Physician-Assisted Suicide

Physician-assisted suicide can be defined as a medical professional assisting to end someone’s life who has chosen to do so on their own terms but are incapable of completing the act due to physical or restrictions based on their religious views. This concept is often confused with euthanasia, which is defined as ending someone’s suffering. Physician-assisted suicide (PAS) is used mainly in cases where an individual is no longer able to function on their own or if their quality of life is severely limited. There has been a considerable amount of debate regarding the issue of PAS. The concerns center on religious, legal and ethical issues of physicians in ending the lives of their patients. I would argue that PAS is a humane practice that should be legalized nationally based on the laws that have already been implemented in Oregon and Washington.

Cases, such as the Terri Schiavo, and physicians who have assisted patients to end their life, such as Jack Kevorkian, have brought the issue of PAS into public light. Terri Shiavo was in a vegetative state after a coma and there was contention around removing her from life support. The case brought the debate for and against PAS to the national scene and after a lengthy legal process Terri’s feeding tubes were finally removed. Jack Kevorkian was a physician who through the use of his suicide machine helped end the lives of over 130 patients whose quality of life was severely impaired. Kevorkian was sentenced to prison for violating the law on television as he taped and broadcast assisting a patient end their life. On the national scene a 1997 ruling by the Supreme Court determined that individuals do not have the constitutional right to end their life. Despite this ruling Oregon continued to uphold the Death with Dignity Act, which legalized PAS. “In November of 1997, following the United States Supreme Court decisions in Vacco v. Quill and Washington v. Glucksberg, which left the states' power to regulate physician-assisted suicide undisturbed, the Oregon voters upheld their law” (O’Brien, 2000 329). However the state did not implement the law until the issue was brought again to the Supreme Court in 2006 when the determination was made that individual states should be allowed to make a decision about legalizing PAS.

Since this decision was made by the Supreme Court only three states in the United States have legalized PAS: Oregon, Vermont, and Washington. All three of the states have distinct provisions before patients can receive PAS. In Oregon the Death with Dignity act stated that patients must only have 6 months to live and both the physician and patient must administer the medication. Washington’s similarly named law, which was passed in 2008, followed similar guidelines to the Oregon law however the state also requires additional physicians to approve the PAS. Vermont’s Patient’s Choice and Control at the End of Life act was recently passed as of this year and implementation or success of the bill has yet to be determined. However the success of Oregon and Washington’s laws in relieving the suffering of individuals at the end of their life provide proof that these bills have been beneficial and should be implemented on a federal level.

PAS should be legalized as the practice provides humane relief to individuals who have often been suffering from debilitating health conditions for several years. End of life decisions give individuals control during a time in their life when they are often not in charge of many of their decisions. Choosing to end their life should also be a right that every individual should have. On a practical side ending the life of patients to prevent their suffering will also save both the hospital and the patient’s family from extensive health care costs. Despite these reasons for supporting PAS, there are many oppositions to the procedure becoming legalized in the United States.

One of the main arguments posed by those that oppose PAS is that the practice can become a slippery slope towards ending the life of individuals who are considered increasingly vulnerable. This is especially the case of those who are disabled as these individuals may be considered to have a limited quality of life by their caregivers and could be made to be euthanized. The issue of involuntary euthanization is also an issue that opponents to PAS have. As individuals at the end of their life may not be able to communicate or have full cognitive capacity they may be euthanized without their permission. However the way in which the laws have been designed in Oregon and Washington it prevents involuntary euthanization of patients. “Contrary to the warnings of the slippery slope, the available evidence suggests that the legalisation of physician-assisted suicide might actually decrease the prevalence of non-voluntary and involuntary euthanasia” (Ryan, 1998 341). As physicians have to follow laws that state patient permission must be obtained, they are not able to legally engage in involuntary euthanasia.

