Arguably nothing in life is more intimate and private than the manner in which one dies. Despite this the idea of a consenting adult willingly taking one’s own life when few other options remain stirs up significant controversy in our society. In this paper I will discuss physician assisted suicide, its history, its current legal standing in the United States, and how it exemplifies societal discipline by enforcing moral standards regarding suicide and death, even in cases where it goes against an individual’s wishes.
University of California Berkeley describes assisted suicide as, “the act of intentionally killing yourself with the aid of someone provides the knowledge remains to do so.” To be clear this is distinct from euthanasia wherein the physician administers the lethal medication. Such practices are illegal almost universally, expect in countries such as the Netherlands, Belgium, and Luxembourg. Currently physician-assisted suicide is legal in seven US states: Colorado, Hawaii, Oregon, Vermont, Washington, Montana, California, as well as the district of Columbia. To qualify you must be of sound mind and terminally ill, with six months or less to live. You must make two verbal requests at least 15 days apart, as well as sign a written request with two witnesses. Finally, the patient must have two doctors overview them to ensure that they meet all physical criteria.
The issue of assisted suicide is unique in that it has mixed pockets of opposition and support on both the left and the right. Some of the strongest opponents of euthanasia come from the handicapped and disabled community. They view any legislation in support of physician-assisted suicide as the first step in the devaluation and dehumanization of those with mental and physical handicaps, and violation of their civil rights. A leading anti-assisted suicide advocacy group, Not Dead Yet, states on their website that, “the political agenda of many assisted suicide organizations includes the expansion of eligibility to people with incurable but not necessarily terminal conditions who feel that their suffering is unbearable…without examining the cause of the suffering or whether it can be alleviated.” In their mind doctor assisted suicide presents a contagious practice which will ultimately lead more people to kill themselves rather than seek the help they need improve their lives.
Additionally, physicians throughout United States feel that assisted suicide is fundamentally against the Hippocratic oath. In its Medical Code of Ethics, the American Medical Association specifically states that permitting physicians to engage in assisted suicide would ultimately cause more harm than good. Rather than prescribe a lethal dose of sleeping pills doctors are encouraged to provide emotional support, comfort, and adequate pain control.
There is also an economic argument put forth by those who hope to rollback physician assisted suicide in states where it is legal. Nevada physician Brian Callister reported that in 2016 while talking to insurance reps for two of his patients, they refused to cover the lifesaving procedures he recommended and instead encouraged him to pursue assisted suicide which they did offer to cover. He argues that rather than giving patients the right to die, assisted suicide legislation creates a medical insurance culture where people have a duty to die. Some opponents go as far to say that assisted suicide will become increasing prevalent amongst poor uneducated minorities who see no other way out.
In rebuttal, supporters of assisted suicide will point that out of the 991 Oregon patients who died after taking their lethal prescriptions from 1998-2015 most were well off college-educated white people. Despite popular belief the reason most chose physician assisted suicide was not due to the pain caused chronic terminal illnesses, rather it is due to the lack of control and dignity they felt during the ending stages of life. In Washington and Oregon 90% of patients were motivated by a loss of autonomy, while in contrast 25% of patients in Oregon and 36% of patients in Washington said they could not tolerate future pain. Additionally, about 50% of patients in both states reported that they feared burdening the people they loved and leaving them with poor last memories. Given that this pain is largely existential and emotional, advocates view large amounts of pain killers and life support as a cruel prolonging of the true suffering.
One particularly vocal advocate for assisted suicide is Dan Diaz. He was widowed by his 29-year-old wife Britney Meynard, a 29-year-old Californian woman who opted to take a lethal prescription after she was diagnosed with aggressive brain tumor. Diaz states, “the dying process is what Britney feared… she was afraid that her final few days on this green earth would be ones where she was tortured by the tumor.” Similarly, when Mary Klein was asked why she opted to end her life after being diagnosed with advanced ovarian cancer she responded, “I want to have the option to control my own body and control my own life.” Others such as John Hofsess, a Canadian man who illegally helped 8 people end their own lives before taking his own, argued that if legal channels are not in place for suicide, people will simply turn to more dangerous and morally grey methods.
I chose this topic specifically because of the moral conundrum it presents. Both view themselves as advocates for the rights of individuals and yet if either side’s wins out in entirety their respective ideals laws and regulations will come to form a framework for what is seen as acceptable legal, moral, and ethical behavior. If physician assistant suicide is legalized and it becomes more of a common practice then it is now, there may very well be a dramatic shift in the way society as a whole treats death, as well as the options and treatment’s we offer and encourage for those that we see as living subpar lives. If the practice is illegalized, we will find ourselves denying sane individuals the right to die in dignity simply because we could not find their choices morally palatable. Either way a framework will emerge that leverages the power of the state to influence and ultimately control the actions of others.
If I am honest in my appraisal of these two sides, I find neither of them terribly appealing. On one hand I am appalled by the idea that a government or community could deny someone the right to die in a way they found dignified and instead have them suffer physically and mentally. On the other hand, I am incredibly disheartened by what seems to be on the surface a tepid endorsement of suicide and a tacit claim that’s some lives are not worth living. Despite these reservations I ultimately believe that physician assisted suicide, if implemented in a manner which allowed those who are beyond recovery to die in a way they saw fit without pushing further into communities that it could do harm to, represents the most ethically sound and morally justified way forward.
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