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The Case for Physician Assisted Suicide

Caroline Peay

English 102
Professor Padgett
5 April 2016

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Introduction
In a world overwhelmed by technology, advantages are at an all time high for citizens.
Recent technological advances have revolutionized the process of dying by making it possible to
prolong the extent of life. However, the consequence of these advantages result in an opportunity
for a lifetime dependence on medical technology. Increasingly, patients are opting for
alternatives for their end of life decisions instead. In the previous decade, Physician Assisted
Suicide (PAS) has been the most controversial topic in this discussion. Although many people
are confused and uninformed about the understanding of PAS. It is frequently mistaken for
euthanasia. Euthanasia is defined as death resulting from medication that is administered by
someone else than the patient (by law a physician) with the explicit intention of ending life at the
explicit request of the patient (Onwuteaka-Philipsen et al. 596). A second end of life process
also confused with PAS is terminal sedation. Terminal sedation is characterized as the
alleviation of a dying patients refractory symptoms such as pain, dyspnea, delirium, or
nausea [which] are treated with symptom specific therapies that may have sedation as a side
effect or are controlled by intentionally inducing sedation (Kaldjian et al. 499). In terminal
sedation, a physician can speed up the process of death through different mechanisms depending
on the medical case.
PAS involves a physician knowingly and intentionally aiding in a persons death whether
it be by administering the drugs to do so or counseling to give them knowledge to perform such
actions. It is always at the request of the patient and with their consent as the patient is the one
executing the action. Although PAS is commonly mixed up with other forms of end of life care,
it is contrastingly very different. The main distinction between PAS and euthanasia or terminal
sedation is that the medicine and end of life care is administered strictly by the patient. It is not

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up to the physician to decide the time of death of the patient nor do patients feel the pressure of
ending their life, rather they are in complete control of the consumption of medicine.
Personal Opinion
As more states continue to seek the legalization of physician-assisted suicide for
terminally ill patients more controversy continues to arise. There are many supporters for PAS as
well as many people against it. As a student pursing the medical field, I think its highly
important to keep up to date on the growing healthcare system and the technological
advancements taking place. I find this medical controversy exceptionally interesting because it
effects countless medical professionals as well as daily Americans. As an American it
specifically affects me right now and what choices I have if I were to become sick and one day it
will influence my decisions as a medical employee. Although I have never needed the option of
physician-assisted suicide, I have witnessed family members and family friends suffer through
life ending illnesses with no possible outcome other than death. I genuinely dont have any
qualifications to write about this besides the few cases I personally witnessed from afar.
However, I feel strongly for the people that have to suffer like those I saw did, people should
have a right to choose when they die and how they die if they are experiencing agonizing pain.
We shouldnt force them to do it alone, they should have the option to console with their doctor
and get the information needed to help them the best way possible. It also isnt fair to force sick
patients to travel and uproot their life more so than it already has been, only to move to another
state for them to receive specific attention from a willing physician. Federally implementing PAS
is more beneficial and ethical, for the individual and doctors and society, as everyone is pledged
civil rights under the 14th amendment, but more humanely a person deserves an alternative to
their excruciating and everlasting suffering.

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History
Although there has been a heightened debate over PAS in the past decade, the
controversial argument dates all the way back to the Greeks and Romans when the Hippocratic
Oath was established in the fourth century B.C. According to the online Greek Medicine Journal,
the Hippocratic Oath states, I will not give a lethal drug to anyone if I am asked, nor will I
advise such a plan (U.S. National Library of Medicine). Due to this inauguration of physicians,
they lawfully could not perform or aid in cases of euthanasia or PAS. However, as time went on
the debate of prohibiting PAS and euthanasia fluctuated. The first United States milestones of
PAS occurred in 1905 and 1906 when Ohio aimed to pass two separate bills. While nothing
came from these bills attempts, it did spark a new contemporary conversation of PAS. In
chronological order listed below are some of the primary and monumental dates that transformed
and progressed this modern conservation. These dates were accessed, specifically chosen, and
copied from the Death With Dignity Organization website.

