Should Doctors Practice Euthanasia?

[neurodoc]

Dutch physicians would probably disagreed with you. Euthanasia has been legal in the Netherlands for over 20 yrs, and the rate of PAS has remained the same. Nor has the societal status of physicians diminished in the eyes of the public.

The Netherlands also provides free heroin to drug addicts (or anyone who wishes to be designated a drug addict).

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[BoardingDoc]

The Netherlands also provides free heroin to drug addicts (or anyone who wishes to be designated a drug addict).

This is not entirely correct. The Netherlands does have a govt funded heroin assisted treatment program, however, this is only for people who the govt has determined are irrevocably addicted and have failed multiple other treatment modalities like MAT.

There is no option to simply say "I want to be designated an addict, give me heroin."

Also, while this sort of program tends to be anathema to a broad swath of Americans, these programs have been a resounding success. They have both decreased heroin related deaths, and their cost has been more than offset by savings on what would otherwise be spent on incarceration and other legal system burdens.

 

[Kryptocoin]

The Netherlands also provides free heroin to drug addicts (or anyone who wishes to be designated a drug addict).

I trained at a hospital that gave beer to alcoholics who won't quit drinking to prevent them from going into DTs. Fortunately for my alcoholics, beer is legal.

 

[dpmd]

I trained at a hospital that gave beer to alcoholics who won't quit drinking to prevent them from going into DTs. Fortunately for my alcoholics, beer is legal.

I too trained at a hospital that did this, and was there when they quit doing so to see how it affected length of stay.

 

[Angry Birds]

So death is a universal negative. That's why we give violent prisoners a quick and humane death while we prolong the suffering and pain of our patients until the ravages of their disease eats them alive.

They both die in the end, except one took a much torturous path to get there.

First: One could quite easily be against the death penalty and also against euthanasia/PAS. This takes away any power of any argument (which is rhetorical anyways). I would contend that many people would fall into this camp.

Second: The presumption of those who are strongly opposed to suicide is that human life is sacred and is to be protected by the law, which is the very reason for the existence of the death penalty in the first place.

Third: Historically, there was no necessity that capital punishment be meted out in a non-painful or sanitized way. In fact, the firing squad is not far from memory. Shall we argue that we should allow patients to sign up to be shot by the firing squad? Additionally, there is an open question as to whether or not our heavily medicalized death penalty process is truly painless or not.

Fourth: What is missed in most of these discussions is the fact that there are alternatives to suicide including palliative pain management and even palliative sedation, the last option of which is willfully ignored by proponents of PAS since it takes the wind out of their sails.

Fifth: Social, societal, and cultural factors are not taken into account. These can often explain why PAS is so strongly needed or desired in certain societies over others.

 

[dadaddadaBATMAN]

First: One could quite easily be against the death penalty and also against euthanasia/PAS. This takes away any power of any argument (which is rhetorical anyways). I would contend that many people would fall into this camp.

Second: The presumption of those who are strongly opposed to suicide is that human life is sacred and is to be protected by the law, which is the very reason for the existence of the death penalty in the first place.

Third: Historically, there was no necessity that capital punishment be meted out in a non-painful or sanitized way. In fact, the firing squad is not far from memory. Shall we argue that we should allow patients to sign up to be shot by the firing squad? Additionally, there is an open question as to whether or not our heavily medicalized death penalty process is truly painless or not.

Fourth: What is missed in most of these discussions is the fact that there are alternatives to suicide including palliative pain management and even palliative sedation, the last option of which is willfully ignored by proponents of PAS since it takes the wind out of their sails.

Fifth: Social, societal, and cultural factors are not taken into account. These can often explain why PAS is so strongly needed or desired in certain societies over others.

For your fourth point, I don’t think palliative sedation really takes the winds out of anyone’s sails.

I’m curious though if you’re ok with the concept of sedation till death, like rass -5.

If so, follow up question: you’re ok with completely destroying any meaningful brain function, as long as there is a heart beat?

