physician-assisted suicide Archives

Charlie Gard, disproportionate care, and assisted suicide

Michel AccadJuly 22, 2017July 30, 2025Ethicsphysician-assisted suicideLeave a comment

Kevin Malik writes in the New York Times in support of Charlie Gard’s parents, presenting a secular, utilitarian argument for the continuation of the child’s treatment.

In the article, Malik draws attention to a contradiction between the State’s position regarding Gard and its position regarding the wishes of a patient with a terminal neurological condition who wishes for assisted suicide.

The practice of withdrawal of care is often invoked in the debate over assisted suicide. Proponents of assisted suicide frequently make an “equal protection” argument: since we allow the death of patients by withdrawing intensive care, shouldn’t we also allow patients to commit assisted suicide?

A few years ago, Neil Garsuch wrote an excellent book examining the legal and moral arguments that bear on the question of assisted suicide. He discussed at length and with meticulous detail the question of withdrawal of care as it might relate to assisted suicide.

Opponents of assisted suicide sometimes argue that withdrawing care is not the same as assisting someone’s suicide because the former is an omission, while the latter is an “action.” Gorsuch explains that that argument is unsatisfactory.Continue reading “Charlie Gard, disproportionate care, and assisted suicide”

The body language of assisted suicide

Michel AccadJanuary 2, 2017January 6, 2017Articles, Ethics, Philosophyphysician-assisted suicide3 Comments

Laws that allow assisted suicide restrict the provision of “aid-in-dying” drugs to patients whose mental status is not impaired and who are capable of sound judgment.

Medscape recently featured a video interview of Timothy Quill, the palliative care specialist and long-term assisted suicide activist. He is interviewed by the ethicist Arthur Caplan, and the two discuss the psychological evaluation of terminally ill patients who request physician-assisted suicide (PAS).

Several points made by Quill caught my attention.Continue reading “The body language of assisted suicide”

Should assisted suicide be legal in a free society?

Michel AccadOctober 13, 2016December 13, 2016Ethicsphysician-assisted suicide2 Comments

Abigail Hall Blanco, a research fellow at the Independent Institute, recently wrote a piece entitled “Assisted suicide is a personal choice” in which she defends the position that assisted suicide should be legal in a free society.

Before discussing this piece, it is important to clarify what Blanco probably means when she asserts that assisted suicide is a “personal choice.” After all, the statement may seem like a triviality: all humans are persons, and therefore all human choices are personal choices.

I suspect that what Blanco means to say is that assisted suicide should be legal because it is a free choice that only affects the person making it. In that sense, the subject and object of the choice are both the same person: The choice begins with the person and the effect ends in the same person.

Having made that clarification, let’s examine the three arguments Blanco makes to support her position. These arguments are counterpoints to claims allegedly made by opponents of assisted suicide.Continue reading “Should assisted suicide be legal in a free society?”

On the deactivation of implantable devices

Michel AccadSeptember 26, 2016December 13, 2016Ethicsphysician-assisted suicideLeave a comment

There is an interesting thread on Twitter generated by a BBC article relating the case of a British patient who was granted the right to have her pacemaker deactivated. Dr. Wes Fisher was interviewed in the article.

The question posed is whether this constitutes assisted suicide or not. Dr. John Mandrola pointed to the position document of the Heart Rhythm Society regarding such cases and seems firm that pacemaker deactivation is not euthanasia.Continue reading “On the deactivation of implantable devices”

Taking stock of our existence

Michel AccadJanuary 28, 2016December 13, 2016Ethics, Philosophyempiricism, gawande, physician-assisted suicide6 Comments

My last post was prompted by a reader’s comment where Victor Frankl’s Man’s Search for Meaning and Atul Gawande’s Being Mortal were juxtaposed. Since receiving that message, I have had occasion to notice that others also associate these two books.

For example, both are mentioned positively in this moving article by Dr. Clare Luz about a friend’s suicide, and in these tweets from Dr. Paddy Barrett’s podcast program:

Must Reads: Man’s Search for Meaning by Victor Frankl. Reread, then reread. Just brilliant! https://t.co/131G3KSYqU pic.twitter.com/zIbAtRsmgU

— TheDoctorParadox (@paradox_doctor) January 2, 2016

Must Reads: Being Mortal: Medicine and What Matters in the End by Atul Gawande. Excellent!! https://t.co/ymiDLtqNQH pic.twitter.com/7YHKEr8GSS

— TheDoctorParadox (@paradox_doctor) January 7, 2016

Friends and patients of mine have likewise mentioned these two works to me, expressing praise and testifying to the deep impact the books have had on them.

