ORLANDO--Those who argue for physician-assisted suicide maintain that it gives terminal patients autonomy to decide when they’ve had enough, when they are through with their life’s work, and when they have made peace with family and friends. They can die where they want with the assistance of a caring physician.

While that all sounds very eloquent, there is an opposite side, Dr. Derek Doyle said at the 15th Annual International Breast Cancer Conference. "I put it to you that physician-assisted suicide is the back door to euthanasia," he said.

Dr. Doyle, vice president of the National Council for Hospice and Specialist Palliative Care Services, London, said that the reason people suggest euthanasia or physician-assisted suicide (he sees little difference between the two) is out of concern for the patient’s suffering. However, a strong argument against physician-assisted suicide is that patient suffering can be relieved through palliative medicine--a specialty in which physicians are trained to attend not only to terminally ill patients’ pain but also to their psychosocial problems and spiritual issues.

"The challenge is for us to exercise that knowledge and have the inclination to do it, and not leave it to our junior staff," Dr. Doyle said.

Pain is fairly easy to relieve, Dr. Doyle said, but many terminally ill patients are depressed, and it is not always easy to diagnose or measure the magnitude of depression. As a physician for more than 40 years, he has seen his patients dip deep into the well of melancholia.

"It’s at these times they could use the drugs we’ve given them to end their life," he said. Yet, the birth of a grandchild or a friend’s visit can raise their spirits, and they are lifted up in direct proportion to the amount of understanding given them by their caregivers."

If physician-assisted suicide were available, patients might feel a sense of obligation to end their lives to avoid becoming a burden on their families and society. "In Britain, politicians are constantly telling us how little money there is and telling the old people what a cost it is to keep them alive, so that many elderly people may believe that their final contribution to society is to take themselves out of society," Dr. Doyle said.

Physician-assisted suicide could also undermine pain management research. "If a person can take a pill and end his life, it makes little sense to spend time trying to define pain or titrate opioids to relieve his suffering," he said.

The last reason Dr. Doyle gave against physician-assisted suicide is that he feels it is so open to abuse by caregivers. Families who can no longer handle the burden of the terminally ill member, might, out of what he calls a "curious compassion," ask the physician to end their loved one’s life.

Even if he thought it were reasonable to offer patients assisted suicide, Dr. Doyle explained that its implementation would be difficult at best. To give higher opioid dosages to end the life of a terminally ill patient, who more than likely is not opioid naïve, could prove difficult. Some of these patients are barely sedated on very heavy morphine doses, even 30 times the prescribed dose. "A speedy useful death aided by a caring physician cannot be guaranteed at all," he said.

Dr. Doyle feels the entire issue is simply a reflection of our "quick fix" society. "If we accept this or accede to it, it will be the most appalling abrogation of our responsibility," he said. Is physician-assisted suicide ever justified? To Dr. Doyle, the answer is an unequivocal "no."