Physician assisted suicide is when a patient voluntarily decides to end his or her life, and a physician will prescribe them the appropriate medication in order to make that happen (“Definition of Physician,” 2004). It is said to be used for “compassionate reasons” only (Marrow, 2007), and it must only take place for an appropriate patient at the right time. But physician assisted suicide has often been confused with other terms such as active euthanasia, mercy killings, and lethal injections. Each of the acts has one distinct difference from physician assisted suicide. With physician assisted suicide, the drug is administered by the patient their self. With mercy killings or lethal injections, the act is done by another person such as a physician. Active euthanasia is when a doctor or other person directly administers the medication to the patient with intentions of ending his or her life even if it is done out of mercy (“Definition of Physician,” 2004). The term mercy killing is simply another way to describe euthanasia. Lethal injections are very similar, but unlike euthanasia/mercy killings they are not always done benevolently. Lethal injection is when you inject someone with a fatal dosage of medicine, but it is often used for capital punishment. Physician assisted suicide is only done out of compassion, and the ultimate decision and administration lies in the hands of the patient.
The first state to legalize physician assisted suicide was Oregon, in 1997. The law established is defined in their Oregon Death with Dignity Act. The United States of America’s Supreme Court came to the decision that there was no constitutional right to people allowing them the right to die, yet they did not prohibit states from making it a right. Therefore, Oregon took action, and it was voted on by the citizens of Oregon with a fifty-one to forty-nine percent margin. In 2001, John Ashcroft challenged the Oregon Death with Dignity Act, yet the Supreme Court upheld their decision to support the act in a six to three win. Recently, “in 2008, 30,973 people died in Oregon; only 60 of them died from PAS.” The legalization of physician assisted suicide has significantly helped in palliative care training, which is places that help with the quality of life when those are suffering and dying. The guidelines are specifically stated as follows: “requires the patient [to] give a fully informed, voluntary decision, applies only to the last six months of the patient’s life, makes it mandatory that a second opinion by a qualified physician be given that the patient has fewer than six months to live, requires two oral requests by the patient, requires a written request by the patient, allows cancellation of the request at any time, makes it mandatory that a fifteen day waiting period occurs after the first oral request, makes it mandatory that forty-eight hours (two days) elapse after the patient makes a written request to receive the medication, punishes anyone who uses coercion on a patient to use the act, provides for psychological counseling if either of the patients physicians things the patient needs counseling, recommends the patient inform his/her next of kin, excludes nonresidents of Oregon from taking part, mandates participating physicians are licensed in Oregon, mandates Heath Division Review, and Does not authorize mercy killing or active euthanasia.” These guidelines were set in place to help protect the physicians and those that are choosing to take their own life (Lachman, 2010, pg 121-123).
The second state to legalize physician assisted suicide was Washington in March 2009. The Initiative-1000 was voted on by the residents of Washington and won in a fifty-eight to forty-two percent vote. This was a relief to those that were advocates for the legalization of physician assisted suicide because of their previous loss in 1991 when the state tried to pass the I-119. The I-1000 was similar to that of the I-119, yet it strictly prohibited euthanasia and lethal injections. It was predicted that if all went well as it did in Oregon, Washington would suffer more deaths due to the difference in populations of the states. Yet, their guidelines had been revised from those of Oregon to a small extent. The Washington I-1000 states the following: “the patient must be an adult (18 or over) resident of the state of Washington, the patient must be mentally competent, verified by two physicians (or referred to a mental health evaluation), the patient must be terminally ill with less than six months to live, verified by two physicians, the patient must make voluntary requests, without coercion, verified by two physicians, the patient must be informed of all other options including palliative and hospice care, there is a fifteen day waiting period between the first oral request and a written request, there is a forty-eight hour waiting period between the written request and the writing of the prescription, the written request must be signed by two independent witnesses, at least one of whom is not related to the patient or employed by the heath care facility, the patient is encouraged to discuss with family (not required because of confidentiality laws), and the patient may change their mind at any time and rescind the request” (Washington aid-in-dying, Initiative 1000, 2010). Once again these guidelines are essential in protecting all parties involved. Although a patient may request the PAS, health care providers are not obligated to meet their demands, even if they meet the previously listed guidelines (Popick, 2008, pg 1).
The third and final state that has legalized PAS currently is Montana. Their act was put into effect in December of 2009. Montana did not come to their decision through a state ballad as those of Oregon and Washington, yet the choice to legalize it was left up to those of the court. The court’s four to three decision raised concern among the advocates of not legalizing it because they did not have a say in the voting. They wanted to vote on the issue just as those in the other two states where it is legalized (Knickerbocker, 2010). Montana’s courts released a statement though saying that they did not find anything in the Montana Supreme Court precedent or Montana statues indicating that physicians aiding in dying is against any public policy. They followed that with saying that in the end, it is not the physician who commits the final act, yet it is the patient. Due the decision of the Supreme Court the only guidelines set in place at this time is that physician assisted suicide is not prohibited by the state laws, yet their draft bill poses the same guidelines as those of the other two states, but is still unapproved at this time (Jackson, 2010).