That position makes about as much sense to me as making a 95yo a full code.



On an unrelated note, I agree with Wilcoworld that if it ever became legal I wouldn’t provide it.

I would prefer that to remain the domain of people who are not involved in the decision to pursue the discussion at all, maybe in a similar vein to how lifenet is in charge of organ donation. if you’re interested in discussing it, they bring in the death guy to talk about it, maybe make him wear one of those old-style plague masks.

 

[WilcoWorld]

I would prefer that to remain the domain of people who are not involved in the decision to pursue the discussion at all, maybe in a similar vein to how lifenet is in charge of organ donation.

That's a good parallel. Quarantining the folks who discuss organ donation from those who discuss whether or not to continue life sustaining therapies is a wise practice IMO.

One key part of having effective goals of care conversations - which are at their best when they discover and honor the patient's values - is to come to the conversation without your own agenda. So, I can not have organ donation in the back of my mind when I'm talking about goals of care.

 

[WilcoWorld]

First: One could quite easily be against the death penalty and also against euthanasia/PAS. This takes away any power of any argument (which is rhetorical anyways). I would contend that many people would fall into this camp.

Second: The presumption of those who are strongly opposed to suicide is that human life is sacred and is to be protected by the law, which is the very reason for the existence of the death penalty in the first place.

Third: Historically, there was no necessity that capital punishment be meted out in a non-painful or sanitized way. In fact, the firing squad is not far from memory. Shall we argue that we should allow patients to sign up to be shot by the firing squad? Additionally, there is an open question as to whether or not our heavily medicalized death penalty process is truly painless or not.

Fourth: What is missed in most of these discussions is the fact that there are alternatives to suicide including palliative pain management and even palliative sedation, the last option of which is willfully ignored by proponents of PAS since it takes the wind out of their sails.

Fifth: Social, societal, and cultural factors are not taken into account. These can often explain why PAS is so strongly needed or desired in certain societies over others.

For your fourth point, I don’t think palliative sedation really takes the winds out of anyone’s sails.

I’m curious though if you’re ok with the concept of sedation till death, like rass -5.

If so, follow up question: you’re ok with completely destroying any meaningful brain function, as long as there is a heart beat?

That position makes about as much sense to me as making a 95yo a full code.



On an unrelated note, I agree with Wilcoworld that if it ever became legal I wouldn’t provide it.

I would prefer that to remain the domain of people who are not involved in the decision to pursue the discussion at all, maybe in a similar vein to how lifenet is in charge of organ donation. if you’re interested in discussing it, they bring in the death guy to talk about it, maybe make him wear one of those old-style plague masks.

If we're going to discuss palliative sedation it could be helpful to make sure we're on the same page as to what it is and how to do it, so here's a more or less authoritative reference:

Controlled Sedation for Refractory Suffering - Part 1 - Palliative Care Network of Wisconsin

Introduction Controlled Sedation for Refractory Suffering (also known as ‘total,’ ‘palliative,’ or ‘terminal’ sedation) can be defined as sedation for intractable distress in the dying. The use of sedation has been reported to be anywhere from 2-50% of hospice patients. Muller-Busch...

www.mypcnow.org

 

[dadaddadaBATMAN]

If we're going to discuss palliative sedation it could be helpful to make sure we're on the same page as to what it is and how to do it, so here's a more or less authoritative reference:

Controlled Sedation for Refractory Suffering - Part 1 - Palliative Care Network of Wisconsin

Introduction Controlled Sedation for Refractory Suffering (also known as ‘total,’ ‘palliative,’ or ‘terminal’ sedation) can be defined as sedation for intractable distress in the dying. The use of sedation has been reported to be anywhere from 2-50% of hospice patients. Muller-Busch...

www.mypcnow.org

Fast facts! <3

It’s possibly mentioned in the source articles but this still doesn’t address recommended duration or depth of sedation.

If it’s till death, I have difficulty distinguishing the difference between this and euthanasia. It’s simply induced vegetative state: it’s not brain death, but in many ways I would consider this worse.

