How Many Doctors Support Suicide for the Terminally Ill?

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Not long ago the New England Journal of Medicine ran an article on the vexed question of physician-assisted suicide in the case of the terminally ill, and doctors were asked to vote, for or against, online. The results of the poll have just been published.

As the editors are at pains to point out, such a poll has no scientific validity, since those who took the trouble to vote were not a representative sample of anyone but themselves. This does not mean, though, that the poll was altogether without interest, though certain data would have made it even more interesting.

In all, the journal received 5,205 votes from doctors around the world. However, the editors noticed that there were multiple votes in quick succession from several locations in Canada, suggesting a concerted effort to influence the result. These – 1,137 of them – were excluded from the report, leaving 4,068 votes deemed valid.

It would have been interesting to know in which direction the discounted votes voted, but this information was not given. Do those against or those in favor of physician-assisted suicide have a more active lobby or pressure group in Canada? I am not sure I would know which way to bet: one could almost hold a poll on the subject. 

The fact that the lobby group (if that is what it was) voted in quick succession suggests a degree of the blindness of monomania, for surely anyone other than monomaniacs would have realized it would be best to vote at intervals rather than in quick succession. I was rather reminded of the few murderers whom I have known who killed for life insurance money after the sum assured on the victim had been raised dramatically. They could seldom wait more than two weeks before they killed the victim and made their claim: a sequence of events that greatly assisted the police in elucidating the crime.

There were 1,712 votes from 39 of the United States and 2,356 votes from 74 other countries. Overall the votes were similar in the U.S. and abroad: 67 percent of American doctors, and 65 percent of foreign ones, were against and 33 and 35 percent, respectively, were for.

There were 11 countries, however, in which a majority of voters were in favor (with Mexico in the lead), and 18 of the 39 American states. Interestingly, Oregon and Washington were not among the former, though they are the two states in which physician-assisted suicide is actually legal. Unfortunately, the sample is too unrepresentative to draw any conclusions from this, for example that doctors in those states who have seen assisted suicide up close have turned against it. The voting might just as well have been the result of die-hard, last-ditch opposition to what has already been accepted.

The voters were allowed to record briefly their reasons for their vote. The main argument for is that doctors have a duty to relieve suffering as well as prolong life. A less good reason given, indeed one that seems to me senseless, was that if physicians assist at birth they ought also to assist at death. Those against used the familiar argument from the slippery slope. We are all of us dying from the moment of conception; why should the mortally ill alone be spared the pain of continued existence? And if assisted suicide is a right, who has the corresponding obligation to provide it?

In Britain, younger doctors are more in favor of assisted suicide than older. Whether this represents a cultural change or merely the effect of aging as the prospect of being shuffled of this mortal coil by homicidally humane young doctors draws closer is not yet known.