Physician-Assisted Suicide: Ethical Problems with Death with Dignity Laws

Introduction: The Ethics of Physician-Assisted Suicide

Euthanasia and physician-assisted suicide (PAS) is a topic that constantly sparks ethical debate. Euthanasia has become a subject of growing interest, especially in the industrialized countries of the world, because of the high standards for medical care and the idea that physician-assisted suicide can improve end-of-life care by alleviating suffering and preventing patients from attempting to end their lives through more painful means. For some, the "right-to-die" movement is compassionate, as it can liberate one from the pain and suffering associated with terminal illnesses; oftentimes these patients are anxiously awaiting death so that they may be released from the agony of their condition.

In the article "Physician-Assisted Suicide: Compassionate Liberation or Murder," Lachman (2010, 121) states that in Ancient Rome, voluntary suicide was sanctioned, and it continued to be sanctioned throughout the Middle Ages. It was the influence of the Christian church, it is suggested, that "ascribed a sinful nature to suicide, which kept it from being explicitly accepted" (2010). There are a number of factors that seem to inspire varied responses to the idea that, to quote Francis Bacon, "the dying may pass more easily and quietly out of life" (Birnbacher & Dahl 2008, v). Some of those reasons are religious, as noted above; others may have to do with the historical experience of the abuse of euthanasia at the hands of reckless physicians (2008, v); and still others reflect the Hippocratic tradition of forbidding any physician from using medicine to actively bring about the death of a patient (2008, v).

Whether one says "physician-assisted suicide," "euthanasia," "right-to-die," "death with dignity," "good death," "rational suicide," "aid in dying," or "merciful release," these are all euphemisms for the possibility of killing someone or helping individuals to kill themselves (2010, 121). PAS gives a human being — who is imperfect and thus capable of error — the role of God, and with this role will inevitably come varying opinions on what constitutes a sufficient reason for being granted the right to die. This paper illustrates the major problems with PAS, with a specific focus on the State of Oregon's Death with Dignity Act, which gives physicians the power to determine who is permitted to die.

Lachman (2010, 121) asserts that physician-assisted suicide, or euthanasia in general, is an issue that lies in a person's moral conscience as well as in any legal or ethical considerations surrounding the patient. Literature and legislation on euthanasia — specifically in the United States, Australia, Japan, Canada, and New Zealand — concerns nurses as well as doctors (Quaghebeur, Dierckx de Casterle & Gastmans 2009, 466) because of each profession's specific role in the care of dying patients. Nurses and doctors alike are intimately involved in the whole process of patient care and are often asked by patients to help assist them in dying. Quaghebeur et al. note that a range of feelings accompanies this topic for nurses and doctors — personal conflict, moral uncertainty, fear, guilt, secrecy, and frustration (2009, 467). These feelings are an inevitable part of any engagement with the concept of assisted suicide, as it means taking an active part in another person's death and claiming the authority to make a decision that no human should be permitted to make for another. While a dying patient will have his or her own reasons for wanting to die, as well as personal beliefs about the ethical or religious challenges involved, there is a fundamental difference between a person taking their own life and a person helping to take another's. There is no ethical or moral framework within which physician-assisted suicide can be soundly rationalized.