The Legality of a Request for Mercy

By: Aurora J. Harrell

Physician Assisted Suicide is a large topic in medical ethics. Should this controversial action become a legal possibility for any individual within the United States? Why would we even consider it? And why might it be a good idea? These ideas are explored through an argument for its legalization according to an interested teen.

In 1996 a survey completed in Oregon showed that, “12% of responding physicians received one or more explicit requests for physician-assisted suicide” [1]. In 1997 physician assisted suicide was legalized in Oregon, which was followed by the spread of the practice down the west and east coast, resulting in the medical ethics debate coming more into focus across the United States [2]. Many people face an illness that will soon result in their death, and, while hospice and palliative care are options, in some cases prolonging life is simply prolonging their suffering. This forces these patients and their families to face a lot of stress alongside the great mental and emotional struggle that comes from facing death. Consequently, physician assisted suicide could become legalized across the entire country for the many patients that feel they require another option outside of prolonging their death. In the United States controlled and regulated physician assisted suicide should be legalized in order to provide comfort and ease the end of a life of terminally ill individuals for the sake of themselves and their families.

For example, physician assisted suicide can provide comfort through the creation of control and options for the dying. A controlled option like this would provide some control. Suddenly, the terminally ill would have a choice, helping them feel in control and providing them with options which eliminates some of the uncontrollable variables. The importance and significance of this is explained by Floris Tomasini who is an expert in the field of philosophy at the University of Leicester. In his article Stoic Defense of physician assisted suicide, he writes: “In everyday life we routinely operate on the basis of imperfect knowledge, rationally choosing between an unknown and a known evil. So, while it may not be rational to opt for death as an unknown for its own sake, it maybe rational to gamble on the uncertainty of death” [2]. This shows that the idea of some knowledge is often chosen simply because it is more comforting than assured uncertainty. Therefore, by creating a choice that minimizes the “uncertainty of death” terminally ill individuals would be able to find comfort [2]. However, choice is not the only fear that those approaching the end of their life face. According to a study performed in 1996 following legalization of P.A.S. in Oregon state “The patient concerns most often perceived by physicians were worries about loss of control, being a burden, being dependent on others for personal care, and loss of dignity” [3]. The overarching concern shown from this is that the patient will lose control over their life and decisions. Thus, they would seek out anyway to maintain control and whatever they can hold onto would comfort them during a time of turmoil. With physician assisted suicide the terminally ill could decide when and how they would go; they could choose between two options: fight the illness to the end or die before it became too advanced and they were no longer themselves. Controlling the method of their uncontrollable death would comfort the dying as it makes death less unknown by minimizing their uncertainty and giving them a know variable to choose before they lose the precious feeling of control. By legalizing physician assisted suicide in the United States would be opening the avenue of comfort to the terminally ill within its borders by creating and protecting a choice that would eliminate some of the uncertainty and loss of control surrounding impending death.

Legalized and regulated physician assisted suicide not only comforts the patient, but also their family by ensuring a well reasoned and desired choice. The family can be sure that this seemingly extreme option is what their loved one desires if the proper regulations are in place such as the ones that were implemented in Oregon. These laws state that a terminally ill individual must receive two diagnoses of having less than six months to live, followed by two verbal requests and a written request with a fifteen day waiting period in order to be given the pills that would result in their assisted suicide [4]. These requirements remove any chance of this being a flippantly chosen option because patients would have to have carefully considered and chosen this option of a long period of time. Thus, the family of the patient can know that this was their loved ones decision and ultimate choice. The Oregon Act further promotes a well reasoned choice by providing “ psychological counseling if either of the patient’s physicians thinks the patient needs counseling” in order to protect the first guideline of the act that “[r]equires the patient give a fully informed, voluntary decision” [4]. Requiring a mental health counselor means that those who would possibly abuse this opportunity to avoid mental suffering that could be managed by other means are caught and assisted through those struggles. Accordingly, this gives the family comfort as it shows the necessity the patient felt towards this action was not influenced by an underlying mental issue. In fact, they are encouraged to maintain life, but the family can take comfort in knowing that in the end it was their relation’s choice. By creating choice and control, legalizing PSA could provide comfort to both the family and the patient in terminal situations.

