Physician-Assisted Suicide: The Case for Legalization

Introduction: The Case for Physician-Assisted Suicide

When we are young, most of us do not think about making a conscious decision to die. We look forward to years of long and healthy life, and if death ever seems appealing it is as an antidote to depression. It does not often, if ever, occur to us that there will be a time when we look forward to the "good death" promised by euthanasia.

Yet it is inevitable that for many of us there will come a time in our lives when suicide may indeed seem appealing because we are fighting a losing battle against a certainly fatal disease that fills our remaining days with pain and despair. In such a position, many of us may wish to have our doctors help us die by prescribing drugs that, when we ourselves take them, will prove to be fatal. Or we may wish that other people should have this option if they so choose. In other words, this paper argues that physician-assisted suicide should be legal in every state.

This is not now the case. Most states, along with most countries, have banned most forms of euthanasia, classifying the act of assisting someone else to die as a form of homicide. Even passive euthanasia — in which a person has been allowed to die because some drug or procedure was withheld — has often been punished as severely as what we now classify as murder (Moreno 31). While such bans may be in agreement with conservative religious points of view, they do not accord with the wishes of most Americans.

Those who believe that physicians should have the legal right to prescribe lethal drugs to their patients as part of the physician's overall role in caring for a patient — care that must sometimes include the acknowledgment of death's dominion — have pushed to legalize what is known as physician-assisted suicide.

Defining Euthanasia: Passive, Active, and Intermediary Forms

Euthanasia can be divided into passive (sometimes called negative) euthanasia, in which someone is allowed to die by the withholding of certain kinds of treatment, and active euthanasia, which involves taking a deliberate action to cause someone's death. There are intermediary routes between these two, such as giving a patient a level of morphine sufficient to alleviate pain that may also hasten death. In this case, the deliberate action is not made to kill a person but rather to reduce pain; the hastening of death is an indirect result of drugs like morphine.

Many people have argued that this last course is the best one: it does not require doctors to act as "executioners" while at the same time allows them to treat their patients' pain. However, such a course does not take into consideration the fact that not all pain — such as that associated with cancer — can be adequately treated, and even some patients facing not insignificant pain but increasing disability may also wish to end their lives.

A number of arguments against the legalization of physician-assisted suicide have been made, but while many of these objections sound legitimate, a closer examination demonstrates that they are logically flawed.

Examining and Refuting Common Objections

Among the most common arguments against physician-assisted suicide is the claim that it will be used to kill healthy people — for example, by relatives seeking an inheritance. However, it cannot be stressed enough that voluntary euthanasia — like the kind practiced in the Netherlands or the kind proposed in a number of U.S. states — always requires an explicit request by the dying person or a person that individual has formally designated as his or her legal representative, as Humphry argues in his seminal work on euthanasia. It is never — as is sometimes believed or assumed — something that a doctor or relative can decide for someone else in order to "put them out of their misery." Such an act would constitute homicide rather than euthanasia.

Another common — and logically problematic — objection is the claim that allowing physicians to prescribe lethal doses of drugs would permit doctors to determine who should live and who should die. However, laws concerning physician-assisted suicide always require written consent from the patient himself or herself and consultation with more than one doctor.

Other opponents argue that the practice puts doctors in fundamental violation of the Hippocratic Oath. This idea is central to the American Medical Association's view on the issue — a position that can be examined using Toulmin's model of logical analysis.

The AMA's Position and Its Logical Flaws

The AMA's position against physician-assisted suicide is rooted in its belief that such an act is "fundamentally incompatible with the physician's role as healer."

In its landmark ruling that there is no constitutional right to physician-assisted suicide, the U.S. Supreme Court used those words to explain part of the reasoning for its decision — specifically, the state's interest in protecting the integrity and ethics of the medical profession. The Court also accepted other key arguments that the AMA and its allies made in friend-of-the-court briefs: the distinction between a patient's right to self-determination in ending care versus the intentional killing of a patient, the effectiveness of palliative care, slippery-slope concerns over regulating such assistance, and the risk to depressed and other vulnerable patients.

These concepts were woven into the Court's analysis of the constitutional issues of due process and equal treatment under the law. Taken altogether, the Court's decision has been characterized by some as deflating much of the rhetoric of the pro-assisted-suicide movement, which critics claim has confused individual rights with the misapplication of a physician's skills.

In fact, despite the AMA's position as stated above, those advocating the legalization of physician-assisted suicide understand that individual rights carry a higher degree of legal protection than do the professional standards of physicians. Applying Toulmin's model, the AMA's "claim" — or position — is wrong on an a priori basis; it is also not supported by the "grounds," the rational basis or facts inherent in the claim, which is that the Court upheld the ethics of the medical profession. Both the "warrant" and "backing" — the primary and subsequent pieces of evidence offered to support the claim — are also false: they are not in fact directly related to the claim.

The "qualifier" — that the pro-assisted-suicide movement "has consistently confused individual rights with the misapplication of a physician's skills" — is a straw man argument and, because this is so, the "rebuttal" has no logical merit.

We can see the logical inconsistency of the AMA's position in the fact that physicians quite often do harm to their patients because they believe the ends justify the means, and this includes hastening death through the treatment of pain. What the AMA is objecting to is that patients are now demanding greater power in their relationship with physicians, who have previously held sole authority to dictate treatment. Rather than acknowledging that the association is fighting to uphold the power of physicians — which would most certainly not be a popular position — the AMA has cloaked its intentions in language suggesting that doctors are only trying to look out for their patients' best interests, without letting the patients themselves determine what those best interests are.

Conclusion: Pain Management, Autonomy, and the Right to Die

Today, pain management and improvement in palliative care is receiving much-needed focus because of discussions of physician-assisted suicide. This is certainly all to the good. However, while better pain management may help prolong quality of life for many, it cannot substitute for the need to establish the right to physician-assisted suicide.

Works Cited

Callahan, Daniel. "Good Strategies and Bad: Opposing Physician-Assisted Suicide." Commonweal, December 3, 1999, sec. 1. 7+.

Cassel, Christine K. "AMA Guidelines for Caring for Patients in the Last Phase of Life." CQ Researcher 7 (1997): 774.

Humphry, Derek. Euthanasia: Essays and Briefings on the Right to Die. Los Angeles: Hemlock Society, 1991.

Orric, Sarah. "House Judiciary Committee Rationale." Congressional Digest 77 (1998): 263–264.

Okie, Susan. "I Should Die the Way I Want To." The Washington Post, January 1, 2002.

Reno, Janet. "Oregon Law and the CSA." Congressional Digest 77 (1998): 262.

Robinson, Bruce A. "Physician-Assisted Suicide: Activity in States Other than Oregon." March 15, 2002.

Rosenblatt, Stanley. Murder of Mercy: Euthanasia on Trial. New York: Prometheus, 1992.

Worsnop, Richard L. "Caring for the Dying." CQ Researcher 7 (1997): 769–792.