Introduction
When there are no more options and death and disease are inevitably going to take over, how far should one go to be sure they die on their own terms? Physician-assisted suicide is a topic that has been debated over since the early 1980’s. Suicide itself is a very controversial topic; the controversy gets worse when involving a physician, who’s duty is to preserve life. Suicide is the general definition of the intention of taking/terminating one’s own life. Physician-assisted suicide has a lot of similarities to euthanasia, meaning “good death.” In physician-assisted suicide, the patient ultimately kills himself or herself with the assistance of the physician. Is it right for a physician to assist in a patient suicide? There are two sides to every story; one side argues that a physician’s main duty is to respect patient autonomy and to relieve suffering, even if that means assisting in the patient’s death, the other argues that if physician-assisted suicide is allowed, it will result in substitutions for interventions that might enhance the quality of life for a dying patient. I will argue that if physician-assisted suicide is legalized; patients would be given the option to terminate their life on their own terms instead of unnecessarily suffering.
Physician assisted suicide usually involves a physician in the following roles: (1) providing the information to a patient about how to commit suicide in the most effective way and (2) providing the means necessary for the patient to commit suicide (Levine 110). Although the physician does play an active role in physician-assisted suicide, when it comes down to it the patient would be the one killing him or herself. A method of physician-assisted suicide that may be used would consist of providing a lethal amount of medication that is usually already prescribed, that the patient would then ingest. This situation might occur if the patient and physician agree that there are no acceptable alternatives and that all required conditions have been met, then the lethal medication should ideally be taken in the physician’s presence (Degrazia, et al 420). Physician and patient hold a balance in power in physician-assisted suicide that is nearly equal; but in the end the patient is the one in control when taking his or her life.
While considering all the aspects of physician-assisted suicide, the doctor’s role must also be considered. Does the act of committing suicide fit in with the role of the physician? The Hippocratic Oath, which is no longer required, states six duties the doctor has to the patient: 1. Duty not to harm 2. Duty not to treat unjustly 3. Duty not to provide “deadly drugs” 4. Duty not to perform “abortive remedy” 5. Duty of beneficence 6. Duty of confidentiality. However, because this oath is no longer required, many physicians do not take it. There are only “ideal” roles of a physician that can be given such as: a doctor should preserve life if possible, a doctor should do what is best for the patient, and a doctor should do what the patient desires (Module 5). These duties are not set in stone, so everything in the case of physician-assisted suicide comes down to autonomy, the control over one’s self, choices, and will (self-determination).
History
Kevorkian. A name idolized by some and lamented by others. Regardless of stance, however, there is no denying that Dr. Jack Kevorkian, M.D. was an extremely passionate physician who worked tirelessly to normalize the practice of physician assisted suicide. However, upon Dr. Kevorkian’s death in 2011, the concept of physician assisted suicide was still widely unaccepted—and remains so to this day. Although Dr. Kevorkian brought physician assisted suicide more attention than it had ever had before, the controversy over physician assisted suicide began long before Dr. Kevorkian ever began his work. In fact, the history associated with physician assisted suicide is a long and complicated one. Perhaps the best place to start is fifth century Greece and the creation of the Hippocratic Oath. The Hippocratic Oath is an Oath that all physicians must take throughout several times in their medical careers. The oath promotes the practice of ethical standards—the most applicable to this case being that a physician should do no harm (this is a paraphrase).
This aspect of the Hippocratic oath is the crux of the argument surrounding physician assisted suicide. Flash forward to America in 1885 when the American Medical Association (AMA) formally opposes euthanasia, physician assisted suicide is not in practice in the United States. The following 100 years represent little to no changes on the views of physician assisted suicide until 1984 when the AMA publishes two reports (“Withholding or Withdrawing Life-Prolonging Medical Treatment, and “Withholding or Withdrawing Life-Prolonging Medical Treatment — Patients’ Preferences”) indicating their previous stance on physician assisted suicide has changed—but only in very specific conditions. Along with this transformation, surveys conducted in the early 1990’s identified that over half of respondents were in favor of physician assisted suicide. This “right to die” movement had taken America by storm, and, on June 4th, 1990, Dr. Kevorkian participated in his first physician assisted suicide.
It is important to note the Dr. Kevorkian was not simply helping anyone and everyone to commit suicide. In fact, he only assisted terminally ill patients, who passed a rigorous series of psychiatric evaluations indicating that they were not depressed and had the mental capacity to make an educated decision regarding their life before he even considered them a candidate for physician assisted suicide. Kevorkian’s first patient was Janet Adkins, a resident of Oregon who decided to commit physician assisted suicide at the age of 52 after being diagnosed with Alzheimer’s. In addition, Dr. Kevorkian only gave his patients the prescription for the lethal drugs but did not administer them himself.
The next 20 years marked heightened tension in the feud over the ethical considerations of physician assisted suicide. Of upmost importance was the Supreme court ruling on June 26th, 1997 in Washington v. Glucksberg and Vacco v. Quill that there [i]s no constitutional right to die. Following this ruling, and despite losing his medical license, Dr. Kevorkian was shown administering drugs to Thomas Youk (suffering from Lou Gehrig’s) on 60 Minutes (Brian, 1998). Unfortunately, the death of Youk was the end of Kevorkian’s great reign as a pioneer of physician assisted suicide. Because Youk suffered from Lou Gehrig’s, he had lost the ability to ambulate—thus, Kevorkian administered the drugs to Youk himself and Kevorkian was convicted of second degree murder by a Michigan Jury in 1999 (Charatan). Even though Youk fulfilled all requirements for considering of physician assisted suicide, the fact that he could not administer the drugs himself led to a lengthy imprisonment for Dr. Kevorkian and an excellent display of the turmoil surrounding physician assisted suicide in the United States.