Alongside providing comfort, physician assisted suicide could ease the circumstances that surround the end of a life. Dying is obviously not always a peaceful experience despite what we would hope. Despite this physicians attempt to prolong life for as long as possible in almost every circumstance. Tomasini explains the fault in this when he quotes a man who eventually killed himself through Physician assisted suicide. He describes that external peace doesn’t equal internal peace, and at the very end it can be impossible to communicate suffering which results in the choice between facing a terrifying death that comes at it’s own speed with suffering for the terminally ill and their family or a facing a premeditated self-killing that is possibly less strained [5]. He describes this choice: “I’ve got death and I’ve got death with suffering” [5]. This shows that prolonging life does not always mean prolonging quality of life. We intrinsically know this, but when we come to understand that providing care is not always the way to ease the suffering of the patient then we come to understand the importance of physician assisted suicide in some people’s lives. The few people that need the choice of physician assisted suicide deserve to have the option available to them to end care in order to end suffering. Thus, through physician assisted suicide their end of life is simplified instead of painfully drawn out. This can also be beneficial to their emotional well-being as a terminally ill individual approaches the end of their life. According the 2010 Death with Dignity Act report the three biggest concerns were “loss of autonomy (93.8%), decreasing ability to participate in activities that made life enjoyable (93.8%), and loss of dignity (78.5%)” [6]. This shows that fear of death is overwhelming when faced with knowledge that it is coming. Consequently, facing death is a major stress, and a source of lack of control, choice, and joy. Finding ways to combat these fears is nigh impossible because of their complexity. We have to somehow create a way to return choice and dignity to the dying before everything about their life slips through their fingers and they wait for death like a living corpse. We can provide this through the option of physician assisted suicide. By ending their torment before it can truly devolve, and further their mental anguish by adding to it with physical suffering, we are able to ease the stress that weighs on those facing the end of their life. Thus, physician assisted suicide can lessen the blow for a dying patient by providing an option that would allow for the end of physical suffering or remove that factor from their death all together.

As the patient’s final moments are eased away from distress, physician assisted suicide can provide similar assistance to the family of the dying. Furthermore, it can make it easier to watch than some of the alternatives. For example, Viki Lauchman in her article, Physician Assisted Suicide: Compassionate Liberation or Murder, writes that currently “[a] legal alternative to physician assisted suicide is for the patient to stop eating and drinking” [7]. Without a simple option those who are truly determined to see their life ended before it gets worse must subject themselves to a drawn out suicide. Someone would only make this choice if they were truly desperate. The determination required to continually refuse our body's natural desires for nutrients and sustainment would enhance their suffering until the end. It would only be done if the patient believed that this suffering that could possibly end is better than the suffering they are or will experience until it claims them. They are choosing the method in which they will suffer to death. By providing those who have this amount of determination to achieve an end, physician assisted suicide can ease the suffering of a desperate and terminally ill individual. As a family watching a relation starve themselves would be distressing if not traumatic as you would have to watch them slowly die in pain knowing they felt they had no other option. Through physician assisted suicide suddenly they have an option that means that the family does not have to watch a drawn out death. This can lighten the burden that weighs on the family of the dying. If physician assisted suicide were legalized (and restricted in a similar fashion to that of Oregon’s Death with Dignity Act) then the terminally ill and their families could have the circumstances and stress surrounding the end of a life eased.

