Assisted Suicide 2

Assisted Suicide: The End of All Options

Lisa Buczke

ENGU - 103, Summer l

Professor: Dr. Ricky DeSoiza

 Assisted Suicide 2

I was 23 when my father died. My dad was a lot of things: intelligent, pillar of strength,

justice junkie, good cop, fighter, and my number one fan. Weak, helpless, and undignified were

not adjectives that would describe my father, not even in the face of his impending death. Like

most people diagnosed with pancreatic cancer, by the time he found out it was too late to treat.

Nonetheless, my dad held onto hope, and he fought. He was given six months to live. He lived

for five weeks. Assisted suicide was not an option then. If it was, my dad never would have used

it. My father knew something that suffering people sometimes forget: life is precious and should

be protected and fought for, regardless of your disease.

Advocates of assisted suicide believe that offering a lethal prescription is humane and

will uphold the dignity of terminal patients. They attempt to present legalization favorably using

terms such as “death with dignity” or “assisted suicide.” Yet, death with dignity still results in

death. Assisted suicide is still suicide, and suicide is wrong. In my research essay, I will show

that assisted suicide is not the best option for the terminally ill. Rather, it is the end of options.

Abuse will take place, and mistakes will happen. Current safeguards do not adequately protect

the elderly, impoverished, and disabled population. Instead of looking for ways to hasten death,

we must focus on improvements to palliative care, which preserves dignity far better than

assisted suicide. Counter arguments state that safeguards protect people from abuse, that only the

person who wants to use assisted suicide may make the request, and the low cost of assisted

suicide takes the financial burden off family members of the terminally ill. I will refute these

claims and show that assisted suicide is a detriment, rather than a benefit.

According to the Center for Disease Control and Prevention (CDC), suicide is the 10th

highest cause of death in the United States among all age groups (2015, para. 1). Suicide is such
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a problem, causing so many negative repercussions, that there are numerous organizations and

fields of medicine dedicated to suicide prevention. In spite of efforts to curb suicide, rates have

continued to climb. Each year suicide rates are higher than the last. Presumably, we can all agree

that suicide is a poor choice. However, when it comes to assisted suicide the answer is not so

clear. To further examine attitudes of assisted suicide, we will look at faith-based groups. It is

important to note that almost all major religions, including but not limited to Christianity,

Judaism, and Muslim groups oppose assisted suicide (Death with Dignity: Religion and

Spiritiuality, n.d.). Viewpoints of the different religious groups are particularly assertive.

“Christianities generally and vigorously oppose such disposing of others’ (and of one’s own)

life” (Delkeskamp-Hays, 2003, p. 167). In a study of elderly women in the Jewish community

“absolute rejection of every act which deliberately terminates life” (Baeke, Wils, & Broeckaert,

2011, p. 259) was observed. Muslims reason that “God has entrusted man with life as a sacred

gift and for this reason, a human being never owns his/her own life” (Van den Branden,

Broeckaert, 2010, para . 26); therefore, humans do not have the liberty to take their own lives. In

fact, out of 27 religions only five support assisted suicide laws (Death with Dignity: Religion and

Spiritiuality, n.d.). Regardless of individual spiritual beliefs, the fact that so many religions are

opposed to the act points to a crucial moral dilemma. To further understand this dilemma, I will

draw on Blaise Pascal, and his famous wager. Pascal’s wager was directed at non-believers in

God, or skeptics. He argued that there is a 50/50 chance: either God does exist or He does not.

Therefore, there are only two choices which include theism or atheism. Pascal argued that since

death is inevitable, we must make a choice, and to chose atheism would be foolish. Pascal

defended his position for choosing God stating “let us assess the two cases: if you win, you win
 Assisted Suicide 4

everything: if you lose, you lose nothing. Do not hesitate then: wager that He does exist” (The

Argument from Pascal’s Wager, n.d., para. 13). If we are to take Pascal’s advice we will chose to

believe that God does exist. With this belief, we should; therefore, live our lives according to

Godly principles. If this is the case, it is clear that we should not support assisted suicide.

In addition to problems with morality, assisted suicide is not an option as media outlets

proclaim. Instead, it is where options cease. Wesley J. Smith, in his article “Assisted Suicide is

Not Compassion” draws on an expert in comfort care, Dr. Ira Byock who strongly believes

“there’s a distinction between alleviating suffering and eliminating the sufferer” (2015, para. 10).