Examples/Evidence
Physician assisted suicide usually involves a physician in the following roles: (1) providing the information to a patient about how to commit suicide in the most effective way and (2) providing the means necessary for the patient to commit suicide (Levine 110). Although the physician does play an active role in physician-assisted suicide, when it comes down to it the patient would be the one killing him or herself. A method of physician-assisted suicide that may be used would consist of providing a lethal amount of medication that is usually already prescribed, that the patient would then ingest. This situation might occur if the patient and physician agree that there are no acceptable alternatives and that all required conditions have been met, th
en the lethal medication should ideally be taken in the physician’s presence (Degrazia, et al 420). Physician and patient hold a balance in power in physician-assisted suicide that is nearly equal; but in the end the patient is the one in control when taking his or her life.
In the past 20 years, physician assisted suicide has grown to be an even more pressing, controversial matter than it started as. At the turn of the century, in Washington v. Glucksberg, The U.S. Supreme Court ruled that state laws banning physician assisted suicide did not violate the Constitution. This ruling, therefore, left the states in charge of determining their stance on physician assisted suicide. This is where the turmoil began. In response to The Supreme Court’s ruling, Oregon passed their “Death with Dignity Act” on October 27, 1997. This law made it legal for terminally ill citizens of that state to inject themselves with lethal medications that were prescribed by a physician. The law also mandated that information and statistics were collected on anyone who chose to partake in said events (public.health.oregon.gov). Dr. Kevorkian, true to form, responded in an extremely controversial matter—and, ultimately got himself imprisoned over it. Dr. Kevorkian submitted a video to 60 Minutes injecting Thomas Youk with lethal substances to allow Youk, who suffered from Lou Gehrig’s disease, to pass on. The video was aired and things quickly spiraled downhill for Dr. Kevorkian. The problems arose because Dr. Kevorkian injected Youk himself instead of the patient administering the drugs their self. Because of this, Kevorkian was convicted of second degree murder and delivery of a controlled substance. He was sentenced to a max of 25 years and served 8 before being released. After this incident, physician assisted law reform hit a standstill for 10 years. Then, finally, Washington passed their “Death with Dignity Act” on November 4th, 2008. This act was similar to Oregon’s but added extra stipulations that only medical and osteopathic physicians could prescribe the lethal medications. Furthermore, anyone choosing to pursue the Act may only do so if they are 1) Washington residents 2) have less than six months to live (doh.wa.gov). In 2009, the Montana Supreme Court ruled, in Baxter v. State of Montana that physicians who prescribed lethal medication to competent patients (those who could make fair, consistent, informed decisions for themselves) who be protected from homicide charges. This made Montana the third state to legalize physician assisted suicide but the only state to do so via judicial court instead of law (americanbar.org). Vermont followed in 2013 with the “Patient Choice and Control at End of Life Act.” This act closely modeled those before it but also required all candidates to undergo psychiatric screening prior to being approved to take part in the act. The most recent state to pass legislature allowing physician assisted suicide was California who passed the “End of Life Option Act” in 2015. The passage of the law in California meant that five states in the U.S. had legalized physician assisted suicide: Oregon, Vermont, Montana, Washington and California.
The U.S. government has held firm to its decision that states determine their position on physician assisted suicide. And while change in favor of physician assisted suicide is happening, it is slow and opposition to the matter is clear. In addition to the five states that have successfully passed legislature regarding physician assisted suicide, several states have attempted without success. In 2012, a physician assisted suicide initiative was added to Massachusetts ballot but did not pass (archive.boston.com). Additionally, in 2014, New Mexico held a hearing for Morris v. Brandenburg. The court ruled that physician assisted suicide would only be legal in Bernalillo County but not in the state as a whole. The states not mentioned have made no attempt to pass legislature regarding physician assisted suicide and, therefore, it is clear that the state governments are still overwhelmingly in favor of keeping physician assisted suicide illegal across the U.S.
Citizens of the U.S. have taken it upon themselves to draw attention to physician assisted suicide. Perhaps most notably, in 2014, Brittany Maynard a 29-year-old with terminal brain cancer and member of the group Compassion & Choices moved from California to Oregon to end her life (California had not yet passed their law allowing physician assisted suicide). Brittany’s was a strong advocate for physician assisted suicide and took to social media to strongly advertise her decision and fight to raise awareness in favor of physician assisted suicide across the U.S. Maynard posted a video to YouTube explaining her choice—a video which now has nearly 12 million views (youtube.com). Her group, Compassion & Choices, as well as a plethora of other exist throughout the States all fighting for the opportunity to die with dignity if one so chooses.
However, there are equally as many groups opposed to physician assisted suicide throughout the US. States that have legislature allowing the act have groups actively working to remove the legislature (ex. True Dignity Vermont (truedignity.org)). These groups run campaigns on platforms that physician assisted suicide fosters abuse. They claim that the lack of follow up on physician assisted suicide can allow the lethal medications to get into the wrong hands and be used to hurt others. These groups also operate under the notion that physician assisted suicide makes those who are elderly, terminally ill and disabled feel as if their lives are not valuable anymore (focusonthefamily.com). These platforms are intense, and undeniably agreeable. Furthermore, it is clear the government leans more toward this side of things since legislature has only passed in 5 states.
