RUNNING HEAD: PHYSICIAN ASSSITED SUICIDE

TITLE: Controversy Behind Physician-Assisted Suicide in the United States

Cinthia Delfin-Aguilar
University Of Texas at El Paso

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Abstract
This literature review will discuss the controversy of physician-assisted suicide
(PAS) in the United States. Although there are already states that allow for a dignified
death, many are still unsure of this topic. With terminal and debilitating illnesses on the
rise, PAS has become a very controversial subject. Some people believe that assisted
suicide should be a legal right to all who have a terminal illness while others believe that
it is ethically and morally wrong. This review will look at defining physician assisted
suicide, understanding the difference between euthanasia and physician assisted suicide,
making sense of why terminally ill patients choose PAS, the ethical questions that it
raises and whether or not we should legalize it across America.
Included in this review is a survey that was conducted on surveymonkey.com. It
included a total of 35 participants and had a total of 8 questions. The questions can be
found after the reference page.

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Intro
With so many debilitating and terminal illnesses these days, it is no wonder why
there has been some controversy as to whether we as Americans, should have the right to
end our own life. Even though it is not easy to understand why people believe that
physician-assisted suicide (PAS) is their best option, it is important to note that choosing
this decision takes a great deal of thought and courage. Physician-assisted suicide is best
defined as a terminally ill person making the decision to end their own life on their own
terms and at their own will. A terminal illness is defined as having an illness, in which
there is no known cure, or when nothing further can be done in order to sustain a persons
life. Many of these terminal illnesses can range in anything from cancer, heart disease,
multiple sclerosis, Lou Gehrigs disease and even some traumatic head injuries
(Medscape). According to the Centers for Disease Control and Prevention terminal
illnesses are the top leading cause of death in the United States with one out of four
deaths attributed to cancer (CDC, 2011).
For many people a terminal illness is a real reality as there is nothing that they can
do except wait for their illness to take over. For doctors, it is a struggle between doing
what they have been taught to do which is save a life at all costs or honor the requests of
their suffering patients. Although physician-assisted suicide has long been debated in the
U.S., it has been practiced in Europe for many years. Currently in the United States,
there are only five states where physician-assisted suicide is legal or also known as the
death with dignity act. These states include Oregon, Washington, New Mexico, Vermont,
and Montana. Some of the reasons behind the illegality in most of the United States is
may be due to the fact that many are unfamiliar with physician-assisted suicide, the

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ethical questions it brings up, and the lack of many peoples understanding as to why
someone choose to end their life this way.

What is the difference between physician-assisted suicide and euthanasia?

Physician-Assisted suicide or PAS is the process in which the attending physician
prescribes their patient a lethal dose of medication. In other words, they only give them
the means for them to end their life (Dennis, 2009). The person is fully of mental capacity
to make the decision and in no way does the doctor actually administer the lethal
medication. Many studies show that most of the time, people do not even end up taking
the medication (Dennis, 2009). Advocates believe this to be because of the power it gives
the patient. Knowing that they can end their life when their last days become unbearable.
Euthanasia on the other hand is different because it can be broken down further into two
sub groups. These sub groups include active and passive euthanasia. In active euthanasia,
the physician knowingly takes a patients life usually by injecting them with a cocktail of
lethal drugs. Cases like these are also sometimes referred to mercy killing. This is when
a person ends someone elses life because they believe it to be best for the suffering
person. Those who oppose euthanasia believe this to be senseless and immoral act upon
the physician because of the Hippocratic oath. Those who advocate euthanasia believe
that when a person who is suffering with a terminal illness and can no longer deal with
their physical pain, they should have every right to want to end their pain and suffering.
Then there is passive euthanasia in where the physician withholds any type of further life
sustaining treatment to the patient and lets nature run its course. This usually includes
terminating any type of life sustaining IVs or taking a person off of life support (Dennis,

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2009). Many people who oppose active euthanasia also tend to be in favor of passive
euthanasia possibly because it may seem less harsh and believe a person is better off
letting the illness take its natural course. Opponents of PAS argue that a since a person is
terminally ill, this puts them at great risk of being abused. Abused meaning that they may
be coursed into the situation and are not mentally stable to make such decisions.

