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Physicians and Their Patients' Suicides

Steven H. Miles, MD
JAMA. 1994;271(22):1786-1788. doi:10.1001/jama.1994.03510460078037.
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THE AMERICAN debate about whether to legalize physicianassisted suicide touches the head and the heart of medical ethics. Participants have focused on moral philosophy or civil rights, speculated about the consequences for society or for patients' views of physicians, and criticized the current provision of end-of-life medical care.1-3 There has been little discussion about how the psychology of doctor-patient relationships may influence decisions about physician-assisted suicide. This issue is relevant to understanding how patients and physicians make decisions and to the design of policy safeguards to prevent improper assisted suicides.

Even clinician/writers have been nearly silent on the psychology of doctoring in physician-assisted suicide. Their writings have centered on moral reasoning, the need for better end-of-life care, the societal consequences of legalization, or historical norms for medical practice.2,4-7 Quill8 has looked at the complex psychology of the patient's request.8 Some clinicians, such as Goodwin9 in


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