Exploring Physician-Assisted Suicide… What ya think???

I’m currently taking a social work and health class as part of my MSW program at UT. One of my most recent assignments has been to choose a bioethical issue and write an extensive research paper on it. I decided to go with physician-assisted suicide, an area I’m still not sure how I feel about. I’ve pulled some sections out of my paper and decided to share them. Please share any comments or thoughts you have on the issue…..

The Definition of Physician-Assisted Suicide

In defining physician-assisted suicide, it is important to differentiate it from euthanasia and other life-ending processes. Euthanasia means that the physician directly administers the lethal medication, usually by injection, while physician-assisted suicide refers to the physician providing the means for the patient to take one’s own life, most commonly with prescription pills (Braddock, 2008). This puts the patient in control of the decision and action at all times. Other life-terminating practices that differ from physician-assisted suicide include: using terminal sedation in order to allow natural causes to actually lead to the death, withholding/withdrawing life-sustaining treatments, and giving out pain medication in situations where the health-care provider knows it may lead to the patient’s death (Braddock, 2008).

Physician-assisted suicide was first made legal in 1994 in Oregon by the Oregon Death with Dignity Act and then again in 2008 in Washington with the Washington Death with Dignity Act (“Failed Attempts”, 2009). Most recently, the Montana Supreme Court ruled in the Baxter v. Montana case that physicians will not be criminally prosecuted for assisting in suicide (O’reilly, 2010). Many are working to create legislation similar to the Death with Dignity Act to be enacted in Montana (O’reilly, 2010).

Looking closer at the Oregon Death with Dignity Act, which is almost identical to the Washington law, one can see that its purpose is to legally permit terminally ill individuals in severe pain the choice of ending one’s own life with the assistance of physicians (“Requirements,” 2006). In order to qualify, one must meet the following: (1) be eighteen years of age or older, (2) a resident of Oregon, (3) capable, which is defined as able to make and communicate health care decisions, and (4) diagnosed with a terminal illness that is expected to lead to death within six months or less (“Requirements,” 2006). Individuals with irreversible illnesses or conditions that are not terminal are not entitled to physician-assisted suicide. If one is eligible, the patient must then undergo a series of intensive steps involving meeting with a physician (and sometimes mental health professionals) several times and requesting the lethal prescription both verbally and orally (“Requirements,” 2006). Very few patients ask for this prescription, and even fewer end up taking it. In 2009, in the state of Oregon only ninety-five individuals requested the lethal prescription, while only fifty-three ended up self-administering it (“2009 Summary,” 2009).

The Arguments for Physician-Assisted Suicide

There seem to be two overarching principles supporting the legalization of physician-assisted suicide: autonomy and mercy. Those in favor believe that “the principle of autonomy, or self-determination [insists] that terminally ill patients have the right to extricate themselves from pain and suffering and to control as much as possible at the ends of their lives” (Battin, 1998, p. 63). Supporters believe patients living in a state of agony due to terminal illnesses have a right to cease their pain and die with dignity. Individuals have the right to choose between life and death during times of immense pain when death is closely inevitable anyway. In addition, many feel that it is unfair to allow patients the right to passive forms of suicide, such as refusal of medical treatments, if patients are not also given an active option when passive measures are not applicable to their medical situation (Pretzer, 2000).

Despite the best efforts of relief care and pain medication, some individuals are still in excruciating pain during the last few months of life (Battin, 1998). Proponents view expediting death as an action of merciful compassion in that it may be the only way to relieve intolerable suffering and to allow individuals to have control of their own lives (Pretzer, 2000). Although some argue it is unethical for doctors to actively assist in ending someone’s life, some also argue that not doing so in certain situations would actually be more unethical. Doctors have an ethical obligation “to avoid doing harm and to do good”; supporters of physician-assisted suicide interpret this to mean that physicians should do anything they can to keep patients out of prolonged pain and suffering (Battin & Emanuel (ed.), 1998, p. 23). It is the responsibility of a physician to assist a dying patient in having a comfortable, easy death, which in some cases may call for physician-assisted suicide, assuming it is the patient’s wish.

A final argument to mention is that, when patients decide to end their lives in order to escape from their suffering, it would be much better for them to be able to do so in a peaceful, open, supported, and accepted way that provides the dying patients with dignity and grace as they depart life.

A Closer Look: The Case of the Harvard Professor

Physician Marcia Angell discusses her experience as a medical intern when she first realized that “medicine did not have all the answers, that there was suffering for which there was no relief” (1998, p. 3). One of her first patients was an elderly man who was a professor of physics at Harvard University. He was suffering from a severe case of multiple myeloma, a form of cancer untreatable at this time. The cancer had spread throughout his body and skeleton, placing him in a chronic state of excruciating pain, all-encompassing weakness, shortness of breath, inability to move, and absolute despair. The professor, who had full mental functioning abilities, begged Dr. Angell to assist in quickening the dying process. At this moment, Angell reflected on medical school, where she was taught that “dying was a medical failure” for the physician in charge and that “their job was to extend life whenever possible” (1998, p. 4). It is cases such as these that have made Angell a supporter of physician-assisted suicide.