The U.S. stands extremely divided on their opinions regarding physician assisted suicide. While change in favor of the matter is occurring, it is clear the U.S. government and its citizens remain overwhelmingly conservative on the matter.
Solutions and Conclusions
Physician assisted suicide has been a grossly controversial matter since it became a matter of US health care in the 1800s. I believe that the states that allow physician assisted suicide are headed in the correct direction and that it should become a nationwide policy to allow physician assisted suicide. The current standards of physician assisted suicide require that candidates meet several requirements before they can be considered for the option. These requirements include: being 18 years of age or older, a resident of the state they are trying to end their life in. They must also meet 6 criterion for consideration. These six conditions are: 1. The patient must have an incurable condition 2. The physician must ensure that the patients suffering and request for suicide is not the result of inadequate comfort care 3. The patient must clearly and repeatedly request to die rather than suffer 4. The patient’s judgment is not distorted 5. There must be a meaningful doctor-patient relationship 6. A second consultation is required to ensure the patients request is voluntary and rational (Degrazia, et al 419). Of course, these would not be the only guidelines in place when considering physician-assisted suicide. Physician-assisted suicide would only be available to those patients who are both terminally ill and suffering. Physicians would not be required to participate in assisted suicide. It would be a personal choice, not an obligation thus keeping the balance between physician and patient autonomy. And because of these guidelines and certain laws that would be required for physician-assisted suicide abuse is not likely.
To keep all parties involved in these matters happy, I believe that states should also conduct psychiatry evaluations on all candidates for physician assisted suicide to determine that none of the candidates f
or physician assisted suicide are doing so for the wrong reasons. Obviously, one could expect a reasonable amount of depression in a candidate for physician assisted suicide. However, the psychiatry evaluation should determine that this depression is linked to their illness and that the patients’ reasons for ending their lives revolve around the terminal illness and are not a product of their depression. These mental health screenings will allow the health care providers to create a sounder ground for physician assisted suicide because, I believe, that no one should have to suffer through a disease and that anyone should have the right to end their life should they choose to do so.
I do not feel that there is ever a way to satisfy all people on physician assisted suicide, I feel that there are people who believe that preserving life is the most important thing no matter what the consequences are on the individuals and what suffering they may have to go through because of this. However, the current standards for physician assisted suicide are stringent to begin with—and the addition of a psychiatric evaluation will make the decision to allow someone to complete physician assisted suicide even more just. The following paragraphs will take a more in depth look at both sides of the argument on physician assisted suicide.
Arguments of Those For Physician Assisted Suicide
When determining the morality of physician assisted suicide, one must consider one of the most important ethical principles in medicine, respect for patient’s autonomy. This premise is incorporated into the laws governing medical practice. Although most doctors believe they know what is best for the patient, autonomy must always be honored if the patient is mentally competent. Some people believe that assisted suicide is a form of killing, and killing is always wrong. On the other hand, withdrawing life-sustaining treatment in a terminally ill patient ultimately leads to death. Without life-sustaining treatment, the disease is able to take its course through the body; it is the disease that kills the patient not the doctor. It seems that society has placed too much emphasis on the passive or active role of the physician. One should consider not so much if the physician’s role is passive or active, but whether the patient’s role is passive or active (Levine 113). Because of the distinctions placed on the actions of the doctor, the patient is often overlooked. In physician-assisted suicide the patient has the main role not the doctor. Therefore, without the patient’s consent and participation the suicide could not occur.
It is important to remember that that all suffering cannot always be relieved if care givers are providing skillful and compassionate care. Generally speaking, death is not always painless and fast. Some people die slowly yet peacefully, and others die quickly. Despite these common depicted death scenarios, there are people out there that don’t get so lucky, and death can be a cruel, painful process. A lot of people’s pain can be taken care of with proper care and medication, yet no matter how well someone is taken care of by palliative care; there are always some patients whose pain cannot be rid of. There will also be some patients who would rather take their own life than continue with medication. Not permitting physician-assisted suicide would be making a patient suffer against his or her own will, which clearly goes against autonomy. It is illogical to think that allowing physician-assisted suicide would divert us from improving comfort care to those who want it; it would just give patients the option and opportunity to end their suffering on their terms.
To extrapolate on my idea of depression screening to increase acceptance of physician assisted suicide, it should be stated that depressed patients will not always seek physician-assisted suicide rather than help. Depression is not an easy disease to diagnose or to treat. Patients who are suffering from a terminally ill disease are likely to be depressed, but that does not mean that depression is the reason for their decision to commit suicide. Depression does not always make the mind irrational nor does it always cause people to want to commit suicide. Yes, there are treatments for depression, but these treatments are not always successful under certain circumstances. Patients who seem depressed and asking for assisted suicide should be encouraged to seek psychiatric treatment, but having depression should not exclude them from assistance with suicide—they should just be ensured to be in sound enough mind to make decisions about their life when considering physician assisted suicide. The requirement of several requests for physician assisted suicide over a period of time works to ensure that the patient is not making a rash decision based upon a temporary state of mind. As always, the decision for death is ultimately the patients.
