Physician assisted suicide

Physician Assisted Suicide (also known as PAS) is defined as “a procedure in which a physician deliberately and knowingly provides lethal drugs at the individual's request for the purpose of self-administration, in which the patient intends to end his or her own life” (Newton, Heather). As a slightly liberal conservative, I believe that physician assisted suicide goes against everything doctors are supposed to stand for, including the oath they took when they were granted their PHD. When they swore to “do no harm” they made a promise that they would do anything and everything within their own power to not harm the life of a human being, a promise that I feel is not being kept when they engage in physician assisted suicide. When an individual chooses to take their own life it is their personal business, a decision I feel they should be allowed to make. However, unless the Doctor is fully willing to offer this service and willing to accept whatever punishment he may be due under his own state laws then I believe that asking the assistance of a health professional to commit suicide is morally and ethically wrong by both parties, not only it is taking advantage of a doctor's education, but it is like asking a doctor to be an accomplice to a murder, your murder. The majority of Republicans agree with this point of view and oppose withholding care despite an individual's differences. Democrats and their supporters of the ‘right to die' believe that patients should be allowed prescriptions of lethal doses by their doctors, if the patient so desires. The history, statistics, laws, court cases, and the political and non-political parties prove that physician assisted suicide occurs very rarely, with only one state where it is legal. And two others where it is allowed under very strict circumstances.

Many government agencies such as the American Medical Association, American Nurses Association, American Geriatrics Association and the American Medical Directors Association stand by their opposition to PAS. Organizations in favor of PAS have tried to get congress to pass legislative bills to legalize PAS. Since then, only one state, Oregon has legalized PAS, and did so in October 1997

as a state law titled the “Oregon Death with Dignity Act”.

There have been few if any steps being taken towards banning PAS but one solution which has been thoroughly evaluated by the opposition would most likely make PAS illegal . By forming a donation fund for the non- government group Not Dead Yet and asking Congress to overturn their decision to leave the legalization of PAS to the states and make it a federal issue, as well as to help fund and support the prohibition of physician assisted suicide. The money gained from the donations and from government as well as benefits of Barack Obama's health care plan will be used to improve and expand hospice care. The only way to eliminate the issue of whether PAS should be legalized is by putting a Federal regulations on it and allowing more access to hospice care as a 'better alternative'.

After the legalization of PAS in Oregon, the following conclusions and statistics can be drawn. “Of the patients in Oregon who request PAS, only 62% of them actually complete it, physician assisted suicide accounts for only 15.6 out of every 10,000 deaths in Oregon. Only 34% of Oregon physicians are willing to prescribe lethal dosages”. Statistics from 2003 show the reasons given for requesting PAS were “84% out of a fear of losing autonomy, 84% reported a concern of decreasing ability to participate in enjoyable activities, 47% reported a concern of losing their bodily functions, 37% reported a fear of burdening their family, friends and/or caregivers, 26% reported a fear of inadequate pain relief” (Strode, Tom). The patient's request for death normally triggers the physician's thorough exploration and understanding of the patient's suffering, the reason the request is being made at that particular time, and a sustained effort to relieve the distress of the patient. The underlying goal of a doctor and patient relationship has been and always will be to comfort and cure. To change the physician's role to one in which comfort includes the intentional termination of life would undermine the trust between physician and patient. Past research on euthanasia and PAS in the United States has resulted in unexpected findings that have significantly affected the public debate. Such findings include public support for

euthanasia and PAS is very closely linked with the reasons patients choose for involvement in PAS; most of the public support PAS only for patients in excruciating pain. Yet, “pain does not appear to be the primary factor motivating patients to request PAS; it is depression, hopelessness and other psychological factors that motivate patient's requests” (Morrow, Angela). Therefore, public support conflicts with the actual facts about patient interest in PAS because both come from the same side of the argument but for very different reasons.