Arguments have been made that most physicians do not support PAS or any other form of euthanization. They state that if the medical professionals are not supportive of the treatment it is evidence that they should not be performed. However, the research on medical professionals’ views on PAS has been conflicted. Also Emmanuel (2002) found that a small proportion of physicians have stated that they have performed PAS despite the fact that it was illegal. This demonstrates that physicians are risking their license and freedom to perform a procedure because they believe that the treatment would relieve their patients of the suffering they are experiencing. Studies have also found that repetitive requests for PAS reduce physician’s reluctance to perform the procedure. “Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive” (Frileux, 2003 330). This demonstrates that physicians who are against the procedure may eventually find that their refusal to perform the procedure reduces once they realize that PAS would be beneficial for the patient as this is what they want.

The safety and effectiveness of the PAS methods have also been called into question by opponents of the procedure. They state that the procedures can take longer to complete than expected, there can be unexpected side effects from the drugs and that patients can feel further pain through related symptoms from the medication being administered making their quality of life worse. They also claim that individuals may survive the procedure, which would prolong their suffering and pain. However, the evidence provided by the PAS procedures performed in Oregon demonstrates that this is inaccurate. “The reports from the first 2 years' experience by the Oregon Health Division, Portland, also show no failed PAS attempts.” (Emmanuel, 2002 142). This provides the evidence that is needed to demonstrate that the PAS procedure is effective and has been in a state where the treatment is legal and has been performed a number of times by qualified physicians.

Other issues raised by opponents of PAS is that physicians are bound by the Hippocratic Oath to practice medicine honestly and do no harm to their patients. A literal interpretation of doing no harm would state that assisting at the end of care procedure is defying the Hippocratic Oath. However, through the evaluation of assisted-suicide, it can be determined to end the life of someone who is suffering from a painful condition would be provided relief through the PAS procedure. Therefore this would not be harmful to the patient and would, in fact, be beneficial for them. Often physicians refuse to even discuss end of life options with their patients which can be detrimental for the patient as their options are not explored. Through exploring and educating patients about the options available to them the physician is ensuring that a patient has full control of the medical decisions affecting their lives.

Religious arguments have also been posed against PAS. These arguments state that the Ten Commandments state that you should not kill and PAS is essentially killing someone. However, not all individuals follow Christian beliefs. Also, science and religion should be separated as a physician should not allow their religious beliefs to impact their medical decisions. Also individuals of religious faith would be able to make their own decisions about end of life care. If they choose not to use PAS they would not be compelled to by the law or their physician.

PAS is a humane treatment that provides relief to those who have suffered for many years. Being able to make a decision about their end of life treatment is a basic right that should be given to every individual. “It should be a rights-package, not a single complex right but a set of rights concerning distinct accepts of physician-assisted suicide. Specifically, it should consist of the bilateral liberty-rights to request or not request, to obtain or not obtain, and to use of not use assistance provided by one's physician to commit suicide” (Wellman, 2005 38). Although there are ethical, legal and religious concerns for the procedure, the evidence for the procedure outweighs these concerns. Through the legalization of PAS the medical field will become inclined to discuss end of life planning with their patients. If patients are prepared and have their living will in place it makes it easier for them to receive the end of life treatment that they would like. If these documents are not in place it can be difficult to make a decision especially if the illness has resulted in their cognitive or communication abilities to be impacted. PAS not only provides relief to a number of individuals but also compels our society to discuss death and end of life treatment with our families and medical professionals.

References

Emanuel, E. J. (2002). Euthanasia and physician-assisted suicide: a review of the empirical data from the United States. Archives of internal medicine, 162(2), 142.

Frileux, S., Lelièvre, C., Sastre, M. M., Mullet, E., & Sorum, P. C. (2003). When is physician-assisted suicide or euthanasia acceptable?. Journal of medical ethics, 29(6), 330-336.

O'Brien, C., Madek, G., & Ferrara, G. (2000). Oregon's guidelines for physician-assisted suicide:A legal and ethical analysis. University of Pittsburgh Law Review, 61(2), 329-365.

Ryan, C. J. (1998). Pulling up the runaway: the effect of new evidence on euthanasia's slippery slope. Journal of medical ethics, 24(5), 341-344.

Wellman, C. (2005). A Legal Right to Physician-Assisted Suicide. Medical Law and MoralRights, 38-53.