Assisted suicide presents a huge contradiction. Depending on what one is suffering from, as in

mental illness, we give options to ease suffering and uphold quality of life, all-the-while fighting

to sustain life . If a mentally ill patient is found to possess harmful substances they are removed

from their possession. Yet if a terminally ill patient has suicidal ideation - as must be the case if

they request assisted suicide, then it has become acceptable practice in some states to supply the

required means for one to kill themselves (para. 56). If we chose to end life, the quality of life

argument is a moot argument. There is no life once it has been ended. Supporters argue for

dignity and quality of life leading up until death. But what kind of quality of life are we

advocating for if instead of focusing on the time we have left we focus on how to quickly bring

upon death? “The attempt to mix models is confusing to both clinicians and patients and

endangers seriously ill patients, particularly those with a history of pre-existing mental illness”

(para. 56). As Peter Allmark notes “it is unclear how death, either induced or natural, adds

dignity to an undignified life” (2002, p. 255). Allmark goes on give an operational definition of

the words “death” and “dignity.” In explaining death in relation to Death with
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Dignity he makes us aware that the term relates to the process of dying. He points out that

dignity is not something that a healthcare provider can give to a person. Rather, dignity is

obtained through how an individual conducts him or herself. If a person leads a life with dignity

then their death will be dignified. If a person lives a life or dishonor then assisted suicide cannot

add honor to that person. (p. 255). Providing patients with this choice does not broaden options

of care it simply allows the patient to be terminated. According to the American Medical

Association (AMA), doctors have a responsibility to provide patients with professionalism,

excellent medical care, and compassion. The AMA also asserts that physicians should uphold the

law while treating patients; but, if laws exist that are contrary to patient well-being, physicians

should work to change the law (AMA, n.d., para. 3-4). The AMA further opinions that “Instead

of participating in assisted suicide, physicians must aggressively respond to the needs of patients

at the end of life” (AMA Opinion 2.211, n.d., para 3). Undoubtedly, assisted suicide extinguishes

life. We would be remiss if we do not attempt to uphold quality of life by giving options that

honor the end of life, not simply end life, even during the transition into death.

Furthermore, not everyone with a terminal prognosis will die. For example, to be entered

into hospice care patients must have a terminal prognosis with 6 months or less to live, much like

patients who qualify for assisted suicide. However, according to Teno, Plotzke, Gozalo, & Mor

of the National Center for Biotechnology Information (NCBI) it is typical that “approximately 1

in 5 hospice patients are discharged alive” (2014, para. 7). Out of the live discharges

approximately 35% will succumb to illness within the next six months, while the remaining 65%

live. This fact shows that mistakes can be made far too easily. If these same mistakes were made
 Assisted Suicide 6

in assisted suicide it would prematurely end the life of someone who could have otherwise

survived.

Moreover, there are certain populations that are especially vulnerable to abuse including

the elderly, disabled and impoverished. Disabled people have long suffered discrimination due to

negative attitudes of others. In a study done by Ma, Chen, Zhou, & Zhang researchers found

“that Asian family members commonly perceive disability as being a burden and undesirable to

the family” (2012, p. 256). Unfortunately, this is not an uncommon attitude in the majority of

society. The Disability Rights Education & Defense Fund (DREDF) proves this by referring to

statistics which show that most people who opted for assisted suicide in Oregon chose it because

they feared loss of independence, not pain (n.d., para 16). Clearly, people dread potential

disability so much that they would rather die than need help. Elderly and impoverished people

have experienced similar problems. According to DREDF those relying on Medicare and

Medicaid, which are both low-cost healthcare plans for the poor and elderly, have already

experienced significant problems with the assisted suicide laws. Many times these insurance

plans have refused to pay for doctor prescribed treatment plans which would sustain life, and

instead offered assisted suicide (para. 22 & para. 29). At the present time, the cost of assisted

suicide ranges “between $400 and $500” (Death with Dignity FAQs, n.d., para. 8), which is well

below treatment costs of for those who wish to fight for life. If these organizations are more

interested in saving money than saving lives, it is explicitly obvious that best interests of those

with terminal illness are not being protected.

