Should Physician-Assisted Suicide Be Legalized? A Debate

Introduction

In basic terms, euthanasia is a medical act to end life. As Math and Chaturvedi (2012) explain, the word derives from Greek and means a peaceful or merciful death. In practice, a physician removes supportive measures, withholds treatment, or introduces a lethal substance upon the consent of a patient. Voluntary euthanasia is medically and legally accepted in some jurisdictions, yet it creates ethical dilemmas for physicians, who are bound by principles that require them to advance patient wellbeing and ensure that no harm befalls those in their care.

The issue of euthanasia is now widely regarded as the act of making death easier through the cooperation of a doctor, rather than the act of "good dying" as it was formerly deemed. Others view it as unethical and immoral, arguing that legalization effectively gives physicians the right to "murder" patients at will. These ethical tensions lead directly to the central question explored in this paper: should euthanasia — and specifically physician-assisted suicide (PAS) — be legalized?

Physician-assisted suicide refers to a physician ending the life of a patient by prescribing lethal medications upon the patient's request (Banovic, Turanjanin, and Miloradovic, 2017). While some argue that PAS is a humane option when a patient has a prolonged terminal illness or has been in a coma for an extended period, others contend that it constitutes a form of murder that violates the rights and beliefs of patients and their families. This paper examines both positions and provides a historical and contemporary overview of the ethical and legal issues surrounding physician-assisted suicide.

Literature Review: Global Legal Frameworks for Assisted Dying

In cases of serious medical illness, there are jurisdictions around the world that permit physicians — or, in some instances, nurses — to administer a lethal medication to a patient in order to end suffering and, consequently, end life (Gerson et al., 2019). Some countries, such as Switzerland, allow non-physicians to assist in end-of-life undertakings, unlike other countries where such assistance must come from licensed physicians. Jurisdictions that have passed laws on assisted dying include various U.S. states, the state of Victoria in Australia, Quebec and Canada at the federal level, Luxembourg, and Belgium (Gerson et al., 2019, p. 113). These jurisdictions have enacted procedures, criteria, and safeguards to prevent misuse and abuse of the practice, though the specific requirements vary considerably across different legal systems.

According to Gerson et al. (2019), people may hasten their death with or without external assistance. Assisted dying can be administered directly by a physician, or an individual may self-administer a lethal dose following a prescription from a physician, provided there are legally sanctioned grounds for doing so.

In all jurisdictions that permit PAS, the request must be persistent over time, informed, well-considered, and voluntary (Pereira, 2011). The law also typically requires that the requesting person be mentally competent at the time of the request and provide written consent. However, even with these safeguards in place, some individuals have managed to access assisted suicide without a valid written consent, and attempts to prosecute those involved have generally failed (Pereira, 2011). In cases where an individual may have had the capacity to consent but did not do so — owing to conditions such as coma or dementia — the situation becomes non-voluntary. In such instances, Pereira (2011) notes that physicians sometimes proceed with assistance based on the belief that it would have been in the person's best interest, though the author emphasizes that written consent is essential to preventing abuse.

It is also important that jurisdictions permitting assisted suicide report all such cases to the relevant oversight body — such as a Federal Control and Evaluation Committee — to enable follow-up and minimize abuse. In many countries, consultation with a second physician is required before PAS is carried out; in Belgium, a third physician must be consulted. If any consulting physician finds fault in the patient's judgment, referral to a psychologist is recommended (Pereira, 2011).

Historically, cases of euthanasia were permitted only for terminal illnesses and only when all other treatment options had been exhausted. In contemporary society, however, the scope of valid reasons has expanded in some jurisdictions. Everyday challenges associated with the aging process, for instance, are sometimes cited as grounds for PAS. Pereira (2011) attributes this shift partly to the fact that elderly individuals frequently feel isolated and consider themselves a burden to their families. It is also worth noting that even where terminal illness is cited as the reason for PAS, physicians may be insufficiently motivated to pursue alternatives such as experimental medicine.

Arguments Supporting Legalization of Physician-Assisted Suicide

There is broad agreement that legal frameworks around PAS differ significantly from jurisdiction to jurisdiction. In some cases, legalizing physician-assisted suicide has not been shown to reduce the protection of vulnerable persons, nor does it appear to lead to an increase in the overall number of PAS cases (Pereira, 2011). Some jurisdictions also hold that there is no meaningful ethical distinction between assisted suicide and withholding life-saving treatment. Proponents of PAS argue that legalization benefits both patients and their families by reducing pain and alleviating the financial burden of treatment for incurable conditions.

