Proponents and opponents
Physician-assisted suicide is a long-discussed issue that has raised significant ethical concerns. The issue has in the past elicited more negative reactions that have significantly depressed efforts to review its pros and give it a deserving legal standing. The religious condemnation this issue receives whenever it is mentioned has traditionally strengthened the rigid approach to and negative attitude towards physician-assisted suicide (Gopal, 2015). Cases of physician-assisted suicide in the early twentieth century were discussed. Patients could hardly be accorded the quality of life they needed if the quality of life involved taking the patient’s life. In 1976, a New Jersey Superior Court denied Karen Ann Quinlan’s parents a request to have the patient removed from a ventilator even though the patient had stayed on the ventilator for months without hope of recovery (Ann, n.d). The Supreme Court later reversed the ruling with the argument that the patient had a right to privacy which also involved removing her from the ventilator.
Analytically, the Supreme Court did not vividly term physician-assisted suicide legal. Instead, the Supreme Court cushioned it under the privacy aspect, indirectly legalizing it without drawing too many critiques to its decision. Open discussions around physician-assisted suicide in the United States started in 1967 with the inception of the right-to-die movement (Gopal, 2015). Such movements opened room for a positive lens from which different critiques and scholars have addressed the ethical concern. In the United States, at least four states have legalized physician-assisted suicide-Oregon, Vermont, Montana, and Washington. The sluggish inception of Physician-assisted suicide across the United States raises significant questions about its pros and cons. This analysis digs into physician-assisted suicide’s pros and cons, its proponents and opponents, and its facts.
Facts around PAS
The global prevalence of chronic health conditions has significantly escalated in the past decades. Despite the massive technological growth and innovation in healthcare, most healthcare settings still face the devastating impacts of chronic diseases (Simmons, 2018). Patients with chronic diseases endure chronic pain that sometimes drives them to opt out the easiest way. Despite the global knowledge of the devastating impact of chronic diseases on patients, only 18 jurisdictions worldwide have legalized physician-assisted suicide (Mroz, Dierickx, Deliens, & Cohen, 2020). However, this number might increase in the coming years because of the heightening public discourse on the constituents of a good death, quality of life, patient autonomy, and end-of-life care. Physician-assisted dying involves physicians knowingly and willingly prescribing a patient a drug that ends their life at the patient’s request.
Physician-assisted suicide is often used as a synonym for euthanasia. However, a thin line distinguishes the two acts of assisted dying in that in euthanasia; the physician actively administers a drug that ends the patient’s life. Contrarily, in physician-assisted suicide, the physician prescribes the drug, and the patient ends their own life by willingly taking it (Mroz, Dierickx, Deliens, & Cohen, 2020). In the United States, only four States-Oregon, Vermont, Washington, and Montana have legalized physician-assisted suicide. The population of people going for PAS is still small, but steady growth is witnessed across states that have so far legalized the act. Research shows that most people going for physician-assisted suicide are more educated and wealthy (Sulmasy, 2019). Whites are more likely to opt for PAS compared to other races.
Proponents of physician-assisted suicide have often highlighted the need to end excruciating pain and death with dignity as some of the primary reasons people opt for physician-assisted suicide. However, the depth of literature on the issue reveals that most patients opting for PAS do so because they have lost control, patient autonomy, and independence (Mroz, Dierickx, Deliens, & Cohen, 2020; Jones & Paton, 2015). This evidence suggests that patients’ families or primary caregivers are rapidly requesting PAS on their patient’s behalf. A patient without autonomy, independence, and control lacks the capacity to seek PAS. However, it is also possible that these patients request PAS when they still have autonomy. Most states that have legalized PAS have also placed legal safeguards to ensure that a patient is worthy of physician-assisted suicide. Essentially, these laws mandate that patients seeking PAS undergo a thorough psychiatric evaluation to ascertain that mental and psychological health problems do not influence their requests. However, a state like Oregon enacted a new law that allows a patient to bypass the waiting period that involved waiting for a psychiatric evaluation.
