Finding Common Ground in This Life


One doctor believes there are patients who will legitimately choose medical aid in dying—we just have to acknowledge them.

I would like to thank Ronald Pies, MD, for his response, “Physician-Assisted Suicide: An Egregious Boundary Violation.”1 It is truly quite a compendium of critiques against physician-assisted suicide. I am not going to rebut his arguments point by point. I respectfully acknowledge that such arguments have been ongoing throughout history.

There are well-documented, strong arguments on both sides. For example, Lydia S. Dugdale, MD, and colleagues2 provide an excellent and succinct summary of positions both for and against physician-assisted suicide. Briefly, they describe how respect for patient autonomy and the compassionate relief of suffering are major arguments in favor of physician-assisted suicide and how unintended harm through suicide contagion and the slippery-slope argument are commonly raised to refute physician-assisted suicide.2 I know Dr Pies is well aware of these arguments. What I am interested in is exploring our common ground.

Part of Dr Pies’ conclusion states, “Physicians should rededicate themselves to securing state-of-the-art palliative care and supportive counseling for terminally ill patients.”1 I am in complete agreement on this point. In fact, I believe that Dr Pies and I already agree on many points. I absolutely agree we must improve access to care so that everyone receives high-quality health care. I absolutely agree we must treat all underlying mental illnesses and medical conditions. I absolutely agree we must provide pain management. I absolutely agree we must provide relevant psychotherapy and grief counselling. We should also pursue all relevant consultations, hire a death doula, and have conferences with the family and friends. We absolutely should give patients the option to choose to voluntarily stop eating and drinking (VSED). We should provide them with all possible options. And after being provided all the options and receiving all the treatments, I believe there is the patient who will legitimately choose medical aid in dying.

This person is currently invisible in the majority of states across our country. The first step is to acknowledge that they exist. To see them. To believe them. Do we share this common ground, Dr Pies? Do you acknowledge that this person exists?

Dr Pagano is a forensic psychiatrist at Cherry Hospital in Goldsboro, North Carolina.


1. Pies R. “Physician-assisted suicide: an egregious boundary violation.” Psychiatric Times. January 11, 2022. Accessed on January 13, 2022.

2. Dugdale LS, Lerner BH, Callahan D. Pros and cons of physician aid in dying. Yale J Biol Med. 2019;92(4):747-750.

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