Suffering, Sanctity of Life and the Moral Dilemma of Physician-Assisted Suicide: What the Netherlands Teaches Us

Dear Editor,

Physician-assisted suicide (PAS) provokes intense debates across different societal quarters, including healthcare, ethical circles, patients, and the general public. The conversations regarding PAS encompass a myriad of ethical, moral, and personal perspectives. This letter will delve into both sides of the debate, suggesting that PAS, in its ultimate form, is morally indefensible. This stance is specifically pertinent considering the use of PAS in circumstances such as the recent case in the Netherlands where almost 40 persons, identifying as autistic or intellectually disabled, were legally euthanized between 2012 and 2021 (Tuffrey-Wijne et al. 2023).

Supporters of PAS often invoke the principle of patient autonomy as a primary justification. As outlined by Manne et al. (2011), autonomy is generally viewed as a fundamental reason to permit PAS and euthanasia. The principle of autonomy posits that competent adults should retain the right to make decisions concerning their own lives, including the manner and time of their death.

Additionally, supporters propose that PAS can mitigate unnecessary suffering. The American College of Physicians (ACP) recognizes the growing demand for the legalization of PAS due to the desire to control the circumstances of terminal illnesses and the dying process (Snyder Sulmasy and Mueller 2017). In a similar vein, Goligher et al. (2017) spotlight the ethical issues tied to PAS and euthanasia in the ICU where patients might be undergoing intolerable pain or distress.

However, there are substantial ethical concerns linked with PAS. The ACP currently opposes the legalization of PAS, pointing to considerable ethical, clinical practice, policy, and other concerns (Snyder Sulmasy and Mueller 2017). They propose the focus should remain on providing care and comfort to patients, as opposed to aiding their death.

Furthermore, the potential for misuse and devaluation of life are substantial risks associated with PAS. Dugdale, Lerner, and Callahan (2019) consider the pros and cons of physician aid in dying, underlining concerns about crossing significant ethical divides. The potential for PAS to be employed in nonterminal instances, such as those related to mental health issues or disabilities, introduces serious ethical concerns. This problem becomes more complex when considering patients with depression (Montanari et al. 2020).

The case of PAS in the Netherlands serves as a grim reminder of these ethical worries. In the Netherlands, PAS has been extended to individuals with autism, a nonterminal condition. This practice implicates the sanctity of life and the potential misuse of PAS. It suggests a worrying trend toward devaluing the lives of individuals with disabilities or mental health conditions. This case is a perfect example of the “slippery slope” argument against PAS, where initial acceptance for terminal illnesses could lead to its usage in nonterminal cases, such as autism, thus undermining the sanctity of life (Campbell 2019).

While the debate surrounding PAS is multifaceted and intricate, the potential for misuse and the denigration of life present compelling arguments against its legalization. The sanctity of life and the ethical obligation of physicians to “do no harm” should remain preeminent. The example of the Netherlands highlights the possible dangers of legalizing PAS, especially for vulnerable groups. PAS should be deemed morally indefensible. Instead, efforts should be channeled toward improving palliative care and supporting patients through the end-of-life process in a manner that upholds their dignity and worth. According to the teachings of the Catholic Church, human dignity is not a value we earn or that can be taken from us. It is inherent and inviolable because God has given it to us. This principle forms the foundation of all Catholic social teachings.

Pope John Paul II, in his encyclical “Evangelium Vitae” (The Gospel of Life), underscored the sanctity of human life. He declared that every human being, from conception to natural death, has an intrinsic dignity and immeasurable worth. Not because of their abilities or possessions, but because of who they are—a unique creation of God. He added: “True ‘compassion’ leads to sharing another's pain; it does not kill the person whose suffering we cannot bear” (Evangelium Vitae, 66).

Biographical Note

Victor C. Ajluni, MD, is an assistant professor of Psychiatry and Behavioral Neurosciences at Wayne State University's School of Medicine in Detroit, MI.