German Medical Chief on Assisted Suicide Debate 'We Don't Want Killing To Be Part of a Doctor's Tools'

A recent survey indicates that 37 percent of doctors in Germany would consider helping a terminally ill patient die, despite German Medical Association guidelines that say this is unethical. Jörg-Dietrich Hoppe, president of the association, discusses the country's debate over assisted suicide, euthanasia and the need to develop new guidelines.


SPIEGEL: Mr. Hoppe, you have always maintained that German doctors do not want to help patients with assisted suicide or active euthanasia. But a recent survey by the German Medical Association (BÄK), which represents the interests of over 400,000 doctors in Germany, shows that 37 percent of all health professionals can imagine assisting patients who wish to commit suicide. One in four doctors would even consider active euthanasia. Has a part of the German medical community turned its back on the official code of ethics?

Jörg-Dietrich Hoppe: No, I see it differently. The survey confirms that a vast majority of doctors can understand the suicide wishes of critically ill patients who are suffering. But the true willingness to assist with those wishes is not widespread. A clear majority still rejects these things.

SPIEGEL: A line in your organization's guidelines on medically assisted suicide says that: "It is contrary to medical ethics for a doctor to assist a suicide." Are one in three of your colleagues now harboring unethical thoughts?

Hoppe: It is precisely that line that we are discussing intensively at the moment. I assume that those who want doctors to be able to assist with suicides haven't given the issue very much thought. This cannot be part of doctors' duties. The public should not be given the impression that doctors are considering death as an alternative to healing, helping or relieving pain.

SPIEGEL: But don't doctors need to consider this if they are serious about a patient's right to self-determination, as guaranteed by the German constitution?

Hoppe: I am convinced that if this attitude spreads, then it will destroy the mutual trust upon which the doctor-patient relationship is based.

SPIEGEL: Still, surveys regularly show that the majority of the population supports the possibility of assisted suicide. And now this shift in values seems to have reached the medical community. Lawmakers no longer consider assisted suicide a punishable crime either. So shouldn't it be left up to patients and doctors themselves to decide what sorts of ethics form the foundation of their trusting relationship?

Hoppe: Up until now, the view of the medical community has been that we don't want killing to be part of a doctor's tools, in any way. We'll see whether it stays that way.

SPIEGEL: Can a professional association even say to one-third of its members that it won't address the fact that they have different medical ethics from the other members?

Hoppe: No, it cannot. Which is why I assume that the current formulation of the guidelines will change to some extent.

SPIEGEL: An example could be the removal of the description, "contrary to medical ethics," perhaps?

Hoppe: We'll see. Once our committee for fundamental ethical and medico-legal principles has completed its work, the issue will be discussed by the board of the German Medical Association and most likely at our annual conference as well.

SPIEGEL: But even within your central commission for ethics there is disagreement on the issue. Last year in SPIEGEL, Jochen Taupitz, a legal expert and a member of your ethics commission, advocated approving medically assisted suicide.

Hoppe: Any doctor who can reconcile his or her ethics with assisting a suicide, may already do so under the today's conditions. Personally, I couldn't reconcile it with my conscience. But I always have an understanding for individual cases. I don't know how many doctors do these things. But unofficially, some things do happen -- and public prosecutors do not do anything about it. However, if we legislate on it, then I worry that it will harm the image of doctors. People could no longer be sure about the attitude with which their doctors are dealing with them.

SPIEGEL: Instead, we currently have a gray area between criminal law, which is more liberal, and the professional code for doctors, which is more rigid. Many doctors fear they could lose their licenses to practice should they assist a suicide. Are they correct?

Hoppe: No. Doctors do not need to be afraid of that. Outside of the case of Hackethal (Editor's note: Doctor and author Julius Hackethal, an advocate of active euthanasia who admitted he had helped his own mother die and was taken to court for his actions) I can't recall any situation in the profession in which a case was brought against a doctor for assisting a suicide.

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F.Falk 07/21/2010
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So much arrogance... "We Don't Want Killing To Be Part of a Doctor's Tools"... You can be 100% sure that your patients dont want that "killing" becomes a part of your tools, too. But it should be allowed for a person with a free a healthy mind to choose this way. Its not your "tool" if a patient decides to end his meaningless pain. Its the choice of the patient. A doctor has to be absurdly arrogant if he thinks its a part of HIS toolset even if its a decision of the patient. It sounds too much like "My patients are my puppets. They do what i command!" in my ears.
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