I have no doubt in my medical career in an attempt to treat someone's pain or breathlessness I have hastened their death. I have no qualms about this and believe in what has been called the principle of double-effect; that is, it is morally justifiable to speed up the dieing process as an unintended consequence of a legitimate intent to treat a patient's physical symtptoms. The Jesuits in medical school told me so.
Tomorrow here in Washington State what was known as I-1000, the Death with Dignity Act, goes into effect and at some point I know I will be asked to cross a line I still find myself staring at with uncertainty. I have known the arguments going both ways for years and they really aren't worth rehashing here. Some lines shouldn't be crossed and some should, but make no mistake, there is a line here.
Some colleagues have offered to prescribe lethal doses for those who aren't comfortable with it in much the same way that physicians refer to colleagues when they aren't comfortable with birth control or abortions. While I have no problem with their decision, I'm fairly certain this approach is not for me.
If I do choose to participate in this process I want it to be only for my patients. It's not that I don't want to be known as a "Dr. Death", although that is true, it's that if I choose to prescribe a medication with the intended purpose of bringing about a persons death I want to know them. I want to know what kind of person they are and who their family is. I want to know how their treatment course has gone and that every palliative maneuver has been exhausted. I want this to be a personal and intimate conversation and not just a casual move like writing a prescription for amoxicillin.
I fear that the only way that I may know what the right choice is for me is to cross the line and by then it may be too late.