Assisted suicide is a tabooed subject around much of the world. Physicians that aid their patients in dying have been sentenced to long jail terms and have lost their licenses. The legalization of physician assisted suicide in Oregon has initiated efforts of legalization in other countries such as the U.K. However, this is a very slow process and many groups, such as the U.S. Attorney General’s office, have prevented these efforts from becoming legalized.
When dealing with the idea of helping someone kill themselves, it is obvious that the church will get involved and have their head-strong ideas. There are three main ideas that are shared among those of the Christian faith and many other faiths. The first one being that life is a gift from God, and only God has the ability to start a life; therefore, He can be the only one to end one. Secondly, that suicide is a sin. Lastly, they believe that God does not allow us to experience anything we cannot handle. He will support us through our suffering and through our rejoices and asking to commit suicide is seen as an equal to not trusting in God. Other groups such as Atheists, Humanists, Secularists, and non-Christians, have two distinctive ideas as well. They feel each person has independence over their own life and that those who have a poor quality of life due to death should have the right to decided to commit suicide with the help of a physician if needed. Lastly, they feel some of the terminal illnesses out there are so painful that it causes life to a burden that can become unbearable. Allowing them to commit suicide is giving them the relief from their excruciating pain (Death with Dignity National Center, 2010).
Three of the most well known religions, Catholicism, Judaism, and the Protestant faith have their own opinions on PAS. Catholicism’s official position states that killing someone violates God’s law and is looked at as offensive to the dignity of a person (Death with Dignity National Center, 2010). They also do not see much of a difference between that of euthanasia and assisted suicide (Gregory, 1997). Judaism also has distinctive ideas on PAS. They are known have a heavy involvement in the attempts to restrict PAS in the courts and Congress. The Jewish faith teaches that suicide is an offensive act towards the higher power who is the “Author of Life” (Death with Dignity National Center, 2010). Lastly the Protestant faith, which encompasses a vast number of denominations, finds it hard to identify one position. Some of believe that PAS is wrong because it violates the Ten Commandments and its law, do not murder. The others believe that it displays a lack of appreciation, trust, and commitment to the Lord as a creator. These religions strictly oppose the idea of legalizing physician assisted suicide based off of their moral stances gained from holy texts and faith (Emanuel, 1998, pg 120-123).
On December 11, 1983, at the age of 25, Nancy Cruzan received severe brain damage after a car accident. She was not breathing and her heart had stopped by the time the paramedics arrived on the scene. She had suffered cerebral contusions from lack of oxygen resulting from the crash. Permanent brain damage can result from lack of oxygen for a period of six minutes and it was estimated that Cruzan had not been breathing for at least twice that long. She passed from a coma to a persistent vegetative state. She never recovered from her persistent vegetative state. She was cared for in a state hospital and her medical expenses were covered. Five years later, her parents realized that she most likely would not recover and asked to have the feeding tubes removed that prolonged her life. The hospital employees refused to do so before taking the matter to court. The court said that the parents could chose to remove her feeding tubes because Cruzan was no longer capable of making this decision for herself. A friend of Cruzan’s told the court that Cruzan had once told her that “if sick or injured she would not wish to continue her life unless she could live at least halfway normally.” However, the state determined this evidence to be unreliable. With a 5-4 margin in the Supreme Court, the court affirmed the decision and said that Cruzan’s tube could be disconnected. On December 15, 1990, her tube was disconnected. Eleven days later, from dehydration, she died (Larson, 2005, pgs. 405-411).
In 1990, at the age of 26, Terri Schiavo suffered cardiac arrest possibly due to a potassium deficiency in her blood due to her bulimia. Every doctor that examined her said the same thing: she was in a “persistent vegetative state.” She was put on a feeding tube to sustain her life. In 1998, her husband, Michael Schiavo, requested that she be removed from the feeding tubes. Typically, no patient regains consciousness after being in a persistent vegetative state for as long as Schiavo had been. Patients that did regain consciousness did so with severe physical and mental impairments. Her parents rejected this notion and took the issue to court. Schiavo had no health care advance directive. After a seven-year legal battle with Terri’s parents, Michael was awarded his wishes. The Florida court found that she was in a persistent vegetative state, which she would most likely not recover from. According to a statement from her husband, the court also found that she would not want to be kept alive in her condition with a feeding tube. Finally, on March 18, 2005, Schiavo’s feeding tube was disconnected. She died thirteen days later of dehydration (Larson, 2005, pgs. 405-411).
