Running head: A DISCUSSION ON ASSISTED SUICIDE

A Discussion on Assisted Suicide

Naomi Everett
Frostburg State University

A DISCUSSION ON ASSISTED SUICIDE

A Discussion on Assisted Suicide

First off, a distinction must be made between assisted suicide and euthanasia. Pozgar
(2013) defines assisted suicide as an action in which a physician voluntarily aids a patient in
bringing about his or her own death (p. 133). In assisted suicide a physician may provide
medications to a patient knowing that it is the patients intention to end his own life while in
euthanasia the physician takes an active role in ending a patients life, such as administering a
lethal dose of medication or withholding lifesaving treatment. Euthanasia is broadly defined as
the mercy killing of the hopelessly ill, injured, or incapacitated (Pozgar, 2013, p. 124).
Legal Precedents
Physician-assisted suicide is illegal in most countries. Assisted suicide has been legal in
Germany since 1751, in Switzerland since 1942, in The Netherlands since 2001, in Belgium
since 2002, and in Luxembourg since 2008 (ProCon.org, 2010). In the United States there are no
Federal laws relating to assisted suicide; all assisted suicide laws are handled at the state level
(ProCon.org, 2013).
Only four states allow for assisted suicide. Montana allows for legal assisted suicide via
court ruling. In the 2009 case Baxter v. Montana, the Montana State Supreme Court ruled:
That we find no indication in Montana law that physician aid in dying provided to
terminally ill, mentally competent adult patients is against public policy and therefore,
the physician who assists is shielded from criminal liability by the patients consent
(ProCon.org, 2013).
In 2009, three separate bills regarding assisted suicide were introduced to the Montana
legislature; all three failed to pass (Barber, 2011).

A DISCUSSION ON ASSISTED SUICIDE

Three states; Oregon, Washington, and Vermont have allowed for physician-assisted
suicide via legislation since 1994, 2008, and 2013 respectively. In all three of these states the
patient must be a resident of the state, must be at least 18 years old, and have a life expectancy of
no more than six months. In addition, the patient must make an oral request to a physician, wait
15 days and then make second oral request to a consulting physician. If the physician feels that
the patients ability to make a sound decision is impaired in any way, a psychiatric evaluation
must be ordered. The physician is also obligated to inform the patient of all alternatives
including hospice and palliative care. After obtaining the prescription there is a 48 hour waiting
period before the patient may pick up the medications from the pharmacy (ProCon.org, 2013).
The earliest case of note in the United States regarding assisted suicide is Washington v.
Glucksberg. Dr. Glucksburg, along with three other physicians, three terminally ill patients, and
Compassion in Dying (a non-profit organization) challenged Washington States physicianassisted suicide ban.
The plaintiffs asserted that the Washington ban was unconstitutional, arguing that the
existence of a liberty interest protected by the Fourteenth Amendment allows mentally
competent, terminally ill adults to commit physician-assisted suicide. The District Court
ruled that the ban was unconstitutional, and the Ninth Circuit affirmed (ProCon.org,
2009, table 1).
In 1997 this ruling was later reversed by the United States Supreme Court in a 9-0 decision
(ProCon.org, 2009). Assisted suicide is now legal in the state of Washington.
In Vacco v. Quill; Dr. Quill, two other physicians, and three terminally ill patients
challenged New York States ban on assisted suicide. The District Court ruled in favor of the
State of New York, and the Second Circuit reversed in favor of Dr. Quill (ProCon.org, 2009,

