Testo Originale:

The headline of an article in last Friday's National Post reads: "Assisted death not painless: A Dutch study of euthanasia cases

found drugs did not always work. Canadian ethicists say it shows doctors require specialized training." This article quoes Dr. Philip

Hebert, director of the Clinical Ethics Centre at Toronto's Sunnybrook Hospital, as stating: "If we are going to do it [euthanasia],

we should at least learn to do it well." Can we really imagine standing before a class of medical stuents and teaching them how to

administer euthanasia -- how to kill their patients? A fundamental value and attitude that we reinforce in medical students, interns

and residents is an absolute repugnance to killing patients. It would no longer be posible to teach that if we were to instruct them

how to carry out euthanasia. The practice of maintaining in physicians this repugnance to killing -- and, arguably, an intuitive

recognition of the need for it -- is demonstrated in the outraged reactons against physicians carrying out capital punishment. We do

not consider their involvement acceptable -- not even for those physicians who personally are in favour of capital punishment. We,

as a society, need to say powerfully, consistently and nambiguously that killing each other is wrong. And physicians are very

important carriers of this message, partly because they have opportunities (not open to members of society in general) to kill

people. It is sometimes pointed out that many socities do justify one form of killing by physicians: abortion. This was justified,

traditionally, on the grounds that it was necessary to save the life of the mother. We now have liberalized abortion laws that reflect

a justification that hinges on te belief that the foetus is not yet a "person." It is argued that abortion is aimed, primarily, not at

destroying the foetus but respecting women's reproductive autonomy - - we focus on the woman not the foetus. Indeed, when

destroying the foetus i the primary aim -- as it is in sex selection -- even those who agree with abortion on demand often regard it

as morally unacceptable. And the rarity of third-trimester abortions in Canada, and other countries like ours, shows that once we

view thefoetus as a person, we do not find killing it acceptable. Euthanasia clearly involves taking the life of a person. Having

physicians carry it out would, therefore, seem likely to affect their attitudes and values, and those of society, in ways that,arguably,

abortion does not -- at least as long as physicians and the rest of us do not see the foetus as a person like us. We cannot afford to

underestimate the desensitization and brutalization that both teaching medical students how to carry outeuthanasia and their doing

this would have on them. We must also consider whether patients' and society's trust in both their physicians and the medical

profession depends in large part on this absolute rejection by physicians of intentionally inflcting death. It is sometimes remarked

that physicians have difficulty in accepting death, especially the deaths of their patients. This raises the question of whether, in

inculcating a total repugnance to killing, we have evoked a repugnance to deah as well. In short, there might be confusion between

inflicting death and death itself. We know that failure to accept death -- when to do so would be appropriate -- can lead to

overzealous and harmful measures to sustain life. We are most likely o be able to elicit a repugnance to killing while fostering an

acceptance of death, if we seek to convey a repugnance to killing (although that is an emotionally powerful word), not to death.

Doing so would be very difficult if physicians were undetaking euthanasia. Teaching physicians to carry out euthanasia takes both

the medical profession and its practitioners far beyond the roles of caring, healing and curing whenever possible. It involves them,

no matter how compassionate their motives in the infliction of death on those for whom they provide care. This means, as Dr.

Leon Kass has so powerfully expressed it, that euthanasia places "the very soul of medicine on trial." We need to protect the

institution of medicine, not only for ts own sake, but also because of the harm to society that damage to it would cause. It has been

suggested that we should have a specially trained group of lawyers, not physicians, who would administer euthanasia. Lawyers, it

was argued, are better t following rules than physicians. People have been appalled at this suggestion, when I have spoken of it.

A common response is: "You would let lawyers kill people!" And yet, that is precisely what physicians would do. We must see

through the "medial cloak" to the true nature of what is involved in euthanasia. With the decline of organized religion in many

postmodern, secular, pluralistic societies, it is difficult to find consensus on the fundamental values on which we base society and

estalish its ethical and legal "tone" -- those that provide the "existential glue" that holds society together. Many people personally

identify with medicine, which is not true of the majority of societal institutions. Therefore, medicine is important wen it comes to

carrying societal values, creating them and forming consensus around them. We must take great care not to harm its capacities in

these regards. Finally, I suggest it is a very important part of the art of medicine to sense and respec the mystery of life and death,

to hold this mystery in trust and to hand it on to future generations -- including future generations of physicians. We need to

consider extremely carefully if teaching young physicians to carry out euthanasia and haing their role models undertake this would

threaten this art, this trust and this legacy.



Margaret A. Somerville (Gale Professor of Law, Professor in the Faculty of Medicine at McGill University, Centre for Medicine,

Ethics and Law in Montreal)