Continuing my argument, just because physician-assisted suicide would be allowed does not mean that the physician would be required to comply with assistance in suicide. Requiring a physician to go against his or her own values would also be forcing and going against physician autonomy. In physician-assisted suicide there is a balance between the patient and physician, and with guidelines and laws in place there would be no risk of abuse. The choice to end life is up to the patient not the physician; the physician would not be responsible for patient death. If physician-assisted suicide is legalized it does not mean everyone is going to take advantage of it, it would just be there as an option if a patient were to choose it. There is no harm in giving terminally ill patients the option to end their life on their terms. Furthermore, in the case of physician-assisted suicide, because the decision relies on the patient and not the doctor, physician-assisted suicide is less likely to become abused– the voluntary nature is the best protection of sliding down the slippery slope of abuse in medical practice. Physician-assisted suicide would only be available to those patients who are both terminally ill and suffering. Additionally, physicians would not be required to participate in assisted suicide. It would be a personal choice, not an obligation thus keeping the balance between physician and patient autonomy. And because of these guidelines and certain laws that would be required for physician-assisted suicide abuse is not likely.
Arguments of Those Against Physician Assisted Suicide
On the side opposed to physician assisted suicide, there are several arguments as to why the act should never be permitted. Primarily, those against the act argue that if physician-assisted suicide is legalized nationally it will cause problems between physicians and patients. Numerous surveys demonstrate that a large portion of physicians support legalizing physician-assisted suicide, but in reality, there are very few physicians who are willing to provide the assistance. And those who are willing to provide the assistance often have a strong influence on patient’s preference for care. For physicians to care for their patients properly, physicians would have to disclose their personal values and attitudes about assisted suicide to avoid conflict. This could lead to major trust issues between patient and physician, where the patient can become suspicious of the physician’s motives. Without good physician-patient relationships treatment and caring become impersonal. I feel that these fears are valid but irrational. Transparency would likely benefit the physician patient relationship because the patient can know more about who is treating them and, consequently, choose a physician that best fits their morals if they so desire.
Another argument against physician assisted suicide is that the physician’s intent is to provide care, not death. It is not the doctor’s duty to end the life of someone who is suffering, it is their duty t
o provide adequate care and treat the patient. There are specialists in palliative care that can provide specialized care to relieve suffering and improve the quality of life. Therefore, physician-assisted suicide is not needed because of the care that can be provided by those trained in palliative care. Certainly, many people would think that physicians are trained in all aspects of medicine, yet there is data out there that suggests that there has been a lack of training in the care of dying patients. This includes assessing and managing multiple symptoms commonly associated with patient’s request for assisted suicide. Several studies have concluded that poor communication between physicians and patients, including physician’s inadequate training and lack of knowledge of caring for a dying patient are barriers to the provision of good care (Levine 122). The argument revolves around the idea that if health care is improved and good care at the end of life is improved there would be a decrease in the request for assisted suicide. Foley believes that the development of better care for dying patients would help to prevent the legalization of physician-assisted suicide. I, again, disagree with this statement. America’s population is living older and older and, thus, the population is seeing more chronic diseases that have longer disease processes than the past. Thus, although patient care is constantly improving, the consequence of chronic diseases means that despite a physician’s best efforts, the patient will, ultimately, eventually still wind up suffering to a certain degree from their diseases. Physician assisted suicide offers the patients an option that preserves their dignity should the suffering become too great.
Conclusively, I am in favor of allowing physician-assisted suicide. According to Act-Utilitarianism moral rules (such as killing) are usually seen as merely rules of thumb, therefore in some cases the rules are not followed. Whenever there is a good reason to believe that breaking the rules will produce a greater balance of good and evil, the right thing to do is break the rule. In a case of physician-assisted suicide we are allowing someone to commit suicide so they will no longer have to suffer. The choice of death is completely up to the patient. Allowing the patient to die would relieve them of their pain and suffering and possibly the pain and suffering of the family members as well. This would result in a greater balance of good and evil. If physician-assisted suicide is allowed not only would patients be able to control when they die, but they are also able to live more peacefully knowing that they have a choice. They would have the opportunity to say goodbye to their families and leave this world with dignity. The disease does not get the chance to turn that patient into someone they are not. Patient autonomy is the most important aspect in medicine. Also, per John Mill, a utilitarian, autonomy is a very important value. This allows people to choose their own plans of life, making their own decisions without coercion or manipulation by others, and exercising firmness and self-control in acting on their decisions (Degrazia, et al 45). It would not be fair to force someone to live a life that is not worth living. If you take away someone’s will they have nothing left, you are forcing them to suffer.
The road to uniting the country for or against physician assisted suicide is far from over. However, I believe that a person should have the right to end their own life if they choose to do so and especially if they have a terminal illness that is causing them great suffering. I also believe that should they choose to end their life, and if they have a terminal illness, they should be able to end their life in the most humane way possible. The prescriptions prescribed by physician assisted suicide allow them to do so and I strongly hope that physician assisted suicide becomes the norm across the country in the coming years.