Safeguards employed are also problematic. DREDF notes that although there has been a

great deal of propaganda surrounding assisted suicide, much of the information is devoid of
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facts. For instance, articles and brochures in Oregon claimed that only the person who wanted to

use assisted suicide could request it. Yet, this is not written in the law. However, it is noted that

family members or heirs may speak for the patient to request assisted suicide. Another problem

is that witnesses are not required (para. 40 & 42). Even if a patient decides to change his or her

mind, it would be easy for a family member or heir to give the unknowing patient medication

with little risk of legal repercussion. Based on these problems the law is not protecting patients,

but it is making it easy for murder to occur. Safeguards are also failing those who have mental

health problems. “Researchers have found hopelessness, which is strongly correlated with

depression, to be the factor that most significantly predicts the wish for death (Hendin & Foley,

2008, p. 128). Because of this, a reasonable person would assume that a psychiatric evaluation

should be necessary for those requesting assisted suicide; but, this is not a requirement (p. 128).

In fact, only “6% of all patients who completed the qualification process” (Coombs, B., 2014, p.

97) have been referred to a psychiatric professional for an evaluation. Furthermore, that

“percentage has diminished over the years, as in the early years some providers referred every

requesting patient for a psychological evaluation” (p. 97). Although doctors were concerned with

psychiatric conditions early on, this consideration seems to have been disregarded as essential

over time. Since the enactment of the law there have been many reported cases of patients with

histories of depression being prescribed legal doses with no referral to mental health providers

(Hendin & Foley, 2008, p. 128-130). If the mental health of patients is not being tested then

safeguards are failing. As DREDF explains, even when physicians do determine that patients are

ineligible for assisted suicide because of psychiatric conditions or coercion, many patients just

doctor shop until they find a willing physician. In fact, the only safeguard that has shown to be
 Assisted Suicide 8

effective is one that protects doctors. So long as doctors claim to have acted in good faith, they

are granted complete immunity in both criminal and civil proceedings (para. 56 & 66).

Unfortunately, this shows that the priority of safeguards is not to keep patients safe.

Due to the enormity of problems with the law, in both moral and practical senses, we

should instead focus our attention on improvements to palliative care. According to Connor,

Pyenson, Fitch, Spence, & Iwasaki, hospice aims to dispense needed care to terminal patients

and family members with an emphasis on fulfilling their various needs (p. 238). It has been

demonstrated that receiving palliative care at a reputable facility is actually proven to increase

life expectancy. For people who borderline between life and death “constant attention to their

emotional well-being and physical health may increase their desire to continue living” (p. 245).

In these cases, patients are assessed and treated for depression if necessary, their spiritual and

physical needs are met, and they feel cared about. The responsibility to assist them is not on their

family members, which means they do not feel like a burden. When patients are motivated to

survive they look towards curative treatment instead of those which will accelerate death, and

many patients do survive or outlive their prognosis by years. Increased funding to palliative care

means we can give more patients a desirable outcome. Even when patients do succumb to

illness, providing comfort care gives them a peaceful, nurtured end of life.

Supporters of the law claim that safeguards are adequate to ensure abuse does not

happen. Barbra Lee Coombs has written extensively on assisted suicide citing the law in Oregon.

She tells us that in Oregon, the patient is supposed to request assisted suicide at least three times.

Two of the requests must be verbal and one written. Patients must make the decision on their
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own, without influence of others (2014, para. 3). As previously discussed, the fact that family

members or heirs may make the request for patients disqualifies Coombs argument that it must

be free of outside influence. Nonetheless, research was done by a team employed by the Oregon

Public Health Division to discover why people requested assisted suicide, and to identify

possible failings of the law. Two years later the same team did research again and validated their

previous conclusions. Based on this research, Coombs surmised the law is operating as planned,

and “the risk of harm is small when the law authorizes terminally ill, mentally competent adults

to access medication that they may self-administer for peaceful dying” (para. 22). What Coombs

fails to explain is that the reliability of the research is dubious. “Reliability is a matter of whether

a particular technique, applied repeatedly to the same object, yields the same result each time”

(Babbie, 2014, p. 152). Having done the research twice hardly qualifies as “repeatedly”, and the

fact that the research was done by the same group also devalues their conclusions. In order to

avoid researcher bias, it is important that the research be done by multiple research teams

(Babbie, 2014, p. 153). Not only was a second team not used, the Oregon Public Health Division

refused to “permit independent investigators to examine the data” (Hendin & Foley, 2008, p.

