When and how to die
===================

* J. Donald Boudreau

I am concerned with the statement in the *CMAJ* editorial on *“*therapeutic homicide*,”* that the euthanasia debate has been theoretical because of the “tacit assumption that doctors do not kill people.”1 This is a less than forceful description of medicine’s mandate.

That doctors do not purposefully take lives is far from a tacit thing. This constraint has been an invariant truth for millennia. The *Hippocratic Oath* includes the injunction, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect*.”*2 An 1826 manuscript states, *“*How can it be permitted that he who is by law required to preserve life be the originator of, or partner in, its destruction?*”*3 Innumerable examples exist where doctors are admonished not to kill. Qualifying this long-standing ethical interdiction as “tacit” saps its intellectual rigour and opens it to questioning. If it is to be disregarded, let it be on the basis of persuasive counter-arguments rather than on the notion that it is not explicit.

I am deeply concerned about potential damage to the medical profession were it to accept assisted suicide as a medical act. I have suggested elsewhere that responsibility for implementing assisted suicide could be mandated to a nonphysician group.4 This would respond to legislative demands while enabling doctors to fulfill the ancient mandate of healing. Euthanizing and healing are not miscible, nor can they be 2 sides of 1 coin. This is not a tacit assumption; it is the expression of a reverberating imperative.

## References

1.  Flegel K, Fletcher J. Choosing when and how to die: Are we ready to perform therapeutic homicide? CMAJ 2012;184:1227.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTg0LzExLzEyMjciO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTg0LzE2LzE4MTQuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  1.  Temkin O, 
    2.  Lilian C
    
    Hippocratic Oath [reproduced and translated by Ludwig Edelstein]. In: Temkin O, Lilian C, editors. Ancient medicine: selected papers of Ludwig Edelstein. Baltimore (MD): Johns Hopkins University Press; 1967.
    
    

3.  Cane W. Medical euthanasia. A paper, published in Latin in 1826, translated and reintroduced to the medical profession. J Hist Med Allied Sci 1952;7:401–16.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=12990787&link_type=MED&atom=%2Fcmaj%2F184%2F16%2F1814.1.atom) 

4.  Boudreau JD. Physician-assisted suicide and euthanasia: Can you even imagine teaching medical students how to end their patients’ lives? Perm J 2011;15:79–84.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=22319424&link_type=MED&atom=%2Fcmaj%2F184%2F16%2F1814.1.atom)