If I don’t have any frontal/temporal lobe left I don’t want to be alive. I think you have referenced something similar regarding complete social isolation.

Edit; fast fact 107 does address this somewhat, but notes it can be variable. I agree that rass 0 to -2 or so would likely reduce the suffering of the patient, though not the family. -3 on downward just feels like a half measure to me.

 

[dadaddadaBATMAN]

That's a good parallel. Quarantining the folks who discuss organ donation from those who discuss whether or not to continue life sustaining therapies is a wise practice IMO.

One key part of having effective goals of care conversations - which are at their best when they discover and honor the patient's values - is to come to the conversation without your own agenda. So, I can not have organ donation in the back of my mind when I'm talking about goals of care.

Another thought, though maybe not a good one. This really seems like a domain of the hospice folks more so than palliative (I am aware it’s a joint speciality but many people wear one hat or the other, at least at a time).

While not all hospice docs would be comfortable with it, any more than all obs perform abortions, it would provide clean separation. Palliative had discussion regarding goals, hospice outlines extent of goals.

This also somewhat mitigates concerns for abuse. You have all the normal markers of capacity/competence, decision maker, and goals of care discussion looked at from multiple angles by multiple physicians. Only eligible if you pass all of them, and could include key phrases regarding potential secondary gain to arm the hospice folks.

Frankly, if someone is good enough at faking things to get past all that the patient is likely screwed anyway.

 

[dpmd]

Fast facts! <3

It’s possibly mentioned in the source articles but this still doesn’t address recommended duration or depth of sedation.

If it’s till death, I have difficulty distinguishing the difference between this and euthanasia. It’s simply induced vegetative state: it’s not brain death, but in many ways I would consider this worse.

If I don’t have any frontal/temporal lobe left I don’t want to be alive. I think you have referenced something similar regarding complete social isolation.

Edit; fast fact 107 does address this somewhat, but notes it can be variable. I agree that rass 0 to -2 or so would likely reduce the suffering of the patient, though not the family. -3 on downward just feels like a half measure to me.

I look at it as the legal option we have for people who want euthanasia and the doctor wants to help them but also wants to not get arrested. Interestingly enough I had pushback from other doctors for the one patient I arranged it for in the hospital. Because of the same thinking on it that it is sort of like really drawn out euthanasia. But where we dislike how drawn out it is they disliked that it would likely hasten death no matter what the intent was.

 

[Angry Birds]

If we're going to discuss palliative sedation it could be helpful to make sure we're on the same page as to what it is and how to do it, so here's a more or less authoritative reference:

Controlled Sedation for Refractory Suffering - Part 1 - Palliative Care Network of Wisconsin

Introduction Controlled Sedation for Refractory Suffering (also known as ‘total,’ ‘palliative,’ or ‘terminal’ sedation) can be defined as sedation for intractable distress in the dying. The use of sedation has been reported to be anywhere from 2-50% of hospice patients. Muller-Busch...

www.mypcnow.org

I don't disagree with you. There is also bioethical literature on the fuzzy line between palliative sedation and euthanasia, warning that the one can easily slide into the other.

Nonetheless, there is a key difference, which is intent. This distinction is already the case with what we currently accept (palliative pain control as opposed to euthanasia).
Of course, intent might not be enough to safeguard against abuse. So, there are all sorts of nuances to be made and discussions to be had.

 

[dadaddadaBATMAN]

I don't disagree with you. There is also bioethical literature on the fuzzy line between palliative sedation and euthanasia, warning that the one can easily slide into the other.

Nonetheless, there is a key difference, which is intent. This distinction is already the case with what we currently accept (palliative pain control as opposed to euthanasia).
Of course, intent might not be enough to safeguard against abuse. So, there are all sorts of nuances to be made and discussions to be had.

I feel like I have been a little bit abrasive, and I owe you an apology for that. It’s unfortunately my nature.

One of the things that is most disappointing about the internet (and modern life in general) is the inability to have a discussion without treating people’s thoughts with contempt.

