The Rationale of Assisted Suicide for the Terminally Ill

According to Mishara and Weisstub, euthanasia is defined as the deliberate act undertaken by one person with the intention of ending the life of another person in order to relieve the person’s suffering, where the act itself is the actual cause of death. Physician-assisted suicide is a specific type of suicide that generally involves providing lethal substances for a patient to ingest that will cause their death. To some, the desire to die may seem like a rash, illogical solution to problems lacking a definitive answer. However, death allows terminally ill patients to finally put an end to their unbearable suffering. Thus, the right to die on one’s own terms may be the only way for patients to take control over the final moments of their life and may be considered rational decisions to confront situations that deprive life of meaning.

There are a lot of arguments about why assisted suicide should not be legal. Many people believe that life is sacred and that people should not be allowed to play God and decide when their lives should end. Typically, the loss of life is thought to be such a negative thing because death robs a person of everything they could achieve in life (Dvorksy). Consequently, the state has an obligation to protect its citizens, particularly the most vulnerable, to enable life. This obligation is filled by prioritizing palliative care and psychosocial interventions before euthanasia is deemed an appropriate option (Mishara and Weisstub 2). One of the most common arguments against assisted suicide is that palliative care available to patients is continuously improving, thus ensuring that people are no longer in any significant pain or discomfort. Finally, the majority of people tend to believe that if assisted suicide were to become legal that there is potential for it to grow out of control (Dvorsky). Once legal, people's attitudes toward suicide may become more tolerant of its practice. This could lead to high rates of abuse by physicians and patients as well as a diminished value for life.

It is important for terminal patients to feel like they have control over their own healthcare, treatment, and fate. Therefore, the option of assisted suicide exists “to allow those who feel they are losing control of their minds or bodies to regain power and see their own will take shape again” (Dvorsky). The human need for a dignified death is grounded as a psychological impulse to be treated as a human being instead of an expendable commodity (Mishara and Weisstub 429). In a study conducted by Loggers et al., the most common reason for patients requesting assisted suicide was a loss of autonomy as their main reason. Other reasons included the inability to engage in enjoyable activities, loss of dignity, and uncontrollable pain or concern about future pain. People should have the ability to choose whether they wish to suffer through painful medical treatments or radical surgery. Many treatments are uncomfortable, expensive, and far from guaranteed in their success of alleviating pain or the underlying medical condition (Dvorsky). Therefore, it is reasonable for someone to live their final moments on their terms instead of suffering for the uncertain amount of time they have left.

Additionally, while palliative has improved over the years, in many cases it is still not enough to allow a person to live comfortably or happily. Palliative care refers to specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness with the goal of improving the quality of life for both the patient and their family members. However, even high-quality palliative care can still result in many undesirable side effects such as nausea, incontinence, loss of awareness rising from semi-permanent drowsiness, and prevalence of intolerable levels of pain (Dvorsky). Additionally, palliative care is only available to a minority of citizens in most countries, and usually only at the end of their life when all other interventions to prolong life have failed. Not to mention the fact that patients may not even be receiving high-quality palliative care if their physician was not well trained in meeting the psychological needs of their patients or in pain management (Mishara and Weisstub 430). Furthermore, advances in technology have resulted in life support and extension systems which have eliminated many cases of quick deaths with much shorter durations of suffering. These technologies may be doing more harm than good in some cases. Just because life can be prolonged does not justify drawing out the suffering of the terminally ill. All of the efforts to reverse or eliminate the process of aging create the potential for people to have unbounded life spans in the future. Should this possibility become a reality, it would be crazy to not let people decide when they wished to terminate their lives (Dvorsky). If a person suffering from terminal illness is unlikely to benefit from the discovery of a cure in their remaining time, suffering is nothing more than intolerable pain. When a person faces a life that is meaningless and also presents a continuous, voluntary, and rational desire to die; there should be no legal or medical interventions that attempt to deny that right.

Furthermore, it is impossible to assess the quality of life on a common standard. People tend to rely on an implicit norm of the burden of normal suffering that establishes which constraints count as bearable and which do not. This means that people try to identify themselves with the affected person and ask themselves if they would feel similarly in the same situation and subsequently come to the same decision. It is wrong to assume that some people can bear a tremendous amount of suffering and immoral to use that assumption to prevent people from taking control over their lives (Schramme 480). It is an individual’s right to decide matters about the trajectory of their life by themselves. Everyone has the right to answer questions about the meaning and significance of human life and suffering, which implies that it is also their right to determine if their suffering is bearable or unbearable (Cholbi 500). Compared to severe, long-lasting suffering, death can easily be seen as the lesser evil and can even be good for the person under insufferable circumstances. The good things in life are what make it worth living. When these things can no longer be achieved, then life loses its worth and appeal. Subsequently, death loses its characteristic of being evil, because it no longer has the power to take anything from a life that has ceased to have meaning (Schramme 481). A patient’s decision to pursue assisted suicide should not be concerned with any outside opinions or judgments about their choice, because it is impossible for anyone else to understand their position in life.

