The emergence of the medieval Judeo-Christian era (12th century) brought about a major shift in social values and norms concerning life and death, effectively putting an end to the idea of the permissibility of suicide. St. Thomas Aquinas has been identified, among others, as influential in proposing the orthodox Christian view of suicide: a violation of one’s duty both to self and to God, therefore never to be justified in any form.

Healthcare practitioner opinion on the acceptability of assisted suicide has been fiercely divided well into the 20th century. One 1899 editorial in the journal The Lancet, for instance, argued that “the question of painlessly shortening the existence of a fellow-being is hardly to be taken seriously.” The editor’s opinion was based on the potential for abuse “by the unscrupulous persons who are unfortunately to be found in every rank of life [that], the medical profession would never countenance it.”

Twenty years later, other authors in another popular publication also questioned the practical application of any law that would allow assisted suicide or euthanasia, but they did acknowledge that if the law could “define and recognize a ‘hopeless’ case”, then “assisted suicide must be entrusted to the medical profession.” The fear then as now was that if assisted suicide were practiced openly, it would be abused if lay persons could practice it upon others.

A 2017 survey of 3,733 medical practitioners in the UK found that the majority view of practitioners was not in support of physician-assisted suicide (PAS), an opinion that was at odds with the general public’s more favorable view of it. One of the major considerations that was identified as a concern was the legality of PAS. But beyond the legal questions surrounding PAS, an even more important question for the medical practitioner is who will be responsible for making the decisions as to who can or cannot be assisted to die?

A related concern revolves around the question of who would be involved in the actual practice of hastening death. It would seem reasonable that healthcare practitioners would be instrumental in ensuring that assisted suicide and euthanasia are conducted properly when it has been authorized. However, despite public opinion generally favoring PAS, physicians are rarely supportive of the view that they should be the ones to be the instrument through which the hastening of death occurs.

Despite these long-standing concerns, there is little doubt that throughout human history those charged with providing healthcare services have assisted very ill patients to die more rapidly than nature would have allowed. And even more than this, there are many who do see the value in providing such “care” if it were not illegal. In 1961, an editorial in The Lancet identified the “gross inadequacy of our provision for decent, seemly quitting of life, with relievable pain and distress relieved and comfort given.”

The tremendous advances in healthcare over the past five decades have benefited society in numerous ways; perhaps the most significant being the ability to sustain and prolong life. But these advances have also meant that it is increasingly possible for patients to have long-term terminal illnesses and more prolonged dying processes. Whereas in the time of Aquinas, a prolonged death may have meant a few weeks, our current medical capacity for prolonging life could leave a patient with years of suffering, physical pain, and decreasing ability to live an engaged life with no hope or end in sight. All of this begs the question, what does it mean to “do no harm” in the 21st century?

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