Physician-Assisted Suicide: The Federal Right to Die
This paper argues for federal legalization of physician-assisted suicide (PAS) as a patient rights and quality-of-care issue. It surveys the social, economic, ethical, political, and legal factors shaping PAS policy in the United States, reviews relevant stakeholders, and applies Longest's Policy Cycle Model to identify goals and objectives. The paper evaluates four policy options—federal legalization, the status quo, a state-by-state approach, and a total ban—against criteria including cost, quality of care, patient and provider autonomy, and political feasibility. It concludes that federal legalization best serves patients in end-of-life phases who wish to die with dignity, while preserving the conscientious-objection rights of providers who oppose the practice.
- Introduction and Policy Problem: PAS defined; federal legalization proposed as policy
- Background: Social, Economic, Ethical, Political, and Legal Factors: Five contextual factors shaping PAS debate
- Stakeholders and Policy Goals: Stakeholders identified; Longest's Model applied to goals
- Evaluation of Policy Options and Alternatives: Four policy alternatives described and compared
- Quality of Care, Autonomy, and Political Feasibility: Options scored on care quality, autonomy, and politics
- Nursing Implications: Practice-level guidance for nurses under federal PAS
- Conclusion: Federal legalization recommended; evidence strategy summarized
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What makes this paper effective
- It systematically organizes a complex policy topic across multiple analytical dimensions—social, economic, ethical, political, and legal—giving the argument both breadth and structure.
- It applies a recognized policy framework (Longest's Policy Cycle Model) to ground abstract advocacy in a concrete procedural approach, lending academic credibility.
- It balances advocacy with fairness by presenting and honestly critiquing all four policy alternatives before recommending the best option, rather than dismissing opposing views outright.
- It consistently connects macro-level policy to bedside nursing practice, making the argument relevant to a health-care professional audience.
Key academic technique demonstrated
The paper demonstrates structured policy analysis: each alternative is evaluated against the same set of criteria (cost, quality of care, autonomy, and political feasibility), enabling an apples-to-apples comparison. This parallel evaluation technique is standard in health-policy writing and allows the recommended option to emerge logically from the evidence rather than from assertion alone.
Structure breakdown
The paper opens with an abstract and policy-problem statement, then builds contextual background across five factor domains. It identifies stakeholders and articulates goals through Longest's Model, evaluates four discrete alternatives, and applies four evaluative criteria in turn. A nursing-implications section translates the policy recommendation into practice-level guidance before a brief conclusion synthesizes the argument.
Introduction and Policy Problem
More and more patients in an 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 proposed in this paper would encourage lawmakers to pass legislation making PAS legal at the federal level. By having the right to die, patients can choose to end suffering in a manner sanctioned by society and law, with the help of providers who view it as an ethically sound approach to quality care.
PAS is a process by which a physician makes available to the patient the means 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 promoting PAS to be effectively developed and implemented. This paper examines those factors, lists the goals of such a policy, identifies options and alternatives, and discusses nursing implications for promoting PAS.
Background: Social, Economic, Ethical, Political, and Legal Factors
If a person suffering from a terminal disease wants to end his or her life rather than endure a deteriorating quality of life for which there is no remedy, proponents of euthanasia argue that the person should have the right to physician-assisted suicide. Opponents of PAS counter that this goes against the essence of the Hippocratic Oath, that suicide is classified as a sign of mental illness under the DSM-5, and that a desire to end one's life should be treated rather than facilitated. Nonetheless, PAS is legal in seven U.S. states as well as in countries such as Canada, the Netherlands, Colombia, Belgium, and Luxembourg (Emanuel, Onwuteaka-Philipsen, Urwin, & Cohen, 2016).
PAS can reduce the amount of time and resources required to provide care for individuals in an end-of-life phase (Smith, 2017). Accordingly, PAS could reduce federal Medicare expenditures on such patients, freeing 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, overall suicide rates have climbed—a trend that could exert a negative economic drag on society if it persists. Additionally, in states like Oregon where PAS is legal, patients who request PAS services must undergo a number of procedural requirements, such as a physician referral and a psychological evaluation (Death with Dignity Act, 1994).
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 facing a terminal illness may have compelling personal reasons for choosing PAS, and out of respect for personal choice, those reasons should not be dismissed.
Policymakers at the governmental level are influenced 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 will not disappear over time; on the contrary, as ethical perspectives shift toward upholding civil rights, PAS 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 in only a handful of U.S. states.
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 on the matter. PAS is currently legal in Oregon, Washington, California, Colorado, Hawaii, Vermont, and Montana, as well as the District of Columbia (Emanuel et al., 2016). Meanwhile, PAS is illegal in 36 states; in the remaining states, the legal status is a gray area (Euthanasia, 2018).
Stakeholders and Policy Goals
Stakeholders impacted by this issue include patients, patient families, physicians, nurses, health care organizations, state and federal lawmakers, taxpayers, medical organizations and associations, insurers, and the health care industry as a whole.
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 of the modern view of life shift more toward preserving quality and maintaining dignity rather than simply ensuring longevity, health care providers face the inevitable question of 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 care may still be 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 patients who desire it 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 give states the option of granting patients who prefer PAS the right to obtain this service. The goal of this policy is to achieve legalization of PAS at the federal level. The objective is to promote PAS within the health care community in a positive manner so that providers more accurately reflect the rising demand for PAS services among patients entering an end-of-life phase who wish to die with dignity while they still retain some quality of life. 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 in a favorable way.
Another objective is to provide the evidence necessary to demonstrate why PAS legalization is needed. 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 equipping stakeholders with the information required to make an informed decision about federally legalizing PAS, this objective facilitates the overall policy goal in a significant way.
Using Longest's Policy Cycle Model, three phases are identified by the policymaker: "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 depends 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 to gather nurses' stories about patients seeking or desiring PAS and present them to U.S. lawmakers, so that an appropriate bill could be introduced to Congress. These stories would help to modify the existing legal position established 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 been implemented in only a handful of states. It is now time for modification of that position, based on the firsthand experiences nurses have gained in caring for end-of-life patients who desired PAS but had no legal recourse because of the laws in their state.
Conclusion
Patients in an end-of-life scenario should have the right to choose to die at a time of their own choosing in order to end their days with a higher quality of life. Though some in the medical community may not agree with this position, the trend in society is toward acceptance of PAS, and in a liberty-loving society this right should be recognized as well. PAS should therefore be federally legalized. The goal of this policy is to educate stakeholders about why federal legalization is warranted by collecting statistical and anecdotal evidence that demonstrates the need for PAS as at least one option available to patients in end-of-life phases who wish to die with dignity.
AMA. (2018). Code of ethics. Retrieved from https://www.ama-assn.org/delivering-care/physician-assisted-suicide
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Death with Dignity Act. (1994). Retrieved from https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/oars.aspx
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