Assisting Death: The Fight For and Against Physician-Assisted Suicide

DISCLAIMER: This is a fact-finding essay that does not reflect the personal opinion of the author.

The debate over whether physician-assisted suicide (PAS) should be legal in America is a long-held one in which there are two diametrically opposing arguments in the public sphere. At this moment in time, most states in the U.S. prohibit patients to end their lives with assistance from medical professionals. Alongside the U.S. Capital, Washington, DC, there are currently five states in the U.S. where PAS is legal: California, Montana, Oregon, Vermont, and Washington. The legalization of PAS in those places has only occurred within the last couple of decades; the earliest legalization transpired in Oregon in 1997 and the latest law went into full effect in Washington, DC on February 18, 2017. There are many challenges to state laws coming from both sides. Proponents of laws that allow for PAS argue that a patient who is terminally ill should have the right to choose when they die; they argue that it is more dignified than dying in a hospital. Opponents of legalizing PAS often cite the value of life and the unintended consequences that arise with making it possible for physicians to give patients life-ending drugs. The crux of this debate centers on concepts regarding the value of human life, the preservation of individual liberties, and the adherence to medical ethics.

It is important to note that physician-assisted suicide or PAS is commonly misconstrued with euthanasia. Euthanasia refers to a type of assisted suicide in which a physician plays a direct role, for example—when a doctor administers a pharmaceutical drug that causes death. With PAS, a physician provides the means for a patient to commit suicide, but does not act directly in ending the patient’s life. Proponents of PAS argue that it is a matter of liberty, but also one of compassion for terminally-ill patients when there is no cure for their disease; they see it as an option for those who would otherwise experience a long and painful death. In a conversation between Jane Hagl and Lauren Aguirre for The Liberty Project entitled “Musings: What Do You Think About Physician-Assisted Suicide?” a common argument is highlighted among proponents of PAS about why they believe the practice should be legal. Lauren Aguirre states:

In these cases, dying is seen as a better option than suffering months or years through treatments. But I also think that if there were a treatment or a cure for their illness, death would definitely not be on the table. When you’re that ill, at that point, it’s about choosing how you want to live your last days or if you want to live them at all. And I feel that people who truly want to die will find another way without a doctor’s help. There should be a safe way, or as safe as they can make it, to end your life if you’re in that situation. (Aguirre)

This viewpoint touches on a view of liberty and medical ethics as they pertain to life in a way that is not intertwined.

Those who advocate for PAS see the circumstances surrounding the issue as exceptions to the rule, that it should be safe and rare. Andrew Solomon, Professor of Psychology at Columbia University, conveys in the NPR debate—“Should Physician-Assisted Suicide Be Legal?”—that the choice to end one’s life centers on dignity and that because not all pain is treatable, “we need to rethink death itself” while ensuring that PAS is stringently regulated. He argues, “Because much of modern medicine prolongs not living, but dying…aid in dying needs to be tightly regulated, as any life or death matter does, but while no one should be pressed into assisted dying, no one should be categorically denied that right” (Solomon). Professor Solomon’s argument is indicative that proponents of PAS view medical ethics regarding the value of human life in a utilitarian manner.

In contrast to PAS supporters, those who oppose PAS often cite unintended consequences of legalizing the practice and reference the overarching philosophy in society—that life has meaning. Ilora Finlay, a palliative care physician and president of the British Medical Association, expressed in the NPR debate, “Should Physician-Assisted Suicide Be Legal?”, that it is dangerous to give that much power to the medical system and caregivers over a patient’s life because prognoses are frequently inaccurate. She says, “Pressures are harder to pick up than depression. “Coercion can be subtle,” she states, [considering] “the costs of care, life insurance about to expire, or just caregiver fatigue.” She also asks, “Are they being made to feel their lives are an inconvenience to be disposed of for the sake of others” (Finlay)? This echoes the sentiments of many PAS opponents; it’s an argument that centers around philosophical notions on the intrinsic value of human life.

Opponents of PAS cite the Hippocratic Oath, a cornerstone of medical ethics that serves as a guide to prevent medical malpractice, in which doctors promise to avoid “therapeutic nihilism” and to do no harm (Mamede and Schmidt). For opponents of PAS, this oath conflicts with giving a physician the ability to directly or indirectly assist in a patient’s suicide. Doctors who oppose PAS often argue that a law allowing the practice removes “critical protections from terminally-ill patients” (Associated Press). This reflects an objection that opponents of PAS raise on how the legalization may unintendedly limit a patient’s choices. They mention that, if legalized, PAS will then become economically desirable to insurance carriers which may result in patients being denied coverage for life-saving treatments that are more expensive. For people who object to PAS, life and liberty are inextricably linked. Ira Byock, director of palliative care at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., represents this viewpoint with his reaction to the PBS Frontline film “The Suicide Plan” as reported in the PBS Frontline article entitled “The Shadow Side of Assisted Suicide” by Jason M. Breslow:

The admonition against killing other people is the bedrock of civilization. Our earliest ancestors decided to collaborate, protecting and looking after one another as an alternative to competition and individual conflict over resources. An obligation to protect and care for one another is an integral part of social compacts. You will not find a “right to die” in the Magna Carta, Declaration of Independence or Constitution. Instead, society exists in service of life, liberty and the pursuit of happiness. (Byock)

With this, it is clear that opponents of PAS view liberty and medical ethics and their application to life in a much different light than those who support PAS legalization.

A conclusion that can be made from examining the facts surrounding this issue: the argument over whether physician-assisted suicide should be legalized will not be over soon. Since the 1997 Supreme Court decisions in the cases of Vacco v. Quill and Washington v. Glucksberg where it was ruled that there is no Constitutional right to physician-assisted suicide, the matter has been turned over to each state to decide if it is legal. What this means for the foreseeable future is most states will not allow for this method of dying; a handful of states will allow it but with varying regulations.

Works Cited

Aguirre, Lauren, and Jane Hagl. “Musings: What Do You Think About Physician-Assisted Suicide?” The Liberty Project, www.libertyproject.com/well-being/musings-what-do-you-think-about-physician-assisted/. Accessed 22 June 2017.

Breslow, Jason. “The Shadow Side of Assisted Suicide.” PBS, Frontline, 13 Nov. 2012, www.pbs.org/wgbh/frontline/article/the-shadow-side-of-assisted-suicide/. Accessed 22 June 2017.

“Debate: Should Physician-Assisted Suicide Be Legal?” Intelligence Squared U.S. NPR. NPR Staff. WNYC, Ney York City. 20 Nov. 2014. Web. www.npr.org/2014/11/20/365509889/debate-should-physician-assisted-suicide-be-legal. Accessed 22 June 2017.

Mamede, Silvia, and Henk Schmidt. “The Twin Traps of Overtreatment and Therapeutic Nihilism in Clinical Practice.” Medical Education, vol. 48, no. 1, 2014, pp. 34-43, www.onlinelibrary.wiley.com/doi/10.1111/medu.12264/abstract. Accessed 22 June 2017.

“The Latest: Suit Over California Life-Ending Drugs Law Ok’d.” Associated Press, 16 June 2017, www.apnewsarchive.com/2017/Judge-allows-legal-challenge-to-proceed-against-California-s-law-allowing-terminally-ill-people-to-seek-prescriptions-for-life-ending-drugs/id-35dc244cc3a949eab7e6018689361262. Accessed 22 June 2017.