Assisted Suicide When We Think of Assisted

Assisted Suicide

When we think of assisted suicide, most of us immediately think of Dr. Jack Kevorkian, the retired pathologist who was sentenced to two terms of imprisonment in 1999 for helping a man suffering from a terminal disease to die (Humphrey 2002). Assisted suicide is a very passionate issue of debate in this country. There are numerous ethical and moral considerations aside from the legal aspects of the practice. The topic is as controversial as abortion and capital punishment. Most everyone has a deep-rooted belief one way or the other, they are either for or against, few ride the middle ground. It has been my observation that those in favor of pro-life are more likely to favor capital punishment and oppose assisted suicide, and those in favor of abortion and assisted suicide are more likely to oppose the death penalty. It is indeed a passionate issue and will continue to be debated for years to come.

There is a difference between physician-assisted suicide and euthanasia. Physician-assisted suicide is a death assisted by a qualified medical practitioner who is acting on behalf a competent, terminally ill patient who wishes to end his/her own life. This is usually achieved by means of lethal injections. Euthanasia, a word taken from a similar Greek word meaning 'easy or good death,' is basically mercy killing, a decision usually decided by the physician and/or family members. It is the act of mercifully ending the life of a hopelessly suffering patient (American pg). Passive euthanasia is the ending of a patient's life by withholding or withdrawing life-sustaining treatments. Active euthanasia is achieved by causing a virtually painless death by means without which life would continue naturally, usually referring to lethal injections. Suicide is the act of taking one's own life voluntarily and intentionally (American pg). And herein lies the debate.

Society at large generally accepts the withholding of intravenous fluids and artificial feedings in cases where the patient is thought to have no chance of survival or quality of life. Many people are including such passages in 'living wills' along with 'do not resuscitate' orders. In cases where a patient has no living will, the decisions to withhold life supporting techniques are usually carried out by the patient's loved-ones with physician consultation (Death 2002).

Euthanasia is quietly used as a means to end the suffering of a terminally ill patient nearing the last stage of the dying process, although it is illegal in every state. It is practiced throughout the country by most physicians as a means of eliminating the needless suffering of a patient who is at the threshold of death. The most common practice of euthanasia by physicians is the increased dosage of pain medication on terminally ill patients to ease their suffering but with the knowledge that it will speed the death process (Death 2002). This is a fairly common and accepted practice by physicians and society, except in cases prohibited by religious beliefs or moral ethics. This is referred to as the Double Effect and is legal across the country. Since the intention of the physician is to provide comfort care for the patient and not actual death, it is not legally considered euthanasia (Death 2002).

Informed adults with decision-making capacity almost always have the legal and ethical right to refuse any recommended life-sustaining medical treatment. The patient has this right regardless of whether he or she is terminally or irreversibly ill, has dependents, or is pregnant. The patient's right is based on the philosophical concept of respect for autonomy, the common-law right of self-determination, and the patient's liberty interest under the U.S. Constitution" (American pg).

In 1994, death with dignity became an end-of-life care option with the popular passage of the Oregon law. Death with dignity is not euthanasia, which is illegal throughout the United Sates. Death with dignity is unique and has become the catalyst for improvements in the end-of-life process (Death 2002). Death with dignity is known in the medical and academic literature as physician-assisted suicide. Under the Oregon law a 'mentally competent state resident with a terminal diagnosis and a prognosis of less than six months to live, may request a life-ending prescription from their physician, however, this prescription must be self-administered' (Death 2002).

According to Lisa Vincler from the University of Washington, there are significant distinctions between law and medical ethics in philosophy, function and power.

A court ruling is a binding decision that determines the outcome of a particular controversy.

A statute or administrative code sets a general standard of conduct, which must be adhered to or civil/criminal consequences may follow a breach of the standard. Conversely, an ethics pronouncement which is not adopted into law may be a significant professional and moral guidepost but it is generally unenforceable. Lawmakers (courts and legislatures) frequently do turn to the policy statements (including any medical ethics statements) of professional organizations when crafting laws affecting that profession. Thus, health care providers may greatly influence legal standards by their work in creating professional ethics standards" (Vincler 1998).

According to Vincler, good ethics is the beginning where the law ends. The moral conscience of society is the precursor to the development of legal rules for social order, thus law and medical ethics share the common goal of creating and maintaining social good (Vincler 1998). This symbiotic relationship is perhaps best expressed in a quote by author William Somerset Maugham, " Conscience is the guardian in the individual of the rules which the community has evolved for its own preservation" (Vincler 1998).

The fourth edition of the American College of Physicians Ethics Manual examines the issues of physician-assisted suicide and euthanasia. It states that "Laws concerning or moral objections to physician-assisted suicide and euthanasia should not deter physicians from honoring a decision to withhold or withdraw medical interventions in appropriate situations" (American pg). However, many fear that many physicians are not adequately trained to arrive at such conclusions with their patients.