The history of the law's treatment of physician assisted suicide in the United States has been and continues to be rejected with nearly all efforts to allow it. 'The right' to assistance in committing suicide is not a basic liberty interest protected by the Due Process Clause. The Due Process Clause of both the fifth and fourteenth amendment which states that Congress cannot make a law that isn't reasonable and fair or that discriminates against a certain group of people, as well as providing rights for those accused of crime. According to euthanasia campaigner Derek Humphrey, in his speech at a world conference “The first signs of organized activity on this issue came in the late 1930s in Britain , but nothing really happened until the 1970s, when the public - the non-medical world - woke up with a shock to the fact that we often die differently nowadays compared to our ancestors.” (Humphrey, Derek). The Supreme Court case of Gallant versus Board of Medical Examiners in 1999 an Oregon physician was disciplined for euthanasia of a 78 year old patient who 'had suffered a severe brain hemorrhage which would soon end her life' (Humphrey, Derek). The patient's daughter said that 'she did not want artificial life support'. After a ventilator was disconnected, the patient unexpectedly continued to breathe, although appeared to be suffering. The physician ordered a lethal dose of succinylcholine to kill the patient, despite the fact she didn't need life support in the first place and had never consented to the lethal injection. The Board of Medical Examiners suspended the physician's license for sixty days for performing euthanasia.

Euthanasia, also known as ‘mercy killing' can be defined as “ending a suffering individual's life from a terminal illness or an incurable condition, by lethal injection or withholding medical treatment” (Standler, B. Ronald.) As of 1999, Oregon legalized PAS under the Death with Dignity Act which allows “terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, prescribed by a physician for that purpose” (Hendin, Herbert). Despite the moral standards that PAS goes against some people are in favor of it for a few reasons. Some of the reasons include ease of pain and suffering of patients, the right to die should be an individual choice, doctors and nurses will have more time to work on savable/curable patients, vital organs can be saved, and patients could die with “dignity on their own terms”. Although, legalizing PAS would violate a physicians' “Hippocratic Oath”, it would in my opinion demean the value of human life, it would open the door to non-critical patient suicides and other abusers to take advantage of the system, some insurance companies may even put heavy pressure on physicians to recommend the assisted-suicide method, just to save a few bucks, and lastly, from a religious stand point it would give doctors too much power by allowing them to “play the role of God”. From a Christian viewpoint, God gave life, it is God's to take away.

Even though the ban of PAS was challenged in several court cases such as Vacco versus Quill in 1997 and Glucksberg versus Washington also in 1997, the Supreme Court and Congress left it as a state issue not a federal law because of the violation of the due process clause of the fifth amendment which states, “No person shall be… deprived of life, liberty, or property, without due process of law…” and the fourteenth amendment which states “nor shall any State deprive any person of life, liberty, or property, without the due process of law”. The United States Constitution allows states to prohibit physician assisted suicide but in 1997 the Supreme Court ruled that “assisted suicide is not a constitutional right” (Hall, Kermit). In 1997, U.S. Congress approved a law banning the funding of

PAS with federal tax dollars. PAS is also legal in several other countries, one such country being the Netherlands. Between the years 1994 and 2008, there have been 75 legislative bills to legalize PAS in 21 states and all of them failed. In New York State it is considered to be and charged as a criminal act to perform physician assisted suicide.

Some key political figures of the Democratic Party also disagree with PAS entirely,they are: Vice Pres. Joe Biden, Senator Chris Dodd, and Rep. Dennis Kucinich. However, most key democratic figures like President Barack Obama, Senator Hillary Clinton and Senator John Edwards, believe the states should decide whether PAS to be legal or not in their own legislation (“Hillary and Obama on Assisted Suicide and Medical Marijuana”). Many disapproving Democrats believe that assisted suicide is a form of extreme individualism, and that The 'free choice' of assisted suicide will sooner or later become a 'forced choice'. Terminally ill or disabled people sometimes do have suicidal feelings when they feel ashamed of their own condition, or when they feel that they are a burden on their families. The desire for death under those conditions is not free, but forced. It is forced by the absence of social support. Although, the bill only applies to people who are terminally ill. The real reason for suicide is not illness itself, but a fear of disability and loosing autonomy. In considering the past, Democrats have led the national fight for Patients' Rights legislation to protect against the cost-cutting excesses of Health Maintenance Organizations (HMOs) because they believed that not allowing people to commit suicide violated religious rights.

