Solemnly Renouncing Physician-Assisted Suicide: A Response to Vincenzo Di Nicola

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FROM OUR READERS

As a psychiatrist, medical ethicist, and avid reader of philosophy, I very much appreciated Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS, DLFAPA, DFCPA, FACPsych’s thoughtful philosophical perspective on euthanasia, suicide, and assisted suicide.¹ Readers of this article may recall that my colleagues (Mark S. Komrad, MD, DFAPA; Cynthia M.A. Geppert, MD, PhD, MA, MPH, MSBE, DPS, MSJ; and Annette Hanson, MD) and I have been frequent contributors on this issue, in strong opposition to assisted suicide.^2,3

Dr Di Nicola rightly places this issue in the broader philosophical framework of “…the value of life, the morality of death, and the role of individual autonomy in decisions concerning one’s existence.” After a magisterial discussion of these issues, Dr Di Nicola concludes by voicing his opposition to assisted suicide, writing:

“As a physician, I will not aid and abet anyone’s death except in the passive sense of not actively intervening to sustain life as in “no resuscitation” orders…I find it incongruent bordering on absurd that I dedicate so much energy dealing with suicidal youth and our attempts as partners with youth, their families, and health and social care services to prevent their repetition while colleagues in my own department are promoting physician-assisted suicide as a right for mental patients.”

Indeed, this paradoxical state of affairs “…parses suicide into 2 tiers—the suicide we should provide and the suicide which we should prevent. Distinguishing who belongs in each category is both clinically and morally impossible, not made any easier by deploying euphemisms for one of them, like ‘death with dignity.’”⁴

Dr Di Nicola modestly adds, “Speaking for myself, I took the Hippocratic Oath…”, which “…enjoins against assisted suicide.” But in an important sense, Dr Di Nicola is speaking for much more than his—or any one physician’s—personal perspective. He is implicitly invoking the ethos of a covenantal community of physicians whose bedrock ethical principles have abjured assisting suicide for over 2 millennia. Indeed, the school of Hippocrates was unique among the ancient Greek schools of medicine in solemnly renouncing physician-assisted suicide.⁵

As the medical ethicist Leon R. Kass, MD, PhD, has memorably put it, “We must care for the dying, not make them dead.”⁶

Dr Pies is Professor Emeritus of Psychiatry and Lecturer on Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor in Chief Emeritus of Psychiatric Times (2007-2010). Dr Pies is the author of several books, including several textbooks on psychopharmacology. A collection of his works can be found on Amazon.

References

1. Di Nicola V.Socrates’ choice: a philosophical perspective on euthanasia, suicide, and assisted suicide. Psychiatric Times. April 28, 2025. https://www.psychiatrictimes.com/view/socrates-choice-a-philosophical-perspective-on-euthanasia-suicide-and-assisted-suicide

2. Komrad MS, Hanson A, Geppert CMA, Pies RW. Beyond terminal illness: the widening scope of physician-assisted suicide in the US. Psychiatric Times. June 6, 2024. https://www.psychiatrictimes.com/view/beyond-terminal-illness-the-widening-scope-of-physician-assisted-suicide-in-the-us

3. Geppert CMA, Pies RW. Autonomy alone does not validate physician assisted suicide. Psychiatric Times. March 7, 2023. https://www.psychiatrictimes.com/view/autonomy-alone-does-not-validate-physician-assisted-suicide

4. Komrad MS. Assisted suicide should not be provided by physicians: a response to H. Steven Moffic, MD. Psychiatric Times, April 23, 2025. https://www.psychiatrictimes.com/view/assisted-suicide-should-not-be-provided-by-physicians-a-response-to-h-steven-moffic-md

5. Pies RW.Deferring to the mastery of death: Hippocrates, Judge Gorsuch, and the autonomy fallacy. Psychiatric Times. April 3, 2017. https://www.psychiatrictimes.com/view/deferring-mastery-death-hippocrates-judge-gorsuch-and-autonomy-fallacy

6. Kass LR. Dehumanization triumphant. First Things. August 1, 1996. Accessed May 6, 2025. https://firstthings.com/dehumanization-triumphant/