Physician-Assisted Suicide Will Most Threaten 
the Weak and Marginalized

Physician-assisted suicide will most threaten the weak and marginalized because of the cultural pressures and economic incentives
that will drive it. The New York State Task Force on Life and the Law, established by Governor Mario Cuomo, explained in its

The Task Force members unanimously concluded that legalizing assisted suicide and euthanasia would pose profound risks
to many patients.... The practices will pose the greatest risks to those who are poor, elderly, members of a minority group, or
without access to good medical care.... The clinical safeguards that have been proposed to prevent abuse and errors would
not be realized in many cases.

Dr. Paul McHugh, University Distinguished Service Professor of Psychiatry at Johns Hopkins University School of Medicine and
Psychiatrist-in-Chief at Johns Hopkins Hospital from 1975 to 2001, highlights that “with physician-assisted suicide, many
people—some not terminally ill, but instead demoralized, depressed and bewildered—die before their time.” This sad reality led
Dr. Leon Kass—a medical doctor, philosopher, and former chairman of the President’s Council on Bioethics—to explain that
physician-assisted suicide “is, in fact, the state’s abdication of its duty to protect innocent life and its abandonment especially of
the old, the weak, and the poor.”

The people most likely to be assisted by a physician in their suicide are suffering not simply from terminal illness, but also from
depression, mental illness, loneliness, and despair. “Researchers have found hopelessness, which is strongly correlated with
depression, to be the factor that most significantly predicts the wish for death,” write Dr. Herbert Hendin, Professor of Psychiatry
and Behavioral Science at New York Medical College and Chief Executive Officer and Medical Director of Suicide Prevention
Initiatives, and Dr. Kathleen Foley, Professor of Neurology at Cornell University’s medical school and attending neurologist, pain
and palliative care services, at Sloan-Kettering Cancer Center. As Dr. Hendin reports:

Mental illness raises the suicide risk even more than physical illness. Nearly 95 percent of those who kill themselves have
been shown to have a diagnosable psychiatric illness in the months preceding suicide. The majority suffer from depression
that can be treated. This is particularly true of those over fifty, who are more prone than younger victims to take their lives
during the type of acute depressive episode that responds most effectively to treatment.

From their decades of professional medical practice, Drs. Hendin and Foley report that when patients who ask for a physician’s
assistance in suicide “are treated by a physician who can hear their desperation, understand the ambivalence that most feel about
their request, treat their depression, and relieve their suffering, their wish to die usually disappears.” They conclude: “Patients
requesting suicide need psychiatric evaluation to determine whether they are seriously depressed, mentally incompetent, or for
whatever reason do not meet the criteria for assisted suicide.”

Yet only five of the 178 Oregon patients who died under the Oregon assisted suicide laws in 2013 and 2014 were referred for any
psychiatric or psychological evaluation. Remarkably, patients were referred for psychiatric evaluation in less than 5.5 percent of
the 859 cases of assisted suicide reported in Oregon since its law went into effect in 1997. “This constitutes medical negligence,”
writes Dr. Aaron Kheriaty, Associate Professor of Psychiatry at U.C. Irvine School of Medicine. Dr. Kheriaty concludes, “To
abandon suicidal individuals in the midst of a crisis—under the guise of respecting their autonomy—is socially irresponsible: It
undermines sound medical ethics and erodes social solidarity.”

Regrettably, even in jurisdictions that require a doctor to mention palliative care and hospice alternatives before proceeding with
assisted suicide, the doctors need not be experts. Drs. Hendin and Foley point out:

They are not required, however, to be knowledgeable about how to relieve physical or emotional suffering in terminally ill
patients. Without such knowledge, which most physicians do not have, they cannot present or make feasible alternatives
available. Nor in the absence of such knowledge are they required to refer the patient to a physician with expertise in
palliative care.

—Ryan T. Anderson Ph.D.

NOTE:  This is excerpted from “Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality”, 3/24/15