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Running Head: Physician-Assisted Suicide

Physician-Assisted Suicide

By

Antilkumar Gandhi

Psychology
Professor Farber
Spring Quarter 2009
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Abstract

Physician-assisted suicide is a very controversial topic in modern-day medicine

and in society at large. It is one form of euthanasia or "mercy killing." Many proponents

of physician-assisted suicide argue that human compassion allow a severely or terminally

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."

Physician-assisted suicide laws could also be abused to allow non-critical patients to

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

varied and invite vigorous debate.


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Physician-Assisted Suicide

Physician-assisted suicide is a form of euthanasia that is creating a great deal of

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.

Euthanasia takes many different forms. Depending on the form of 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
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continued to receive nutrition through her feeding tube. Her parents had wanted to

continue that form of life support.

A second kind of euthanasia involves discontinuing feeding or hydration from a

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

her wishes. She died in 2005.

A third kind of euthanasia is withholding treatment at the patient's request that

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

euthanasia mentioned thus far can be grouped under the heading of

"Withdrawing/Withholding Treatment," (American Geriatrics Society, 2007). The

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
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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

Washington in 2008. Despite being legalized in these states, physician-assisted suicide

still faces a great deal of opposition from many national and state medical societies, and

there is no clear consensus from the medical community on whether it is considered

medically ethical.

The sixth kind of euthanasia is also arguably the most controversial. It involves

having a doctor, at the request of a severely or terminally ill patient, administering a

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

Kevorkian was a vocal advocate of this form of euthanasia as well as physician-assisted


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suicide. He is a former pathologist who claims to have helped over a hundred people

commit suicide. He devised a machine he called a "thanatron" which would administer a

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

lack of compassion and humanity.

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
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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

also have this right.

After considering the benefits to the patient of allowing physician-assisted

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

family and friends a lot of anguish and suffering.

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
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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.

Another powerful argument used to justify physician-assisted suicide is the belief

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.

Infringing on a patient's right to die is an unnecessary violation of personal liberty.

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
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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

to keep more of their estates to pass on to their family.

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

they could concentrate on those patients.

A final argument to be made in favor of physician-assisted suicide is the fact that

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
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long as the primary intention is not to cause death. Some physicians have already

admitted to covertly practicing this form of physician-assisted suicide. Legalizing

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

relationship between caregivers and the ill.

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.

Another compelling argument against the practice of physician-assisted suicide is

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.

Another argument that can be made against physician-assisted suicide is that

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
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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

slippery slope by allowing physician-assisted suicide in any form.

Another excellent argument against physician-assisted suicide is that it may

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

should be explored thoroughly before giving up on a person and labeling them as

"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
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need to be maximized so that physician-assisted suicide, even if it were legalized, would

become irrelevant.

A very powerful argument against physician-assisted suicide involves a scenario

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

abuses of the health care system.

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.
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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

misdiagnosis. This type of nightmare scenario could occur if physician-assisted suicide

became legalized in the United States.

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

in the years to come.


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Conclusion

The fierce debate over euthanasia in general has come to a head over the issue of

legalizing one form of it--physician-assisted suicide. Proponents of it argue that it should

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

and autonomy. Opponents of legalization of physician-assisted suicide argue that it is

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.
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