Ross Whittaker

Kelly Turnbeaugh
ENGL-1010-073
April 29, 2016
On the debate of Physician Assisted Suicide
When deciding which controversial topic I wanted to write about I decided that I wanted
to pick something out of the norm that I expected get chosen frequently. These subjects include
the legalization of marijuana, abortion, e-cigs and gun rights. As I thought to what has affected
me in my life I found myself wondering with the prevalence of terminal cancer and incurable
diseases such as ALS if people today are more willing to end their suffering sooner rather than
later. I have watched as family members have had degenerative sense of self or have been
diagnosed with cancer and been told how long they should expect. Would theses family members
or similar cases opt for Physician Assisted Suicide, henceforth PAS, which is an aid in death by
means of prescribing lethal dosage drugs? But there is another side to the freedom of suffering.
What about the moral and ethical choices involved? Even if the patient is willing is the
physician? The question is bigger than should PAS be legalized or kept legalized in the few states
that currently allow aid in death.
Assisted suicide has been a topic for debate since the origins of life support and the
dilemma of when a patient should be let go. The Hastings Center is a bioethics research institute
focused on the ethical issues of health and healthcare. Robert Veatch who is a long-time fellow of
the Hastings Center has classified three major events in the early years of bioethics that has
shaped our views of assisted suicide. The first was the advent of technology that allowed

individuals to choose what they did with their bodies. These included the ventilator, dialysis
machines, organ transplants, contraceptives and abortion techniques. With the new developments
in medicine not only could patients be assisted in living but completely prevented from dying.
The second was the Harvard Ad Hoc Committee on Brain Death which was the first exercise in
bioethics of differentiation facts and values. The committee focused on whether calling someone
dead was a biological fact or a philosophical judgement. The third was a court case of parents
Joseph and Julio Quinlan versus a physician named Robert Morris. In the case Robert Morris
refused to take the Quinlans daughter off of a ventilator and the court ruled that the physician
over the patient could not automatically insist on life support (Veatch). The question still remains
whether the voluntary act of forgoing lifesuport is similar in ethics with choosing to end life
early.
Currently there are five states that allow PAS: Oregon, Washington, Montana, Vermont,
and most recently California as well the Netherlands. Oregon passed the Death with Dignity Act
in 1997 which stipulates that a patient must make a formal oral request, make another request 15
days later, make a written request signed by two witnesses, the doctor must advise alternatives
such as hospice care as well as remind them that its okay to change their mind, then the doctor
can affirm the decision with a second physicians approval and finally prescribe the lethal drugs
which must be administered by the patient (Engber). One big stipulation is that the drug must be
taken and administered by their own self. Otherwise the procedure would be classified as
euthanasia which is illegal. Theres a lot of time and consideration that is required before the
drugs are even prescribed. This is intentional to make sure that the patient has time to think about
what they are about to do and potentially change their minds.

To most people dying is considered a big deal. Physicians especially are always trying to
cure patients of an illness and prevent death rather than aid it. The Hippocratic Oath featured the
statement I will neither give a deadly drug to anybody if asked for it, nor will I make a
suggestion to this effect (Edelstein) which still influences todays practitioners. As with
Oregons Death with Dignity Act doctors are ultimately the deciding party to whether a patient
should be permitted to end their life. Many of these patients are also mentally ill. Studies have
been documented that almost 90 percent of completed suicides had come psychiatric disorder
just before their death (Carlson). With these high rates of mental illness phycologists are called
upon to determine if the decision for PAS is made in good mental comprehension.
Abilash Gopal who is an Assistant Clinical Professor in Psychiatry and the Law at the
University of California found that in patients who were received by Oregon physicians for aid
in dying 20 percent were depressed however only 7 percent were referred for psychiatric
evaluation (Gopal). This raises the concern of whether patients are in the right frame of mind to
be deciding life altering actions. Gopal believes that there is a rising need for psychiatrists to
provide the necessary screening for such serious matters as assisted suicide.
As psychological conditions are evaluated the psychiatrist is put in a position where they
are the gatekeepers of PAS which can be a strenuous burden. Mark Sullivan of the Hastings
Center, a bioethics research institute, is concerned that this "safeguard" inappropriately uses a
technical clinical procedure to disguise our society's ambivalence about suicide itself (Sullivan).
With the doctors being the last line before a patient participates in PAS it can be difficult to
separate whose decision it really is in the end. Will a patient start the process but end up finishing
it because the psychologist deems that they are mentally fit. Ultimately the physician and