122). Even more alarming is that other states who have legalized assisted suicide have closely

followed the methods and laws of Oregon. Furthermore, self-administration of the drug is also

questionable. As stated in the article by DREDF, there is no mention of self-administration in the

act (n.d., para 40). This means that there is no legal protection to guarantee that patients take the

drug of their own accord.

I do agree with the claim that the low cost of assisted suicide takes the financial burden

off family members. However, this simply means the terminal patient is made to feel like a
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burden. According to research by DREDF, 12% of patients reported feeling like a financial

burden in 1998. That number has steadily risen up to 45% in 2007 (n.d. para 47). It seems that

the longer assisted suicide is in place, the more pressure patients feel to unburden their family

members by dying quickly and uneventfully.

The efforts to pursue assisted suicide are at best, a misguided attempt to empower the

dying. At worst, it is a money saving effort that exploits the most disadvantaged part of our

population. If we truly want to uphold dignity in the dying we must do so by removing barriers

to their dignity, such as offering suitable pain control and making them feel valued, and loved at

the end of their lives. We must also be vigilant to make sure that we do not cheat individuals of

the time they may have left. If we insist on keeping assisted suicide laws, we will lose people

who could have survived their illness. Life is valuable, and it should be treated as such. We

cannot be so quick to speed our deaths. We need to live, or die trying.

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References

Allmark, P. (2002). Death with dignity. Journal of Medical Ethics, 28, 255-257. Retrieved from

http://pmj.sagepub.com/content/28/7/931.full

American Medical Association. (n.d.) Retrieved from http://www.ama-assn.org/ama/pub

physician-resources/medical-ethics/code-medical-ethics/principles-medical-ethics.page

Babbie, E. (2014). The basics of social research. (6th ed.). Belmont, CA: Wadsworth Engage

Learning.

American Medical Association: Opinion 2.211. (1996). Retrieved from http://www.ama-

assn.orgama/pub/physician-resources/medical-ethics/code-medical-ethics/

opinion2211.page?

Baeke, G., Wils, J.P., & Broeckaert, B. (2011). We are (not) the master of our body’: Elderly

Jewish women’s attitudes towards euthanasia and assisted suicide. Ethnicity & Health,

16, 259-278. doi: 10.1080/13557858.2011.573538

Center for Disease Control and Prevention, (2015). Retrieved from http://www.cdc.gov/nchs/

fastasts/suicide.htm

Connor, S., Pyenson, B., Fitch, K., Spence, C., & Iwasaki, K. (2007). Comparing Hospice and

Nonhospice Patient Survival Among Patients Who Die Within a Three-Year Window.

Journal of Pain and Symptom Management, 33, 238-246. doi:10.1016/j.jpainsymman.

2006.10.010

Coombs, B. L. (2014). Oregon’s experience with aid in dying: Findings from the death with

dignity laboratory. Annals of the New York Academy of Sciences, 1330, 94-100. doi:

10.1111/nyas.12486
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Death with Dignity FAQs. (n.d.). Retrieved on June 15, 2016 from https://

www.deathwithdignity.org/faqs

Death with Dignity: Religion and Spirituality. (n.d.). Retrieved on June 11, 2016 from http://

www.deathwithdignity.org/learn/religion-spirituality/

Delkeskamp-Hayes, C. (2003). Euthanasia, physician assisted suicide, and christianity’s positive

relationship to the world. Christian Bioethics. 9, 163-185. doi:1380-3603/03/0902-3-163/

Ma, L., Chen, S., Zhou, M., & Zhang, J. (2012). Social axioms and implicit attitudes about

people with disabilities. Social Behavior and Personality, 40(2), 251-258. Retrieved from

http://sx.doi.org/10.2224/sbp.2012.40.2.251

Smith, W. J. (2015, April, 15). Assisted suicide is not compassion. Charlotte Lozier Institute.

Retrieved on 05/29/2016 from http://lozierinstitute.org.assisted-suicide-is-not-

compassion/

Teno, J.M., Plotzke M., Gozalo P., & Mor V. (2014). A national study of live discharges from

hospice. Journal of Palliative Medicine, 17, 1121-1127. doi: 10.1089/jpm.2013.0595

The Argument from Pascal's Wager. (n.d.). Retrieved on June 11, 2016 from: http://

www.peterkreeft.com/topics/pascals-wager.htm

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