Currently, physician assisted suicide is not legal in the majority of the United States because the medical ethics argument leans toward the importance of a focus on palliative care. The argument stands that when a person is faced with a terminal illness or the end of their life their physician should treat their pain and symptoms to relieve suffering in the form of palliative care and hospice and this should continue until their death. In this account the argument against physician assisted suicide is correct. However, while palliative care should be our main concern, when a person’s life become “incontrivatably hopeless” they deserve to not have their suffering drawn out [2]. In a documentary put together by Janet Firshein, and medical ethics researcher, two medical experts debate physician assisted suicide. The main argument for assisted suicide explains that the option for physician assisted suicide in working system would only arise after the best of care had been provided to relieve symptoms and every treatment plan failed, leaving a “mentally competent patient” suffering and “continu[ing] to request assistance in dying” [8]. Palliative care cannot do everything. Eventually there is not stopping inevitable death and most often natural death caused by an illness is painful. Barbara Lee explained this to the U.S. House Subcommittee on the Constitution Concerning the Legality of Assisted Suicide in 1996 when she stated, “The problem is that medical science has conquered the gentle and peaceful deaths and left the humiliating and agonizing to run their relentless downhill course. The suffering of these individuals is not trivial and it is not addressed by anything medical science has to offer” [9]. What palliative care cannot manage must be dealt with due to its enormity. Those who are not assisted by palliative care require some other option. Therefore, even if only for these small cases, our system should provide an option. It is important to care for these few who face such great torment already. By legalizing physician assisted suicide we create the option for an end to suffering when palliative care is no longer purposeful or useful and is simply prolonging agony. Despite palliative care being an important part in treatment towards the end of life, patients who face an agonizing end deserve an option that will allow them the ability to control their suffering.

When a physician is faced with being an accomplice in a suicide for someone with terminal health it is their job to not only prolong life but also minimize suffering. A study by the Pew Research Center shows that, “42% of Americans have had a friend or relative suffer from a terminal illness or coma” from 2002 to 2006 [10]. Legalizing physician assisted suicide would provide the people behind these staggering statistics a chance to control the end of their life, seize control over their suffering, and end it on their own terms. The legalization across the United States of physician assisted suicide would have to be strictly regulated and mandated but would be a worthwhile legal endeavour as it could provide comfort and ease the suffering of the terminally ill and their families.

References

[1] Back, Anthony L. (27/03/1996). Physician-Assisted Suicide and Euthanasia in Washington State. JAMA, American Medical Association, jamanetwork.com/journals/jama/article-abstract/399087. Retrieved: (01/02/2019)

[2] Death with Dignity. (07/12/2018). The Impact of Death with Dignity on Healthcare. Death With Dignity, www.deathwithdignity.org/news/2018/12/impact-of-death-with-dignity-on-healthcare/. Retrieved: (01/02/2019)

[3] Tomasini, Floris. (06/2014). Stoic Defence of Physician-Assisted Suicide. Acta Bioéthica, vol. 20, no. 1, pp. 101. EBSCOhost, doi:10.4067/S1726-569X2014000100011. Retrieved: (01/02/2019)

[4] Back, A. L., et al. (27/03/1996). Physician-Assisted Suicide and Euthanasia in Washington State. Patient Requests and Physician Responses. Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pubmed/8598619. Retrieved: (01/02/2019)

[5]Lachman, Viki. (04/2010). Physician-Assisted Suicide: Compassionate Liberation or Murder?” MEDSURG Nursing, vol. 19, no. 2, pp. 122. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=aph&AN=49783272&site=ehost-live. Retrieved: (01/02/2019)

[6] Tomasini, Floris. (06/2014). Stoic Defence of Physician-Assisted Suicide. Acta Bioéthica, vol. 20, no. 1, pp. 107. EBSCOhost, doi:10.4067/S1726-569X2014000100011. Retrieved: (01/02/2019)

[7] Oregon Public Health Division(2010). Oregon's Death with Dignity Act--2010. pp. 1–6, Oregon's Death with Dignity Act--2010, www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year13.pdf. Retrieved: (01/02/2019)

[8] Lachman, Viki. (04/2010). Physician-Assisted Suicide: Compassionate Liberation or Murder?” MEDSURG Nursing, vol. 19, no. 2, pp. 121. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=aph&AN=49783272&site=ehost-live. Retrieved: (01/02/2019)

[9] Firshein, Janet, et al. (22/04/1995). Before I Die: Opinions. Thirteen, MetroFocus, www.thirteen.org/bid/vp-assisted.html. Retrieved: (01/02/2019)

[10] Lee, Barbara C. (29/04/1996). Testimony Before The U.S. House Subcommittee On The Constitution Concerning The Legality Of Assisted Suicide.” Gifts of Speech - Shirley Chisholm, Sweet Briar College NETBLK-SBCNET, gos.sbc.edu/l/lee.html. Retrieved: (01/02/2019)

[11] Pew Research Center. (2006). Facts. NHDD, www.nhdd.org/facts/. Retrieved: (01/02/2019)