Last updated on: 6/13/2018 9:52:49 AM PST
Do Euthanasia and Physician-Assisted Suicide Violate the Hippocratic Oath?
General Reference (not clearly pro or con)
Mattie Quinn, MS, health care reporter for Governing Magazine, in a Feb. 2018 article, "How Far Will the Right-to-Die Movement Go?," available at governing.com, stated:
"Primum non nocere. First, do no harm. Medical students have been taking this vow since Hippocrates came up with it in ancient Greece in the fifth century B.C. It is universally acknowledged to be the foundation of Western medicine. But the Hippocratic oath isn't as black or white as it once seemed.
Nowadays, people are living longer than ever -- with diseases that Hippocrates could never have imagined -- and in circumstances in which a doctor could end their suffering. For more than a century, some American physicians have been arguing for a patient's right to choose death, and for doctors to be able to assist in the process."
Feb. 2018 - Hippocratic Oath (192KB)
Mattie Quinn, MS
Jack Ende, MD, President of the American College of Physicians, as quoted in a Jan. 2018 article, “Hospitalists Weigh Ethical, Practical Impacts of Aid-in-Dying Laws,” available at acphospitalist.org, stated
"The principle of patient autonomy is critical and must be respected, but it is not absolute and must be balanced with other ethical duties and principles. Physician-assisted suicide asks physicians to breach both the general duties of 'first, do no harm' (nonmaleficence) and to act in the patient's best interests (beneficence), and also the specific prohibition on physician-assisted suicide that has been a tenet of medical ethics since Hippocrates. Proponents of physician-assisted suicide have not offered strong enough arguments to change that."
Jan. 2018 - Jack Ende, MD
Christian Medical & Dental Associations in an article, “Physician-Assisted Suicide and Euthanasia,” accessed on May 15, 2018 and available at cmda.org, stated:
"'I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.' Hippocratic Oath
The statement above is the foundational moral principle of medicine, pledged by doctors for centuries as they attempt to cure and relieve suffering without injuring the patient. It’s a principle being eroded by the movement to legalize physician-assisted suicide (PAS) and euthanasia. When combined with an impersonal and technological healthcare system, the movement to support PAS has proven lethal. Prescribed suicide is an immoral slippery slope that corrupts the doctor-patient trust. Put simply, it’s dangerous. And it's not just dangerous for the physicians and healthcare workers, but it's also dangerous for our country, our healthcare system and for every patient."
May 15, 2018 - Christian Medical and Dental Associations (CMDA)
Ronald W. Pies, Emeritus Professor of Psychiatry at SUNY Upstate Medical University, in a Jan. 7, 2018 article, "How Does Assisting Suicide Affect Physicians?," available at theconversation.com, stated:
"[A]s a physician and medical ethicist, I believe that MAID/PAS flies in the face of a 2,000-year imperative of Hippocratic medicine: 'Do no harm to the patient.'...
I believe that the ambivalence and discomfort experienced by a substantial percentage of PAS-participating physicians is directly connected to the Hippocratic Oath – arguably, the most important foundational document in medical ethics. The Oath clearly states: 'I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.'...
Indeed, when patients nearing the end of life express fears of losing control, or being deprived of dignity, compassionate and supportive counseling is called for – not assistance in committing suicide."
Jan. 7, 2018 - Ronald W. Pies, MD
Josef Kure, DPhil, Head of the Department of Medical Ethics at Masaryk University (Czech Republic), in his 2011 chapter "Good Death Within Its Historical Context and as a Contemporary Challenge: A Philosophical Clarification of the Concept of Euthanasia" from the book, Euthanasia - The 'Good Death' Controversy in Humans and Animals, wrote:
"The Hippocratic tradition, whose core is the Hippocratic Oath, prohibits the killing of a human being, just as it forbids any aid in suicide (in present-day terminology in 'physician assisted suicide'): 'To please no one will I prescribe a deadly drug nor give advice which may cause his death.' Euthanasia as a direct killing of the patient, regardless if upon his/her request or without any request, is not forbidden by the Hippocratic Oath directly. But such a prohibition can be deduced, a fortiori [with greater reason or more convincing force], from the prohibition of any help in suicide. So euthanasia as the killing of a patient by the physician is not in accordance with either the Hippocratic Oath or the spirit of the Hippocratic tradition."