Charatan, F. (1999). Dr. Kevorkian found guilty of second degree murder. BMJ : British Medical Journal, 318(7189), 962
Brian, D. (1998, November 23). Death video could be trouble for Kevorkian. Knight Ridder/Tribune News Service. Retrieved April 21, 2017, from http://www.highbeam.com/doc/1G1-53248558.html?refid=easy_hf
When there are no more options and death and disease are inevitably going to take over, how far should one go to be sure they die on their own terms? Physician-assisted suicide is a topic that has been debated over since the early 1980’s. Suicide itself is a very controversial topic; the controversy gets worse when involving a physician, who’s duty is to preserve life. Suicide is the general definition of the intention of taking/terminating one’s own life. Physician-assisted suicide has a lot of similarities to euthanasia, meaning “good death.” In physician-assisted suicide, the patient ultimately kills himself or herself with the assistance of the physician. Is it right for a physician to assist in a patient suicide? There are two sides to every story; one side argues that a physician’s main duty is to respect patient autonomy and to relieve suffering, even if that means assisting in the patient’s death, the other argues that if physician-assisted suicide is allowed, it will result in substitutions for interventions that might enhance the quality of life for a dying patient. I will argue that if physician-assisted suicide is legalized; patients would be given the option to terminate their life on their own terms instead of unnecessarily suffering.
Physician assisted suicide usually involves a physician in the following roles: (1) providing the information to a patient about how to commit suicide in the most effective way and (2) providing the means necessary for the patient to commit suicide (Levine 110). Although the physician does play an active role in physician-assisted suicide, when it comes down to it the patient would be the one killing him or herself. A method of physician-assisted suicide that may be used would consist of providing a lethal amount of medication that is usually already prescribed, that the patient would then ingest. This situation might occur if the patient and physician agree that there are no acceptable alternatives and that all required conditions have been met, then the lethal medication should ideally be taken in the physician’s presence (Degrazia, et al 420). Physician and patient hold a balance in power in physician-assisted suicide that is nearly equal; but in the end the patient is the one in control when taking his or her life.
While considering all the aspects of physician-assisted suicide, the doctor’s role must also be considered. Does the act of committing suicide fit in with the role of the physician? The Hippocratic Oath, which is no longer required, states six duties the doctor has to the patient: 1. Duty not to harm 2. Duty not to treat unjustly 3. Duty not to provide “deadly drugs” 4. Duty not to perform “abortive remedy” 5. Duty of beneficence 6. Duty of confidentiality. However, because this oath is no longer required, many physicians do not take it. There are only “ideal” roles of a physician that can be given such as: a doctor should preserve life if possible, a doctor should do what is best for the patient, and a doctor should do what the patient desires (Module 5). These duties are not set in stone, so everything in the case of physician-assisted suicide comes down to autonomy, the control over one’s self, choices, and will (self-determination).
History
Kevorkian. A name idolized by some and lamented by others. Regardless of stance, however, there is no denying that Dr. Jack Kevorkian, M.D. was an extremely passionate physician who worked tirelessly to normalize the practice of physician assisted suicide. However, upon Dr. Kevorkian’s death in 2011, the concept of physician assisted suicide was still widely unaccepted—and remains so to this day. Although Dr. Kevorkian brought physician assisted suicide more attention than it had ever had before, the controversy over physician assisted suicide began long before Dr. Kevorkian ever began his work. In fact, the history associated with physician assisted suicide is a long and complicated one. Perhaps the best place to start is fifth century Greece and the creation of the Hippocratic Oath. The Hippocratic Oath is an Oath that all physicians must take throughout several times in their medical careers. The oath promotes the practice of ethical standards—the most applicable to this case being that a physician should do no harm (this is a paraphrase).
This aspect of the Hippocratic oath is the crux of the argument surrounding physician assisted suicide. Flash forward to America in 1885 when the American Medical Association (AMA) formally opposes euthanasia, physician assisted suicide is not in practice in the United States. The following 100 years represent little to no changes on the views of physician assisted suicide until 1984 when the AMA publishes two reports (“Withholding or Withdrawing Life-Prolonging Medical Treatment, and “Withholding or Withdrawing Life-Prolonging Medical Treatment — Patients’ Preferences”) indicating their previous stance on physician assisted suicide has changed—but only in very specific conditions. Along with this transformation, surveys conducted in the early 1990’s identified that over half of respondents were in favor of physician assisted suicide. This “right to die” movement had taken America by storm, and, on June 4th, 1990, Dr. Kevorkian participated in his first physician assisted suicide.
It is important to note the Dr. Kevorkian was not simply helping anyone and everyone to commit suicide. In fact, he only assisted terminally ill patients, who passed a rigorous series of psychiatric evaluations indicating that they were not depressed and had the mental capacity to make an educated decision regarding their life before he even considered them a candidate for physician assisted suicide. Kevorkian’s first patient was Janet Adkins, a resident of Oregon who decided to commit physician assisted suicide at the age of 52 after being diagnosed with Alzheimer’s. In addition, Dr. Kevorkian only gave his patients the prescription for the lethal drugs but did not administer them himself.
The next 20 years marked heightened tension in the feud over the ethical considerations of physician assisted suicide. Of upmost importance was the Supreme court ruling on June 26th, 1997 in Washington v. Glucksberg and Vacco v. Quill that there [i]s no constitutional right to die. Following this ruling, and despite losing his medical license, Dr. Kevorkian was shown administering drugs to Thomas Youk (suffering from Lou Gehrig’s) on 60 Minutes (Brian, 1998). Unfortunately, the death of Youk was the end of Kevorkian’s great reign as a pioneer of physician assisted suicide. Because Youk suffered from Lou Gehrig’s, he had lost the ability to ambulate—thus, Kevorkian administered the drugs to Youk himself and Kevorkian was convicted of second degree murder by a Michigan Jury in 1999 (Charatan). Even though Youk fulfilled all requirements for considering of physician assisted suicide, the fact that he could not administer the drugs himself led to a lengthy imprisonment for Dr. Kevorkian and an excellent display of the turmoil surrounding physician assisted suicide in the United States.
