The Complications of Physician-Assisted Suicide

There is a heavy debate on the legality, morality, and ethics surrounding physician-assisted suicide because itr's difficult to determine what qualifies a person for assisted suicide because there has not been enough thorough research. There are many aspects, both beneficial and detrimental, that have not been adequately explored. This should be a cause for concern for both doctors and patients. The controversy surrounding physician-assisted suicide and voluntary euthanasia is rooted in the lack of knowledge about the regulations, demand, qualifications, moral and ethical issues, the current legality surrounding the issue and why it should continue to be illegal in most states.

Most who oppose physician-assisted suicide base their opinion on the moral and ethical arguments and the possible risks. In the American Medical Association Journal of Ethics, Faith Lagay states, ""Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, [it] would be difficult or impossible to control, and would pose serious societal risks"" (Lagay,2001). Physician-assisted suicide can not be considered palliative care, which is specific medical treatment focused towards patients with serious or terminal illness, because it is not healing the patient and is generally considered unethical. In the New England Journal of Medicine (NEJM), Richard A. Gingrich, M.D explains that Many patients are very susceptible to feelings of guilt of being a burden on their families which could lead to requesting assisted suicide not because they really want to die, but because they may feel that their families, or even society, would be better off without them (Gingrich, 1993). This is a major concern for physicians who would be willing to conduct assisted suicide because itr's difficult to determine the real reasons someone would request it. Guilt on the part of the patient is not considered a valid reason because it could be a side effect of a mental illness or trauma. Stephen S. Lefrak, M.D., a reputable professor of medicine, states in the NEJM, The error lies in assuming that physicians have the talent and the personal qualities to meet the proposed safeguards and policies. Can we be so arrogant about our abilities that we would allow ourselves to govern the distribution of death? (Lefrak, 1999). This quote makes an essential point, itr's not another personr's responsibly or right to decide the fate the end of anotherr's life. Nobody should be granted the power to rightfully and inconsequentially distribute death, which is essentially what physician-assisted suicide is.

On the other hand, people who support physician-assisted suicide or euthanasia refer to it as treatment for patients as a euphemism to make people believe that itr's a medical procedure to ease the morality issues. The supporters defence explains that the main argument is that people have the right to control what happens to their own body and have the right to make their own decisions. Faith Lagay states, Most terminally ill patients who wish to commit suicide want to do so by medical means, nonviolently, out of respect for themselves and others. Yet medical suicide is not easy to accomplish; dosage and timing of drug administration matter critically, especially if the drug is taken orally, and failed attempts can cause greater trauma than death itself for the patient and caregivers. Patients may beg caregivers to complete their failed attempt at dying. These circumstances and possible consequences convince some physicians that helping a patient who is determined to end his or her life prevents a greater harm than it causes. Moreover, some believe that ending, at a patient's request, the physical pain and mental anguish from which that patient will not recover does not violate the spirit or goals of medical ethics (Lagay, 2001). Some argue that if someone is experiencing unbearable and constant pain deserves the option to make the decision to end their own life if they feel itr's totally necessary, but is it worth the possible detriment? Therer's still questions left unanswered on how to determine what makes that totally necessary in a specific situation. Lagay also states, Some bioethicists believe that, when law and professional ethics come into conflict, physicians have obligations beyond their one-on-one covenant with patients. Alex Capron and Eliot Freidson, for example, have written that physicians have a social and political duty to create an environment that encourages the ethical practice of medicine. On this view, physicians should support and campaign for regulations that ensure humane care for the terminally ill and reimbursement for the costs of proper end-of-life care. Such provisions will reduce patients' concerns that their end-of-life care is overwhelmingly burdensome to others (Lagay, 2001). A main concern that advocates have is to provide a respectable, proper end to oner's life. Advocates for legal assisted suicide argue that allowing a small number of assisted suicides under carefully controlled and restricted conditions is better than secret and unregulated activity.