2011 - Josef Kure, DPhil
The Lutheran Church, Missouri Synod, in the 2001 "President's Commission on the Sanctity of Life," titled "That They May Live," available at www.lcms.org, wrote:
"Assisted-suicide/euthanasia violates the Hippocratic Oath, the foundation for medical ethics for more than 2,000 years. The Hippocratic Oath explicitly forbids assistedsuicide/euthanasia by requiring doctors to pledge, 'to give no deadly medicine to anyone if asked, nor will I make a suggestion to this effect.' The Christian ethicist, Gilbert Meilaender, interprets the Oath as creating a positive obligation for physicians to 'be committed to the bodily life of their patients.' Assisted-suicide/euthanasia clearly conflicts with this moral obligation since it is an act intended to end the patient’s bodily life. This is one reason why organized medicine—ranging from the World Medical Association, to the American Medical Association (AMA), to almost all of the state medical associations—overwhelmingly opposes legalizing assisted-suicide/euthanasia."
2001 - Lutheran Church Missouri Synod
Richard C. Eyer, DMin, Director Emeritus of the Concordia Bioethics Institute at Concordia University Wisonsin, in an Oct. 1999 Campus Presentation Series, "Ethics and Suffering: From Healing to Relief of Suffering," available at www.mtio.com/articles, stated:
"The aim of medicine is, according to the [Hippocratic] Oath, to heal and not to kill.
The Oath made clear what it means to 'do no harm.' The meaning of 'injury or wrongdoing' was named specifically as abortion, euthanasia, sexual abuse, and breach of confidentiality. In contrast, in postmodern medicine the interpretation of what constitutes 'harm' lies in the eye of the beholder. The Kevorkian spectacle has illustrated this... The jury accepted Kevorkian’s defense that he was only aiming at the relief of suffering and he was set free. No one pointed out the obvious that the means used to relieve suffering was to kill the patient. This case, along with others that followed, contributed to the deconstruction of Hippocratic medicine and the subsequent promotion of postmodern medicine; moving the profession of medicine away from the aim of healing and into the murky waters of relief of suffering through assisted suicide and euthanasia."
Oct. 1999 - Richard C. Eyer, DMin
Leon Kass, MD, PhD, former Chairman of the President's Council on Bioethics, wrote in his Winter 1989 article "Neither for Love nor Money: Why Doctors Must Not Kill" that appeared in the journal Public Interest:
"The prohibition against killing patients... stands as the first promise of self-restraint sworn to in the Hippocratic Oath, as medicine's primary taboo: 'I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect'... In forswearing the giving of poison when asked for it, the Hippocratic physician rejects the view that the patient's choice for death can make killing him right. For the physician, at least, human life in living bodies commands respect and reverence--by its very nature. As its respectability does not depend upon human agreement or patient consent, revocation of one's consent to live does not deprive one's living body of respectability. The deepest ethical principle restraining the physician's power is not the autonomy or freedom of the patient; neither is it his own compassion or good intention. Rather, it is the dignity and mysterious power of human life itself, and therefore, also what the Oath calls the purity and holiness of life and art to which he has sworn devotion."
Winter 1989 - Leon Kass, MD, PhD
Michael J. Strauss, MD, MPH, internist, in an Oct. 23, 2016 letter to the editor, “Right-to-Die Legislation Doesn’t Violate the Hippocratic Oath,” available at washingtonpost.com, stated:
"[T]he question is whether this 2,400-year-old oath is an appropriate standard for evaluating policy today and whether a doctor prescribing aid-in-dying medication to a terminally ill adult who requests this option to end unbearable suffering would violate the oath.
Though many people assume that the oath is still taken, it is rarely administered in its original form, if at all. In any case, to assess the oath’s relevance, one must examine what it precludes and what it recommends. Modern medicine has already ignored the fact that the oath precludes the following: 'to cut for stone' (a common urological procedure) and to 'use the knife,' which would prohibit surgery altogether. How relevant are these preclusions today?
The oath also directs physicians, including me, to 'help the sick.' So a modern interpretation of the oath might be: Do what is right for the patient.
Granting terminally ill patients' informed requests to end life peacefully, at times and amid surroundings of their choosing, does not violate this oath."
Oct. 23, 2016 - Michael J. Strauss, MD, MPH
Robert Olvera, MD, as quoted in a May 18, 2015 article, "Doctors Debate the Ethics of Assisted Suicide," available at scpr.org, stated:
"There's people that tell me why are you doing this [advocating for PAS], you're supposed to cure, you're supposed to help this person, my answer to that is some people need help dying. To prolong a death in some cases is not helpful, it can be counter productive. My objective is that given the Hippocratic Oath, I'm not going against it, I'm helping people, people like my daughter [Emily, who died at 25 after a 17-year battle with leukemia] who need help at the end of their lives. What spurred me is Emily on two occasions when she was lucid and competent, she asked me to give her enough sleeping pills so that she could go to sleep permanently. She was blind, but in the bed and had to be carried, but her mind was still competent. Had I known it was legal in five other states... and understanding what her wishes were, I would have left [to go to a legal state] in a heartbeat."