Examples/Evidence
Physician assisted suicide usually involves a physician in the following roles: (1) providing the information to a patient about how to commit suicide in the most effective way and (2) providing the means necessary for the patient to commit suicide (Levine 110). Although the physician does play an active role in physician-assisted suicide, when it comes down to it the patient would be the one killing him or herself. A method of physician-assisted suicide that may be used would consist of providing a lethal amount of medication that is usually already prescribed, that the patient would then ingest. This situation might occur if the patient and physician agree that there are no acceptable alternatives and that all required conditions have been met, th
en the lethal medication should ideally be taken in the physician’s presence (Degrazia, et al 420). Physician and patient hold a balance in power in physician-assisted suicide that is nearly equal; but in the end the patient is the one in control when taking his or her life.
In the past 20 years, physician assisted suicide has grown to be an even more pressing, controversial matter than it started as. At the turn of the century, in Washington v. Glucksberg, The U.S. Supreme Court ruled that state laws banning physician assisted suicide did not violate the Constitution. This ruling, therefore, left the states in charge of determining their stance on physician assisted suicide. This is where the turmoil began. In response to The Supreme Court’s ruling, Oregon passed their “Death with Dignity Act” on October 27, 1997. This law made it legal for terminally ill citizens of that state to inject themselves with lethal medications that were prescribed by a physician. The law also mandated that information and statistics were collected on anyone who chose to partake in said events (public.health.oregon.gov). Dr. Kevorkian, true to form, responded in an extremely controversial matter—and, ultimately got himself imprisoned over it. Dr. Kevorkian submitted a video to 60 Minutes injecting Thomas Youk with lethal substances to allow Youk, who suffered from Lou Gehrig’s disease, to pass on. The video was aired and things quickly spiraled downhill for Dr. Kevorkian. The problems arose because Dr. Kevorkian injected Youk himself instead of the patient administering the drugs their self. Because of this, Kevorkian was convicted of second degree murder and delivery of a controlled substance. He was sentenced to a max of 25 years and served 8 before being released. After this incident, physician assisted law reform hit a standstill for 10 years. Then, finally, Washington passed their “Death with Dignity Act” on November 4th, 2008. This act was similar to Oregon’s but added extra stipulations that only medical and osteopathic physicians could prescribe the lethal medications. Furthermore, anyone choosing to pursue the Act may only do so if they are 1) Washington residents 2) have less than six months to live (doh.wa.gov). In 2009, the Montana Supreme Court ruled, in Baxter v. State of Montana that physicians who prescribed lethal medication to competent patients (those who could make fair, consistent, informed decisions for themselves) who be protected from homicide charges. This made Montana the third state to legalize physician assisted suicide but the only state to do so via judicial court instead of law (americanbar.org). Vermont followed in 2013 with the “Patient Choice and Control at End of Life Act.” This act closely modeled those before it but also required all candidates to undergo psychiatric screening prior to being approved to take part in the act. The most recent state to pass legislature allowing physician assisted suicide was California who passed the “End of Life Option Act” in 2015. The passage of the law in California meant that five states in the U.S. had legalized physician assisted suicide: Oregon, Vermont, Montana, Washington and California.
The U.S. government has held firm to its decision that states determine their position on physician assisted suicide. And while change in favor of physician assisted suicide is happening, it is slow and opposition to the matter is clear. In addition to the five states that have successfully passed legislature regarding physician assisted suicide, several states have attempted without success. In 2012, a physician assisted suicide initiative was added to Massachusetts ballot but did not pass (archive.boston.com). Additionally, in 2014, New Mexico held a hearing for Morris v. Brandenburg. The court ruled that physician assisted suicide would only be legal in Bernalillo County but not in the state as a whole. The states not mentioned have made no attempt to pass legislature regarding physician assisted suicide and, therefore, it is clear that the state governments are still overwhelmingly in favor of keeping physician assisted suicide illegal across the U.S.
Citizens of the U.S. have taken it upon themselves to draw attention to physician assisted suicide. Perhaps most notably, in 2014, Brittany Maynard a 29-year-old with terminal brain cancer and member of the group Compassion & Choices moved from California to Oregon to end her life (California had not yet passed their law allowing physician assisted suicide). Brittany’s was a strong advocate for physician assisted suicide and took to social media to strongly advertise her decision and fight to raise awareness in favor of physician assisted suicide across the U.S. Maynard posted a video to YouTube explaining her choice—a video which now has nearly 12 million views (youtube.com). Her group, Compassion & Choices, as well as a plethora of other exist throughout the States all fighting for the opportunity to die with dignity if one so chooses.
However, there are equally as many groups opposed to physician assisted suicide throughout the US. States that have legislature allowing the act have groups actively working to remove the legislature (ex. True Dignity Vermont (truedignity.org)). These groups run campaigns on platforms that physician assisted suicide fosters abuse. They claim that the lack of follow up on physician assisted suicide can allow the lethal medications to get into the wrong hands and be used to hurt others. These groups also operate under the notion that physician assisted suicide makes those who are elderly, terminally ill and disabled feel as if their lives are not valuable anymore (focusonthefamily.com). These platforms are intense, and undeniably agreeable. Furthermore, it is clear the government leans more toward this side of things since legislature has only passed in 5 states.
