Professional Documents
Culture Documents
Physician-Assisted Suicide
By
Antilkumar Gandhi
Psychology
Professor Farber
Spring Quarter 2009
Physician-Assisted Suicide-2
Abstract
and in society at large. It is one form of euthanasia or "mercy killing." Many proponents
ill person the chance to choose death as a way to alleviate their suffering. It has also been
argued that it should be allowed to so that a person with a progressive and degenerative
illness be allowed to end their life before the last stages of the disease and "maintain their
dignity." Some proponents believe it is a simple matter of personal liberty and should be
allowed. It would also save a dying person's friends and family from watching the
suffering of their loved one. Other reasons to allow physician-assisted suicide include a
decrease in health care costs and preservation of a dying patient's estate. Arguments can
also be made against physician-assisted suicide, the first and most important being that it
demeans the value of human life. Those against also argue that it is immoral to kill,
while physician societies maintain that it violates the Hippocratic Oath to "do no harm."
commit suicide. Opponents of physician-assisted suicide also maintain that better pain
management and comfort care can be provided to alleviate suffering of dying people
without resorting to suicide. The arguments for and against physician-assisted suicide are
Physician-Assisted Suicide
passionate debate on both sides of this issue. Euthanasia is a term derived from Greek
meaning "good death." Euthanasia is a general term for "mercy killing" -- taking the life
of a critically ill or injured person in order to spare them suffering. The central issue in
the debate over euthanasia is whether the taking of human life in this manner can be
considered ethical, legal or moral. These are difficult questions regarding a difficult
issue. Despite the passage of laws allowing physician-assisted suicide in the states of
Oregon and Washington, there is still no consensus in the United States on how to regard
euthanasia.
ethicists, legal experts and the lay public may be in favor of some forms and not others.
There are six different categories of euthanasia that are recognized by experts on this
issue, (Torr, 2000, p. 17). The first kind is the discontinuation of life support systems
such as ventilators when a person is in an irreversible coma and cannot live without the
help of these life support machines. One famous example of this type of euthanasia in
the United States was the Karen Ann Quinlan case. In 1975, she went into an irreversible
coma after taking tranquilizers and drinking alcohol. She was only kept alive by a
respirator which allowed her to breathe and a feeding tube which was her only way of
getting nutrition. Her parents wished to remove her from the respirator, since they
believed that this was not the way that their daughter would wish to live. After a lengthy
court battle, her parents won the right to turn off her respirator. Karen Ann Quinlan
continued to live for nine more years, though, despite being off the respirator. She
Physician-Assisted Suicide-4
continued to receive nutrition through her feeding tube. Her parents had wanted to
comatose patient who does not need any other form of life support. Karen Ann Quinlan's
parents rejected this form of euthanasia when their daughter continued to live after
withdrawal of the respirator. But in the case of Terri Schiavo, withdrawal or continuation
of nutrition and hydration was the focal issue. She was a woman who had been in a
persistent vegetative state for 15 years. She required a feeding tube for nutrition and
hydration, but did not require any other kind of life support. Her husband wished to
discontinue the feeding tube because he said that his wife had previously stated that she
would not wish to live in such a condition. However, Terri had never signed any legal
documents stating that this was her wish. Her parents objected to removal of the feeding
tube and this led to protracted legal proceedings. Her case attracted a lot of media
attention and fueled public debate on the issue of euthanasia. Eventually, the courts
allowed her husband to remove her feeding tube and to carry out what he believed to be
will extend life but not cure a severe or terminal illness. One example would be a patient
who has an advanced form of cancer who refuses further treatment. All of the forms of
fourth kind of euthanasia involves providing powerful forms of pain relief to someone
who is in a great deal of physical pain due to a medical condition, knowing that the
Physician-Assisted Suicide-5
medication may hasten the patient's death. This principle is known as the "Double
Effect" and is generally widely accepted as medically ethical. Physicians would be the
ones prescribing these high and potentially lethal doses of pain medicines. They would
be within the bounds of established medical ethics as long as it is clear that the primary
intention of providing these medications is to relieve suffering and not to cause death.