Some jurisdictions allow assisted suicide for patients suffering from a futile mental condition. In 1994, the Dutch Supreme Court rules that the seriousness of the suffering of the patient does not depend on the cause of the suffering, which rejects a distinction between physical and mental suffering. Psychiatrists and mental health nurses are frequently confronted by people who have the desire to die, but since many cases are the results of treatable disorders it is still necessary for psychiatrists to first try and prevent suicide (Berghams, Widdershoven, Heerding 436). However, for some, psychiatric disorders are more than causes of unbearable suffering. For instance, major depressive disorder is accompanied by a depressed mood, sleep difficulties, fatigue, feelings of worthlessness or guilt, an inability to concentrate or make decisions on a daily or near-daily basis. These side effects can cause clinically significant distress and severe impairment in social, occupational, or other important areas of functioning. Additionally psychiatric pain and distress manifest as suffering and create a profound sense of alienation from one's cares and from oneself. Some psychiatrists argue that psychiatric disorders have a stronger case for assisted suicide than those with bodily illnesses. At certain stages, many bodily illnesses are asymptomatic. For instance, cancer is often only detectable through diagnostic testing in its early stages. However, for some psychiatric disorders can be so severe that they begin to exhibit physical symptoms. People with major depressive disorder can develop “affective paralysis,” in which their body physically slows down and their mental energy completely stagnates. William Styron believes “In depression…faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come” (Cholbi 499). Schizophrenia patients are another example of patients condemned to live with their non-fatal but severely debilitating mental disorder. The inability to cure or improve their condition often makes these patients see the condition as definitive of their identity, which may cause them further pain and suffering as they are unable to live their lives in a way that is not defined by the conditions of their mental instability.

In respect to how the legality of assisted suicide would affect attitudes toward a willingness to die, studies conducted in the Netherlands, where the practice of assisted suicide is legal, show no evidence of cases of non-voluntary assisted suicide. Additionally, there is no evidence to support that the legality of assisted suicide increases the desire to die in patients with incurable diseases. For example, a study conducted on patients suffering from amyotrophic lateral sclerosis, one of the most common illnesses where assisted suicide is requested, reported that 94% of patients had no desire for assisted suicide. However, 57% of them could imagine a time when they might want it done in the future (Dvorsky). Another 2010 study from the Netherlands reported similar statistics in which two-thirds of the requests for euthanasia did not result in the administration of euthanasia or physician-assisted suicide. In addition, for one-half of the instances where the person’s request for euthanasia was not carried out, the patient died before the request could be granted. Also, there are only about four hundred requests for euthanasia or physician-assisted suicide in the absence of a severe physical or mental disease each year in the Netherlands. Most of these patients are elderly people who are beginning to experience a significant diminished quality of life as their body forgoes the process of aging. These patients feel that they are through with life and have already experienced enough of it that there is no need to struggle through the harsh struggles of an aging body (Mishara and Weisstub 433). The proximity of natural death occurring so close to a patient's requests for assisted suicide raises some important questions between letting an illness slowly run its course and a patient's desire to end their life at a time of their choosing. Is there any benefit to extending life an extra week or two if the person is unable to procure any enjoyment from their existence?

Assisted suicide is also legal in a few states in the United States. Under Washington State’s Death with Dignity Act, competent adults living in Washington who have been diagnosed with a medical condition that estimates their life expectancy to be six months or less have the “right to request and self-administer lethal medication prescribed by a physician” (Loggers et al. 1418). However, in December 2011, three years after the Death with Dignity Act passed; only 255 patients had participated in the program. Of those patients, 78% had been diagnosed with cancer (Dvorsky). Loggers et al. conducted a study that reported the frequency of patients seeking assisted suicide by implementing a Death with Dignity program through the Seattle Cancer Care Alliance. From March 2009 to December 2011, only 114 patients inquired about the Death with Dignity program. Of those 114, forty-four patients chose not to proceed with the program or were deemed ineligible. Thirty patients initiated the process but eventually opted out of the program or died before they were able to complete the process. Only forty patients received lethal prescriptions and died. These statistics reveal that participants of the Death with Dignity Act program account for just 0.02% of the annual deaths for patients of the Seattle Cancer Care Alliance (Loggers et al. 1420). This small percentage proves that the legality of assisted suicide is not a motivational influence for the terminally ill who request assisted suicide.

While voluntary physician-assisted suicide and euthanasia may be legal in some locations, it is by no means a decision that is made rashly or irresponsibly. For instance, the program managed by the Seattle Cancer Care Alliance carefully assesses a patient’s rationale for dying, psychological state, and confirms that the patient has received a terminal prognosis. They also take painstaking care to educate both the patients and their families about alternative methods of treatment. Once a patient's request is granted, there is still a mandatory fifteen-day waiting period before the lethal prescription is available to the patient. On average, it takes about 16.6 weeks for a patient to complete the program after making their initial request. That is a significant amount of time for terminal patients to make sure they are still content with their decision. The individual always has the option of changing their mind (Mishara and Weisstub 431). Additionally, all the physicians in the program are not advocates of assisted suicide, but instead make sure that patients are aware of their alternative treatment options (Loggers et al. 1420). In cases where physicians deny patient requests for euthanasia on the basis that other treatments would be more beneficial and should be tried first, patients were willing to try alternative options and rarely returned with their requests. Most physicians are aware that patients often go through a phase of initial shock when they receive their diagnosis and begin treatment, where the desire to die is high and irrational. However, after the first three to five months of living with the disease, the risk of suicide declines substantially (Mishara and Weisstub 433). These cautionary measures by physicians prove that requests for assisted suicide and euthanasia are not granted without extreme consideration of all of the factors at work. Physicians still value life when there is still a life to be saved, and see no reason to preserve life when it would only mean prolonging suffering.

