Assisted suicide is an idea which keeps evolving. Who could have foreseen the development of groups of non-doctors which help hundreds of people to die in Switzerland? Now a bioethicist from the University of Tübingen in Germany has proposed what he calls “commercially assisted suicide” (CAS) – paying a non-doctor to kill patients.
Roland Kipke argues in the journal Bioethics that there are no ethical arguments against CAS which cannot also be deployed against physician-assisted suicide (as in Oregon). It is not a popular cause, as the thought of CAS horrifies both supporters and opponents of assisted suicide.
Kipke rolls out several arguments in favour of CAS. It is not a breach of medical ethics because no doctor is involved. A for-profit provider will be more readily available than a doctor, who may have qualms of conscience.
He takes a very sceptical view of the competence of doctors. A commercial provider may not be skilled at detecting depression, but neither are doctors:
“The most common psychiatric disorder, and, at the same time, the disease that is most commonly associated with suicidal intentions, is depression. Several studies clearly show that a large number of physicians fail to recognize the depressive disorders of their patients. This is particularly remarkable because people with depression account for about 10% of a GP's patients…. Therefore, it is not justified to say that doctors are in general particularly able to assess the conditions for an autonomous decision for suicide.”
Nor are doctors particularly competent at prescribing adequate doses of drugs to commit suicide.
“a doctor does not normally learn (in education and medical practice) how many grams of sodium pentobarbital cause a quick death. Above all, the necessary knowledge about the correct dosage is limited and can easily be acquired by non-physicians.”
Kipke feels that patients would have more autonomy in making their final decision if they use a commercial provider.
“Studies have shown that doctors' assessment of the quality of life and of the suicidal wishes of seriously ill patients depends significantly on the psychological situation of the doctors themselves, and that they systematically underestimate the quality of life of their patients. Quite a few doctors also advocate directive counselling, even on morally controversial issues. It is probable that this is not fundamentally different with regard to their decisions for or against suicide.”
Finally, would CAS be another step forward in the insidious commercialisation of human life? No, says Kipke. “Doctors always earn their living from the needs of their patients: no one takes offence.” Why not a commercial provider?
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