May 18, 2015 - Robert Olvera, MD
Ronald A. Lindsay, JD, PhD, President and CEO of the Center for Inquiry, Rebecca P. Dick, JD, Lawyer for the Federal Trade Commission's Mergers Division, and Tom Beauchamp, PhD, Professor of Philosophy and Senior Research Scholar at the Kennedy Institute of Ethics at Georgetown University, in their 2006 Washington University Journal of Law & Policy article, "Hastened Death and the Regulation of the Practice of Medicine," available at www.law.wustl.edu, stated:
"Because the Hippocratic Oath instructs physicians not to provide a 'deadly drug,' some have concluded that physicians, by their training and moral commitment, must necessarily reject assistance in hastening death. This is not so. The provision in the Hippocratic Oath that prohibits providing a deadly drug did not even reflect accepted medical practice in ancient Greek city-states where, upon request, a physician could provide a lethal drug for a suffering patient. In some sense, physicians who provide assistance in hastening death are adhering to a longstanding understanding of the scope of medical practice: to care for and meet the needs and desires of a patient in all stages of the patient’s life. Significantly, the activities a physician undertakes in providing assistance in hastening death are the same as those often carried out by a physician who oversees a withdrawal of treatment. As a purely medical matter, there is little to distinguish a physician’s activities in withdrawing treatment from activities in hastening death through other means."
2006 - Ronald A. Lindsay, JD, PhD
Steven H. Miles, MD, Professor and Maas Family Endowed Chair in Bioethics for the Center for Bioethics and Professor of Medicine at University of Minnesota Medical School, in his 2004 book The Hippocratic Oath and the Ethics of Medicine, stated:
"the history of the euthanasia debate and descriptions in the of the care of dying persons in ancient Greece make it unlikely that 'I will not give a drug that is deadly' refers to anything like our concepts of physician-assisted suicide, voluntary or non-voluntary euthanasia, or discontinuing life-sustaining treatment.
...The Greek-derived word euthanasia (literally: 'good death') was not coined until 280 BCE, about a century after the Oath was written. This new word did not refer to assisting death; it referred to a natural death without agony."
2004 - Steven H. Miles, MD
Philip Nitschke, MD, Director and Founder of Exit International, in his June 5, 2001 interview with Kathryn Jean Lopez titled "Euthanasia Sets Sail" that appeared in the National Review Online, available at www.nationalreview.com. commented:
"Over time the Hippocratic Oath has been modified on a number of occasions as some of its tenets became less and less acceptable. References to women not studying medicine and doctors not breaking the skin have been deleted. The much-quoted reference to 'do no harm' is also in need of explanation. Does not doing harm mean that we should prolong a life that the patient sees as a painful burden? Surely, the 'harm' in this instance is done when we prolong the life, and 'doing no harm' means that we should help the patient die. Killing the patient--technically, yes. Is it a good thing--sometimes, yes. Is it consistent with good medical end-of-life care: absolutely yes."
June 5, 2001 - Philip Nitschke, PhD, MBBS
Stephen R. Reinhardt, LLB, Judge on the US Court of Appeals for the Ninth Circuit, in the May 28, 1996 majority opinion for Compassion in Dying v. State of Washington, wrote:
"In Roe [v. Wade], the Court cited a scholar's conclusion that the Hippocratic Oath 'originated in a group representing only a small segment of Greek opinion and that it certainly was not accepted by all ancient physicians.' The Court stressed the Oath's 'rigidity' and was not deterred by its prohibitory language regarding abortion. As Roe shows, a literalist reading of the Hippocratic Oath does not represent the best or final word on medical or legal controversies today. Were we to adhere to the rigid language of the oath, not only would doctors be barred from performing abortions or helping terminally ill patients hasten their deaths, but according to a once-accepted interpretation, they would also be prohibited from performing any type of surgery at all, a position that would now be recognized as preposterous by even the most tradition-bound AMA members."
May 29, 1996 - Stephen R. Reinhardt, LLB
Thomas A. Preston, MD, former Chief of Cardiology at Pacific Medical Center and Professor of Medicine at University of Washington, in his 1995 Seattle Law Review article "Physician Involvement in Life-Ending Practices," stated:
"The context in which physicians might end patients' lives has changed. Hippocrates never had a patient on a ventilator. As recently as about thirty years ago no physician had a patient with recurrence of leukemia after bone marrow transplantation. Modern medicine has changed the context in which patients now die, from one natural death with relative impotence of physicians to change the course of dying, to medical prolongation of life resulting in different and unnatural forms of dying. The injunction against lethal drugs in the old context of dying remains valid, but we rightly should reassess it in the context of modern forms of dying.
…The physician who prolongs her patient’s life, but who then aids in the patient’s request to die, has not violated the Hippocratic injunction, and in fact has fulfilled the physician’s duty to heal so far as is reasonable without producing harm."
1995 - Thomas A. Preston, MD