The Arguments against Physician-Assisted Suicide

There are several sound arguments that reason against physician-assisted suicide; the concept of the “slippery slope” is one of the most prominent. Many wonder: if we allow this, what is next? For instance, some believe that if individuals are allowed to legally choose between life and death, even if at first allowed only in situations where extreme pain and a terminal illness are present, the concept of choice in this matter could eventually lead to individuals with psychological or mental health issues arguing for the right to end their life due to emotional pain and suffering (Messerli, 2007). The popular attitude towards the subject could also gradually alter, ultimately leading to a society that legalizes suicide since dying would now be seen as a human right.

Another argument of the “slippery slope” threat is that suicide and homicide are on a spectrum, and legalizing physician-assisted suicide is just a step in the direction that leads to involuntary killing of vulnerable populations, such as “the elderly, sick, disabled, or disadvantaged minorities” (Mitchell, 2007, p. 60). It is this notion that convinces advocates of these populations to speak out against physician-assisted suicide for fear that it could lead to abuse. This is not the only abuse issue surrounding physical-assisted suicide. Critics believe that some patients who meet the qualifications to request assisted suicide will be coerced, pressured, or guilted into doing so, especially those without social support and sufficient finances (Pretzer, 2000).

Many skeptics believe that the legalization of physician-assisted suicide combined with the assumed pressure on vulnerable groups will lead to less health care focus on palliative, end-of-life care. For instance, the American Geriatrics Society has issued a statement opposing any active versions of euthanasia or physician-assisted suicide due to its concern that these processes could be abused in order to cut costs by ending lives earlier and decreasing the provision of expensive palliative care for the dying (Francis, 1998). The Society also speculates that caregivers could coerce the elderly into choosing assisted suicide, particularly if the caregivers are beneficiaries (Francis, 1998). The American Academy of Hospice and Palliative Medicine takes a neutral stance on the legalization of physician-assisted suicide, but does feel that it should be approached with great caution (“Positions,” 2007). Most hospice and palliative practitioners believe that the health care focus should not be on legalizing suicide in these cases of terminal illness and severe suffering; instead, the focus should be on improving comfort and palliative care in order to relieve patients from all suffering.

Various religious and moral stances strongly oppose physician-assisted suicide. Most traditional understandings of religion tend to believe that killing is inherently wrong, and that legalizing any form of induced death would be wrong, as well, in that it would place individuals and medical professional in positions where they may choose to act in a way seen as sinful by certain religious communities (Messerli, 2007). To some, it is this straightforward: ending life is immoral because life itself is so sacred. The American Bar Associate created a Model Penal Code in 1980; its core belief is that “an individual’s life is sacred, is continuous, and in no way contingent upon life’s circumstances: the right to life is both inalienable and sacred” (Dyck, 2002, p. 59). Many interpret this to mean that assisted suicide violates the absolute right to life no matter the situation and is thus unaligned with morality.

Lastly, miraculous recoveries occasionally occur, especially with medical breakthroughs and pharmaceutical advances constantly developing (Messerli, 2007). Often, physicians misjudge the amount of time a patient has left or the probability that a patient could recover. Critics argue that it is the lawmakers’ responsibility to block the legalization of physician-assisted suicide in order to protect countless lives from the inevitable human errors in diagnosis and prognosis (Braddock, 2008). Opponents of legalization fear that those who are thought to meet the qualifications for physician-assisted suicide may actually not meet them, which leads to such patients basing their ultimate decision on a false reality. The only way to control for this possibility is to keep physician-assisted suicide from being an available option and instead focusing on comfort care at end of life.

A Closer Look: The Case of Sidney Cohen

When Sidney Cohen’s physician informed him that his cancer was so advanced that he had only three months left to live and that they would be quite painful, Cohen wished desperately that physician-assisted suicide or euthanasia was legally available (Dyck, 2002). He spent the next few weeks “bed bound by pain and weakness, having been able to only drink water…desperate, isolated and frightened” (Dyck, 2002, p. 1). However, Cohen eventually agreed to hospice homecare; the service controlled all of his pain, restored his ability to enjoy life, and helped Cohen with his fears surrounding his death. Cohen is miraculously alive today. Although he continues to battle cancer, his condition has improved dramatically and unexpectedly. He now functions relatively normally and believes that he is “living a full life, worth living” (Dyck, 2002, p. 2). Cohen currently cherishes this extra time he and his wife have together. Together, they are working to accept his eventual death and to calm their anxieties. Despite previously believing in the right to end life in times of terminal illness and severe pain, Cohen and his wife now are strongly “against it on religious, moral, intellectual and spiritual grounds” (Dyck, 2002, p. 2). Because Cohen did not have this option, he has transformed his life perspective. His eventual death will now truly be a peaceful one.

What ya think???