RE: Deferring to the Mastery of Death: Hippocrates, Judge Gorsuch, and the Autonomy Fallacy

Psychiatric Times, April 03, 2017,  By Ronald W. Pies, MD

We all know about the slippery slope of giving psychiatric patients to right to request suicide from a medical professional. However, terminally ill medical patients who have terrible pain and suffering and are near death (perhaps on a respirator, have multi organ failure, frequent sepsis, oozing blood from skin and other orifices, repeated seizures, etc), are vastly different from psychiatric patients. Pies and Geppert’s argument does not deny that a physician could not induce a comatose state in these persons, perhaps even a permanent coma until death. Coma (without brain death) is not death medically or legally, although it essentially accomplishes the same thing as death does in removing the patient’s awareness and experience from a living state.

I would have trouble thinking that physician-assisted coma should be illegal or unethical as a form of medical treatment with specific indications just like any other medical treatment (i.e., it would not be indicated for psychiatric illness), and encourage further debate about it. One could argue that these patients can still be aware of things, but the same could be said of patients on morphine. Coma still racks up medical bills, and it may still be painful for a family to see their loved one in this state. Notwithstanding these caveats, we don’t have to argue about physician-assisted dying if we consider coma is good enough.

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