The fifth kind of euthanasia involves giving a patient with a severe or terminal
illness access to the means to kill themselves in order to avoid a lingering death. This
access is usually in the form of medication that is prescribed by a physician for the
express purpose of causing death. This is the form of euthanasia that is usually referred
to as physician-assisted suicide. In this type of situation, the physician is only giving the
patient the means to commit suicide, not actually administering the medication. The
patient would take the medicine if they wish and do so at the time and place of their
choosing. The physician would not normally be present. This is the type of medical
scenario that has been legalized in Oregon in 1994 and just recently in the state of
still faces a great deal of opposition from many national and state medical societies, and
medically ethical.
The sixth kind of euthanasia is also arguably the most controversial. It involves
lethal injection to that patient. The physician is acting to initiate the act of dying for that
patient. This form of euthanasia is called voluntary active euthanasia. Dr. Jack
suicide. He is a former pathologist who claims to have helped over a hundred people
lethal dose of medications when the button was pushed by the patient. He committed
voluntary active euthanasia in 1998 when he gave a lethal injection to a patient who was
in the last stages of Lou Gehrig's disease. This act was taped and aired on the show "60
Minutes." He was later convicted of second-degree murder for this act, despite the fact
that the patient gave full and voluntary consent. He spent over 8 years in prison. Now he
no longer assists in suicides but continues to advocate for laws allowing physician-
assisted suicide.
The arguments for and against physician-assisted suicide have been under
constant debate by legal experts, religious leaders and physicians, as well as physician
societies, for many years. The first and most powerful argument for physician-assisted
suicide is that it can relieve tremendous pain and suffering of severely and terminally ill
patients. Patients with advanced cancer or other diseases that lead to a painful death that
medical science is not yet able to treat effectively should be offered the option of cutting
short the pain that is inevitably tied to the end stages of their disease. Because of their
special expertise, physicians are best suited to assist a patient in ending their life in a
peaceful and pain-free manner. As a society, failing to offer patients this choice shows a
Along with saving terminally ill patients from pain, physician-assisted suicide
should be legalized to allow patients with degenerative, progressive illnesses the option
of choosing death before it robs them of their mental and physical faculties. Diseases
such as Lou Gehrig's disease, multiple sclerosis, Huntington's disease and Alzheimer's
Physician-Assisted Suicide-7
disease lead to a slow, inevitable decline in function that medical science has been unable
to treat effectively. A person with one of these diseases may wish to choose death as a
way to preserve their dignity and in order to be remembered by their family and friends
as they wish to be remembered, rather than as a shell of their former selves. Former
President Ronald Reagan suffered from Alzheimer's disease. He was out of the public
eye when he was in the last stages of the disease, so he is able to be remembered by the
public as a strong and capable leader, rather than as an Alzheimer's victim. Others should
suicide, the benefits to the family and friends of the dying person should also be
considered. The suffering of a dying person's friends and family can be just as acute as
the patient's suffering itself. While it is not physical suffering, it still takes its toll on
loved ones mentally and emotionally. In addition to watching someone they love die a
lingering death, often in agony, in the end, the family and friends do not even have the
chance to say their final goodbyes because the patient is in a semiconscious state.
Allowing physician-assisted suicide would spare not only the dying person but their
In keeping with the argument that it is important to also consider the feelings of a
dying person's friends and family, physician-assisted suicide should also be allowed
because it can prevent a dying person from resorting to drastic measures in order to take
their own life. Many instances of suicide have occurred in which a terminally ill person
wishes to end his life but is too afraid to enlist the aid of a loved one (for fear they'll be
prosecuted) and is unable to enlist the aid of their physician because it is illegal. In these
Physician-Assisted Suicide-8
cases, the severely ill people chose among the methods of suicide that they had at hand.
Some used guns and put a bullet through their head; others hung themselves or took an
overdose of sleeping pills. Usually their family or friends were the ones to find their
messy and horrifying remains. In hopeless situations in which the dying person is intent
on dying soon, physician assistance should be made available so that the procedure is
humane and not unduly stressful on the loved ones of the dying person.
that a person has a right to die, just as they have a right to live. It is a question of
individual freedom and autonomy, and no one has the right to decide for another the
manner of their death. Society does have a strong interest in the preservation of life, but
this should not override the rights of a terminally ill patient who wishes to end their life.