I suspect that many readers of this blog will at least be familiar with these two books. If not, summaries are here (Frankl) and here (Gawande).

I read the books in succession and found the difference between the two striking. Frankl and Gawande seem to be at polar opposites on the question of life and death. In this post, I will explore this difference, starting with Gawande’s point of departure.Continue reading “Taking stock of our existence”

Is assisted suicide “medically necessary?”

Michel AccadNovember 10, 2015December 13, 2016Ethics, Healthcare economicsphysician-assisted suicide2 Comments

André Picard, one of Canada’s foremost healthcare journalists, published an article today in which he analyzes the funding rationale for his country’s healthcare system.

Canada has the most singularly bizarre health-funding model in the world. It is, to use the technical term, bifurcated – meaning there are two distinct categories.

“Medically necessary” care, defined as hospital and physician services, is paid 100 per cent from the public purse. Selling these services privately is, with few exceptions, illegal or subject to punishing penalties…

The rest of health care is, by default, not deemed medically necessary, but still gets varying degrees of public funding. Only about 6 per cent of dental care is paid publicly, as are almost half of prescription drug costs, and about two-thirds of long-term care costs.

Given Canada’s perennial healthcare budget deficits and notorious waiting lines for medical care, Picard adds:

Getting the mix of public and private care right means ensuring everyone has access to essential care in a cost-effective manner, and still allowing patients a modicum of choice, and the ability to supplement their publicly funded care with other services.

At some point, we have to make some clear, coherent decisions to ensure that happens. Doing so begins with asking, and answering, the question: What is really “medically necessary”?

The final question Picard asks couldn’t come at a more opportune time.Continue reading “Is assisted suicide “medically necessary?””

The suicide Robin Williams was denied

Michel AccadNovember 4, 2015December 13, 2016Ethicsphysician-assisted suicideLeave a comment

The autopsy performed after Robin Williams committed suicide showed that the actor had widespread Lewy body disease. His widow Susan just revealed that information and told reporters that depression was only a small part of the myriad of frightening and incomprehensible symptoms that beset him for more than a year before he took his life. As the disease progressed, he suffered from impaired movement, anxiety, paranoid thoughts, and depression.

Last month, Governor Jerry Brown signed into law a bill that allows doctors to prescribe a lethal medication to terminally ill patients who wish to end their lives. In the letter he issued as he signed the bill, he wrote: “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

But apparently, Jerry Brown and those who support the law would deny “that right” to people who, like Robin Williams, suffer from Lewy body disease.Continue reading “The suicide Robin Williams was denied”

At the tribunal of Jerry Brown’s conscience

Michel AccadOctober 21, 2015December 13, 2016Ethicsphysician-assisted suicide2 Comments

When California Governor Edmund Gerald “Jerry” Brown, Jr. signed into law ABx2 15, legalizing assisted suicide in the state, he issued the following statement explaining the reasoning behind his decision:

In his 1993, John Paul II had this to say about the kind of examination of conscience through which Governor Brown would become “certain” about the comfort that the law would provide him and others:Continue reading “At the tribunal of Jerry Brown’s conscience”

A deadly choice for the medical profession

Michel AccadApril 17, 2015September 10, 2021Ethicsmedical ethics, physician-assisted suicide4 Comments

[As part of the debate on physician-assisted suicide, the San Francisco Medical Society kindly invited me to write an article taking the “contra” position. Below is the text of the article. You can find the print version along with the article taking the “pro” position here.]

When a terminally ill but mentally competent patient wishes to die, should a physician be allowed to bring about such wish? The California legislature is considering that question, and physicians will soon be asked to weigh in on it. Until recently, so-called “physician-assisted dying” (PAD) garnered little support among doctors. Currently, however, enthusiasm in its favor is growing. What are the reasons given to justify this emerging practice? Do they truly warrant legal sanction? And do they justify an about-face from the medical profession’s long-held stance on this matter?Continue reading “A deadly choice for the medical profession”