I might not understand your view, but I do respect it and I am trying to figure it out.

I still have a lot of difficulty in understanding why intent to reduce neurological function to the approximate level of a cucumber until death is different from intent to kill.

This may be just a value question: I think of life as characterized by agency/consciousness. In a lot of ways I don’t view a lobster or a jelly fish as more alive than my iPhone, as they operate off of neural nets with hardwired and predictable responses.

Removing consciousness (permanently) to me is equivalent to death.

 

[WilcoWorld]

It’s possibly mentioned in the source articles but this still doesn’t address recommended duration or depth of sedation.

To paraphrase another thinker - it should be as deep and as long as necessary and not a bit more. Flipping it: as light and brief as possible.

 

[WilcoWorld]

I still have a lot of difficulty in understanding why intent to reduce neurological function to the approximate level of a cucumber until death is different from intent to kill.

Yeah, in order for it to count as palliative sedation rather than a slow euthanasia the clinician has to at least have the willingness and intent to stop the sedation if the suffering has come under control - kind of like sedation holidays in the neuro ICU. We do this on my palliative unit, and often times (I don't have numbers) we will find that after a night of sedation the patient can be brought "back up" and is able to be comfortable and conscious.

 

[Angry Birds]

I feel like I have been a little bit abrasive, and I owe you an apology for that. It’s unfortunately my nature.

One of the things that is most disappointing about the internet (and modern life in general) is the inability to have a discussion without treating people’s thoughts with contempt.

I'm the same way, so apologies all around.
I'm terribly abrasive online and it's not a good thing. I edit my initial posts to take out some of the snark but I suspect it still oozes out. But, anyways, thank you for these kind words.

I might not understand your view, but I do respect it and I am trying to figure it out.

I still have a lot of difficulty in understanding why intent to reduce neurological function to the approximate level of a cucumber until death is different from intent to kill.

This may be just a value question: I think of life as characterized by agency/consciousness. In a lot of ways I don’t view a lobster or a jelly fish as more alive than my iPhone, as they operate off of neural nets with hardwired and predictable responses.

Removing consciousness (permanently) to me is equivalent to death.

So, my view on this issue is embedded in a larger worldview, which I think goes against the highly utilitarian, secular materialist, and capitalist one that currently dominates our society.

To answer your question more specifically though: I think what I am reacting against is the style of argumentation that is often done, which is to find a liminal or outlier case and then use that to generalize to the usual case, which is actually the intent behind such reasoning. In other words, I know that trying to locate the fuzzy zone between palliative sedation and euthanasia is intended to normalize not just euthanasia but suicide based on a worldview that stresses consent and utility over and above all other values.

 

[dadaddadaBATMAN]

I'm the same way, so apologies all around.
I'm terribly abrasive online and it's not a good thing. I edit my initial posts to take out some of the snark but I suspect it still oozes out. But, anyways, thank you for these kind words.



So, my view on this issue is embedded in a larger worldview, which I think goes against the highly utilitarian, secular materialist, and capitalist one that currently dominates our society.

To answer your question more specifically though: I think what I am reacting against is the style of argumentation that is often done, which is to find a liminal or outlier case and then use that to generalize to the usual case, which is actually the intent behind such reasoning. In other words, I know that trying to locate the fuzzy zone between palliative sedation and euthanasia is intended to normalize not just euthanasia but suicide based on a worldview that stresses consent and utility over and above all other values.

I think there are more than a few outlier cases where this can be a reasonable option, but I agree that this tactic is frequently used. The generalizability of these cases where things are clear-cut is wanting.

I understand the idea that utility and consent are being placed on a pedestal to the cost of other values.

I would argue there is another “soft” value, dignity, that is also important. It isn’t impossible to value this and oppose pas or euthanasia. but if one values it strongly or more than the intrinsic value of life it can support an argument for euthanasia or pas.

 

[dadaddadaBATMAN]

To paraphrase another thinker - it should be as deep and as long as necessary and not a bit more. Flipping it: as light and brief as possible.