Along with violating a patient's right to die, prevention of suicide can also violate
a person's right to religious freedom. Religious views are inextricably linked to views on
suicide in general. Many religions view suicide as a sin. By preventing suicide, the state
is supporting the view of some religions that suicide is a sin. This violates the separation
of church and state in the United States. The state cannot and should not legislate
morality.
The above arguments in favor of physician assisted suicide looked at the issue
from the point of view of the terminally ill person. But there are reasons that society in
general should favor physician-assisted suicide. One compelling reason is that health
care costs can be reduced. Health care costs in the United States continue to rise every
year at an astounding rate. Insurance premiums also are on the rise at the same
Physician-Assisted Suicide-9
unsustainable rate. Providing care for a severely or terminally ill patient, especially
during the last stages of life is very expensive. It puts a burden on the health care system
as a whole, but also can drain money from the dying person's estate. Knowing that health
care costs are rising at an unsustainable rate, the government and the health insurance
industry are looking for ways to cut costs in any way they can reasonably do so.
Spending tens of thousands of dollars keeping a patient alive who is terminally ill but
wants to die seems a poor way to use our finite health care resources. Allowing
physician-assisted suicide would be a way help cut health care costs and allow the dying
Besides a lack of funds, the health care system in the United States also lacks
enough trained personnel. There is a critical nursing shortage in hospitals and, to a lesser
degree, a shortage of doctors. There have been multiple studies linking the lack of
trained staff to a decreased quality of care. The quality of care that is provided will only
continue to deteriorate as the nursing shortage continues and as the baby boomers
become senior citizens with increasing health problems. It does not make sense to
continue to provide care to terminally ill patients who want to die. Nurses and doctors
have many other patients that are able to be saved and quality of care would improve if
it already occurs but in secret. Anonymous surveys of doctors show that many do give
large doses of pain meds to dying patients with the expectation that they will die.
Physicians are protected by the principle of "The Double Effect," whereby it is medically
ethical to give a patient large doses of pain medications in order to relieve suffering as
Physician-Assisted Suicide-10
long as the primary intention is not to cause death. Some physicians have already
physician-assisted suicide would allow for more open and frank discussions between
physicians, severely ill patients and their loved ones and would promote a healthier
The many and varied arguments in favor of physician-assisted suicide have been
discussed, but there are many valid arguments that can be made against physician-
assisted suicide. First among these is that it is against medical ethics and any physician
who participates in this act would be violating the Hippocratic Oath. This oath states that
the physician should do no harm to the patient. Assisting in suicides can only be
considered harmful to the patient. Having physicians participate in such activities can
only lead to a decreased reverence for life by the physician and a weakening of the
doctor-patient relationship.
that it demeans the value of human life. Many religious and secular traditions exist
which speak out against the taking of human life. "Thou shalt not kill" is a
commandment that is also found in most religions of the world. Many religious leaders
and physicians argue that life is valuable in all its stages and should thus be respected.
legalizing it could lead to abuses in which non-critical patients are allowed to commit
suicide. Patients who are severely depressed could convince a physician to help them
commit suicide instead of receiving care and treatment for depression. Allowing
physician-assisted suicide for the terminally ill seems like a merciful and loving thing to
Physician-Assisted Suicide-11
do, but it only leads to a very slippery-slope in which eventually all people who want to
commit suicide for any reason may be allowed to do so. This would be against the core
values of most people in the United States. Therefore, we should not even start down that
prompt physicians and patients to give up to early in finding a cure for the disease. A
patient who has been diagnosed as having a terminal illness and only a short time left to
live and with the prospect of severe pain in the last few months of life may choose death
over treatment. A slim chance at recovery is still a chance and all treatment options
"terminal." Besides which, there is always the possibility of a "miracle cure." There are
new therapies being discovered all the time. Also, there are documented cases in which
people who were diagnosed with terminal illnesses ended up recovering and living much
longer than their original prognosis. The power of the human spirit should not be
underestimated.