1973 American Hospital Association creates Patient Bill of Rights, which includes
informed consent and the right to refuse treatment.
1986 - Americans Against Human Suffering is founded in California, launching a
campaign for what will become the 1992 California Death with Dignity Act
1990 - The American Medical Association adopts the formal position that with informed
consent, a physician can withhold or withdraw treatment from a patient who is close to
death, and may also discontinue life support of a patient in a permanent coma. Lastly,
Congress passes the Patient Self-Determination Act, requiring hospitals that receive
federal funds to tell patients that they have a right to demand or refuse treatment. It takes
effect the next year.
1994 - The California Bar approves physician-assisted suicide. The Conference of
Delegates says physicians should be allowed to prescribe medication to terminally ill,
competent adults self-administration in order to hasten death. More importantly, The
Death with Dignity Act, also known as Measure 16, was originally passed by a narrow
margin in Oregon. It was challenged in the federal court shortly after and was barred
from taking effect.
1997 The previous measure mentioned in 1994, was approved by a ratio of 60:40 and
The Oregon Death With Dignity Act was subsequently enacted in November of 1997.
1998 - 16 people die by making use of the Oregon Death With Dignity Act, receiving
physician-assisted suicide in its first full year of implementation.

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2009 - The Washington Death With Dignity Act goes into effect in March.
2013 - Vermont Governor Peter Shumlin signs a bill to make Vermont the third state in
the US with a Death with Dignity law on May 20.
2015 - California legislature passes End of Life Option Act, a Death with Dignity law.

Despite the fact that only five states, Oregon, Montana, Washington, Vermont, and
California, lawfully allow PAS under the Death With Dignity Act many more are soon to arise.
Although countless states will try for legalization, the reality is they will fail on their first
attempts and possibly even the attempts after that. Nevertheless, some states will achieve this bill
and join the overall controversy of federal implementation instead of separate state
implementation.
Benefits and Disadvantages
There are numerous benefits and disadvantages surrounding the argument of federally
implementing PAS. One of the main debates is that citizens have the right to die. Under the
Death With Dignity Act there are strict implications physicians must follow when prescribing the
medication for patients wishing to die. The attending physician must, among other things,
determine that the patient is mentally competent and an Oregon [or other legislated state of PAS]
resident, and confirm the patients diagnosis and prognosis (Tucker 1602). The benefit of
having the right to die for competent, terminally ill patients is described by Ziegler and Bosshard
as, a choice among a continuum of options at the end of life (297) Under the 14th
amendment these competent and terminally ill patients should have the choice and right to die
because they are promised equality and ownership of their own body. The counter argument of
this benefit defends that PAS is not legal in all states and because of this the asserted right to
assistance in committing suicide is not a fundamental liberty interest protected by the Due
Process Clause (Washington v. Glucksberg 1997). Although this is arguing that PAS is not legal

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and therefore people should not feel inclined to have the right to participate in suicide whether
they be on the receiving or administering side, PAS is legal in some states and thus allows the
right to suicide. If the government were to federally legalize PAS, the dividing of the states
would cease and everyone would have a right to suicide because it legal under PAS and
therefore become a fundamental liberty in the interest of the people.
Another predominant argument for the benefit of federally legalizing PAS is that patients
who are experiencing a grueling life ending illness would no longer have to. Patients would no
longer have to uproot their life to move to another state and go through the process of becoming
a resident to seek treatment from a willing physician. Patients would no longer have to live a life
in a vegetable like state or be dependent on life-sustaining treatment. According to B Steinbock,
the [ethical] argument from suffering asserts that it is cruel to force a dying patient whose pain
cannot be controlled with medication to continue living. It is undeniable that many terminally ill
patients die in terrible pain (235). Contrastingly, the disadvantage to this is that opponents of
PAS claim that there have been abuses, that there are insufficient safeguards, and that existing
safeguards do not work (Steinbock 238). Although those are valid cases of possible intentional
or unintentional physician misconduct and patient harm from PAS, the final and most crucial
counter argument to this is that by not legalizing PAS, this position condemns the patient to live
out a life he or she does not want a form of cruelty that violates the patients rights and
prevents discharge of the fiduciary obligations of the physician (Shaw 320).
Protestors against PAS also defend the disadvantages of federally legalizing it by
claiming it will undoubtedly result in the legalizing of euthanasia. Which as previously
mentioned before, euthanasia is when physicians cannot only prescribe lethal medication but also
administer is. This is worrisome for protestors because certain groups of patients such as the

