Physician Assisted Suicide

Physician Assisted Suicide Physician assisted suicide (PAS) was first legalized in the state of Oregon in 1996 and since that time has been a prevalent and controversial topic for other states and countries. PAS is best described as when “the physician intentionally helps the patient to commit suicide by providing drugs for their self-administration at the patient’s competent and voluntary request” (Gutierrez-Castillo, 2020). This means that the physician is allowed to prescribed a medication to a patient, but ultimately it is up to the patient to take the medication. The physician’s job is done after the medication has been handed to the patient. Technical Aspects Physician assisted suicide (PAS) comes with many aspects that must be considered including educating the patient about PAS and who is eligible to be considered to use PAS. To be considered for PAS, the patient must meet certain requirements including: being a resident of a state where the law is in effect, being 18 years or older, being sound of mind and capable of making your own healthcare decisions, have a terminal illness that will likely lead to death within 6 months, and being able to self-administer the medication without assistance (Death with dignity, 2022). In addition to these requirements, the individual must request for the help to die two times 14 days apart from each other and a second doctor must meet with the patient to confirm they are sound of mind and are not trying to end their life because they are depressed. Many times, PAS is used interchangeably with euthanasia, but to many it comes as a surprise to find out they are different. Euthanasia can either involve a patient requesting medication or not. The physician will administer the medication, usually a lethal injection or through an intravenous line. In regards to euthanasia, there are not protocols or processes that must be followed like there are with PAS, so essentially a physician can give a lethal medication to a patient if they alone deem that it is okay to do so. Many believe that physicians who partake in euthanasia are playing the role of God by deciding who dies and who gets to live. PAS is legal in 10 states including; California, Colorado, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, Washington, and the District of Columbia. Other states have attempted and continue to try to legalize PAS, but there has not been a new legalization since early 2021 when New Mexico became the 10th state to legalize PAS. Public Policies Since the first legalization of physician assisted suicide, there have been many considerations to further the law in the United States, but there has not been much change that has been occurring regarding physician assisted suicide. In the last 5 years, 4 states officially legalized PAS and many other states, some multiple times, have attempted the legalization of PAS, but there has not been any success with them (Patient Right Council, n.d.). One of the most recent changes in California, SB380, was approved by Governor Newsom on October 5th, 2021. This bill rejects the need to wait 15 days between requests for aid-in-dying and allows individuals to wait only 48 hours between their requests. This bill has only been approved in the state of California, and the 15-day waiting period is still in effect in the other nine states and the District of Columbia. In 1989, before physician assisted suicide was legalized in the states, Russ Fine convinced the United Kingdom court of Birmingham to approve his desire to end his life after describing his battle with insurance, not being taken care of properly after his motorcycle accident, and being moved from care home to care home (Pence, 2017). Even before it was legalized in the United States and other countries, there were existing cases that were taken to court and approved because of the incompetence of caregivers and the grueling battle with insurance to cover fees of nurses and equipment. The legalization of PAS has come a long way in many states because of the strong arguments that have been presented in these court cases. Arguments Supporting While not everyone is going to agree with physician assisted suicide, there have been some promising arguments that have allowed and persuaded individuals to legalize the action. Some of the main reasons that patients consider aid-in-dying is for their autonomy, relieve of suffering, and because it is believed to be a safer medical practice. Many patients who only have 6 months left to live consider physician assisted suicide because they lose their autonomy (Dugdale et al., 2019). Patients lose their right to do some of the most basic things by themselves such as toileting, showering, and eating. Many patients start to believe that they are a nuisance to those who have to care for them and they feel they have lost their dignity in addition to their autonomy by having to be cared for. Relief of suffering is another big factor that patients use to consider aid-in-dying (Dugdale et al., 2019). While there is the option of hospice care, many believe that their life is being dragged out longer and in many instances hospice care has not helped to relieve pain and suffering in the end stages of life for those who are terminally ill. Patients also take into consideration their families. Patients do not want their family members to grieve for months on end that they are going to die and believe that it is easier for family members to see them die quickly rather than go months before their body can no longer fight. Lastly, physician assisted suicide is believed to be a safer medical practice than the alternative (Dugdale et al., 2019). Patients who are rejected for aid-in-dying have taken their life into their own hands and have ultimately committed suicide because they did not want to live the next 6 months knowing that they were going to die anyways. Again, patients consider their family members and believe that committing suicide is a better alternative for them instead of them watching the patient die for months. While our supporting arguments serve a great purpose in the discussion, we still have to consider the arguments that are against PAS. Arguments Against Many reasons as to why PAS has not been legalized in many states and countries is because of some the prominent arguments that have been presented in the discussion of physician assisted suicide. The first argument against PAS is the slippery slope argument (Dugdale et al., 2019). Opponents are concerned that once physicians start involving themselves with aid-in-dying, that they will not be able to make clear judgements about who is a real candidate and who is not for aid. In this sense, they start to spiral down the slippery slope to a point where physicians are questioned whether they are doing the right thing and if they are practicing an ethical medical practice. The next argument that goes hand-in-hand with the slippery slope argument is the Oath of Hippocrates. This oath is still currently used at graduation ceremonies in many medical schools and medical professionals are expected to abide by it. The oath states, “The physician must… have two special objects in view with regard to disease, namely to do good or to do no harm” and goes on to also say that physicians promise to “abstain from whatever is deleterious and mischievous” and to “Give no deadly medicine to any one if asked” (Hajar, 2017). Lastly, PAS should be not be a legal option for ill patients because there is the option of hospice care. Hospice care focuses on the care, comfort, and quality of life of a person who is nearing the end of their life (NIH, 2021). Hospice care is not only for the dying patient, but support can be provided for the family as well. Hospice care means that no measures are being taken to extend or prolong the patient’s life. All that is being done is making sure the patient is not in pain and is comfortable. In a lot of cases of hospice care, even food is removed from the plan of care of the patient because providing nutrients to someone is likely to extend their life longer. Personal Opinion and Conclusion Physician assisted suicide is one of the most controversial topics not only in the medical field, but throughout the world. There are great supporting and opposing arguments for PAS, but I believe that physician assisted suicide is necessary for patients who have terminally illnesses or for those patients that are wheelchair bound, paralyzed, and can no longer do activities of daily living on their own. I believe that everyone has a right to dignity, autonomy, and a relief of their suffering. I have strongly told my own family that if I ever became paralyzed or could no longer take care of myself and there was a choice to end my life, do it. I do not want to be a burden to my family or expect anyone to do everything for me therefore, I am a strong supporter of physician assisted suicide because I would want it for myself in the case that something ever happened to me.