This is a fair explanation. Thank you

 

[Angry Birds]

"deep and as long as necessary"

Case study.

Had a 70 yo F with advanced dementia last year. Also with pretty bad HF, COPD and ESRD. However her dementia became so severe she would become agitated and physically fight the dialysis staff. Once she became too violent SNF sent her to my ED because the dialysis center refused to service her anymore.

Daughter is POA. Demands "full code," everything be done, dialysis to continue as scheduled. She wasn't acutely ill, mind you, the facility just refused to continue dialysis.

And therein lies the problem.

Since she really had no acute medical issue she was largely clear to be discharged the moment she arrived. Psych got consulted and played around with a few meds but the same issues kept rising regardless: fighting dialysis staff in the hospital--violently. Ultimately psych recommended she be left alone and just sedated with haldol prior to dialysis.

That plan worked in the hospital, but no SNF would take her because sedating patients for dialysis is not a viable community solution, at least in my area. All nursing homes refused her. As a result she lived in the hospital for the next three months. In that timeframe palliative care strongly encouraged the daughter to change her to DNR-CC and just stop dialysis but the daughter refused.

And so, for the next three months, she would just occupy a hospital bed. Three times a week they would sedate her and tie her to the dialysis machine. Sometimes they did not do a good job and she would still attack the staff. Hospital ethics consultant got involved at one point, but like the other two cases I've followed that involved them they were useless in making a difference. No change to plan.

What ultimately happened? She got pneumonia just sitting in a bed all day and died three days later. If she hadn't, I wonder how much longer she would have wasted valuable resources. She wasn't brain dead, she was just a confused wild animal that no one would take.


Related to above: a long time ago, back when I was dumb young I was a hardcore democrat. I was outraged at the misinformation about the affordable care act, Sarah Palin had been saying it would have "death panels" where physicians would decide who lives and who dies. It wasn't true, but a lot of people thought it was and it caused quite a stir.

I now look back on that outrage and I'm like, "wow, physician death panels. We need those."

I recognize I'm an outlier on this site. I'm very pro-euthanasia. I enjoy employment so I would never test those waters myself, but if there was a death panel I'd be first to sign up for it. The woman in the case above I'd vote to euthanize or force POA to chance code status to DNR CC and withdrawal all care. What a pointless, painful endeavor she inflicted upon her mother.

But, you know, "sanctity of life"--the phrase we use to authorize medical torture.

Cool story, bro.*

The problem is that the case does not make your point. There is a difference between DNR and refraining from treatment than euthanasia and from PAS. Your case would fall under the first category, which I don't think anyone is defending.

More to the point, if you could not get the patient or proxy to agree to DNR, how do you expect to enforce euthanasia or PAS? It really seems like you are arguing that you as the physician have the right to terminate life without even consent. I know you don't mean this but this is what the implication is.

* This is the snarky part, I confess. I'm kidding and doing it on purpose.

 

[BoardingDoc]

"deep and as long as necessary"

Case study.

Had a 70 yo F with advanced dementia last year. Also with pretty bad HF, COPD and ESRD. However her dementia became so severe she would become agitated and physically fight the dialysis staff. Once she became too violent SNF sent her to my ED because the dialysis center refused to service her anymore.

Daughter is POA. Demands "full code," everything be done, dialysis to continue as scheduled. She wasn't acutely ill, mind you, the facility just refused to continue dialysis.

And therein lies the problem.

Since she really had no acute medical issue she was largely clear to be discharged the moment she arrived. Psych got consulted and played around with a few meds but the same issues kept rising regardless: fighting dialysis staff in the hospital--violently. Ultimately psych recommended she be left alone and just sedated with haldol prior to dialysis.

That plan worked in the hospital, but no SNF would take her because sedating patients for dialysis is not a viable community solution, at least in my area. All nursing homes refused her. As a result she lived in the hospital for the next three months. In that timeframe palliative care strongly encouraged the daughter to change her to DNR-CC and just stop dialysis but the daughter refused.

