By Lewis M. Cohen
Hippocrates, the father of medicine in Western culture, forbade medical assistance in dying 2,500 years ago. However, nowadays, most Americans want to control the manner and the timing of their deaths. They demand the right to make treatment choices and to have sovereignty over their bodies. According to a 2018 Gallup poll, even though individuals might not chose it for themselves, more than 72 percent believe that doctors should be able to help terminally ill patients end their lives.
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The good news is that one-in-five of us now reside in states that no longer criminalize families and physicians who fulfill the requests of loved ones by hastening death. The bad news is that four-in-five Americans lack protections, and their friends, families, and doctors run the risk of criminal prosecution. But there is momentum to pass medical aid-in-dying laws, and in the five years since the death of Brittany Maynard, the 29-year-old Californian woman with a brain tumor who moved to Oregon to take advantage of their statute, California (2015), Colorado (2016), Washington, D.C. (2017), Hawaii (2018), New Jersey (2019), and Maine (2019) have enacted statutes. The Commonwealth of Massachusetts is currently deliberating about a protocol, while New York Gov. Andrew Cuomo has announced that he is prepared to sign a bill if passed by his state's legislature.
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The right to die movement was kick started in 1964, when Dr. Louis Lasagna, a dean from Tufts University School of Medicine, published a major revision of the Hippocratic Oath. His version is now intoned by most graduation students, and it is notable for having dropped all mention of Greek gods and goddesses, how to treat slaves, and bans against doctors carrying out surgical procedures or abortions. Dr. Lasagna also deleted the following prohibition from the original oath: "Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course." He substituted the following inspiring words: "Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God."
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Dr. Lasagna's updated Hippocratic Oath has had increasingly greater import as state medical societies and organizations like the Academy of Hospice and Palliative Medicine shifted their ethical stance about medical assistance in dying from one of condemnation to a more neutral, thoughtful position. A new generation of physicians recognizes that medicine must distinguish between prolonging life and prolonging suffering, and doctors are increasingly accepting a role in helping patients to die well.
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About ten years after Dr. Lasagna's revision, a British journalist named Derek Humphry wrote a book about the death of his wife from metastatic breast cancer. Jean Humphry had requested her husband's assistance in obtaining a lethal dose of medication to end her life if she reached the point that suffering had become unbearable. Following her demise, English law enforcement authorities deliberated and finally decided not to charge him with murder. Afterwards during a book tour, when 60 Minute's Mike Wallace asked, "What are you going to do next?" Humphry announced, "I'm going to form an organization and fight to change the laws [criminalizing euthanasia]." Perhaps thinking his jovial guest was kidding, Mike Wallace laughed uproariously.
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Humphry arrived in California at a crucial moment when not only had the Hippocratic Oath been rewritten, but the award-winning play (and later popular Hollywood film) Whose Life Is It Anyway? was garnering acclaim, and there had recently been two widely publicized court cases about stopping life-support treatment: Nancy Cruzan and Karen Ann Quinlan. In 1980, Humphry founded the Hemlock Society with the dual mission of providing information to dying persons who wanted to foreshorten their lives, and towards the passage of legislation permitting physician-assisted suicide. At its peak, the Hemlock Society had fifty-seven thousand paid members spread across eighty-six chapters throughout the United States. The author Richard Co?te? wrote, "The self-deliverance genie had been forever freed from its bottle and had taken on a robust, self-sustaining life of its own."
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At the same time, Dr. Jack Kevorkian's right-to-die crusade culminated in his ill-fated decision to show a videotape - also during a 60 Minutes interview - of him euthanizing a man with amyotrophic lateral sclerosis. This would result in a criminal trial and lengthy prison sentence, and while Dr. Kevorkian's behavior would trigger a backlash and the formation of opposition groups, he remains the best known of the movement's proponents.
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The Hemlock Society would eventually morph into the Final Exit Network, a group of volunteers dedicated to helping suffering people learn how to end their lives, and Compassion & Choice and the Death with Dignity National Center, which are each promoting assisted dying laws around the country.
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However, immediately after passage of California's momentous End of Life Options Act, many observers were unsure whether Governor Jerry Brown, a former Jesuit seminary student, would sign the bill.
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"In the end," Brown explained, "I was left to reflect on what I would want in the face of my own death. 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."
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And despite the original prohibition by Hippocrates 2,500 years ago, there is a growing consensus that doctors must not only strive to cure disease and prolong life but to also ameliorate suffering and facilitate the best possible deaths for all patients.
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Lew Cohen is an author, professor of psychiatry at the University of Massachusetts-Baystate School of Medicine, and recipient of a Guggenheim Fellowship. He has written the recently published book, A Dignified Ending.