Patients in Oregon can now take a prescribed pill to end life in less than two days under the Oregon Senate Bill 579. Oregon Senate Bill 2217, recently passed, allows physicians to inject patients with lethal drugs (Sulmasy, 2019). Analytically, states that have signed PAS into law gradually deviate from the original perception of PAS into euthanasia. As discussed earlier in this analysis, the only difference between euthanasia and PAS is that in the latter case, the patient takes the drug alone while the physician’s role is only to prescribe it. The physician’s administration of a lethal drug is only a hair’s breadth away from euthanasia. Legalizing PAS in various jurisdictions has had tremendous implications on psychiatric healthcare. Psychiatrists deal with several psychiatric challenges, some of which involve suicide.
Psychiatrists are responsible for relieving patients of psychiatric symptoms such as suicidal ideation. On the other hand, the dilemma caused by legalized PAS allows patients to fulfill such symptoms as suicidal ideation (Gopal, 2015). The legalization of PAS has somehow reduced the validity of psychiatric treatment by going against the same health problem psychiatrists are supposed to avert. Scientific knowledge on suicide has often claimed that psychological and social problems mostly cause suicide. These problems are often perceived as beyond human control but can be managed by psychiatric intervention. Physician-assisted suicide has come as a solution to mental health problems manifesting their symptoms in suicidal ideation. On the other hand, PAS poses a threat to psychiatric intervention and invalidates the need to assess patients for mental health problems before they can take the prescribed drugs. Physician-assisted continues to raise controversies as the proponents strongly argue for its benefits while the opponents view the issue from a negative lens.
The Proponents of PAS
The proponents of PAS often highlight various benefits linked to medical practice. Death with dignity is a common synonym the proponents of PAS use to refer to the term. In this context, PAS supporters argue that patients with chronic and end-stage diseases often experience excruciating pain (Dugdale, Lerner, & Callahan, 2019). The pain can be extreme for healthcare interventions to manage. Most patients are drawn into a state of despair that reduces them to children. It is not uncommon to witness an adult patient groaning and crying out of pain. Physician-assisted suicide helps patients experiencing pain and despair to have a dignified end. Patients can experience psychological or physical pain. Cluster headaches, commonly referred to as suicide headaches, can also be quite excruciating to patients driving them to commit suicide. Instead of painful suicides, physicians help such patients to go through a painless death that helps them restore their dignity. When Oregon legalized PAS, the state adopted Death with Dignity as the preferred name.
Loss of independence and control of one’s life can devastate individuals. Research shows that as opposed to the majority perception that most patients opt for PAS to reduce pain, most patients opt for physician-assisted suicide because they have lost autonomy, independence, and control of their lives (Dugdale, Lerner, & Callahan, 2019). Patients still need to have control over the circumstances that define their death. The gained control may not come in the original form where the patient actively participates in the decisions regarding their treatments. Patients with debilitating health conditions resort to PAS. A patient may envision a future of suffering and opt to escape this future to have control over their life.
Quality of Care
The proponents of PAS have widely argued that PAS is a safe medical practice as it involves a physician prescribing medication that relieves patients of pain and helps them restore their lost dignity. PAS is one of the most preferred end-of-life care because it provides patients with the peace they desire (Dugdale, Lerner, & Callahan, 2019). States that have legalized PAS have put in place certain safeguards that protect patients against abuse by physicians. The safeguards also mandate that only qualified and registered physicians can take part in assisting the patient through the merciful ending of life.
Relieving Patients and Families of Suffering
The primary aim of medical interventions is to relieve patients of suffering. Suffering may manifest in different forms ranging from psychological to physical. Suffering extends beyond physical pain. Psychological suffering can be more devastating because some patients may not understand or know how to express this pain (Dugdale, Lerner, & Callahan, 2019). The economic and social burden of suffering inflicted on families can be devastating. Chronic and end-stage diseases often leave huge financial impacts on family resources. A patient may opt for physician-assisted suicide to save the family resources and are themselves from suffering.