psychologist are using their skills to determine the appropriate course of action that needs to be
taken.
As mentioned a physicians responsibility to the patient are to evaluate their physical and
mental state. In doing so a physician is helping a patient to either cure what is ailing them or
reduce the amount of discomfort that the patient experiences. Some of their duties may include
tending those that are dying and be in a position to ease the patient into a state of eternal rest.
Some, if not most, physicians would be against the idea of putting a human down but other may
consider themselves to be the only way to help the patient. As Nikola Biller-Andorno states if a
physician is prepared to go forward with a patients request of PAS there isnt any compelling
ethical reason that they shouldnt be allowed to do so. In any case, careful regulation,
comprehensive monitoring, and an ongoing critical debate are required to ensure that physicianassisted suicide remains a choice that is based on caring relationships among the patient, the
family, and health care professionals (Biller-Andorno).
With assisted suicide being legal in only five states as well as the Netherlands this leaves
a large part of the globe left in a position where aid in death is not an option. There is an
alternative method that is legal and ethical everywhere that involves the patient voluntarily
ceasing to eat and drink. Voluntary Stopping of Eating and Drinking (VSED) can take one to
three weeks to be a sufficient means to end a life. Patients eventually die from terminal
dehydration. No doctors are required but caregivers are common to manage the palliative care,
similar to hospice care, through the period of VSED. VSED is usually performed in the home of
the patient and the caregiver makes sure that the patient is comfortable, their mouths are kept
clean and in good health, as well as recording the time of death. Vikki Lachman is a supporter of
VSED and cites the chemical reactions in the body when food and water nutrition are

unavailable to argue that VSED is not painful when other discomforts are managed by palliative
care measures. When calorie deprivation is prevalent ketones are produced which causes a partial
loss of sensation while water deprivation causes an increase in dynorphin which is an extremely
strong opiate (Lachman). This physiological response would seem to be the bodys own aid in
easing the passing of a person, at least through the means of starvation.
When looking at assisted suicide I find that if people may stipulate the point at which
life-support should be stopped then shouldnt there also be a point in physical health that people
may opt to end their suffering? If I were in constant pain and I was confident that there wasnt
anything left for me to enjoy Id probably want to leave on my terms. Similar to life-support I
would not want to be kept alive by a machine if I wasnt there.
Physicians who are unwilling to prescribe a lethal drug are more common than not but as
long as physicians are not forced to comply with a patients request then there shouldnt be a
moral dilemma since they could simply refuse. With a refusal a patient could just find someone
else to aid their accelerated death. On top of this I believe that if a patient is really determined to
leave the world there is nothing stopping them from overdosing on a less lethal drug; however I
do believe that if physicians were to help then the process would be more pleasant.
VSED is what I would consider as slow suicide. If it truly is peaceful and painless then
its very much a viable option since most of the world does not permit aid in death. Aside from
the moral and ethical challenges of assisted suicide that VSED gets around I think there would
still be guilt of having others take care of you and see you fade away to nothing. I believe this
option is not for those that still have caring family because the duration is long and members of
the family will have to come to terms that one of their own is in the process of killing
themselves.

Assisted suicide is a morally challenging subject and needs to be taken into careful
consideration by those who are seeking it out. As long as everyone is in agreement with the
decision to request Physician Assisted Suicide then I submit that their decision is respected and
complied with. Death of a loved one is a tragic and unescapable occurrence but the suffering of a
loved one is even more tragic. Physician assisted suicide is a necessary option for those who
need it. It should in no way be encouraged or considered trivial. With proper screening and full
understanding a person should be able to do whatever they please with themselves.

Works Cited
Biller-Andorno, Nikola. "Physician-Assisted Suicide Should Be Permitted." The New England
Journal Of Medicine (2013): 1454-1452. Web. 20 April 2016.
Carlson, Gabrielle A, Charles L. Rich, Patricia Grayson, and Richard C. Fowler. "Secular Trends
in Psychiatric Diagnoses of Suicide Victims." Journal of Affective Disorders (1991): 12732.
Edelstein, Ludwig, Owsei Temkin, and C L. Temkin. Ancient Medicine: Selected Papers of
Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1967. Print.
Engber, Daniel. How Does Assisted Suicide Work? 6 October 2005. Web. 29 April 2016.
<http://www.slate.com/articles/news_and_politics/explainer/2005/10/how_does_assisted_
suicide_work.html>.
Gopal, Abilash A. "Physician-Assisted Suicide: Considering The Evidence, Existential Distress,
And An Emerging Role For Psychiatry." Journal Of The American Academy Of
Psychiatry And The Law 43.2 (2015): 183-190. PsycINFO. Web. 20 April 2016.
Lachman, Vicki D. "Voluntary Stopping Of Eating And Drinking: An Ethical Alternative To
Physician-Assisted Suicide." MEDSURG Nursing 24.1 (2015): 56-59. Academic Search
Premier. Web. 20 April 2016.
Sullivan, Mark D., Linda Ganzini, and Stuart J. Youngner. "Should psychiatrists serve as
gatekeepers for physican-assisted suicide?" The Hastings Center Report July-Aug 1998:
24+. Web. 20 April 2016.

Veatch, Robert M. "From forgoing life support to aid-in-dying." The Hastings Center Report
Nov.-Dec 1993: S7+. Opposing Viewpoints in Context. Web. 20 April 2016.