Physician-Assisted Suicide a Review of Relevant Literature

Physician-Assisted Suicide

A Review of Relevant Literature and Popular Opinion

Physician-assisted suicide has become a hot topic of late and many people think it is about these physicians becoming killers. This is not true, however, despite the opinions that many hold. The main problem is that many feel that physician-assisted suicide will give doctors too much control over the deaths of their terminally ill patients. This is not the case, however, as physician-assisted suicide will actually give the terminally ill patients more control over their death, and therefore by extension, more control over their life. Not all physicians would be able to do this in good conscience but there are some, most notably Dr. Jack Kevorkian, that feel that they are capable of this type of practice in order to help the suffering of their patients.

Some patients actually request this because they cannot be helped by any modern means to get better in any way and the pain that they are going through in the process of dying is simply too great for them to bear (Rogatz, 2001). Physician-assisted suicide is not legal anywhere in the United States except Oregon but there are strong opinions that indicate that it is unreasonable to stop physicians from performing this kind of service if it is the patient's desire and the only thing that will ease that individual's suffering (Rogatz, 2001). Naturally, if there are pain medications that will help the patient or if there is some strong chance that the patient can be helped and made to get better by normal medical means this should be undertaken.

For those that are terminally ill, however, this physician-assisted suicide is often seen by those patients to be the best option. There are quite a few arguments that want to keep physician-assisted suicide illegal because of the possibilities for misjudgment and misuse of this procedure (Rogatz, 2001). Others, though, believe that all individuals have a right to control what happens to their own body and that physicians all have a duty to relieve the pain and the suffering that their patients are undergoing (Rogatz, 2001). When a patient is competent society strongly recognizes that individual's right to choose what they want done or not done to their body. Self-determination is one of the rights that competent adults have and these individuals are able to indicate whether they want to have treatments such as life-support withdrawn or withheld should they become necessary (Rogatz, 2001).

Suicide in itself used to be illegal throughout the country but that is no longer the case (Rogatz, 2001). However, Oregon is the only state that allows physicians to help an individual take his or her own life to ease pain and suffering (Rogatz, 2001). When patients seek this type of help assistance can be given to them very humanely and if they are left to themselves they often have a lot of uncertainty and confusion over what they might do (Rogatz, 2001). Many of them also hold religious convictions that are strongly affected by ideas of deliberately taking one's own life. The patient is really the only individual that is able to judge whether death is something that is welcomed or feared and if the patient chooses death as a welcoming alternative to the pain and suffering that he or she is facing physicians should be able to administer humane ways of ending a person's life (Rogatz, 2001).

There are key arguments that are made against this type of physician-assisted suicide. The first one has to do with the Hippocratic oath which indicates that a physician should do no harm (Rogatz, 2001). Some believe that doctors would be receiving a license to kill patients if they were allowed to assist in suicide. There are physicians in Oregon where physician-assisted suicide is legal that have helped patients in this way, and many have branded them as murderers (Rogatz, 2001). This is odd because withdrawing treatment that is life-sustaining such as removing a ventilated or feeding tube is generally accepted by most of society (Kass, 1993). This requires a conscious act of will and a definite action by the doctor yet a doctor in that same area cannot prescribe a medication for his or her patient and then leave it up to the patient when and if he or she wishes to take it, knowing that the outcome will be death (Rogatz, 2001).

It is hard to fathom why the prescribing of a medication to induce a peaceful and tranquil death would be seen as murder when removing a ventilator or other life-sustaining support is not seen in that same way. In either aspect the patient dies and the doctor is the one who has assisted in this (Wellman, 2001). Physicians who comply with pleas from patients that are dealing with a great deal of pain and suffering are actually doing good, and not doing harm as many would suggest (Wellman, 1997).

Another argument made against physician-assisted suicide is that these patients have not received enough control for their pain or they may be depressed and they have not been diagnosed and treated properly (Rogatz, 2001). It is assumed that this is why these individuals consider the ending of their lives. Pain is not the only reason, nor does it appear to be the most popular reason, that these individuals seek physician-assisted suicide (Rogatz, 2001). Many of these individuals are not able to control their bladder or bowel functions, they may have vomiting that cannot be stopped, severe wasting away of their body, no mobility, or a total and complete dependence on other individuals (Rogatz, 2001). These individuals also lose much of their dignity and many of the things that they feel made them human in the past have been lost to them. Because of this many of these individuals seek out physician-assisted suicide so that they may end their lives with at least some dignity left (Dworkin, 1993).

Still another argument against physician-assisted suicide is that the trust that patients and doctors have in one another would be strongly undermined (Rogatz, 2001). This is not technically accurate, however, because a fatal dose of medication is not given to the patient by the doctor (Brock, 1997). The medication is provided at request and the patient then determines whether he or she wishes to take the medication and at what time. There is no concern that the doctor will be coming in to kill the patient at some appointed hour. Individuals that are dying of some kind of terminal disease sometimes take their own lives early on in the disease to spare the pain and suffering that may come for themselves and their families at a later date (Callahan, 1990). If these individuals were aware that physician-assisted suicide was an option to them when the pain and loss of control became too much they would likely remain alive longer and their families and friends would have more time to spend with them.