The U.S. stands extremely divided on their opinions regarding physician assisted suicide. While change in favor of the matter is occurring, it is clear the U.S. government and its citizens remain overwhelmingly conservative on the matter.
Solutions and Conclusions
Physician assisted suicide has been a grossly controversial matter since it became a matter of US health care in the 1800s. I believe that the states that allow physician assisted suicide are headed in the correct direction and that it should become a nationwide policy to allow physician assisted suicide. The current standards of physician assisted suicide require that candidates meet several requirements before they can be considered for the option. These requirements include: being 18 years of age or older, a resident of the state they are trying to end their life in. They must also meet 6 criterion for consideration. These six conditions are: 1. The patient must have an incurable condition 2. The physician must ensure that the patients suffering and request for suicide is not the result of inadequate comfort care 3. The patient must clearly and repeatedly request to die rather than suffer 4. The patient’s judgment is not distorted 5. There must be a meaningful doctor-patient relationship 6. A second consultation is required to ensure the patients request is voluntary and rational (Degrazia, et al 419). Of course, these would not be the only guidelines in place when considering physician-assisted suicide. Physician-assisted suicide would only be available to those patients who are both terminally ill and suffering. Physicians would not be required to participate in assisted suicide. It would be a personal choice, not an obligation thus keeping the balance between physician and patient autonomy. And because of these guidelines and certain laws that would be required for physician-assisted suicide abuse is not likely.
To keep all parties involved in these matters happy, I believe that states should also conduct psychiatry evaluations on all candidates for physician assisted suicide to determine that none of the candidates f
or physician assisted suicide are doing so for the wrong reasons. Obviously, one could expect a reasonable amount of depression in a candidate for physician assisted suicide. However, the psychiatry evaluation should determine that this depression is linked to their illness and that the patients’ reasons for ending their lives revolve around the terminal illness and are not a product of their depression. These mental health screenings will allow the health care providers to create a sounder ground for physician assisted suicide because, I believe, that no one should have to suffer through a disease and that anyone should have the right to end their life should they choose to do so.
I do not feel that there is ever a way to satisfy all people on physician assisted suicide, I feel that there are people who believe that preserving life is the most important thing no matter what the consequences are on the individuals and what suffering they may have to go through because of this. However, the current standards for physician assisted suicide are stringent to begin with—and the addition of a psychiatric evaluation will make the decision to allow someone to complete physician assisted suicide even more just. The following paragraphs will take a more in depth look at both sides of the argument on physician assisted suicide.
Arguments of Those For Physician Assisted Suicide
When determining the morality of physician assisted suicide, one must consider one of the most important ethical principles in medicine, respect for patient’s autonomy. This premise is incorporated into the laws governing medical practice. Although most doctors believe they know what is best for the patient, autonomy must always be honored if the patient is mentally competent. Some people believe that assisted suicide is a form of killing, and killing is always wrong. On the other hand, withdrawing life-sustaining treatment in a terminally ill patient ultimately leads to death. Without life-sustaining treatment, the disease is able to take its course through the body; it is the disease that kills the patient not the doctor. It seems that society has placed too much emphasis on the passive or active role of the physician. One should consider not so much if the physician’s role is passive or active, but whether the patient’s role is passive or active (Levine 113). Because of the distinctions placed on the actions of the doctor, the patient is often overlooked. In physician-assisted suicide the patient has the main role not the doctor. Therefore, without the patient’s consent and participation the suicide could not occur.
It is important to remember that that all suffering cannot always be relieved if care givers are providing skillful and compassionate care. Generally speaking, death is not always painless and fast. Some people die slowly yet peacefully, and others die quickly. Despite these common depicted death scenarios, there are people out there that don’t get so lucky, and death can be a cruel, painful process. A lot of people’s pain can be taken care of with proper care and medication, yet no matter how well someone is taken care of by palliative care; there are always some patients whose pain cannot be rid of. There will also be some patients who would rather take their own life than continue with medication. Not permitting physician-assisted suicide would be making a patient suffer against his or her own will, which clearly goes against autonomy. It is illogical to think that allowing physician-assisted suicide would divert us from improving comfort care to those who want it; it would just give patients the option and opportunity to end their suffering on their terms.
To extrapolate on my idea of depression screening to increase acceptance of physician assisted suicide, it should be stated that depressed patients will not always seek physician-assisted suicide rather than help. Depression is not an easy disease to diagnose or to treat. Patients who are suffering from a terminally ill disease are likely to be depressed, but that does not mean that depression is the reason for their decision to commit suicide. Depression does not always make the mind irrational nor does it always cause people to want to commit suicide. Yes, there are treatments for depression, but these treatments are not always successful under certain circumstances. Patients who seem depressed and asking for assisted suicide should be encouraged to seek psychiatric treatment, but having depression should not exclude them from assistance with suicide—they should just be ensured to be in sound enough mind to make decisions about their life when considering physician assisted suicide. The requirement of several requests for physician assisted suicide over a period of time works to ensure that the patient is not making a rash decision based upon a temporary state of mind. As always, the decision for death is ultimately the patients.
