Physician-Assisted Suicide generally refers to a practice in which the physician gives a patient a prescription for a lethal dose of medication, which the patient intends to use to end his/her life. The physician provides the means for death but it is the patient who must make the conscious decision to use the drug to effect death. For those who take the drug, the physician’s writing a prescription is a necessary step in the process that leads to the patient’s death, but it is not the determinative or even the final step.
Euthanasia, on the other hand, generally means that the physician acts directly, for instance by giving a lethal injection, to end a patient’s life. The physician, at the patient’s request, not only provides the means for death but also is the agent of death.
Why Do Patients Request Physician-Assisted Suicide?
• Severe physical and emotional suffering
• Not wanting to live in pain
• Not wanting to be a burden
• Not wanting to be dependent on others for personal care
• Being tired of life
• Loss of ability to maintain personal relationships
• Problems in interpersonal relationships
• Feelings of isolation and separation
• Financial pressures
Some studies suggest that issues of dignity, control and independence motivate requests for PAS more often than unrelieved pain or other symptoms. Patients want to be in control by having a lethal dose of medication on hand in case suffering should become intolerable in the future.
Is Physician Assisted Suicide Legal?
As of January 2011, physician-assisted suicide is legal in 3 states (Oregon, Washington and Montana). Other states are considering PAS legislation. The Oregon Death with Dignity Act typically serves as a template for the other states.
To request a prescription for lethal medications, the Oregon Death with Dignity Act requires that a patient must be:
· An adult (18 years of age or older).
· A resident of Oregon.
· Capable (defined as able to make and communicate health care decisions), and
· Diagnosed with a terminal illness that will lead to death within six months.
To receive a prescription for lethal medication, according to the Oregon Death with Dignity Act, the following steps must be fulfilled:
· Two oral requests to physician, separated by at least 15 days.
· Written request, signed in the presence of two witnesses.
· Confirmation of diagnosis & prognosis by a consulting physician.
· Confirmation of competency by both prescribing and consulting physician.
· If either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder, the patient must be referred for a psychological examination.
· The prescribing physician must inform the patient of feasible alternatives to assisted suicide, including comfort care, hospice care, and pain control.
· The prescribing physician must request, but may not require, the patient to notify his or her next-of-kin of the prescription request.
Is Physician-Assisted Suicide Ethical?
1. Sanctity of Life: Physician-assisted suicide is morally wrong because it contradicts strong religious and secular traditions against taking human life.
2. Passive vs. Active Distinction: There is an important moral difference between passively “letting die” and actively “killing.” Treatment refusal or withholding treatment equates to letting die (passive) and is justifiable, whereas physician-assisted suicide equates to killing (active) and is not justifiable.
3. Potential for Abuse: Here the argument is that certain groups of people, lacking access to care and support, may be pushed into assisted death. Furthermore, assisted death may become a cost-containment strategy. Burdened family members and health care providers may encourage option of assisted death. To protect against these abuses, it is argued, physician-assisted suicide should remain illegal.
4. Integrity of the Medical Profession: The Hippocratic Oath states, “I will not administer poison to anyone where asked,” and “Be of benefit, or at least do no harm.” Furthermore, major professional groups (AMA, AGS) oppose assisted death. The overall concern is that linking physician-assisted suicide to the practice of medicine could harm the public’s image of the profession.
5. Physicians Make Mistakes: These may include: errors in diagnosis and prognosis, failure to diagnosis depression, inadequate treatment of pain, etc. Since these types of mistakes may result in unnecessary death, the State has an obligation to protect human lives from these inevitable mistakes.
Arguments in support of Physician-Assisted Suicide
· Respect for Autonomy: Death with Dignity legislation fulfills the 4 criteria for making autonomous choices: knowledge of the intended procedure, ability to weigh various alternatives, mental competence and lack of coercion. Decisions about time and circumstances of death are very personal. Competent person should have right to choose death.
· Justice: Justice requires that we “treat like cases alike.” Competent, terminally ill patients are allowed to hasten death by refusal of burdensome life-sustaining treatments. For some patients, treatment refusal will not suffice to hasten death; their only option is suicide. Justice requires that we should allow assisted death for such patients.
· Compassion: Some physical and psychological burdens are so severe they cause unbearable suffering that goes beyond pain. It is not always possible to relieve this kind of suffering. Thus physician-assisted suicide may be a compassionate response to unbearable suffering.
· Individual liberty vs. state interest: Though society has strong interest in preserving life, that interest lessens when person is terminally ill and has strong desire to end life. A complete prohibition on assisted death excessively limits personal liberty. Therefore physician-assisted suicide should be allowed in certain cases.
· Openness of discussion: Some would argue that assisted death already occurs, albeit in secret. For example, morphine drips ostensibly used for pain relief may be a covert form of assisted death or euthanasia. That physician-assisted suicide is illegal prevents open discussion, in which patients and physicians could engage. Legalization would promote open discussion.
The Following Conditions May Justify Physician-Assisted Suicide
• Voluntary request by competent patient
• Ongoing patient-physician relationship
• Mutual and informed decision making by patient and physician
• Supportive yet critical and probing environment of decision making
• Considered rejection of alternatives
• Structured consultation with other parties in medicine
• Patient’s expression of a durable preference for death
• Unacceptable suffering by the patient
Use of a means that is as painless and comfortable as possible