Assisted dying, without the doctor? Ethicist says physicians can help without prescribing lethal dose

Dr. Lynda Young, former president of the Massachusetts Medical Society, spoke in March to a legislative committee considering a bill that would permit physicians to prescribe life-ending drugs to patients with a terminal illnesses.

She cited the American Medical Association’s long-standing policy: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.’’ Members of Young’s organization have repeatedly voted to object to such a change in their role.

But what if the sickest patients could end their lives in a way sanctioned by law without direct involvement from their doctors?

In an article published Wednesday by the New England Journal of Medicine, Dr. Lisa Soleymani Lehmann, director of the Center for Bioethics at Brigham and Women’s Hospital, and research assistant Julian Prokopetz propose a policy they say could distance doctors from the process — perhaps resolving one of the main objections to the ballot question Massachusetts voters will consider in November on whether to allow terminally ill patients to end their lives.


“Writing a prescription that allows a patient to acquire a lethal dose of a medication with the explicit intention of ending their own life really goes beyond the accepted norms of what physicians do,’’ Lehmann said in an interview.

But, she said, communicating to patients that they are at the end of their lives does not. They write:

Prognosis and treatment options are part of standard clinical discussions, so if a physician certifies that information in writing, patients could conceivably go to an independent authority to obtain the prescription. We envision the development of a central state or federal mechanism to confirm the authenticity and eligibility of patients’ requests, dispense medication, and monitor demand and use. This process would have to be transparent, with strict oversight.

I asked Lehmann how a doctor’s certification that a person is at the end of life would be different than a prescription issued by doctors. The difference is largely in how doctors would perceive their role, she said. The prescription is “the proximate act that results in the death of the patient.’’ The certification would provide information doctors are accustomed to giving patients.

Another option, Lehmann said, is that patients could use their medical records, in which a doctor has documented their prognosis, to satisfy the requirement for certification.


“We’re going to need to rethink and be creative about how we can extract the physician’’ from more direct involvement in a patient’s death, she said.

Massachusetts voters will consider a ballot question in November that would allow physicians to prescribe life-ending drugs to patients who are terminally ill and expected to die within six months. Lehmann has not been involved with that effort, she said.

A note on language: Opponents of the ballot initiative refer to the process as “physician-assisted suicide.’’ Proponents often call is “death with dignity.’’ Lehmann uses the phrase “assisted dying.’’

The drugs would be used by people who are already dying and want an option, she said. “This isn’t suicide,’’ she said.

Hear her speak about the issue in a New England Journal podcast.

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