Continuing my argument, just because physician-assisted suicide would be allowed does not mean that the physician would be required to comply with assistance in suicide. Requiring a physician to go against his or her own values would also be forcing and going against physician autonomy. In physician-assisted suicide there is a balance between the patient and physician, and with guidelines and laws in place there would be no risk of abuse. The choice to end life is up to the patient not the physician; the physician would not be responsible for patient death. If physician-assisted suicide is legalized it does not mean everyone is going to take advantage of it, it would just be there as an option if a patient were to choose it. There is no harm in giving terminally ill patients the option to end their life on their terms. Furthermore, in the case of physician-assisted suicide, because the decision relies on the patient and not the doctor, physician-assisted suicide is less likely to become abused– the voluntary nature is the best protection of sliding down the slippery slope of abuse in medical practice. Physician-assisted suicide would only be available to those patients who are both terminally ill and suffering. Additionally, physicians would not be required to participate in assisted suicide. It would be a personal choice, not an obligation thus keeping the balance between physician and patient autonomy. And because of these guidelines and certain laws that would be required for physician-assisted suicide abuse is not likely.
Arguments of Those Against Physician Assisted Suicide
On the side opposed to physician assisted suicide, there are several arguments as to why the act should never be permitted. Primarily, those against the act argue that if physician-assisted suicide is legalized nationally it will cause problems between physicians and patients. Numerous surveys demonstrate that a large portion of physicians support legalizing physician-assisted suicide, but in reality, there are very few physicians who are willing to provide the assistance. And those who are willing to provide the assistance often have a strong influence on patient’s preference for care. For physicians to care for their patients properly, physicians would have to disclose their personal values and attitudes about assisted suicide to avoid conflict. This could lead to major trust issues between patient and physician, where the patient can become suspicious of the physician’s motives. Without good physician-patient relationships treatment and caring become impersonal. I feel that these fears are valid but irrational. Transparency would likely benefit the physician patient relationship because the patient can know more about who is treating them and, consequently, choose a physician that best fits their morals if they so desire.
Another argument against physician assisted suicide is that the physician’s intent is to provide care, not death. It is not the doctor’s duty to end the life of someone who is suffering, it is their duty t
o provide adequate care and treat the patient. There are specialists in palliative care that can provide specialized care to relieve suffering and improve the quality of life. Therefore, physician-assisted suicide is not needed because of the care that can be provided by those trained in palliative care. Certainly, many people would think that physicians are trained in all aspects of medicine, yet there is data out there that suggests that there has been a lack of training in the care of dying patients. This includes assessing and managing multiple symptoms commonly associated with patient’s request for assisted suicide. Several studies have concluded that poor communication between physicians and patients, including physician’s inadequate training and lack of knowledge of caring for a dying patient are barriers to the provision of good care (Levine 122). The argument revolves around the idea that if health care is improved and good care at the end of life is improved there would be a decrease in the request for assisted suicide. Foley believes that the development of better care for dying patients would help to prevent the legalization of physician-assisted suicide. I, again, disagree with this statement. America’s population is living older and older and, thus, the population is seeing more chronic diseases that have longer disease processes than the past. Thus, although patient care is constantly improving, the consequence of chronic diseases means that despite a physician’s best efforts, the patient will, ultimately, eventually still wind up suffering to a certain degree from their diseases. Physician assisted suicide offers the patients an option that preserves their dignity should the suffering become too great.
Conclusively, I am in favor of allowing physician-assisted suicide. According to Act-Utilitarianism moral rules (such as killing) are usually seen as merely rules of thumb, therefore in some cases the rules are not followed. Whenever there is a good reason to believe that breaking the rules will produce a greater balance of good and evil, the right thing to do is break the rule. In a case of physician-assisted suicide we are allowing someone to commit suicide so they will no longer have to suffer. The choice of death is completely up to the patient. Allowing the patient to die would relieve them of their pain and suffering and possibly the pain and suffering of the family members as well. This would result in a greater balance of good and evil. If physician-assisted suicide is allowed not only would patients be able to control when they die, but they are also able to live more peacefully knowing that they have a choice. They would have the opportunity to say goodbye to their families and leave this world with dignity. The disease does not get the chance to turn that patient into someone they are not. Patient autonomy is the most important aspect in medicine. Also, per John Mill, a utilitarian, autonomy is a very important value. This allows people to choose their own plans of life, making their own decisions without coercion or manipulation by others, and exercising firmness and self-control in acting on their decisions (Degrazia, et al 45). It would not be fair to force someone to live a life that is not worth living. If you take away someone’s will they have nothing left, you are forcing them to suffer.
The road to uniting the country for or against physician assisted suicide is far from over. However, I believe that a person should have the right to end their own life if they choose to do so and especially if they have a terminal illness that is causing them great suffering. I also believe that should they choose to end their life, and if they have a terminal illness, they should be able to end their life in the most humane way possible. The prescriptions prescribed by physician assisted suicide allow them to do so and I strongly hope that physician assisted suicide becomes the norm across the country in the coming years.
Charatan, F. (1999). Dr. Kevorkian found guilty of second degree murder. BMJ : British Medical Journal, 318(7189), 962
Brian, D. (1998, November 23). Death video could be trouble for Kevorkian. Knight Ridder/Tribune News Service. Retrieved April 21, 2017, from http://www.highbeam.com/doc/1G1-53248558.html?refid=easy_hf