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What is the morality of legalizing physician assisted suicide in the United States?

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What is the morality of legalizing physician assisted suicide in the United States?

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Although the act itself goes by a number of names depending on the state or even the individual doctor, the definition remains the same. It is legally defined as the practice of a physician providing a competent, terminally ill patient with a prescription for medication that will be taken with the primary intention of ending their life.

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Physician assisted suicide is currently only legal in ten states: Oregon, New Jersey, Maine, California, Colorado, DC, Montana, Washington, Hawaii, New Mexico, and Vermont. Oregon was the first state to legalize it in 1994 Oregon's Dignity in Death Act which was significant in not only changing the perception and stigma surrounding patients who go through with this but also leading the way to other states legalization. Above is a map which shows the states where it is legalized or pending.

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The criteria in the United States currently 

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The criteria in the United States currently 

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As of right now in the United States, though it varies slightly in state to state, the criteria of a patient who would be a candidate are as follows: the patient must be at least 18 years old, been diagnosed with an incurable terminal illness with a prognosis of 6 months or less to live, have tested as psychologically stable, are well informed of all hospice and other pain management treatment options, and are able to administer the lethal medication themselves without assistance from others.

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Should this criteria be changed to be broader or more restrictive?

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Should this criteria be changed to be broader or more restrictive?

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While it is not currently allowed in the US, most other nations that allow physician assisted suicide include non terminal illnesses as valid reason to end their lives. The label is much wider there and allows for those with mental illness to seek out physician assisted suicide along with those with physical illnesses. Essentially anything that makes a patient's life unenjoyable is an approved reason. Should the United States follow and do the same in broadening the acceptable conditions? This has sparked a lot of controversy and brings up other more targeted conversations of what the ethics of physician assisted suicide really are. There is truly no correct answer to this as it is so specific to each person who wishes to go through with physician assisted suicide. How can the government draw the line when each individual has a different threshold of what is livable and what isn't?

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According to bioethics philosophers Tom Beauchamp and James Childress who published the well-known textbook 'Principles of Biomedical Ethics", there are numerous reasons why doctors may support physicians assisted suicide in a way that still remains ethical. One of the top reasons being the importance of a patient maintain their autonomy over themselves which includes choosing to accept/deny treatments and choosing how and where they die. Another reason seen in Beauchamp and Childress's text textbook is the idea as the core of medicine itself is the aim to relieve suffering, physician assisted suicide is an extension of this merciful release of suffering. When there is nothing further that can be done to cure a patient, isn't it more merciful to give them back their autonomy and relieve them of their pain?

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There are a multitude of reasons as to why a doctor may refused to be part of as assisted suicide. This is very personal to each individual but across my research I have seen some general trends. For some it goes against their religious beliefs or their morals. Others don't support it because the AMA doesn't support it. Others worry about the effects it may have on our populations suicide rates as a whole despite there being little effort that suicide rates have increased in states where it is permitted.

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There are numerous benefits that would come from country-wide legalization of physician assisted suicide. Currently, the US Supreme Court does not consider assisted suicide a right to be decided by the government which leaves the decision up to each state themselves. This is problematic as it not only means that people in 40 states don't have that option but also because it means there are no country wide standards or regulations in place. Right now, not even the AMA (American Medical Association) has released a set of standards for physicians to follow and without this guidance, there is very little regulation about the whole process. If it was legalized everywhere in the US, countrywide regulations and rules could be set to ensure that the patient's best interest are always the priority.

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Why would a patient be considering this?

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Why would a patient be considering this?

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Patients could have a wide variety of reasons for considering this depending on their individual diagnosis and their perspectives on how they want to spend the end of their lives. Based on a study done in Oregon on patients who sought out physician assisted suicide, some of the reasons include “losing autonomy” (90.6%) or are “less able to engage in activities making life enjoyable” (89.1%), some fear a “loss of dignity” (74.4%), being a “burden on family, friends/caregivers” (44.8%), or “losing control of bodily functions” (44.3%) and concerns about inadequate pain control in 25.7% of cases. (data taken from Oregon's Dignity in Death Act). It all comes down to a similar core idea of trying to retain a sense of self or control in how their life ends when so much choice has already been robbed from them with their illness.

