ISSUES IN LAW & MEDICINE.(overview)

Editor's note. Issues in Law & Medicine is a peer-reviewed professional journal published three times a year by the National Legal Center for the Medically Dependent & Disabled, Inc. and the Horatio R. Storer Foundation, Inc., Published since 1985, Issues is devoted to providing useful information on recent legal and medical developments to assist attorneys, health care professionals, educators, and administrators on legal, medical, and ethical issues arising from health care decisions.

Of particular interest to pro-lifers in the March edition of Issues in Law & Medicine is "Countertransference and Assisted Suicide," written by psychiatrists Francis T. Varghese and Brian Kelly. This intriguing analysis looks at the unexamined role of countertransference (the conscious or unconscious emotional response of a physician to a patient) in requests for assisted suicide.

The authors point out that the wish of a patient for an assisted death or euthanasia needs to be carefully evaluated within a broad context that takes into account the interpersonal, social, and cultural factors that can influence the patient's understanding of suffering; the kind of concerns he or she feels; and how they make their decisions. Central to this discussion is the nature of the relationship between the patient and doctor.

When physicians attempt to put themselves "in the patient's shoes" in order to make clinical decisions and evaluations of "quality of life," it leaves the patient highly vulnerable to the doctor's personal and unrecognized biases concerning illness, death, and disability, Varghese and Kelly write.

While doctors may presume that proper medical decisions can be made based on what treatment they think they would wish were the physician in the patient's situation, in fact this adds a new and potentially very dangerous dimension to the doctor-patient relationship: the wishes of the doctor for the patient are presumed to be identical to those of the patient. This type of interaction between doctor and patient is not empathy; it is what psychiatrists call "countertransference."

The authors explain that it is well known that doctors have great difficulty dealing with death and dying. Indeed, dealing with terminally ill patients can be very emotionally draining for the doctor. Physicians must tread a difficult path, facing the patient's suffering and distress with its many determinants while attempting to maintain empathy but avoiding over-identification.

The legal and ethical arguments in favor of euthanasia, which enshrine the principle of individual autonomy, fail to address this key issue: there often are a host of other players with less than altruistic motives who have an interest in a patient's perceived suffering coming to a [lethal] end. Candor requires that policy makers understand that the patient's expression of a wish to die may be accompanied by - - or be a reflection of - - the doctor's wish to kill.