What are some of the reasons terminally ill patients choose physician-assisted
suicide?
There can be many reasons as to why a terminally ill person may want to end his or her
life. Whether the person may have six months or a few weeks to live, the amount of pain
that they are in is immeasurable to what they are actually experiencing both emotionally
and physiologically. According to Varelius (2012) patients who are terminally ill, no
longer think they have a purpose in life. They believe they are a burden not only on their
family but also on their community. People may also feel strained because of rising
medical costs and start to lose faith that they will ever get out of it and leave their family
with debt. Interestingly enough opposing physicians also disagree with the patients
reasoning, as they believe they could give their life more meaning if they dont end it
shortly. This brings to attention that opponents of PAS can agree that they think they can
be more interested in prolonging his or her life so long as they have a good family and/or
friend support. Activist of PAS question whether or not the persons anguish is being
taken into consideration. Whether family or doctors are just trying to keep the person
alive out of their own selfishness and whether or not they are trying to keep them alive
for the wrong reasons.

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It is also only natural that people fear death. But when someone is diagnosed with a fatal
illness and know that there is no looking back, this fear can intensify even more. Many
people like Brittany Maynard who was diagnosed with stage four brain cancer, become
fearful of living their everyday life. They know that because of the intensity of their
illness, their death will most likely be a painful one. They are aware of what is to come
and many begin to feel a loss of power. Although they may try to live their last weeks or
months of life as comfortable and courageous as possible, most days they are in extreme
pain. Due to the pain and their bodys physical deterioration, terminally ill people start
relying on other people for everyday things making them more depressed that they can no
longer car for themselves. People who disagree with physician-assisted suicide argue that
with proper palliative treatment, death can be painless or at least not as bad as it could be.
Then again who else knows what death really feels like is what others say. According to
Dennis (2009), many of the times, patients do not even take the lethal medications. For
advocates such as Maynards husband, he believes that between suffering and allowing
to decide when enough is enough, it provides a lot of relief and comfort if and when she
decides that it is time (The Brittany Fund) This goes to show opponents that just
knowing that they are able to die a dignified death is such a relief versus letting their
disease to take control of them. Another reason why PAS opponents may disagree that
voluntary suicide is wrong is because with all of the new technology these days, death
may be able to be prolonged and leave the person with even more desperation. For
activist, it is a question of when is enough enough? How long should a person have to
suffer just because society believes PAS is wrong?

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Is it ethically correct?
Upon graduating school of medicine, many physicians take on the Hippocratic
oath. The Hippocratic oath is the foundation of which a doctors moral and ethical code
of conduct is described. It sets the standards as to which every doctor should abide by.
Even though the oath has been modernized throughout time, the principles are still pretty
much the same. The Hippocratic Oath in an nutshell proclaims I will keep the sick from
harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will
I make a suggestion to this effect. (Tyson,2001) A physician is seen as a healer and not a
killer and for this reason, opponents of PAS believe that no doctor should be permitted to
kill intentionally, or assist in killing intentionally in any way shape or form. Where as
advocates of PAS feel that the doctor as a healer should want to heal the pain of their
patients in any way that they chose to as they are the ones suffer. As the chart below
shows, although many physicians have prescribed the lethal drugs, many patients do not
end up participating in taking their own death. This goes to show that despite what
opponents may believe, it can be concluded that PAS is less of an ethical issue and more

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of a personal one.

By giving the patient the freedom to choose their time of death, they in no way expect
participation in every case. One source also reveals that Of 114 people who requested
lethal medication in Oregon in 2011, only 71 actually used it and died. (Eldred, 2014)

Should there be a legal right to die?

Currently in the United States, physician-assisted suicide is already legal in five
states. These states include Oregon, Montana, Vermont, New Mexico, and Washington.