A DISCUSSION ON ASSISTED SUICIDE

table 1). As in the 1997 Washington case, the United States Supreme Court upheld the
constitutionality of New York's ban on physician-assisted suicide in a 9-0 decision ProCon.org,
2009). Assisted suicide is still illegal in New York State.
In 1994, Oregon became the first state to pass a law permitting a physician to prescribe
lethal doses of controlled substances to terminal patients. In 2001, United States Attorney
General, John Ashcroft, declared this violated the Controlled Substances Act of 1970. Ashcroft
threatened to revoke the medical license of any physician that prescribed lethal doses of
controlled substances. Oregon sued the Attorney General in federal district court. Both the
district court and the Ninth Circuit ruled that Ashcroft's mandate was illegal. On January 17,
2006 in Gonzales v. Oregon, the United States Supreme Court ruled in a 6-3 opinion that the
Controlled Substances Act did not authorize the Attorney General to ban the use of controlled
substances for physician-assisted suicide, upholding Oregons 1994 Death with Dignity Act
(ProCon.org, 2009).
Ethical Viewpoints
American Medical Association (AMA) (1996) opinion 2.211 clearly states that
physician-assisted suicide is fundamentally incompatible with the physicians role as healer
(para. 2). The AMA (1996) goes on to counsel physicians to aggressively address a patients
end-of-life needs; including emotional support, pain control, and respecting the patients
autonomy. Polzgar (2013) describes the ethical principle of autonomy as the right of a person to
make ones own decisions. Does this right extend to the right to end ones own life? Polzgar
(2013) further asserts that when two or more medically acceptable options are appropriate that a
competent patient has the absolute right to select the option that they deem the best as long as the
patient has been fully informed of the risks and benefits of each option. Autonomy can further

A DISCUSSION ON ASSISTED SUICIDE

be classified as negative or positive. Negative autonomy, the right to be left alone, is universally
accepted in the medical field. Competent adults may choose to decline any and all medical care
(Discovery Institute, 2009). On the other hand, the right to positive autonomy has its limits. The
right to medical treatment is limited by the judgment of the physician; a patient cannot simply
demand treatments that are not medically appropriate (Discovery Institute, 2009). When
considering the issue of autonomy the logical question is: Is assisted suicide appropriate medical
treatment? The Discovery Institute (2009) article states quite plainly:
If killing is medical treatment, then patients who have a disease for which the medical
profession has decided that killing is an effective and appropriate remedy have a right [to]
choose it. If killing is not a medical treatment, then patients do not have a right to choose
it, at least as a part of their medical treatment (para. 9).
Referring back to AMA opinion 2.211: Physician-assisted suicide violates a physicians
role as a healer. The ethical principle of beneficence expresses the idea that we are to do good,
be kind, and show compassion (Pozgar, 2013). While the ability to show compassion is a mark
of moral strength, Pozgar (2013) notes that compassion can blur ones judgment. Does a healer
not violate his moral integrity when he fails to adhere to the Hippocratic Oath? The Hippocratic
Oath states that a physician will give no deadly medicine to any one if asked (Pozgar, 2013, p.
352). The physician-patient relationship dictates that the physicians primary commitment must
be for the patients welfare whether the physician is preventing or treating illness or helping the
patient cope with illness, disability, and death (Pozgar, 2013, p. 374). This does not however
dictate that a physician must hasten death to lessen suffering. In fact, medical ethics requires
physicians to adhere to the ethical principle of nonmaleficence, to avoid causing harm (Pozgar,
2013).

A DISCUSSION ON ASSISTED SUICIDE

Patients have rights. Patients have the right to choose the medical care they wish to
receive (Pozgar, 2013, p. 443). Patients have the right to participate in decisions relating to
their care. They have the right to refuse treatment and to right to execute advanced directives.
Patients have the right to compassionate care and pain management. Can these rights be
interpreted into the right to assisted suicide? While a compassionate caregiver can certainly
understand a dying patients desire to end suffering, is it a right? Can a patient demand it of a
physician? If a patient demands an antibiotic for a viral infection, should the physician comply?
What about demanding a surgery that the physician does not feel is medically prudent? There is
a limit to patients rights. The argument can be made that a physicians help is not necessary to
end a life. Suicide can be carried out quite effectively without medical assistance (Discovery
Institute, 2009, para. 12). For a patient that wishes to commit suicide the deed can be performed
without a physician.
For both the patient and the physician the concept of situational ethics applies. In
situational ethics a persons values can change as circumstances change (Pozgar, 2013). A
patient who would normally consider suicide to be morally wrong may alter his choice when
faced with the ethical dilemma of his own mortality and suffering. A compassionate physician,
dedicated to healing and saving lives, may choose to interpret a patients right to autonomy to
include the right to die in an effort to avoid prolonged suffering. Beauchamp (1999) interprets
all aid-in-dying as primarily about increasing liberty rather than about killing or allowing a
patient to die. Beauchamp (1999) further explains that in the states where assisted suicide is
legal, such as Oregon, it is only the oral request for suicide assistance that separates the legal act
from an illegal one; a simple change in circumstance.
Personal Ethical Viewpoint