The Peace and Freedom Party, more well known as California's Feminist Socialist Party is against physician assisted suicide just like the Republican Party. The Peace and Freedom Party is committed to socialism, democracy, ecology, feminism and racial equality. They represent the working class and work towards a world where cooperation replaces competition. (Ytuarte, Eddie) This party opposed the Vietnam War and favored Ralph Nader for the Presidential election in 2008. There are two

main reasons why this particular party opposes PAS which are money and pity. According to the article, “Why I'm Against Physician Assisted Suicide” by Eddie Ytuarte, he states that, “…assisted suicide will be used as a way to keep down health care costs.” Undeniably, it is costly to keep severely ill people alive. However, not every illness ends in death. The second reason can be easily explained as the way society views the disabled and the dying which is that they are pitiful, and near death with a limited life and nothing to live for. Physicians or any individual should not allow their feelings to intervene with their morals of murder.

American Medical Association delegates chose to support pro-life legislation in Congress that would essentially ban assisted suicide. At an AMA convention the delegates voted to continue supporting a bill that regulates the use of pain medication, despite objections from doctors who said the measure would be an intrusion into state-regulated medicine. Delegates said it was more important to stop the assisted suicide law adopted by Oregon voters and to prevent other states from following that state's lead. “It's a question of whether the ends justify the means,” stated Dr. Donald Schroeder, an AMA delegate, “I strongly oppose federal intervention, but I'm so opposed to physician assisted suicide that I support this action.” The American Nurses Association believes that the “nurse should not participate in assisted suicide. Such an act is in violation of the Code for Nurses and the ethical traditions of the profession. Nurses, individually and collectively, have an obligation to provide comprehensive and compassionate end-of-life care which includes the promotion of comfort and the relief of pain” (Position Statement on Care at the End of Life). The American Directors Association opposes the involvement of a physician in assisted suicide or euthanasia of any patient. AMDA understands that they are trusted with the care of people who are vulnerable physically, mentally, and/or emotionally. Their position recognizes that physician involvement in assisted suicide or euthanasia would destroy the trust between a doctor and a patient (Position Statement on Care at the End of Life).

Not Dead Yet is a national working class organization of people with and without disabilities formed in response to the increasing popularity of physician assisted suicide and euthanasia in the U.S. Active in at least thirty states, Not Dead Yets' mission is to advocate against the legalization of PAS, and to bring a disability-rights perspective and awareness to the legal debate surrounding PAS. Not Dead Yet works to educate, coordinate and lead community effort to stop the “right to die” from “becoming a duty to die or a right to kill”.

Currently, Oregon is saving hundreds of thousands of dollars per person that dies from PAS and since the federal government is restricted from intervening with state laws is has cost the federal government nothing. By raising money through donations to the Not Dead Yet organization, which will go towards better and easier access to hospice care as well as if Congress is persuaded to overturn physician assisted suicide from a state law to a federal law and financially help the Not Dead Yet's donation fund. There are over 4,500 hospice agencies in the United States, but because of funding restrictions and the inflexibility of the Medicare Hospice Benefit requiring patients to have a life expectancy of six months or less, millions of people don't have access to them. By using these donations, federal dollars and Barack Obama's health care plan, the financial means would be slowly but surely reached. Obama's health care plan will save each American $2,500 a year for health costs, prevent insurance companies from over charging, cover all pre-existing conditions and import safe and cheaper drugs made in other countries. An estimated 60-80 million dollars will be needed to fund hospice care and to ban physician assisted suicide. If this solution succeeds, no person will be denied or unable to afford hospice care any longer and the battle between giving the right to murder and improving access to health care will also end. The lethal doses that are prescribed but never used will be out of irresponsible hands and put back into the educated health care professionals office. Essentially, the goal of this solution focuses on improving and allowing easier access to medical care rather than taking the easy route of legalizing physician assisted suicide and giving up on sick American's.