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The death with dignity law first passed in Oregon in 1994 and was intended for the relief
of competent terminally ill patients. The law required patients to be at least 18 years of
age, be able to properly communicate about their decision with their physician, that they
have a prognosis of less than six months to live, have two witnesses (only one a family
member), and must write a request and wait no less than 15 days for a second request.
( Schencke,2015)
As you can see this is a tedious process and one of the reasons that people who
are for PAS say that anyone who goes through this process has time to decide and must
meet many conditions.They also feel that simply because a person makes a request does
not necessarily mean that they will take the medicine. Patients can also choose to
withdraw their request at any time. The death with dignity law allows for ill people to
have a peaceful death whenever and if they ever chose to. (People for the legalization of
PAS believe that every person suffering from a terminal illness should have the peace of
mind that they can end their suffering if they chose to. All that terminally ill patients
want is the chance to die a more dignified death. For their loved ones to see them go in
peace rather than watching them suffer into a painful death. On the other hand, you have
other people who think this goes against many of cultural beliefs and that they should
wait for nature to take its course. They also believe that since it their prognosis is only an
estimate of time, it is hard to predict who is to say that they are not also capable of out
beating their prognosis. Some also argue that this makes it easy for physicians to take
advantage of the less time consuming option and for go any further palliative treatment.
(Broeckaert, 2013)Advocates however dont think this would be an issue as patients

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would still receive palliative care and would in no way influence how the physician
would treat the patient.
A study which included 35 people ranging in ages 18-50 showed that most of
them where in favor of physician-assisted suicide. When asked whether or not they
believed it to be ethically correct on the doctors part, almost 70 percent answered yes.
When asked why, one of the respondents said There comes a point for the terminally ill
when there is no going back. Disease progression and end of life progression can make
someone's last days full of suffering and misery. At that point, it's more humane to let
someone die with their dignity and full cognition. One of those who opposed of PAS
said No because in the Hippocratic oath it states that they will not supply a deadly drug
if it was asked for. Doctors are supposed to help people not kill them, emphasizing again
the need for a doctor to take into consideration the oath that he or she swore upon
becoming a physician. Surveyors where also asked if they thought that PAS should only
be limited to terminal illnesses. Yes, physician assisted suicide should only be intended
for those who have already reached the end of their road and only has worsening
symptoms in their future. It should not be intended for suicide ideation in someone who
has otherwise not come to end of life, was one reply. While those in opposition of
assisted suicide believed that it was the easy way out but the truth is, there that no
matter what someone will be suffering. That be the doctor who must face the request of
his dying patient, or the suffering person who lives day to day not knowing when their
disease will finally kill them.

Conclusion

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As you can see there are many reasons as to why some people are for legalization
of physician-assisted suicide. With medical technology advancing everyday as well as the
growing number of debilitating and terminal illnesses this is something that should
definitely be talked about. Although many terminally ill patients choose to face death
with amazing strength and courage, there are also those who do not wish to die a slow
painful or even sudden death. Because of all of the issues mentioned above, it is easy to
see why there is so much controversy with the issue of legalizing PAS in the United
States.

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References
Broeckaert, B. (2011). Palliative Sedation, Physician-Assisted Suicide, and Euthanasia:
'Same, Same but Different'?. American Journal Of Bioethics, 11(6), 62-64.
doi:10.1080/15265161.2011.577518
Dennis, D. (2009). Living, dying, grieving. Sudbury, Mass.: Jones and Bartlett.
Eldred, S. (2013, January 17). Assisted Suicide: Legalize It? : DNews. Retrieved June 25,
2015, from http://news.discovery.com/human/life/could-assisted-suicide-be-legal-acrossus-130117.htm
How to die in Oregon [Motion picture]. (2011).USA.
Schencker, L. (2015). Assisted-suicide debate focuses attention on palliative, hospice
care. (Cover story). Modern Healthcare, 45(20), 22-25.
The Brittany Maynard Fund. (n.d.). Retrieved July 12, 2015.
Tyson, P. (2001, March 27). The Hippocratic Oath Today. Retrieved July 12, 2015, from
http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.htm
Varelius, J. (2013). Ending Life, Morality, and Meaning. Ethical Theory & Moral
Practice, 16(3), 559-574. doi:10.1007/s10677-012-9374-3

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Questions asked in survey

1.
2.
3.
4.
5.

What is your gender?

What is your age?
Do you identify with any religion?
Do you or have you known anyone with a terminal illness?
Do you think physician-assisted suicide would be an option if you were diagnosed
with a terminal illness?
6. Do you believe it is ethically correct for a physician to assist in suicide? Why or
why not?
7. Should physician-assisted suicide only be limited to terminal illnesses? Why or
why not?
8. Should physician-assisted suicide be legal across the nation?