Physician-Assisted Suicide: The Right to Die Abstract

More and more patients in and end-of-life phase are expressing a desire for physician-assisted suicide (PAS) as an option that allows them to die with dignity and forego the pain and suffering associated with their disease and deteriorating condition. Yet in most states in the U.S., physician-assisted suicide remains illegal. The policy of this paper would be for lawmakers to be encouraged to pass a bill that makes PAS legal at the federal level. By having the right to die, patients can choose to end suffering in a way sanctioned by society and law with the help of providers who view it as an ethically sound approach to quality care.

Policy Problem

Physician-assisted suicide (PAS) is an issue that touches on quality of life factors. PAS is a process by which a physician makes available to the patient the means for the patient to terminate his or her life at his or her choosing. While the American Medical Association (AMA, 2018) has stated that PAS is “fundamentally incompatible with the physician’s role as healer,” Zukowski (2014) writing for Johns-Hopkins argues that patients should have the option or right to die so that they can close out their lives with dignity and quality in a manner of their choosing. There are numerous social, economic, ethical, political and legal factors surrounding this issue that must be addressed in order for a policy of promoting PAS to be effectively developed and implemented. This paper will examine those factors, list the goals of such a policy, identify options and alternatives, and nursing implications for promoting PAS.

Background

Social factors. If a person suffering from a terminal disease wants to end his or her life rather than suffer from a deteriorating quality of life for which there is no help, proponents of euthanasia feel a person should have the right to physician-assisted suicide in such cases. Opponents of PAS argue that this goes against the essence of the Hippocratic Oath, that suicide is a sign of mental illness according to the DSM-V, and that a desire to end life should be treated rather than indulged. Nonetheless, in 7 states in the U.S., PAS is legal, as well as in countries like Canada, Netherlands, Colombia, Belgium and Luxembourg (Emanuel, Onwuteaka-Philipsen, Urwin & Cohen, 2016).

Economic factors. PAS can reduce the amount of time and resources required to provide care for individuals in an end-of-life phase (Smith, 2017). Thus, PAS could reduce the amount of federal money spent via Medicare on patients, which could shore up funds for others. Zukowski (2014) notes that “approximately 25% of Medicare costs are to treat 5% of Medicare users to cover end-of-life care.” On the other hand, Jones and Paton (2015) have shown that in states where PAS has been legalized, suicide rates have climbed—a point which could have a negative economic drag on society if it should persist. Additionally, in states like Oregon where PAS is legal, there are a number of procedural processes that patients must who request PAS services must undergo—such as referral from physicians and a psychological evaluation (Death with Dignity Act, 1994).

Ethical factors. Herx (2015) argues that PAS “and euthanasia go against the very core of the palliative care approach and have no place within palliative care” (p. 82). This sentiment coincides with the argument that PAS is antithetical to the Hippocratic Oath. However, as Kamisar (1998) has noted, an individual who is faced with a terminal illness may have good personal reasons for wanting to go the route of PAS and out of respect for personal choice, these reasons should not be ignored.

Political factors. Politicy makers at the governmental level are impacted by ethical, economic and social factors, but as Clark (2014) points out, “the history of assisted suicide made it almost inevitable that by default, it would become an object of direct democracy” (p. 84). In other words, the issue is not one that will go away with time; on the contrary, as ethical perspectives shift towards upholding civil rights, PSA will continue to gain support from advocacy groups promoting quality of life and dying with dignity objectives. For the time being, PAS has found support among a handful of states in the U.S.

Legal factors. The Supreme Court ruled in Washington v. Glucksberg (1997) that PAS is not protected by the U.S. Constitution. However, some states have passed their own laws regarding PAS. PAS is legal in Oregon, Washington, California, Colorado, Hawaii, Vermont and Montana as well as...

Meanwhile, in 36 states, PAS is illegal; in the other states, PAS is a gray area (Euthanasia, 2018).
Stakeholders

Stakeholders who are impacted by this issue include patients, patient families, physicians, nurses, health care organizations, state, local and federal lawmakers, taxpayers and medical organizations and associations, insurers, and the health care industry as a whole.

Policy Goals & Objectives

A review of the literature shows that PAS is meeting with increasing social acceptance around the world (Emanuel et al., 2016; Frey & Hans, 2016). As the moral and ethical foundations upon which the modern view of life is situated shifts more towards preserving quality and maintaining dignity rather than ensuring longevity, health care providers face the inevitable decision about how to handle PAS requests (Clark, 2014). Some states have already taken action to give patients the right to request physician assisted suicide (Death with Dignity Act, 1994). While palliative may still be considered an option for those who have no interest in PAS, patients who prefer the option of choosing the time and manner of their own death are increasing in number (Jones & Paton, 2015). Much of the medical community remains opposed to PAS (Huxtable & Mullock, 2015); however, in order to meet the needs and wishes of patients, the medical community should at least adopt a neutral perspective on PAS so that if the patient does desire it, he or she can be matched with a physician willing to provide the requisite services.

For these reasons, it is important that health care providers push U.S. legislators to provide states with the option of granting patients who prefer PAS to the right to obtain this service. The goal of this policy is to achieve legalization of PAS at the federal level. The objective of this policy are to promote PAS among the health care community in a positive manner so that health care providers can more accurately reflect the rising demand in modern society for PAS services among patients entering into an end-of-life phase seeking to die with dignity while they still have some quality of life left. This objective will be pursued by educating health care providers about the benefits of PAS and encouraging them to urge their organizations and associations to lobby legislators to address the need for PAS among today’s population in a favorable way.

Another objective is to provide the necessary evidence that shows why there is a need for PAS legalization. As Mason, Leavitt and Chaffee (2006) state, one of the main barriers to “crafting policy is that there can be a lack of clarity about the evidence that is needed” (p. 69). By providing stakeholders with the information needed to make the right decision for legalizing PAS at the federal level, this policy objective facilitates the overall goal in a significant way.

Using the Longest’s Policy Cycle Model, three phases are identified by the policy maker: “a policy formulation phase, an implementation phase, and a policy modification phase” (Mason et al., 2006, p. 65). Moreover, the Longest Model holds that policy formulation dependents substantially on legislators and that “it is in this phase that nurses can serve as a knowledge source to legislators in helping frame the problem and bringing nursing stories and patient narratives to illustrate how health problems play out with individual constituents/populations” (Mason et al., 2006, p. 65). For this reason, another objective of this policy is for nurses’ stories about patients seeking or desiring PAS to be gathered together that they might be presented to U.S. lawmakers so that an appropriate bill could be introduced to Congress based on these stories which will help to modify the existing decision handed down by the U.S. Supreme Court in the 1990s. That decision represented the first window of opportunity for federal law to acknowledge the patient’s right to die. Since then, the right to die has only been implemented in a handful of states because of the Supreme Court’s decision in Washington v. Glucksberg. Now it is time for modification of that position to take place, based on the stories and experiences that nurses have obtained first hand in dealing with end-of-life patients who desired PAS but had no recourse to it because of the laws in their state.

Evaluations of Options & Alternatives

Nurses all over the U.S. have encountered end-of-life patients who have sought PAS services instead of palliative care services out of a desire to exercise…