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The perspective of a woman who went through with physician assisted suicide

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The perspective of a woman who went through with physician assisted suicide

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While I was researching, I found this article as a source cited for a different article that I was reading, and I found it really eye opening to see the firsthand perspective of someone who went through with physician assisted suicide. So often in this topic do we see this issue presented as an ethical decision that doctors must make rather than the equally important side of how physician assisted suicide impacts that patient and those close to them. Sandy Bem was in her 60's when she began to mentally and cognitively decline which led to her diagnosis of early onset Alzheimer's. Prior to her diagnosis, she was a renowned gender and sexualities professor at Cornell who prided herself on her ability to think deeply and originally. After much deep thought, Sandy decided that she did not wish to continue on if her illness took away what made her herself and felt a sense of control and peace in her remaining time knowing she wouldn't have to endure that suffering that comes from loss of self. There are thousands in similar positions to Sandy in states where physician assisted suicide is not legal. Those not given the choice, along with their supporting family members and friends, are subjected to unnecessary suffering that comes with prolonging the life of someone who is tired of fighting.

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The Last Day of Her Life (Published 2015)

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When Sandy Bem found out she had Alzheimer’s, she resolved that before the disease stole her mind, she would kill herself. The question was, when?

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Is it possible legalization could be detrimental to lower income people with poor access to health care?

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Is it possible legalization could be detrimental to lower income people with poor access to health care?

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This article brings to light the possibility that chronically ill lower income citizens with poor access to health care may become victims to more easily accessible physician assisted suicide. As they don't have the resources provided for them to adequately treat their disease and keep comfortable, some are turning to prematurely ending their lives in order to end their suffering. The writers of this article bring an interesting point of view that is not strictly criticizing the legalization of physician assisted suicide but instead criticizing the lack of support disability services citizens along with the lack of quality health care available at affordable rates.

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Are Canadians being driven to assisted suicide by poverty or healthcare crisis?

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Critics argue laws are being misused to punish the poor but experts say cases represent country’s failure to care for its most vulnerable citizens

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The most cardinal rule that everyone knows that doctors must follow is first and foremost "do no harm". Physician assisted suicide by definition breaks this oath... or does it? Is it an act of mercy or unethical to allow a patient to die under a doctor's orders? This topic was first brought to my attention while I was in high school, and I was intrigued with the layers of complexity it had. There is no definitive "right" or "wrong" side to such a personal, sensitive topic. As I intend to pursue a career in medicine one day, it is possible I may have to someday decide for myself, as a physician, if this is something I morally agree with or disagree with and how this may affect my patients' care. Throughout my research, my questions have only grown as I've gained more perspectives both pro and con, patient/doctor, and the states opinion on the legality and morality of physician assisted suicide. I believe that if I am to one day become a doctor, being educated on all types of sources in this matter from emotional personal anecdotes to scientific journals is of the utmost importance.

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Focus: Death: Pros and Cons of Physician Aid in Dying - PMC (nih.gov)

Links to an external site.

States with Legal Medical Aid in Dying (MAID) - Euthanasia - ProCon.org

Links to an external site.

Assisted Suicide: A Right or a Wrong? - Markkula Center for Applied Ethics (scu.edu)

Links to an external site.

Are Canadians being driven to assisted suicide by poverty or healthcare crisis? | Canada | The Guardian

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I found this article to be very helpful in my research as it offered the health care workers point of view on physician assisted suicide along with statistical data to back it up. With the sensitivity needed to do this topic justice, it was very important to me to thoroughly cover all angles possible. Above is a statistical chart with the varying specialties and correlations in their feelings towards physician assisted suicide.

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*From the Veterans Affairs Medical Center, Philadelphia, Pennsylvania.

†From the Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

‡From the Center for Bioethics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

§From the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.

¶From the Department of Operations and Information Management, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.

Supported by a grant from the University of Pennsylvania Cancer Center. Dr. Asch is the recipient of a Department of Veterans Affairs Health Services Research Career Development Award.

Address correspondence to: David A. Asch, MD, Division of General Internal Medicine, 317 Ralston-Penn Center, 3615 Chestnut St., Philadelphia, PA 19104-2676.

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Euthanasia Among US Critical Care Nurses: Practices,... : Medical Care

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60 US critical care nurses, of whom 1,139 (73%) responded. Nurses were asked to report whether they had received requests to engage in euthanasia and whether they had engaged in euthanasia. In addition, nurses were asked to respond to items assessing their attitudes toward end-of-life care. Results.