Opponents of Physician-Assisted Suicide
Arguments against physician-assisted suicide continue to prevail over the proponents’ ideals. Only eighteen states globally have legalized physician-assisted suicide. Opponents of the medical action have laid down several claims ranging from organ donation to advanced depression in chronic illnesses.
Depression is a prevalent mental health problem. Most chronic diseases today present with depression as one of the major symptoms. In their study, Dugdale, Lerner, and Callahan (2019) established that 70% of elderly patients diagnosed with cancer suffer from depression. Depression instills in patients the feeling of hopelessness where they detach from reality and cannot envision a better future. Depression somatically manifests, calling for thorough psychiatric evaluation to provide patients with the most effective interventions. However, in states like Oregon, where a patient is allowed to take the prescribed lethal injection or drug within two days, it reduces the duration required for an effective psychiatric assessment of patients. Most patients caged in this situation may be seeking suicide because of the constant suicidal ideation manifesting as a symptom of depression. In essence, the opponents of PAS argue that it takes away the opportunity for patients to live a better life when they could be admitted to psychiatric hospitals to restore their will to live.
The issue of organ donation has elicited debate across different states. Sulmasy (2019) established that euthanasia and physician-assisted suicide have become major sources of organ donation. While the United States has been reluctant to follow this trend of using PAS as a source of organ donation, the future may take a different trajectory that will see several people in the United States undertaking PAS for organ donation. Organ donation is a lucrative business that can attract the illegal killing of patients in the presence of physician-assisted suicide.
The Slippery Slope
Doctors take a commitment oath that holds them responsible for saving lives. Physician-assisted suicide allows physicians to hasten a patient’s death. Once a doctor takes this path, they slip from the oath, increasing their susceptibility to making slippery decisions. Physicians present patients with information that should guide their decisions in choosing or forgoing physician-assisted suicide. Opponents of PAS have pointed to the growing cases of PAS as an outcome of increased physician coercion of patients to take the PAS alternative among the existing. The opponents of PAS also claim that the rising call to legalize euthanasia in the United States is steered by physicians who have embraced physician-assisted suicide as a quick fix to health cases they find challenging.
One single suicide case in a family may create a thread of suicides. Research highlights that a spike often follows high-profile suicide cases in suicide cases. Family members of patients who opt for suicide become highly susceptible to suicide because they begin to perceive it as an easy alternative (Dugdale, Lerner, & Callahan, 2019). For instance, in 2014, Oregon witnessed high-profile death cases followed by increased suicide cases from lethal injection. States that legalized assisted suicide have witnessed more cases of suicide than states which still hold the act illegal.
Physician-assisted suicide is an ethical issue that has raised discussion across states. Globally, only eighteen states have legalized physician-assisted suicide. In the United States, at least four states have legalized PAS. The proponents of PAS continue to support and call for the legalization of PAS across the United States. The proponents argue that PAS relieves patients of suffering, restores patients’ autonomy, independence, and control, and ensures quality care to patients in their end-stage life. Contrarily, opponents of physician-assisted suicide describe the action as a slippery slope for physicians, suicide contagion, increased depression among patients, and suicide contagion. The arguments from both viewpoints continue to elicit more reaction as the benefits seem worth exploring while the cons present significant implications to public health and policymakers. Perceptively, PAS should remain illegal due to its overwhelming cons.
American Psychiatric Association. (2017). APA Resource Document on Physician-Assisted Death. Retrieved from https://www.psychiatry.org/file%20library/psychiatrists/directories/library-and-archive/resource_documents/2017-resource-document-on-physician-assisted-death.pdf
Ann, K. (n.d). The Story of Karen Ann Quinlan Made Headlines! Quinlan Hospice. Retrieved from https://karenannquinlanhospice.org/about/history/
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Simmons, K. M. (2018). Suicide and Death with Dignity. Journal of Law and the Biosciences, pp. 436–439. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121057/
Sulmasy, D. P. (2019). Physician-Assisted Suicide and the Perils of Empirical Ethical Research. JAMA Network Open. Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2747689