Making new laws won't stop those in pain from committing suicide. Complete banning of the issue which has been argued for far too long is the only resolution. Improving the system of hospice care will not only benefit the issue of PAS but it will also benefit the rest of America who need medical help or have been deprived of health care. Rather than letting people kill themselves, this gives a more positive alternative as well as a successful outcome. Suicide is a choice made by a person in an unstable mindset out of fear or desperation, but what they choose to do with their life, even ending it remains a personal decision. If a person commits suicide (which is illegal in many states) there isn't anyone to punish but if a law is made regarding otherwise, victims who experience the emotional distress of losing a loved one through suicide may look for someone to blame and abuse the law. Nothing can be done once an individual takes the route to suicide unless they were pressured to by another person. Any suspicion that may lead to evidence that the person received advice from a health professional should be examined with a fine-tooth comb. If physician assisted suicide was legalized, many of those dreaming of becoming a doctor would be too afraid to, because they would be forced to live with the guilt of aiding in suicide. Legalizing PAS would be like legalizing murder. This is a major concern that should be addressed throughly.

If an average teenager were to say they wanted to commit suicide we would be extremely worried, and deliver them to the psych ward of our local hospital as soon as possible. What is it that is so different with our elderly population? Why do we write them off as second class citizens under the assumption that they are 'old and going to die soon anyway'? Do we just not care about our Elderly Population anymore? My mom is a nurse and just the other day she was out of town at a seminar where the lecturer told her that “Oregon is a weird state” for allowing doctors to assist us in committing suicide, I tend to agree. The lecturer actually told her about documented cases where people would move to Oregon for the sole reason of being able to get prescribed medication to kill themselves because they felt there was no other way, if that isn't sad, I don't know what is. There is always a better alternative to PAS, and if we work together, I know we can find the answer. Death is supposed to be a last resort, not a first choice.

Works Cited

1. Hendin, Herbert, and Kathleen Foley "PHYSICIAN-ASSISTED SUICIDE IN OREGON: A MEDICAL PERSPECTIVE." Michigan Law Review Vol 106. Issue 8 (2008): 1613-1639. Academic Search Premier. EBSCO. Accessed October 18, 2009.

2. Newton, Heather. "Euthanasia: Overview." EBSCOhost - world's foremost premium research database service. EBSCO, 2009. Accessed November 16, 2009. <>.

This article presents an overview of euthanasia. Distinctions between euthanasia and assisted suicide are discussed. Vocabulary such as "Hospice," "Informed consent," and "Physician-assisted suicide" are defined. Particular focus is given to ethical questions surrounding euthanasia, the right to die, and quality of life issues. U.S. court cases involving euthanasia and physician-assisted suicide are also discussed

3. Strode, Tom. “Assisted suicide nearly doubles in Oregon; 'duty to die' lamented.” Baptist Press. 2009. Accessed October 15, 2009.


4. Morrow, Angela. “Why Would Anyone Consider a Hastened Death?” Reasons for Seeking Physician-Assisted Suicide. July 29, 2008. Accessed October 23, 2009. <>.

5. Hall, Kermit. “US Supreme Court: Washington v. Glucksberg and Vacco v. Quill”. The Oxford Companion to the Supreme Court of the United States. 2009. Accessed November 23, 2009. <>.

6. “Position Statement on Care at the End of Life.” Resolutions and Position Statements. 2009. American Medical Directors Association: Governance. Accessed November 11, 2009. < p97.cfm>.

For other sources see attached Source Cards.