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The Ethics of Physician-Assisted Suicide

Esmeralda Ayala

California State University Channel Islands

HLTH 307-003: Issues and Ethics

Professor Ashley Winans

May 12, 2023

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Physician-assisted suicide is the voluntary termination of one’s own life by

administration of a lethal substance with the direct or indirect assistance of a physician (Marks,

2021). Physician-assisted suicide is also known as PAS or Aid-In Dying known as AID. In the

1800’s a man by the name Samuel Williams proposed a dose of morphine to end a patient’s life

(Herath et al., 2021). During the 1980’s Jacob Kevorkian from Detroit, MI started spreading the

word through newspapers to let the public know of lethal medications to end one's life, as he was

considered to be a death counselor (Dugdale et al., 2019). In 1990, Kevorkian had his first patient

take her life with his assistance (Dugdale et al., 2019). In some cases doctors were even

considered to be murderers and were incarcerated due to the action (Dugdale et al., 2019). Even

though doctors around the world were administering this service, it didn't mean it was legal. To

this day, physician-assited suicide was and still is prohibited in other countries or states. People

with Terminally ill diseases should have the right to take their own life; Therefore,

Patient-Assited Suicide should be legal in more states and countries.

Oregon became one of the first states in the United States to pass its death with dignity

Law in 1997 (Dugdale et al., 2019). Along came Washington legalizing PAS in 2008 and

Vermont in 2013 (Dugdale et al., 2019). It wasn’t until after Brittany Maynard who was

diagnosed with a terminally ill disease, who decided to move from California to Oregon to go

through the process of the physician-assisted suicide in 2014 (Dugdale et al., 2019). After

Maynard became an advocate for PAS, and after her passing, the state of California then

legalized PAS in 2015. Since then Colorado, the District of Columbia, Hawaii, New Jersey and

Maine have also legalized physician-assisted suicide (Dugdale et al., 2019). Some of the

countries who also legalized physician-assisted suicide were Switzerland, the Netherlands,

Belgium, Luxembourg, Austria, Spain, Columbia and Canada (Montagna et al., 2023). Although
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many of these states and countries were in favor of physician-assited suicide, others have

opposed it due to the ethical concerns with PAS.

Patients deserve to be respected and even so more when it comes to their own medical

decisions. Having patient autonomy ensures the patient that their medical decisions will be

respected regardless of what their physicians recommend. Studies have been conducted within

groups of physicians to collect data as to whether or not physician-assisted suicide should be

legalized. From 2015 to 2016, a study was evaluated to test the point of views and needs of

physicians and health care workers in a Canadian hospital (Frolic et al.,2022). The goal for this

study was to help health care professionals understand the patient's last will and to help aid in a

PAS situation. Based on the findings of this study, it was found that nearly more than 90% of the

participants supported the idea of PAS (Frolic et al., 2022). Many of the participants found

themselves in disbelief as they knew this was breaking their Hippocratic Oath. Hippocratic Oaths

were created over 2,400 years ago (Kopel, 2022). This ceremonial oath is taken by physicians to

vow that they will help the sick and do no harm to them (Kopel, 2022). One participant even

stated, “It is against everything we learned as nurses” (Frolic et al., 2022). Although some

physicians feel they are breaking their oath and this goes against everything they believe in,

others argue,”the relief of suffering through lethal ingestion is humane and compassionate if the

patient is dying and suffering is refractory” (Dugdale el al., 2019). Nonetheless, physicians

understand and respect the patient’s autonomy when it comes to physician-assisted suicide.

When dealing with a terminally ill patient, most of the time the doctors and families do

not know what the person’s last wishes are before they leave this earth. Of course, not unless a

written will is left behind. However, beneficence requires doctors to do what is best for others

when it comes to their well being. In the case of PAS, the doctor must administer and care for the
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ill patient (Akdeniz et al., 2021). Even if that means taking their own life when they are ready to

do so, alongside with their family. If a terminally ill patient decides to follow the route of PAS,

they are under the care of the doctor. The doctor explains all of the knowledgeable information

that the patient and their family need to know during the process of PAS. Many of the patients

who decide to do physican-assited suicide, they do it to end their pain and suffering. They would

rather do this before the disease takes over their body and mind while they are still coherent.

One other thing about PAS is that it is also less expensive to administer it than to do an

end-of-life care. With that being said, it definitely takes away the financial burden off of the

family while administering the PAS process. PAS can decrease the amount of suffering between

the family and the patient as everything is planned out accordingly with time by the patient

(Frolic et al., 2022). It has been stated by (Dugdale et al., 2019), that up to half of the patients

with cancer suffer from symptoms of depression. Within the processes of PAS, it is important for

the patient and family to receive the support they need from their physician and friends.

Psychotherapy is the treatment of mental or emotional disorder or of related bodily ills by

psychological means (Merriam-Webster, n.d.). This therapy is for patients that may be mentally

ill or have emotional difficulties. Cancer patients can be emotionally distressed and

psychologically distressed. Psychotherapy helps cancer patients cope with the challenges of the

terminal illness (Saracino et al., 2019). According to (Saracino et al., 2019), the three goals to

psychotherapy are to one, help promote a supportive environment and have patients inspect their

personal issues and feelings that surround them. Two, to give a better understanding of the

possible resources available before and after diagnosis. Three, help patients to discover the sense

of meaning in life even when their illness progresses. When it comes to a patient and physician

relationship, through out the process of physician-assisted suicide it shows that physicians are
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there to do good acts of kindness. This shows that beneficence is a good ethic benefit for both the

patient and physician.