The law must respect a competent person's choice as long as it does not harm others (Dvorsky). However, in most cases where a patient requests assisted suicide, their families are supportive of their choice. Loggers et al. did not receive any complaints from family members or caregivers about the process or manner of death. In fact, families often described the death as peaceful even when lethal prescription took longer than thirty-five minutes to end the patient’s life. Furthermore, both patients and families frequently expressed gratitude as soon as the patient receives the prescription, even if the patient never fills or ingests it. This reveals how important family members also value a sense of control when faced with a loved one’s unexpected terminal condition (Loggers et al. 1420). Families are also grateful to have the chance to remember their loved ones when they still have full control of their capacities instead of remembering the misery of physical suffering and mental anguish (Mishara and Weisstub 432). Lethal prescriptions also offer the advantage of making the time of death predictable in comparison to the unpredictable amount of time it would take for their medical condition to run its course. This allows family members to be there in the moment of death and say their goodbyes to a loved one. In addition, patients also have many financial considerations and prefer to die sooner so that their inheritance will not be used to cover the expensive and prolonged cost of care (Gillet and Chamberlain 457). Patients want to be sure that they are not sending their families into bankruptcy after they are gone.

As to whether physicians have the right to assist someone with their decision to end their life, it is certainly not comparable to an act of homicide. People rely on the assistance of other people to pursue their own personal goals. In order to truly respect someone’s autonomy, services must be offered that support people in the pursuit of their individual lives, which can sometimes include decisions to die (Schramme 484). If physicians did not assist with patients' choices to end their life, then there is a huge risk that the patients may attempt suicide by themselves. The consequences of a botched suicide might cause the patient to die an extremely horrific, painful death. On the other hand, their suicide attempt might have even worse consequences; they might survive their attempt at the cost of being permanently handicapped afterward. Furthermore, some people are severely handicapped and are unable to end their lives without assistance. Advanced stages of certain diseases can even cause paralysis (Dvorsky). Often patients who wish to die are just simply unable to perform the act by themselves, which is why they require physician assistance. This unwillingness to perform the act shows that patients still value the sanctity of life, even though their lives have become void of meaning and ceased to be enjoyable.

All of the statistics about physician-assisted suicide and euthanasia reveal that these actions are not hostile ones that devalue the meaning of life. If anything, the rationale for ending a life under certain circumstances honors the meaning of life. It is cruel and inhumane to force people to suffer and endure circumstances from which they cannot recover. Surviving for the sake of surviving is an empty way of sustaining life. The terminally ill deserve the right to control what they can about their lives once they receive their prognosis. They have the right to decide when they have had enough suffering, spent enough money on expensive and invasive surgery, and invested enough hope in their recovery; and thus should have the legal right to request physician assistance when they have finally decided that it is their turn to go.

Works Cited

Berghmans, Ron, Guy Widdershoven, and Ineke Heerding. "Physician-assisted Suicide in Psychiatry and Loss of Hope." International Journal of Law and Psychiatry 36 (2013): 436-43. Science Direct. Web. 7 Nov. 2013.

Cholbi, Michael J. "The Terminal, The Futile, And The Psychiatrically Disordered." International Journal of Law and Psychiatry 36 (2013): 498-505. Print.

Dvorsky, George. "Why You Should Fight For Your Right to Die." Io9. N.p., 6 June 2013. Web. 9 Nov. 2013. <http://io9.com/why-you-should-fight-for-your-right-to-die-511684884>.

Gillet, Grant, and Joshua Chamberlain. "The Clinician's Dilemma: Two Dimensions of Ethical Care." International Journal of Law and Psychiatry 36 (2013): 454-60. Print.

Loggers, Elizabeth T., Helene Starks, Moreen Dudley, Anthony L. Black, Frederick R. Appelbaum, and Marc Stewart. "Implementing a Death with Dignity Program at a Comprehensive Cancer Center." The New England Journal of Medicine 368.15 (2013): 1417-424. Print.

Mishara, Brian L., and David N. Weisstub. "Premises And Evidence in the Rhetoric of Assisted Suicide and Euthanasia." International Journal of Law and Psychiatry 36 (2013): 427-35. Science Direct. Web. 8 Nov. 2013.

Schramme, Thomas. "Rational Suicide, Assisted Suicide, and Indirect Legal Paternalism." International Journal of Law and Psychiatry 36 (2013): 477-84. Science Direct. Web. 8 Nov. 2013.