Other arguments include the fact that patients that wish to commit suicide can do it on their own, but this seems relatively cruel as taking a fatal dose of medication prescribed by a doctor will not induce any type of pain or suffering and will be not nearly as traumatic on the patient and those that the patient leaves behind (Rogatz, 2001). Requests for physician-assisted suicide are not thought to be very frequent, at least in the eyes of those that do not wish the law to be changed, but there are enough individuals that have asked their physicians about this option to warrant a re-evaluation of the laws regarding the rights of a patient and a physician (Rogatz, 2001).

Some believe that permitting physician-assisted suicide would allow for involuntarily euthanizing patients that are frail or elderly and also patients that are incompetent (Rogatz, 2001). There is no strict evidence or logical ground, however, that indicates that this would be so. Adequate protection against any type of abuse of the elderly or infirm would certainly be necessary and important to avoid any type of advantageous euthanasia based on life insurance policies and other issues that other individuals might be able to inherit. There are other arguments that are also made regarding physician-assisted suicide and why it should not take place but there are also many arguments that are in favor of it.

Life is certainly a very precious gift and there are very few individuals that wish to part with it, but under tenuous and painful enough circumstances life loses much of the value that it had (Rogatz, 2001). Individuals that are competent and find that the suffering that they are enduring and the suffering that their family is going through far outweighs the value that they still have in their life should not have to shoot themselves, starve themselves, or jump off of a high place in order to end their lives (Rogatz, 2001). There should be more merciful and less painful means of taking care of this type of pain and suffering for individuals that are truly not going to get any better and wish for a peaceful and dignified death.

The argument could be made that people just die and there is no real difference but there is a strong difference between a good death and a bad one (Brody, 1992). People that are made to be afraid, to suffer, and to rely solely on others for any kind of care often do not wish to live any longer and these people may linger a very long time in this pain and fear before they pass away. Once they have passed away they have no more suffering but the length of suffering that they must endure during the time between when they get sick and when they actually die is often excruciatingly painful not only for them physically and emotionally but for their families emotional well-being as well. Individuals that are permitted to pass away peacefully and in a dignified manner will be much less likely to take their own lives in any type of cruel or unpleasant way or prolong the suffering of themselves or their families beyond what is necessary to get affairs in order and say final goodbyes to everyone (Battin, 1994).

These individuals will often remain on this earth somewhat longer because they know that the option for physician-assisted suicide is available to them. They know that when the suffering gets to be too much they can take medication and fall asleep and pass away peacefully as opposed to being afraid of what might come and not having anyone to help them get through the final days or hours of their lives. Lately there have been many calls for removing the ban on any type of physician-assisted suicide (Rogatz, 2001). Many people call it euthanasia but it is not exactly the same thing. Euthanasia is something that is done by the physician which specifically ends an individual's life, such as giving that person a lethal injection (Rogatz, 2001). In physician-assisted suicide this is not the case. As has been mentioned, physician-assisted suicide usually involves the use of prescription medication that is only given to the patient in a container.

The physician does not actually administer the drug and it is up to the patient when or even if he or she chooses to take that drug. Not only do these patients that wish to partake of physician-assisted suicide have concerns about their own declining physical and mental abilities but many of them are also concerned about financial burdens that are placed on their family, losing control of what it is that they are able to do with their lives, and being alone and in pain in later years as a disease progresses (Rogatz, 2001).

It has long been a cultural norm that medicine is designed to preserve life for as long as possible (Orentlicher, 1997). However, being alive and having a life are not the same things and the quality of life is often more important to most people than the length. Naturally, most individuals wish to live a long and productive life but if given the choice between having 50 good years of life or 70 years of life where the last part was a struggle, many people would choose to die sooner and have a good death rather than live longer and have a painful life.

It was not all that long ago that individuals were granted the right to ask that life-saving treatments be withheld (Snyder & Sulmasy, 2001). This means that those in cardiac arrest with do-not-resuscitate orders would not receive treatment or those that were on a ventilator and not able to breathe on their own would have their life-support machines turned off. Not everyone agrees with this idea but it is one that has largely been seen as being accepted by most of society and certainly by the medical community.

They are many more physicians today that would utilize physician-assisted suicide for the patients that they see struggling and suffering day after day, sometimes for quite a long time, before their illness finally takes them. However, if these individuals are not able to assist their patients because of the legal ramifications they must only sit by and watch them suffer. Essentially, they are unable to help these patients and this is something that a physician finds extremely difficult, since his or her whole life is supposed to be about helping others. Sometimes these physicians prescribe pain medications and do other things that allow the patient to pass away peacefully but physicians must be extremely careful in the utilization of these types of tactics because if it were found that they had done it deliberately they would likely be removed from practice and prosecuted for murder, despite what the wishes of their patient might have been (Snyder & Sulmasy, 2001).

Although Oregon is the only state that has legalized physician-assisted suicide many other states have looked at bills to legalize it. In all of the other states these bills have been defeated (Snyder & Sulmasy, 2001). Some other countries have also legalized physician-assisted suicide (Thomasma, 1996). In 1997 the United States Supreme Court made a ruling that indicated that there was no constitutional right for an individual to have physician-assisted suicide (Snyder & Sulmasy, 2001). The Ninth Circuit Court of Appeals, however, did make a ruling that individuals have the right to choose when and how they wish to die (Snyder & Sulmasy, 2001). Because of this competent and terminally ill individuals who wished for a lethal dose of prescription medication found that they had a right to this because it was unconstitutional to ban them for choosing this particular type of life-ending measure.