Why is euthanasia a controversial issue in medical ethics, particularly in geriatric patients with terminal illnesses?

Why Euthanasia Remains Contrary to Medical Ethics

Euthanasia and physician-assisted suicide fundamentally violate the core ethical principles of medicine by breaching the duties of beneficence and nonmaleficence, transforming physicians from healers into agents of death, which is incompatible with the physician's role in society. 1

Core Ethical Violations

The American College of Physicians opposes legalization of physician-assisted suicide based on fundamental ethical principles that have guided medicine since Hippocrates 1:

• Physicians have duties based on beneficence (acting in the patient's best interest) and nonmaleficence (avoiding harm) that are violated when intentionally ending a patient's life 1
• The physician's role as healer and comforter is fundamentally incompatible with participating in intentionally ending life 1
• Control over the manner and timing of death has not been and should not be a goal of medicine 1

The Autonomy Argument Is Not Absolute

While proponents emphasize patient autonomy as justification, this principle must be balanced against other ethical duties 1:

• Patient autonomy is critical but not absolute—it must be balanced with beneficence, nonmaleficence, and justice 1
• Physicians routinely limit autonomy in other contexts: declining to prescribe non-indicated tests, refusing illegal prescriptions, or avoiding futile care like CPR on brain-dead patients 1
• Physicians are moral agents with professional ethical responsibilities, not merely service providers 1

The Slippery Slope Is Real, Not Theoretical

Evidence from jurisdictions where euthanasia is legal demonstrates concerning expansion beyond initial safeguards 1:

• In the Netherlands, euthanasia is now granted for patients "tired of living" with loneliness and psychological suffering as qualifying symptoms 1
• In Belgium, euthanasia deaths increased from 2% (2007) to 5% (2013), with approval rates rising from 55% to 77% 1
• Women with complex psychiatric histories receive euthanasia for psychiatric disorders, often with physician disagreement about eligibility 1
• Safeguards and controls are not consistently followed, with concerns about underreporting 1

Practical Safeguards Are Inadequate

The proposed protections fail in real-world application 1:

• Prognostication of terminal illness is inherently difficult and unreliable 1
• In Oregon 2014, only 3 of 105 patients who died under the law received psychiatric evaluation, despite depression being common in terminal illness 1
• Restricting euthanasia to terminally ill, decisionally-capable adults creates legal discrimination concerns that will inevitably lead to expansion 1
• Patients cannot take pills may argue for expansion from assisted suicide to direct euthanasia 1

The Real Problem: Inadequate Palliative Care

The desire for euthanasia reflects failures in end-of-life care, not a need for physician-assisted death 1:

• Requests for assisted suicide are driven by loss of autonomy, inability to participate in activities, and loss of dignity—not uncontrolled pain 1
• 90% of U.S. adults don't know what palliative care is, but over 90% want it when informed 1
• Inadequate reimbursement, access barriers, and training deficits in palliative care persist 1
• Ethnic and racial disparities in end-of-life care access and outcomes are increasing 1

Impact on the Patient-Physician Relationship

Legalizing euthanasia fundamentally alters trust in the medical profession and the patient-physician relationship 1:

• It transforms the physician's societal role from healer to potential agent of death 1
• Vulnerable populations—elderly, disabled, mentally ill, socioeconomically disadvantaged—face increased risk 1
• The medicalization of death through lethal prescriptions contradicts the patient rights movement's goal of natural, dignified death 1

Common Pitfalls to Avoid

• Do not conflate withdrawal of life-sustaining treatment with euthanasia—the former allows natural death from underlying disease with different intent and ethical standing 1
• Do not assume pain is the primary driver—most requests stem from psychosocial concerns addressable through comprehensive palliative care 1
• Do not ignore that desire for death fluctuates over time and may indicate treatable depression or inadequate symptom management 1

The Alternative: Comprehensive End-of-Life Care

Society's focus should be on improving access to hospice and palliative care, not medicalizing death 1:

• Vigorous pain control, including palliative sedation that may hasten death, is ethical and legal under the principle of double effect 1
• Simple interventions like the 3 Wishes Project can improve dignity and meaning in dying 1
• Advance care planning, improved communication, and care coordination address most end-of-life concerns 1