As physicians hold under oath to not harm others, nonmaleficence is the principle of

withholding from causing any unnecessary harm (Akdeniz et al., 2021). Even though it may

seem wrong for the physician to support and be part of PAS, people may feel that physician’s are

inflicting pain towards the patient but in reality they are not. The physician’s obligation here is to

adhere to his oath which does not inflict harm to others. In this case, the physician is relieving the

patient from all their pain and suffering. In no way are they hurting the patient other than

accepting the patient's last wishes.

Everyone deserves to be treated fairly, no matter where they’re from, what their ethnicity

is, gender, sexuality, and wealth. In medical ethics, justice plays an important role when it comes

to a patient who is terminally ill. With justice, the patient feels secure that they will be treated

fairly during the process of PAS and that their confidentiality will be respected. Medical

resources are often limited and should be administered fairly and equally (Akdeniz et al., 2021).

It is the responsibility of the physician to provide equal medical care by providing the terminally

ill patient with the resources they need and educating them by providing them with the

information they need to know about the PAS process (Akdeniz et al., 2021). By educating the

patient with the information they need to know about their disease and about PAS, it shows a

good communication skill set between physician and patient. This builds a strong relationship

between both physician and patient. It also makes the patient feel comfortable knowing that

everything will be taken care of once they decide to leave this world. Even though patients have

the right to make their own choice, physicians should provide the patient with every medical

option they can get their hands on and what the outcomes are for each possible option (Akdeniz
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et al., 2021). Justice helps people maintain good health. If we didn’t have justice in a medical

setting, patients would not trust the physician, the medicine or the treatment.

As stated before, Patient-Assisted Suicide should be legalized in more states and

countries to help terminally ill patients alleviate their pain and suffering. Since Physician-Assited

Suicide was implemented we have seen a rise in this program in a span of a 5 year period

(Montagna et al., 2023). With the rise of PAS, many may see this as a positive thing, an

achievement for something great. Something good that a terminally ill patient can take advantage

of. While others may see the increasement of cases as something negative, something to be

worried about. With autonomy, only the patient has the right to make their own medical choices

and their choices are well respected. Family members are there to only provide their love and

support for the patient. Beneficence is an act of kindness, physicians are there to help patients

with their wellbeing and the patient benefits from this act of kindness. When it comes to

non-maleficence, the physician is under oath and his duty is to protect the patient and do no harm

to the patient. Lastly, justice, with justice, patients get treated fairly. Resources and medical

attention are equally provided to the patient as well. Making physician-assisted suicide a well

thought out plan for a terminally ill patient.

To conclude, I think it is important to keep the patient well educated on the aspects of

their disease and the options of treatment they can select from. During the process of

Physician-Assisten Suicide both parties, the patient and the families will endure mental and

emotional distress. Psychiatrists can provide the psychological help they will need. Despite of

everyones beliefs and traditions, physician-assited suicide has helped terminally ill patients and

their families find the peace they were looking for. The decision- making is up to the patient and
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with the good communication of the physicians, patients can now rest in peace as they leave this

world on their terms.

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References

Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care.

SAGE Open Medicine, 9, 20503121211000918.

https://doi.org/10.1177/20503121211000918

Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Pros and Cons of Physician Aid in Dying.

The Yale Journal of Biology and Medicine, 92(4), 747–750.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913818/

Frolic, A., Murray, L., Swinton, M., & Miller, P. (2022). Getting Beyond Pros and Cons: Results

of a Stakeholder Needs Assessment on Physician Assisted Dying in the Hospital Setting.

HEC forum : An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues, 34(4),

391–408. https://doi.org/10.1007/s10730-022-09492-w

Hetzler, P. T., 3rd, Nie, J., Zhou, A., & Dugdale, L. S. (2019). A Report of Physicians' Beliefs

about Physician-Assisted Suicide: A National Study. The Yale Journal of Biology and

Medicine, 92(4), 575–585.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913834/

Kopel J. (2021). The Hippocratic Oath across the interfaith spectrum. Proceedings (Baylor

University. Medical Center), 35(2), 266–269.

https://doi.org/10.1080/08998280.2021.1993113

Marks J. (2021). Medical Definition of Physician-assisted suicide,

https://www.medicinenet.com/physician-assisted_suicide/definition.htm. Accessed 6 Apr.

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Montagna, G., Junker, C., Elfgen, C., Schneeberger, A. R., & Güth, U. (2023). Long-term

development of assisted suicide in Switzerland: analysis of a 20-year experience

(1999-2018). Swiss Medical Weekly, 153, 40010.

https://doi.org/10.57187/smw.2023.40010

“Psychotherapy.” Merriam-Webster.com Dictionary, Merriam-Webster,

https://www.merriam-webster.com/dictionary/psychotherapy. Accessed 6 Apr. 2023.

Saracino, R. M., Rosenfeld, B., Breitbart, W., & Chochinov, H. M. (2019). Psychotherapy at the

End of Life. The American Journal of Bioethics : AJOB, 19(12), 19–28.

https://doi.org/10.1080/15265161.2019.1674552