And so, for the next three months, she would just occupy a hospital bed. Three times a week they would sedate her and tie her to the dialysis machine. Sometimes they did not do a good job and she would still attack the staff. Hospital ethics consultant got involved at one point, but like the other two cases I've followed that involved them they were useless in making a difference. No change to plan.

What ultimately happened? She got pneumonia just sitting in a bed all day and died three days later. If she hadn't, I wonder how much longer she would have wasted valuable resources. She wasn't brain dead, she was just a confused wild animal that no one would take.


Related to above: a long time ago, back when I was dumb young I was a hardcore democrat. I was outraged at the misinformation about the affordable care act, Sarah Palin had been saying it would have "death panels" where physicians would decide who lives and who dies. It wasn't true, but a lot of people thought it was and it caused quite a stir.

I now look back on that outrage and I'm like, "wow, physician death panels. We need those."

I recognize I'm an outlier on this site. I'm very pro-euthanasia. I enjoy employment so I would never test those waters myself, but if there was a death panel I'd be first to sign up for it. The woman in the case above I'd vote to euthanize or force POA to chance code status to DNR CC and withdrawal all care. What a pointless, painful endeavor she inflicted upon her mother.

But, you know, "sanctity of life"--the phrase we use to authorize medical torture.

That's unfortunate that your hospital ethics committee allowed that to continue. We have a similar committee at my hospital and I know the docs on it. They almost certainly would have decided that they would not continue sedating the patient 3x/wk in order to perform dialysis. Palliative care would be offered and if unhappy with the decision, the daughter would be free to have the patient DCed at her discretion.

 

[Birdstrike]

Everyone agrees human beings deserve an ethical, dignified death. If only human beings were ethical & dignified enough to trust with that power.

 

[dpmd]

That's unfortunate that your hospital ethics committee allowed that to continue. We have a similar committee at my hospital and I know the docs on it. They almost certainly would have decided that they would not continue sedating the patient 3x/wk in order to perform dialysis. Palliative care would be offered and if unhappy with the decision, the daughter would be free to have the patient DCed at her discretion.

I'm fairly confident the ethics committees at both the hospital I trained at and where I am now would not have decided to simply keep allowing that either unless perhaps the patient had specifically requested aggressive prolongation of life on an advance directed prior to becoming incapacitated despite knowing she had a form of dementia that would progress and renal failure. Otherwise her fighting the dialysis folks would have been discussed as no longer assenting to that treatment (sometimes people who lack capacity to consent are still asked to assent to treatment and are allowed to refuse in certain circumstances) and a reason to push back against the POA.

 

[WilcoWorld]

Case study.

Had a 70 yo F with advanced dementia last year. Also with pretty bad HF, COPD and ESRD. However her dementia became so severe she would become agitated and physically fight the dialysis staff. Once she became too violent SNF sent her to my ED because the dialysis center refused to service her anymore.

Daughter is POA. Demands "full code," everything be done, dialysis to continue as scheduled. She wasn't acutely ill, mind you, the facility just refused to continue dialysis.

And therein lies the problem.

Since she really had no acute medical issue she was largely clear to be discharged the moment she arrived. Psych got consulted and played around with a few meds but the same issues kept rising regardless: fighting dialysis staff in the hospital--violently. Ultimately psych recommended she be left alone and just sedated with haldol prior to dialysis.

That plan worked in the hospital, but no SNF would take her because sedating patients for dialysis is not a viable community solution, at least in my area. All nursing homes refused her. As a result she lived in the hospital for the next three months. In that timeframe palliative care strongly encouraged the daughter to change her to DNR-CC and just stop dialysis but the daughter refused.

And so, for the next three months, she would just occupy a hospital bed. Three times a week they would sedate her and tie her to the dialysis machine. Sometimes they did not do a good job and she would still attack the staff. Hospital ethics consultant got involved at one point, but like the other two cases I've followed that involved them they were useless in making a difference. No change to plan.

