The morality of life and death and doctors

June has been a month of reflection on life, death, our values, and the greater good. We commemorated the 75th anniversary of the 1944 Normandy invasion (D-Day), which began the liberation of France from German occupation and turned the tide of World War II. In what must have been a decision fraught with soul searching, generals sent young soldiers into what could be certain death on the shores of Normandy. Their bravery was an act of unquestionable honor.

Contrast that with a law school ethics class scenario. The leader of an invading horde tells the mayor of your town that if he lets him kill a child, he will spare the lives of the town’s residents. Does the mayor sacrifice one innocent child for the good of many? On a practical level, anyone who would wantonly kill a child is not to be trusted. Morally, is the life of an innocent child reduced to a numbers game? What justifications can the mayor offer to convince the townsfolk to act like mindless, soulless, cowardly creatures and decide not to fight for the sanctity of life?

Life is precious and fleeting. Once gone, you can’t get it back. This month the news has presented two ends of the spectrum: physician assisted suicide and abortion.

Years ago, people found Dr. Jack Kervorkian’s “death machine” ghoulish. He likely was well-meaning but was misguided. Now physician assisted suicide is culturally acceptable and legal in several states. New Jersey is the latest state to jump on the physician-assisted suicide bandwagon that includes Colorado, the District of Columbia, Hawaii, Oregon, Vermont, Washington, and Montana. Maine’s bill has made it to the governor’s desk.

Physician-assisted suicide (aka aid in dying or death with dignity) now has an oft-used abbreviation (PAS) to mask a deed that runs counter to the command in the Oath of Hippocrates not to harm our patients. Some reasonably argue that it is harmful to refuse to follow a patient’s request to be irreversibly put out of her misery. But when does relieving pain—whether physical or emotional—transition into hastening death?

Some of these suicide laws have a requirement for counseling, but this can be merely one visit with a psychiatrist or psychologist. Moreover, the death may not be so dignified. A study in the New England Journal of Medicine of euthanasia and physician-assisted suicide in the Netherlands found complications in 7 percent of assisted suicide patients, including failure to remain unconscious, extreme gasping for air, vomiting, and muscle spasms. Physicians had to complete the procedure.

Did the cultural acceptance of physician-assisted suicide lead an Ohio critical care physician to take it upon himself to end some of his patients’ lives? His defense to the indictment on 25 counts of murder is that he was providing “comfort care” with massive amounts (up 10 to 40 times the therapeutic dose) of fentanyl. Merely because the patients were receiving palliative care did not mean they consented to lethal overdoses. Keep this in mind as we are steered toward hospice in our later years.

Simultaneously, several states passed or introduced laws prohibiting abortion after a fetal heartbeat is detected. Rep. Ilhan Omar decried the “horrifying” opposition to abortion as religious fundamentalists imposing their will on lawmakers. There are pro-life atheists who view abortion as an issue of respecting humanity. I am absolutely flummoxed by how the same ultrasound and anatomy can be described as a vibrating clump of cells or a baby on its way into the arms of a loving parent depending on the mindset of the mother.

Additionally, to “promote the dignity of human life from conception to natural death,” the Department of Health and Human Services will stop funding research with fetal tissue from elective abortions. Private research is unaffected. Some researchers objected, arguing that fetal tissue has aided in the advancement of medical science. Nazi experiments during World War II likewise provided novel medical information. Their experimental bone grafting, use of sulfa drugs, limb transplantation, and artificial insemination are now standard medical procedures. And the United States cannot justify its Tuskegee experiment in which black men were not given treatment for syphilis so doctors could see the natural progression of the disease. This experiment ended not during the 1940s in the wake of Nazi atrocities or penicillin being accepted as the treatment of choice for syphilis in 1945, but in 1972.

Does the end justify the means, if eventually the means will lead you down the road to perdition? I prefer to practice medicine in the mode of Dr. Mildred Jefferson, the first black woman accepted to Harvard Medical School: “I became a physician in order to help save lives. ... I am not willing to stand aside and allow the concept of expendable human lives to turn this great land of ours into just another exclusive reservation where only the perfect, the privileged, and the planned have the right to live.”

Dr. Singleton is a board-certified anesthesiologist. She is president of the Association of American Physicians and Surgeons. She graduated from Stanford and earned her MD at UCSF Medical School. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. She lives in Oakland, Ca.