The Assisted Suicide Debate

Assisted Suicide: The Debate

Brittany Maynard’s 2015 video posted by the British newspaper The Guardian is heartbreaking testimony to the intelligence and the forethought this young woman placed into her decision to request life-ending medication. It highlights that individuals who reject palliative sedation for the terminally ill do so because, like Maynard, they are afraid of the suffering and the loss of functioning that this can cause. Given that patients like Maynard have already lost significant functioning and quality of life (Maynard had brain cancer), forcing them to take matters into their own hands and try to orchestrate their own suicides without the assistance of a physician seems cruel.

A physician should always be a facilitator of improved quality of life and wellness, and while this usually means helping the patient lead a better and higher quality of life, in Maynard’s instance, a peaceful death was her goal, rather than enduring an agonizing death or artificially prolonged life. Of course, Stephanie’s story (2015) is incredibly moving, and she shows great courage in the face of her suffering and the uncertainty of her own life. But it is not fair to compare the two existences of these two women—their pain, their challenges, and the stages of their disease are all unique.

Even though Stephanie has made one choice and Maynard made another does not make one more valid than the other. What I disagree with Stephanie is that allowing some individuals to make a choice of assisted suicide invalidates her own. Ultimately, choice is what matters. It is also very difficult to compare the pain tolerance and outlook of different diseases. I disagree that the choice of a terminally ill patient—in pain, and potentially debilitated—who is making a choice while still competent to end their life is “giving up,” as Stephanie says. It maybe they are merely giving up pain, not giving up on life.

Patients making choice to die with dignity, is rather, like all life decisions, making a choice which is best for themselves, after consulting with friends and family members, and the guidance of a trusted medical provider. Making physician-assisted suicide illegal merely takes the physician out of the equation. It will not cure terminal illnesses, stop mental and physical suffering from disease, and will merely force patients who desire to die with dignity to seek treatment elsewhere.

It should be noted that in both cases of the women in the video, neither suffered from clinical psychiatric disorders. In a few countries, severely affected patients with psychological and well as physical disorders can request assistance in dying (the Netherlands, Belgium, Luxemburg) but this raises questions about competency as well as what types of illnesses are deemed to be acceptable to include under the law as permissible (Grassi et al, 2022). Regardless, Maynard clearly wished to have assistance in passing before she became incapacitated by her brain tumor.

Of course, ethical issues do arise when a physician must evaluate the relative mental competency of the patient, and determine if the patient is genuinely terminally ill or rather is depressed or otherwise mentally distraught from the understandably draining mental and physical suffering caused by living with a terminal illness. Critically ill patients deserve psychological as well as physical care. The patient’s wishes should be evaluated in privacy with the healthcare provider as well in the presence of family members, to determine that the patient is genuinely expressing his or her will, versus the desire of family members.

However, despite the ethical reservations a physician might experience in facilitating dying rather than the preservation of life, a physician must also commit to wellness, the wishes of the patient, and evaluating the relative quality of life. Only the patient knows what it is like to live within her body and mind at that present moment. The physician can give advice about disease progression, but should not make a moral judgement of the patient.