There are many different laws and regulations is each state, some states have relatively lenient laws and in others itr's completely illegal. It is stated that in most states, a licensed healthcare professional who, with the purpose of helping someone commit suicide, provides the physical means by which another person can commit or attempt to commit suicide, or participates in a physical act by which another person commits or attempts to commit suicide, is guilty of a felony. Only seven states in the US (and DC) have legalized physician-assisted death with the exception of certain qualifications. These states are California, Colorado, Hawaii, Montana, Oregon, Vermont, Washington, and DC. The patient must be at least 18 years old, must have one written request and two oral requests (at least 15 days apart), and have less than 6 months until expected death (State-by-State, 2018). Every few years these laws change and adapt to the needs of the people in those specific states and more states have continued to be more open to legalizing assisted suicide for specific patient situations. Faith Lagay states in the American Medical Association Journal of Ethics, That a state can legalize physician-assisted suicide, as Oregon has in fact done, highlights the difference between what's legal and what's ethical; what the state allows residents to do and what members of a given profession, in this case medicine, believe they ought to do. Though a state may legalize physician-assisted suicide--or abortion, or capital punishment, for that matter--it cannot force doctors who oppose the practice on grounds of professional ethics or from personal beliefs to participate. In Oregon, the legal right to seek a physician's help in ending one's life went into effect in 1997 (Lagay, 2001). Laws surrounding this topic are very difficult to put into place because the laws would have to be more generalized to suit more than just certain patients, causing a more widespread normalization of this practice. Normalization would increase the possibility of doctors suggesting assisted suicide to vulnerable patients that wouldnt have thought of it as an option in the first place. The misuse of this practice by physicians and the vulnerability of patients is one of the main concerns in regards to physician-assisted suicide, because they are the most difficult aspects to control.

Doctors who support physician-assisted suicide have to consider the factors behind a patientr's request for assisted suicide, and it depends on specific circumstances if the doctor would be willing to assist a patient's death. Itr's stated in the American Medical Association Journal of Ethics, If a state does legalize physician-assisted suicide, what choices do physicians in that state face? Must they opt either to (1) refuse aid to patients determined upon killing themselves, thus driving those patients to seek help from other, possibly unknown, physicians or inexperienced caregivers or (2) violate their profession's principal code of ethics? (Lagay, 2001). One of the main reasons a doctor might consider it is if the patient experiences unrelenting, constant pain. It can be extremely difficult to determine a patient's level of pain, because there is no actual medical way to measure pain other than by the patientr's word, which increases the inconsistencies of a patient evaluation. Itr's rare that a mentally competent person would actively chose suicide over other medical treatments and itr's difficult to determine oner's mental competency without having a foolproof system of determining such, which has not been put in place. So until that is created, physician-assisted suicide should not be legalized. There is not enough research around the drugs or methods used to conduct euthanasia or the effects that come along with the drugs.

There has continuously been more questions than answers, doctors know that there are both benefits and deficits but dont have the evidence to come to a solid conclusion. There seems to be more possible disadvantages than advantages because itr's more difficult to control the negative, unexpected outcomes. It is extremely important to have the most accurate and useful information on physician-assisted suicide because it is human lifes that are at stake. There needs to be continued research on all the possible deficits to the patient, the families, and the doctors involved. Currently, society doesnt have the essential information needed to create a policy that would comply with all the ethical issues brought about by assisted suicide, and that is why it should not be legalized until that information is obtained.

Works Cited

Fiesta, Janine. Legal Aspects of Physician-Assisted Suicide. Nursing Management, vol. 28, no. 5, 1997, p. 17. https://web.b.ebscohost.com.libproxy.cnm.edu:8080/ehost/pdfviewer/pdfviewer?vid=1&sid=261ce594-60df-436c-a4eb-e1e310e4aad4%40sessionmgr104

Gingrich, Richard. Assisted Death and Physician-Assisted Suicide | NEJM. New England Journal of Medicine, 1 Apr. 1999, www.nejm.org/doi/full/10.1056/NEJM199304013281313.

Lagay, Faith. Physician-Assisted Suicide: What's Legal and What's Professional? Journal of Ethics | American Medical Association, American Medical Association, 1 Jan. 2001, https://journalofethics.ama-assn.org/article/physician-assisted-suicide-whats-legal-and-whats-professional/2001-01

Lefrak, Stephen. Assisted Death and Physician-Assisted Suicide | NEJM. New England Journal of Medicine, 1 Apr. 1999, www.nejm.org/doi/full/10.1056/NEJM199304013281313.

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