Most people agree that life is valuable. However, when an individual is in profound agony, the perceived value of life may diminish — hence the desire for relief from pain (Goligher et al., 2017). It follows that life should not be prolonged at any cost when suffering cannot be alleviated and recovery is not possible, as is the case with many terminal illnesses. In such circumstances, relieving a patient's pain through assisted dying may be the most humane course of action. Goligher et al. (2017) acknowledge that PAS is not a pleasant experience, but argue that in cases of extreme suffering, it may be the only viable option and that the burden of dying can outweigh the burden of living.

This position is indirectly supported by Bernat (1997), who observes that some patients feel their illness imposes unfair suffering and financial hardship on their families. As Lorenz and Lynn (2003) note, patients in this situation may weigh the family's financial circumstances and conclude that relieving loved ones of costly medical bills for an untreatable illness is morally justifiable. Patients may also seek to relieve family members of the burden of providing long-term care when a condition is severely limiting.

A further argument invokes religious reasoning: for believers, death represents a transition from the physical to a tranquil spiritual realm (Goligher et al., 2017). For those experiencing severe and unrelenting pain, PAS may therefore be understood as a path to peace rather than mere cessation of life.

Goligher et al. (2017) also challenge the supposed moral distinction between withdrawing life-sustaining treatment and physician-assisted death. If it is ethically permissible to withdraw a life-supporting intervention during therapy, the authors argue, then PAS should likewise be permissible, since both aim primarily to provide comfort — the only difference being the specific instrumental act. In both scenarios, the physician determines the timing of the act and bears moral responsibility. Furthermore, the authors contend that it is inconsistent to honor a patient's consent to withhold treatment yet refuse to honor the same patient's consent to PAS, since both decisions are intended to convey respect and minimize suffering. Denying a patient's autonomous choice in this context could itself be considered unethical. The authors conclude that a patient should be allowed to die at a chosen time rather than sacrificing quality of life for quantity, and that providing lethal medications at a competent patient's considered request is morally defensible.

Conclusion

The debate on whether to legalize euthanasia is a worldwide issue that spans across multiple realms — and not just the medical one. Both ends of the debate have compelling pros and cons. Given this complexity, it would be most productive to explore the discussion from an interdisciplinary perspective in order to identify common ground.

This paper has presented convincing arguments in support of PAS as well as equally compelling arguments in opposition to it. Some contend that alternatives to treating terminal illnesses should be pursued and implemented in clinical settings rather than resorting to PAS. At present, one such alternative is palliative sedation, in which medications are administered to induce unconsciousness and thereby relieve extreme pain or discomfort. Unlike euthanasia, this approach is not intended to hasten death but to restore comfort and dignity. Palliative care more broadly is an important approach for patients who have lost hope or who view their illness as a burden to their families.

However, it must also be acknowledged that current alternatives may not be entirely sufficient in every scenario — particularly in cases where all clinical efforts have failed to contain a patient's pain and suffering from a terminal illness such as cancer, and the patient makes an explicit and considered request that their suffering be ended. In such circumstances, the ethical, legal, and medical communities must continue to engage in honest and rigorous dialogue.

References

Banovic, B., Turanjanin, V., & Miloradovic, A. (2017). An ethical review of euthanasia and physician-assisted suicide. Iran J Public Health, 46(2), 173–179.

Bernat, J. L. (1997). The problem of physician-assisted suicide. Semin Neurol, 17(3), 271–279.

Geomally, L. (1997). Euthanasia and assisted suicide: Seven reasons they should not be legalized. Bioethics Centre.

Gerson, S. M., Bingley, A., Preston, N., & Grinyer, A. (2019). When is hastened death considered suicide? A systematically conducted literature review about palliative care professionals' experiences where assisted dying is legal. BMC Palliative Care, 18, 75.

Goligher, E. C., Ely, E. W., Sulmasy, D. P., Bakker, J., Raphael, J., Volandes, A. E., Patel, B. M., Payne, K., Hosie, A., Churchill, L., White, D. B., & Downar, J. (2017). Physician-assisted suicide and euthanasia in the intensive care unit: A dialogue on core ethical issues. Critical Care Medicine, 45(2), 149–155.

Lorenz, K., & Lynn, J. (2003). Moral and practical challenges of physician-assisted suicide. JAMA, 289(17), 2282.

Math, S. B., & Chaturvedi, S. K. (2012). Euthanasia: Right to life vs. right to die. Indian Journal of Medical Research, 136(6), 899–902.

Pereira, J. (2011). Legalizing euthanasia or assisted suicide: The illusion of safeguards and controls. Current Oncology, 18(2), 38–45.