Physician Assisted Death

If you were terminally ill, with poor quality of life and only months to live, would you refuse life-sustaining treatment? Would you choose to do physician-assisted suicide (by self-ingesting a lethal pill) if available? At what point does death become a more attractive option than living with terrible illness?

In the nine states of California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, Washington, as well as the District of Columbia, physician assisted death (PAD) is a legal and viable option for certain populations. PAD involves terminally ill patients choosing to commit suicide via a pill instead of prolonging their suffering after signing off with their physician. However, in the 39 other states (minus Montana whose stance is unclear), any death that is induced or hastened by physicians is strictly illegal. For instance, that act in Alabama would be classified as a Class A felony, and a first or second degree murder in the state of Massachusetts (Britannica ProCon, 2023). 

Starting with Oregon in October of 1997, these ten states have passed “Death with Dignity” acts in order to provide specific patients with an alternative end-of-life treatment option. There are clear and strict criteria, however, that determine whether patients are eligible for physician assisted death. Patients must be 1) at least 18 years old, 2) be terminally ill with a life expectancy of less than six months, 3) have intact mental capacity, and 4) be able to ingest the drug independently. As such, diagnoses will be reexamined and confirmed, and psychiatric evaluations will affirm the patient’s mental state. Throughout the entire process, physicians must explain all possible treatment options like hospice care, and the patient will be given chances to reassess and withdraw their request (UCLA Health, 2016).

The ethics of physician assisted suicide is hotly debated. Those who support it cite the ultimate responsibility of doctors to the patient’s wellbeing, of which quality of life plays an important role. Is prolonging a life with immense physical and emotional pain and no plausible treatment options really in the best interest of the patient? Additionally, physicians still possess moral codes and cannot be expected to personally agree to continuation of life sustaining treatment or end of life care options in the cases eligible for PAD as stated previously. Furthermore, doctors must respect their patients’s autonomy. On the other hand, some state that PAD contradicts the Hippocratic Oath and a physician’s responsibility to heal by signing off on accelerated death. Must doctors not strive until the end to cure their patients, or at least provide the best palliative care possible? Also, regulating PAD may be difficult with differing legislation across states (AMA Code of Medical Ethics). 

One must also note the role that cultural and religious perspectives play. In most Christian denominations, Islam, and Hinduism, physician assisted death is largely opposed and goes against the values that life is sacred and only God should be able to determine when life ends (Liu, 2013). The act of artificially shortening life is often viewed as sinful and disrespectful to the all-powerful creators that gave the gift of life.

This debate has also taken place in the courts. In the landmark case Washington v. Glucksberg (1997), physicians from the state of Washington challenged the state’s ban on physician-assisted death. In this case, the ban was argued as violating the Fourteenth Amendment’s equal protection clause because it denied people the right to choose death over life. However, the Supreme Court unanimously ruled in favor of the Washington, stating that the right to assisted suicide is not protected by the Constitution and that the ban aligned with the state’s values of sustaining life and preventing euthanasia. Therefore, states now have the jurisdiction to permit or prohibit PAD.

All in all, the ethical arguments surrounding physician assisted death are a complex web of legal and cultural beliefs. As organizations like Death with Dignity continue to fight for PAD legislation, it is very plausible that more states will continue to legalize medically assisted suicide in the future. Ultimately, this issue can be boiled down to two questions: 1) Is a life full of pain and suffering worth prolonging? and 2) In the greater context of life and spirituality, what right do we have as humans to artificially shorten and end our own lives?  

References

American Medical Association. (n.d.). Physician-Assisted Suicide. AMA Code of Medical Ethics. https://code-medical-ethics.ama-assn.org/ethics-opinions/physician-assisted-suicide.

Liu, J. (2013, November 21). Religious Groups’ Views on End-of-Life Issues. Pew Research Center’s Religion & Public Life Project. https://www.pewresearch.org/religion/2013/11/21/religious-groups-views-on-end-of-life-issues/.

ProCon.org. (2023, August 9). States With Legal Medical Aid In Dying (MAID) . Britannica ProCon. https://euthanasia.procon.org/states-with-legal-physician-assisted-suicide/.

UCLA Health. (2016). Introduction to California End of Life Option Act. UCLA Health System. https://www.uclahealth.org/patient-resources/support-information/advance-directive/introduction-california-end-life-option-act.

Washington v. Glucksberg. (n.d.). Oyez. Retrieved August 9, 2023, from https://www.oyez.org/cases/1996/96-110.