Why should suicide never be an option?

Pros & Cons: assisted suicide

Commercial euthanasia is prohibited, but private assisted suicide is unpunished. But how should doctors behave when their patients wish to die? Should assisted suicide by doctors be legitimate in exceptional situations? Is there a risk of abuse and a dam break? A pros and cons

On the subject: The step from changing the therapy goal and refraining from active therapeutic measures to medical support for suicide in seriously ill people has been the subject of controversial discussion in the medical profession for years. However, this year's 115th German Doctors' Conference on organized euthanasia clearly positioned itself. With a large majority, the delegates called for a general ban. They were concerned that the "increasing commercialization of euthanasia leads to fears that desperate people are increasingly choosing to commit suicide," says the resolution of the Doctors' Day. "That is why the legislature must penalize all facets of commercial and organized euthanasia under criminal law, including those organizations in which there is no legal evidence of profit-making practice."

The federal government has reacted and launched a bill to ban commercial euthanasia. Commercial suicide helpers make themselves liable to prosecution according to the draft. In the private context, however, assisting suicide, like suicide itself, is still not a criminal offense. The draft bill from the Federal Ministry of Justice caused controversy in the summer because in its explanatory text doctors or nurses were counted among the “people close to them” for whom assisted suicide should not be punished. For doctors, this should apply "if a long-term personal relationship that goes beyond the purely professional relationship" has arisen, as can be the case, for example, with a long-term family doctor. This sentence has since been removed from the cabinet decision. HE


Dr. med. Michael de Ridder: The internist, intensive care physician and long-time chief physician of a rescue center is the author of the book “How do we want to die?”. Photo: Georg J. Lopata

The board of directors of the German Medical Association praised the president, who died in November 2011, as the “integrating figure of the medical profession in difficult times”. med. Jörg-Dietrich Hoppe. Just under a year earlier, Prof. Hoppe had once again demonstrated his indeed outstanding integrating power to do justice to divergent ethical attitudes within the medical profession. On the question of medically assisted suicide, he publicly took a wise position: “Assisting suicide is not one of the medical duties. But it should be possible if the doctor can reconcile it with his conscience. "

At the moment, however, there can hardly be any question of integrating different views within the medical profession on the question of the permissibility of assisted suicide. The decision of the German Medical Association in Kiel in 2011 on this central medical concern was rash, in fact, came about in a stroke of a hand. In doing so, the medical profession would have had a moratorium, and thus time for an internal medical debate appropriate to the seriousness and complexity of its subject. After all, according to surveys, a third of German doctors are open to the question of assisted suicide.

It is therefore almost astonishing when Hoppe's attitude towards medically assisted suicide, cited above, remains completely unmentioned during a symposium on palliative medicine held in his honor. In this way, a consensus within the German medical profession is assumed on questions of end-of-life medicine that does not exist.

Hoppe's successor, Prof. Dr. med. Frank-Ulrich Montgomery, recently the draft bill submitted by the Federal Ministry of Justice to ban commercial euthanasia. It was a bill that Hoppe would have largely approved. Finally, it was expressed in it that the decision to assist suicide can only be made on the basis of a conscientious decision by the doctor. This in turn requires an established and mutual trust between the patient and his doctor. It does not need to be emphasized at this point that no doctor can and must never be obliged to provide such assistance.

If, despite an in-depth dialogue with a hopelessly ill patient and after he has been comprehensively informed about all palliative medical options, his wish for a self-determined end of life turns out to be sustainable and plausible, there is no room for organized or even commercialized euthanasia.

The draft law and the original explanatory text from the Ministry of Justice, which also included doctors and nurses who provide intensive care to the sick and who should not be punished for assisted suicide, point in the right direction: the decision to assist suicide is only allowed on the basis of a conscientious decision by the doctor and a close relationship of trust with the patient.

To make this clear, Prof. Dr. Edzard Schmidt-Jortzig, former Federal Minister of Justice and until recently chairman of the German Ethics Council, take advice: “In contrast to the law, ethical norms cannot claim to be generally binding. . . Law is the regulatory instrument of the state, ethics that of the individual who acts responsibly and who listens to his conscience. "


Prof. Dr. med. Dr. Eckhard Nagel: The surgeon and philosopher is the Medical Director of the Essen University Hospital and a member of the German Ethics Council. Photo: epd

Suicide remains a contradiction to life and medical assistance to suicide is not a form of human affection. Confusing this would have dramatic consequences. Rather, it is important to find an answer to the question of the importance we attach to that interpersonal support - palliative medicine - which does everything imaginable to alleviate suffering that allows death but does not bring about it.

The central goal of palliative medicine is the attempt to support the dying to approach death with dignity, to prepare for it and, if possible, to be able to experience it consciously. This includes averting nausea, fear and shortness of breath, but also physical care and relieving feelings of hunger and thirst, but also human affection, pastoral support and the express willingness not to leave the dying person and his immediate environment alone. Of course, it may well be appropriate to limit or even terminate a treatment, but doctors can also respond to this within the framework of palliative care support. The possibilities extend to palliative sedation, which can override any perceptible perception. It is essential that the possibilities of palliative medicine are expressly neither medically nor legally equated with euthanasia or assisted suicide and do not constitute aiding and abetting suicide.

Assisted suicide is something completely different. It aims to support a living person in carrying out self-responsible suicide. This inevitably results in the assumption of responsibility for the death of a person and a judgment about the worth or worthlessness of a life. Due to the irreversibility of this decision, such an act comes close to a final rejection of being human. It remains unclear to what extent the right to self-determination can also extend to decisions about the end of life of one's own choosing and to what extent other people are allowed to implement a corresponding decree. It is precisely at this point that bioethical controversies come into play and cannot be resolved either through plausible individual cases or through a redefinition of humanity.

If we were to tolerate euthanasia, it would have massive effects. This can already be seen from the fact that possible abuse scenarios would have to be ignored and thus intuitively accepted. People could no longer rely on medical acts being carried out solely to protect their existence; the essential basis of trust between doctor and patient would be permanently damaged. In addition, such a decision would result in a permanent control discussion. Because then one can never be absolutely certain that a patient's desire to commit suicide does not arise from a temporary emotional crisis that could be overcome or alleviated by other action. It is hardly possible to establish beyond any doubt the intentions of a patient and the doctor assisting the suicide.

Life is an undeserved, wonderful gift that we accept on our birthday and whose natural dangers we have to learn to deal with. Modern medicine will not change the finiteness of our existence. Sometimes it will heal, often it will alleviate, and it will always comfort. This is not a resigned description of medical options, but the answer to the challenges of a self-determined life that knows about one's own human limits.