempt to export to the world medical community a uniquely extreme and problematic distortion in the history of medical ethics.

The living laboratory of the Netherlands and Belgium demonstrates that a “slippery slope” is not just a theoretical concern. It is a profoundly disturbing reality that has developed after these countries allowed the killing of certain patients on request to be a “treatment plan” in the House of Medicine in 2002. In that year, these countries removed any distinction between terminal/nonterminal conditions and physical/mental suffering, in the criteria for medical euthanasia. That development opened euthanasia to people with psychiatric disorders. Now, well over 100 psychiatric patients are euthanized on request each year in Benelux, supported by the same treating psychiatrists who had previously been trying to prevent their suicides.

As a clinical psychiatrist and medical ethicist of 35 years, I have been quite active, both nationally and internationally, lecturing and speaking against physician-assisted suicide and euthanasia. I have been especially concerned about and arguing against the extension of these practices to include psychiatric patients in Belgium and the Netherlands. Along with a colleague, I crafted and shepherded through to approval the new Position Statement on Medical Euthanasia of the Non-Terminally Ill by the American Psychiatric Association (APA) and its strong ethical stance against psychiatrists participating in bringing death to non-terminally ill patients. [The APA remains opposed to all physician assisted suicide and medical euthanasia, but we needed a special policy statement regarding the non-terminally ill, in light of what is happening with psychiatric patients in Benelux].

The WMA is keeper of the covenantal Community of Medicine, which has carefully evolved and “professed” a clear ethos since our Hippocratic origins. Our “profession” has a venerable history in its stance against euthanasia and related practices, which has been thoughtfully cultivated throughout the history of countries that have risen and fallen, some of which now exist as part of the WMA. The WMA’s current stance against euthanasia and assisted suicide is a strong protection against contemporary attempts to bend medical ethics to social demands-attempts we have seen before in the era of eugenics, forced sterilization, the Nazi T4 program, and the Holocaust-all which were done with the complicity of medical organizations and the participation of the leading physicians of their time. These examples remind us that medical ethics are indeed vulnerable. It is vital that the WMA preserve its current, principled, and enduring stance against physicians providing death to their patients, not merely getting out of the way of natural death while ministering to patients’ suffering. The words of Margaret Meade to a psychiatrist friend are worth remembering:

The followers of Hippocrates were dedicated completely to life under all circumstances, regardless of rank, age, or intellect-the life of a slave, emperor, foreign man, defective child. . . This is a priceless legacy which we cannot afford to tarnish. But society has repeatedly attempted to make the physician into the killer . . . It is the duty of society to protect the physician from such requests.

I hope that as representatives of the WMA you would consider that organization’s ongoing mission to protect physicians from such requests. Please utilize your presence at the WMA to sustain this 2300-year-old Hippocratic ethos.

I am a psychiatrist on the faculty of Johns Hopkins and the University of Maryland. In my travels throughout North America and Europe to address this issue, I speak about the venerable history of medical ethics, and I particularly articulate the fundamental ethos of psychiatry-we prevent suicide, not provide it.

I urge you and other WMA representatives to spend a few minutes listening to the two-part podcast I did for Psychiatric Times on this issue:

Part I: Focus on Belgium and the Netherlands, which reviews what is happening in those countries which rapidly moved beyond euthanasia for the terminally ill to the non-terminal, and are now on the verge of removing any medical criterion- pushing for physicians to be able to voluntarily euthanize those who are “tired of life,” or feel they have “completed” life.

Part II: Focus on Canada, which also reviews attempts to thwart physician conscientious objection in Ontario.