Even when a miracle cure does not occur or patients are not able to recover from
their terminal illness, it does not mean that physician-assisted suicide is their only option
for relief from severe and intractable pain. Pain medication and pain management offer
very powerful therapies that can allow a person with a terminal diagnosis to live out the
rest of their days in relative comfort. Hospice and Palliative Care are relatively new
options for patients and can provide the relief that patients need without resorting to a
drastic measure such as physician-assisted suicide. Hospice and Palliative Care are
underutilized options in many parts of the country. Access to these types of programs
Physician-Assisted Suicide-12
become irrelevant.
in which an insurance company may put undue pressure upon a patient or physician to
opt for the physician-assisted suicide procedure rather than any heroic measures that may
end up being much more costly to the insurance company. Health insurance companies
are always looking to cut costs and maximize profits. Many feel that they already have
too much power in deciding which tests and treatments a patient gets. If a terminally ill
patient has the option of asking for physician-assisted suicide, they may be pressured to
commit suicide rather than pursuing treatment. The doctor may feel pressured by the
insurance company to recommend the assisted-suicide procedure rather than any of the
other (more expensive) options. Allowing physician-assisted suicide may lead to such
Along the same lines of the last argument, allowing physician-assisted suicide
could also lead to undue pressure from families on severely ill patients. Many patients
"don't want to be a burden" on their families, and might be pressured to consider suicide
so that their families no longer have to care for them. Also, there may be greater pressure
on poor patients and those without insurance to choose suicide as their only means of
"treatment," since they can't afford to go to specialists and receive expensive, potentially
life-saving treatment. Every life is precious and these inequities in our society and in
access to the health care system should not be allowed to interfere in life-and-death
medical decisions.
Physician-Assisted Suicide-13
Finally, one last argument against physician-assisted suicide is that patients may
be wrongly diagnosed. The cancer that was diagnosed may have been inappropriately
staged. The tests run to diagnose a terminal disease could have provided a false result.
These mistakes in diagnosis could lead a patient who thinks they are terminally ill to
request physician-assisted suicide and possibly receive it, when in actuality, it was just a
The debate over physician-assisted suicide and euthanasia in general rages on. So
far, Oregon is the first state to legalize physician-assisted suicide in 1994. The new law
faced court challenges and could not be put into effect until 1997. Since then in Oregon,
dozens of patients per year request help from their physician to commit suicide for their
terminal condition. Several other states including California, Michigan and Maine have
attempted to legalize physician-assisted suicide, but those measures were defeated. Just
recently in the 2008 election, the state of Washington passed a "Death with Dignity Bill"
that was modeled closely after the Oregon law. The passage of these laws in two states
has by no means put an end to the debate regarding physician-assisted suicide. In fact, it
has led to more impassioned public discussion and thought. Whether physician-assisted
suicide becomes legalized in the other 48 states in the U.S. remains to be seen, but no
doubt the experiences of the states of Oregon and Washington will be closely scrutinized
Conclusion
The fierce debate over euthanasia in general has come to a head over the issue of
be legalized to allow alleviation of incredible pain and suffering on the part of ill patients
as well as their family members. They argue for it also as a question of personal liberty
immoral and demeans the value of human life. Now that it has been legalized in the
states of Oregon and Washington, the arguments for and against physician-assisted
suicide can be assessed through real-life situations and scenarios. Whether or not more
states will legalize physician-assisted suicide, questions about the morality and ethics of
physician-assisted suicide will likely persist and be discussed into the future.
Physician-Assisted Suicide-15
References
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Assisted Suicide. Retrieved 5/5/09 from Ethics in Medicine: University of
Washington School of Medicine. Website:
http://depts.washington.edu/bioethx/topics/pas.html
Drickhamer, Margaret A., M.D. and Lee, Melinda A., M.D. and Ganzini, Linda, M.D.
(1997). Practical Issues in Physician-Assisted Suicide. Annals of Internal
Medicine, 126(2), pp. 146-151.
Dworkin, Gerald and Frey, R.G. and Bok, Sissela (1998). Euthanasia and Physician-
Assisted Suicide: For and Against. New York: Cambridge University Press.
Emanuel, Linda M, M.D., ed. (1998). Regulating How We Die: The Ethical, Medical,
and Legal Issues Surrounding Physician-Assisted Suicide. Harvard University
Press.
Torr, James D., ed. (2000). Euthanasia: Opposing Viewpoints. San Diego, California:
Greenhaven Press, Inc.