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disabled, those with mental illness, poor people and minority group members, could feel
pressured into choosing death due to economic pressures or care taker promptings (Steinbock
237). Regardless of the protestors apprehension, those supporting PAS believe this fear is not
substantial enough to abolish the legalization altogether. Supporters conclude the only way they
would not strive to seek the legalization of PAS is if actual evidence of a possible surge in
euthanasia was documented beforehand (Frey 1998).
Ultimately, there are an ample amount of benefits and disadvantages of PAS and those
mentioned above, although they are the primary debates, do not consider and include all
arguments. It is noted that overtime PAS has the potential to reduce the cost of healthcare within
the United States (Battin, Emanuel, 1998). Organ donation after ones death in order to save
another persons life is also seen as a beneficial factor of PAS. Specifically, PAS may save the
life of another person who does not have a life ending illness, but only a general illness and who
has a chance of surviving a considerably while longer. Furthermore, the availability of PAS
may have contributed to the improvement of end-of-life-care (Steinbock 238). Meaning citizens
who had the opportunity to request PAS were exposed to a more in depth and effective
discussion with their physicians about alternative options if they couldnt proceed with the lethal
medication. In essence, if the federal government were to legalize PAS and give citizens the
option of their right to die, it could in reality increase alternative end-of-life care instead. At the
same time, there are also more disadvantages of PAS that were not brought to light. Such as
physicians gaining a significant amount of power and in certain aspects going against the
Hippocratic Oath they took. Many also claim that if PAS is legalized, great care must be taken
to ensure that it is not offered to individuals whose unbearable suffering is actually treatable
depression (Steinbock 239). All benefits and disadvantages considered, the argument for

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federally legalizing PAS is an ongoing debate that has credible positions on each side. But at the
same time the realization of death and the end of life is a difficult and saddening process in itself,
the addition of suffering and pain is unethical for not only physicians, but lawmakers to allow.
Physicians Point of View
In order to appropriately comprehend the argument between these benefits and
disadvantages of legalizing PAS it is essential to explore the opinions of those who would be
administering and counseling patients. More than every before, physicians are releasing their
point of view on the debate as they are increasingly pressured by society to defend a side. In
2006, a study was conducted by the University of Vermont medical students in association with
university-affiliated physicians as well as other professors and staff members. The survey was
designed to assess whether clearly defined variables gender, specialty, location of practice,
whether the physician is currently practicing, whether the patients are cared for through the end
of life and whether the physician has experience with patient requests of PAS were predictive
of physician support of the proposed PAS legislation (Craig et al. 400) The results of this
study concluded that of the 1052 participants (with a 48% response rate), 15.7% were undecided,
16.0% believed it should be prohibited, 26.0% believed it should not be legislated and 38.2%
believed PAS should be legislated. Furthermore, 50.1% responses back said they would
participate in PAS under a law (Craig et al. 400). Overwhelming, reports of those not in favor of
PAS were due to moral and ethical beliefs such as previous held beliefs or physician to patient
relationships. Whereas physicians supporting PAS reported patient autonomy and level of
uncontrollable pain as main decision making factors.
Although it has been ten years since the study previously mentioned above was
published, the results of the physicians opinions are still similar of those held by todays

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physicians. The most noticeable difference of physicians point of view in recent years is the
inclusion of physicians from other countries. Currently, the United States and Europe are
observing and conducting experimental research pertaining to PAS and the influential role the
physician has on type of care received. In a recent survey published in 2008, six European
countries and Australia questioned physicians in what their likelihood of receiving requests for
PAS was and their willingness to perform. Overall, the Netherlands had the highest rate (71%) of
receiving such a request and the highest rate (56%) of willingness to administer, prescribe or
supply drugs for end of life care. (Lfmark et al.) Within each of these cases, similar results were
found of willing physicians who would participate in PAS under a law and believe it was
effective for specific patients. Although the US varies from these countries in many different
ways, they all are currently on the verge of accepting and implementing some type of legislation
regarding PAS.
For the most part physicians are for the use of PAS under a law such as the Death With
Dignity Act because it establishes a set of guidelines that would ensure minimum malpractice
lawsuits and room for error. To federally allow PAS in every state, would increase rate of
participation of physicians. Granted, research of the opinions of physicians should increasingly
take place to validate the previous results as well as gauge the future perspectives. Ultimately,
the physicians point of view is imperative in the implementation of federally legalizing PAS in
the United States because they are the ones prescribing such doses and without their support the
bill would never be practiced.
Conclusion
As the medical field continues to technologically advance and extend end-of-life care, it
is important for a citizen to know his or her rights involving their options shall they acquire a life

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threatening illness or someone in their family does. In order for a resident to understand their
options they must keep up with this growing controversial subject. Historically, and most
recently, PAS has been at the top of medical debates worldwide. Although the overall debate is
relatively the same, PAS currently affects each individual differently depending on which state
they reside in. If the government were to federally implement PAS, all citizens would be
affected in the same way and each would benefit more so than before. Citizens would be given
their right to when they die, how they die and where they die in order to relieve them of
excruciating pain due to a terminal illness. Conclusively, the benefits of implementing such a
legislation nationally cannot be deemed as unethical by the United States and therefore cannot be
unaccepted by both physicians and the public.

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Frey, RG. (1998). The Fear ofa Slippery Slope) Euthanasia and Physician-Assisted Suicide: For

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