“First, Do No Harm”

By Edward Mahoney

In medical school, all physicians are taught as a First Principle “primum non nocere,” or “First, Do No Harm.” The hundreds of Vermont physicians and nurses who comprise most of the membership of the Vermont Alliance for Ethical Healthcare are convinced that the act of writing a prescription so a patient may commit suicide is fundamentally inconsistent with this principle and thus with the ethical practice of medicine.

This week the Judiciary Committee of the Vermont Senate is hearing testimony on S. 103, the latest version of a determined attempt by a national organization to use the Vermont Legislature to overturn “primum non nocere,” or at the very least re-interpret it to the point of being meaningless.

The Vermont way of caring for and supporting one another does not include assisting someone in the act of suicide. The excellent physicians and nurses who labor long for the welfare of their patients do not include a prescription for death among their duties. Vermont has an excellent system of both palliative care and hospice care available to patients throughout the state. We are becoming a national leader in that area, and VAEH has actively supported these efforts.

The VAEH encourages the Legislature to likewise “do no harm” to the many Vermonters at the end of life who need to know that their healthcare providers – their very link to life and comfort and dignity – are not compromised by any capacity to deliver death. End of life care is a co-operative process involving the patient, family, and healthcare providers. If even one link in the chain is empowered to enable the patient’s suicide, the potential for abuses becomes widespread. Here are just three:

  • Elderly Vermonters suffer from a relatively high incidence of elder abuse, according to the state’s social workers. Could the “option” of assisted suicide become a tool in the hand of the abuser?
  • Depression among end-of-life patients is widespread but often difficult to diagnose. It is, however, relatively simple to treat. Our resources would be better directed at treating end of life depression with effective, compassionate care, rather than with a lethal dose.
  • Vermont’s healthcare insurance system is undergoing radical change. The state’s insurance commissioner was quoted in an Addison County newspaper last year as saying that cost-control of end-of-life treatment, including coverage for treatment, would have to become a greater priority. Although he has subsequently denied these statements, every thinking, informed Vermonter realizes that in the new state-run health care insurance system, the State of Vermont will be under extreme pressure to reduce costs in the most expensive areas of medical care – which, of course, includes end-of-life care as well as care for the severely disabled and chronically ill. In the State of Oregon, where assisted suicide is already legal, there have been several reports of end-of-life patients being denied payment of permitted medical expenses, but being offered full coverage for medication to end their lives by suicide.

VAEH members who are health care professionals also view with alarm any unintentional message that this legislation would send to Vermonters who are at-risk for suicide. Even if this bill could safeguard Vermonters at end-of-life from potential abuses – which it can’t – it cannot possibly keep suicide-prone Vermonters from thinking that the State of Vermont agrees that when life gets too hard, it’s okay to end it all.

The VAEH urges concerned Vermonters to leave a message for their state senators at the Vermont Statehouse during working hours at (802) 828-2228.

(Dr. Edward Mahoney is President of the Vermont Alliance for Ethical Healthcare and is a professor at St. Michaels College.)