A DISCUSSION ON ASSISTED SUICIDE

I recall a conversation I had with my Mother when I was a child. I could not understand
why suicide was illegal. If a person wanted to die why should they be forced to live? Even at
that young age I valued the right of autonomy so it was of no surprise to me that my Ethical Lens
Inventory (ELI) (2013) found my preferred lens to be Rights and Responsibilities and my core
values to be autonomy and rationality. I of course have an understanding of death and dying
now that I could not have comprehended at that time.
The Rights and Responsibilities Lens draws from deontological ethics and focuses on our
duty to one another within a community. In deontological ethics we do what is right even if the
outcome may not lead to good; it is doing the right thing that is of primary importance (Pozgar,
2013). If I were to base my ethical viewpoint on assisted suicide solely based upon my Rights
and Responsibility Lens I would conclude that assisted suicide is ethically wrong even if it
means prolonged suffering.
My core values are autonomy and rationality. I obviously value a persons individual
rights but in addition to that I value the application of universal rules that can be applied to
everyone within a community. I find my core values in conflict. While I value a persons right
to make decisions for himself, I must conclude that suicide is morally wrong for all members of
the community and that this moral standard must be applied universally.
Before I began my research I had already determined for myself that I support assisted
suicide, not as a patients right but as an acceptable option for care for the dying. While I will
not argue the legality of assisted suicide, the more Ive read on the subject the more Ive come to
the realization that assisted suicide violates the medical code of ethics. Physicians, and nurses,
are dedicated to healing and ethical principle of nonmaleficence. Assisted suicide is simply
morally wrong and I could not participate in assisting someone with their own death.

A DISCUSSION ON ASSISTED SUICIDE

That being said I still feel that terminally ill patients who wish to seek out a physician to
assist them in dying should have access to this service. I do not feel that physicians should be
obligated to provide this service, even if they practice in a state where assisted suicidal is legal. I
relate this to abortion. A patient has the option to choose but physicians should be under no
obligation to provide the service. Those physicians who are willing can legally perform the
service if their state allows.

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References
American Medical Association. (1996). Opinion 2.211 - physician-assisted suicide. Retrieved
December 5, 2013, from http://www.ama-assn.org//ama/pub/physicianresources/medical-ethics/code-medical-ethics/opinion2211.page
Barber, M. (2011, April 5). Just what are death with dignity laws anyway? [Blog post]. Retrieved
from http://www.deathwithdignity.org/2011/04/05/just-what-are-death-dignity-lawsanyway
Beauchamp, T. L. (1999). The medical ethics of physician-assisted suicide. Journal of Medical
Ethics, 25, 437-439. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC479288/pdf/jmedeth00007-0003.pdf
Discovery Institute. (2009). Is physician-assisted suicide ethical? Retrieved from
http://www.opposingviews.com/i/is-physician-assisted-suicide-ethical#
Ethical lens inventory report for Naomi Everett. (2013). Retrieved from
http://ethicsgame.com/Exec/Eli/EthicalLensResults.aspx?R=1
Pozgar, G. D. (2013). Legal and ethical issues for health professionals (3rd ed.). Burlington,
MA: Jones & Bartlett Learning.
ProCon.org. (2009). Legal precedents: Landmark euthanasia and physician-assisted suicide legal
cases. Retrieved December 5, 2013, from
http://euthanasia.procon.org/view.resource.php?resourceID=000131
ProCon.org. (2010). International perspectives: Legal status of euthanasia and assisted suicide.
Retrieved December 5, 2013, from
http://euthanasia.procon.org/view.resource.php?resourceID=000136

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ProCon.org. (2013). State-by-state guide to physician-assisted suicide. Retrieved December 5,
2013, from http://euthanasia.procon.org/view.resource.php?resourceID=000132

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