What ultimately happened? She got pneumonia just sitting in a bed all day and died three days later. If she hadn't, I wonder how much longer she would have wasted valuable resources. She wasn't brain dead, she was just a confused wild animal that no one would take.


Related to above: a long time ago, back when I was dumb young I was a hardcore democrat. I was outraged at the misinformation about the affordable care act, Sarah Palin had been saying it would have "death panels" where physicians would decide who lives and who dies. It wasn't true, but a lot of people thought it was and it caused quite a stir.

I now look back on that outrage and I'm like, "wow, physician death panels. We need those."

I recognize I'm an outlier on this site. I'm very pro-euthanasia. I enjoy employment so I would never test those waters myself, but if there was a death panel I'd be first to sign up for it. The woman in the case above I'd vote to euthanize or force POA to chance code status to DNR CC and withdrawal all care. What a pointless, painful endeavor she inflicted upon her mother.

But, you know, "sanctity of life"--the phrase we use to authorize medical torture.

This case is a travesty. The patient's dignity and autonomy were undermined by her daughter's ill-conceived decision.

I see it as a compelling case for a legal reform, but not a case for euthanasia. If dialysis had been discontinued (as the patient was demonstrating that she wanted by attacking the staff) then she would've died a relatively peaceful death in about 2 weeks or less.

 

[WilcoWorld]

I'm the same way, so apologies all around.
I'm terribly abrasive online and it's not a good thing. I edit my initial posts to take out some of the snark but I suspect it still oozes out. But, anyways, thank you for these kind words.



So, my view on this issue is embedded in a larger worldview, which I think goes against the highly utilitarian, secular materialist, and capitalist one that currently dominates our society.

To answer your question more specifically though: I think what I am reacting against is the style of argumentation that is often done, which is to find a liminal or outlier case and then use that to generalize to the usual case, which is actually the intent behind such reasoning. In other words, I know that trying to locate the fuzzy zone between palliative sedation and euthanasia is intended to normalize not just euthanasia but suicide based on a worldview that stresses consent and utility over and above all other values.

Would you please elaborate on what your worldview is and how it informs your thinking on this issue?

 

[Angry Birds]

Would you please elaborate on what your worldview is and how it informs your thinking on this issue?

Ah, this would take a lot of detail but for now I would refer you to the following book: Patrick Deneen, Why Liberalism Failed.
I should clarify that Deneen is critical here of both classical and progressive liberalism, which includes most of the loudest voices in today's American politics (libertarians, Republicans, Democrats, progressives).

As an ER doc, I find Deneen's thesis to be compelling based on what I see at work. This includes the broken families and isolated individuals that I see not only in my work colleagues but also the patients that I see, their rotting corpses being sometimes the only indication to their neighbor to call 911, with next of kin nary to be found... Rampant drug abuse, suicide, homelessness, and misery.

I am a liberal-communitarian, thereby seeking to affirm some positive key values of liberalism while also trying to counter the excesses of liberalism and to instead seek to promote individual and societal flourishing.

Many of you may have sensed that I have a religious inclination as well, although I suspect many -- reared in the mythology of secular liberalism -- would have a stereotypical image of me based on that alone. I consider religions to be human social constructs, which however are important to promoting healthy societies, families, traditions, and nations. I therefore hold religion and tradition to be important, and these do not have to be one religion or another. This is hardly the dogmatist simpleton that many secular liberals would immediately jump to in their minds. From a popular perspective, my views on religion are not too far from those of Jordan Peterson, although I tend to read more serious philosophers and also reject many of Peterson's political views. I am not a populist, nationalist, or social reactionary. I think we have to move forward but perhaps the default should be in a Burkean sort of way (although occasionally ruptures with the past are needed).

Bottom line: I think the overwhelming emphasis on consent and individual autonomy is misguided, which is the prize virtue for unfettered liberalism/libertarianism, leading to the social breakdown that is apparent to me when I work in the ER. I see physician-assisted suicide as the inevitable end result of this process.