These cases, as well as their decisions were very similar. Both women came from white, middle-class, suburban neighborhoods. They were Roman-Catholic and in their twenties. Both suffered severe trauma and slipped into a persistent vegetative state in which they were unlikely to recover. The lack of oxygen in the initial medical emergency probably incurred permanent brain damage. And each woman’s life was sustained by years of tube feeding that would provide nutrition and hydration. Similar results would be seen in most other states with the same situation. But the women were from different states: Cruzan from Missouri and Schiavo from Florida. And the views of the families for each case were different: Cruzan’s family’s decision was uniform while Schiavo’s family’s decision was divided (Larson, 2005, pg. 408-409).
Another interesting case that is currently being debated is the case of a 95 year-old woman named Bernice Packford. Packford resides in Canada and she has been a social activist all of her life and helped families and children. Her work gained her the title of her city’s citizen of the year (Maclean’s, 2010.) She said, “I am in good health. I’m not suffering from an illness that will be eventually fatal. So my case is not covered [in the current death with dignity debate]. I’m tired and I do suffer from congestive heart failure [which robs her of energy and requires her to use a walker]. I’m facing imminent sickness or a stroke, which will leave me conscious and helpless. And that thought fills me with horror” (MacQueen, 2010). She just wants to die peacefully, but she says that she could not take her own life by her own hand. She has lived a life in which she has gave back to her community, but now she wants her society to give her something that no one else can give her. She wants the doctors to legally allow her to die when she wants (Maclean’s, 2010).
Packford claims to be backed by the majority of Canada. Sixty-seven percent of Canadians agree that euthanasia and assisted suicide should be legalized, according to the Angus Reid Public Opinion survey earlier this year. Others argue that it is unethical for medical professionals to play a role in the death of their patient when they have taken and oath to “do no harm.” She just wants to die when she finds it convenient. Is this really such an issue? Although Packford’s case is seemingly simple, many issues will be raised if she is allowed her request. If her request is granted, many other people who feel like they have become a burden on others will contemplate taking their lives prematurely. It is civil duty to protect the lives of the citizens. Making suicide an easier option for citizens violates the duty of the government to protect its citizens. Instead of allowing suicide for anyone that wants it, perhaps this option should be limited to those people suffering from mental health, aging, or diseases without cure (Maclean’s, 2010).
We interviewed a lady, whom we will refer to as Pam. Pam’s mother, Dianna, had been diagnosed with cancer. After going through several surgeries for her heart and battling cancer for many years, she fell while living in an assisted living facility. She broke her hip, and because her immune system was very weak, the doctors told her she had approximately seven to nine months to live. Dianna was very concerned about the burden she would place on her family. She had also been suffering for years and may not ever be able to walk again. “Mom was always concerned that she would be an inconvenience to others, and she had been in a lot of pain for a very long time,” said Pam. Because Dianna was a resident of Tennessee, physician assisted suicide was not an option for her. After living seven and a half months and enduring excruciating pain, Dianna passed away. “She suffered much longer than she should have had to. Not only physically, but she also suffered emotionally and financially. It was hard for me to watch her be in so much pain and not be able to do anything about it.”
Our opinion on this subject is based on several theories: egoism, social contract theory, and utilitarianism. We believe that physician assisted suicide should be legalized in the remaining U.S. states just as it has been legalized in Oregon, Montana, and Washington. According to egoism, we should seek out the best option for our bodies and ourselves. Our decisions on this case are also based on social contract theory. If you were in the situation where you could not make decisions for yourself, you would want someone else to be able to make that decision for you to help to relieve your pain. Patients oftentimes resort to physician assisted suicide based on a utilitarian approach because their death would relieve their pain and also cease the burden that they are placing on their families.
Many people have argued that if the legalization of physician assisted suicide spreads to more states the amount of people that will chose to end their lives prematurely will drastically increase. We feel that this is untrue. Some have compared the legalization of physician assisted suicide to the legalization of abortion. Whether these acts are legal or not, they are happening everywhere (“Evolving Policy,” 2009, pg. 114). Tucker refers to these illegal acts as “back alley” practices. Oregon, Washington, and Montana are not the only locations that the act of physician assisted suicide is taking place. Therefore, there are definite advantages for the legalization of physician assisted suicide. If it is legalized, there are checks and limitations put into place. As stated before, the patient will be required to submit two verbal requests as well as one written request. The physician will be required to receive a second opinion from another physician. These two measures alone will help to monitor that these act of ending someone’s life is done for the proper patient for valid reasons.
The legalization of physician assisted suicide is a very controversial issue in today’s society. Although there have been three states to legalize it, there are many ethical issues still facing it. The three ethical issues that are discussed help sum up the stances people have taken when it comes to the idea of someone taking their own life. The three cases of Nancy Cruzan, Terry Schiavo, and Bernice Packford demonstrate the feelings of individuals who are put into the situation of whether or not their pain is worth living through? In conclusion our position supports the legalization of physician assisted suicide because of egoism, utilitarianism and the social contract theory.
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