The Legalization of Physician Assisted Suicide
Of all the controversial topics to I could have chosen to discuss, the topic of physician assisted death is one that seems to be very taboo, even to date. Oregon is the only state to successfully pass a bill legalizing the practice; this bill is called the Death With Dignity Act (DWDA). Some may confuse physician-assisted death with euthanasia, yet they are two completely different acts. Euthanasia requires a physician, or other entity, to administer a deadly concoction; physician-assisted death is at the request of a terminally ill patient, the doctor provides a prescription of lethal medication which the patient takes of their own free will when they decide the time has come. The legalization of physician-assisted suicide will open up just one more option for patients suffering from terminal illnesses and allow them to die with a little dignity. Terminally ill patients don’t have a lot of options, most suffer greatly on a day-to-day basis. The addition of just one more option to such a short list can do a lot to psychologically comfort a patient. In his essay “Physician-Assisted Death in the United States: Are the Existing Last Resorts Enough?” Timothy E. Quill outlines several aspects of physician-assisted death, specifically the fact that terminally ill patients need as many options as they can get.
Terminally ill patients suffer a great deal; they know that eventually they will die. He states that there are “several ‘last resort’ options, including aggressive pain management, foregoing life-sustaining therapies, voluntarily stopping eating and drinking, and sedation to unconsciousness […]” (17-22). Some of the suggested last-resort methods seem to be no better than physician-assisted suicide. Take, for example, the method of voluntarily stopping eating and drinking (VSED); for a patient, who is already suffering from the chronic pain of illness, is it fair to ask them to add the suffering of voluntary hunger and dehydration? Sedation to unconsciousness seems to be no better of a solution; the patient is put into a comatose state until they eventually die. This solution seems to ease the suffering of the patient, yet extend the suffering of the family. Aside from VSED and sedation, to forgo life-sustaining therapies seems to be no better. If a patient is currently undergoing palliative care to treat symptoms that are causing them to suffer, why stop the treatment and increase the suffering rather than end the suffering once and for all? Quill goes on to discuss the fact that the choices available to a terminally ill patient are so few that there should be no harm in adding just one more to the very short list.
For example, Quill states that “some patients will need a way out, and arbitrarily withholding one important option from patients whose options are so limited seems unfair” (17-22). Quill makes the point that a patient suffering from a terminal illness will want a way out; not necessarily a way out of life, but a way out of the suffering. There are very few options for someone with chronic suffering, as relief is difficult to come by for someone who is dying. Physician-assisted suicide is just one of these options, and it’s an option that should not be overlooked. In addition, Quill goes further to state that the option of physician-assisted suicide is only an option, just one choice a patient can make about their own health care. “Most patients will be reassured by the possibility of an escape, and the vast majority will never need to activate that possibility” (17-22). This is a very powerful quote, as it brings forth the point of legalizing physician-assisted suicide doesn’t mean that the act will result in a large amount of deaths. The legalization of the act will simply add one more possibility to the list of last-resorts available to a patient.
The quote also goes as far as to say that the vast majority of patients will simply be reassured that, should all other options be exhausted, there is still the possibility of a final escape; never actually needing to use it, should palliative care and hospice suffice in controlling the symptoms of suffering. With the examples provided, we can see that the need for legalizing physician-assisted death is important for patients who suffer from day today. Opening just one more option, when there are so few to choose from, will give the patients a sense of reassurance that they can still have control over their lives. Physician-assisted death is intended as a last resort option; denying the patient a final escape, when all other options have been exhausted, is unfair. Now that we’ve established that a terminally ill patient will benefit from knowing that they have the option of a final escape, let’s talk about why a patient would resort to using physician-assisted suicide.
Among the most sensible reasons to end one’s life, the thought of an end to suffering comes to mind. However, we already know that end-of-life palliative care is put into place in order to help ease the suffering and pain of a terminal illness. This is true, but when is too much? Going back to Timothy Quill, he states that “there will always be a small percentage of cases where suffering sometimes becomes unacceptably severe […]” (17-22). While suffering is a constant, there are several degrees of suffering; sometimes this suffering can be easily controlled with palliative care and aggressive pain management. However, Quill notes that there are times where the suffering cannot be easily controlled, and there comes a point when it becomes simply unacceptable. When suffering reaches this point, it is time for a patient to start thinking about last resort options; looking for a way to end the suffering. A patient living with terminal cancer is, without a doubt, suffering.
Palliative care and hospice care are programs put into place with no intent other than to alleviate the suffering. In her essay “Euthanasia and Assisted Suicide: There is an Alternative”, Sylvia Dianne Ledger describes suffering as such, “It occurs when a person perceives the impending destruction of themselves, and it is associated with a loss of hope” (81-94). This description of human suffering is excellent when trying to advocate an end to said suffering. Ledger states that a person suffers when they sense their own destruction, when they realize that their end is near. Facing one’s own mortality is not an easy thing to do. The thought of being unable to stop your own demise can, indeed, cause great suffering. Ledger goes as far as to say that this realization of one’s own mortality is associated with a loss of hope, a sense of despair. Along with a loss of hope, there are several reasons why a patient would choose physician-assisted suicide as a last resort option. In an article titled “The Case for Physician-Assisted Suicide: How can it Possibly be Proven?” from the Journal of Medical Ethics, E Dahl and N Levy report that, according to Oregon’s Death With Dignity Act, “the most frequently reported reasons for choosing physician-assisted death under the DWDA are ‘loss of autonomy’, ‘loss of dignity’, and ‘loss of the ability to enjoy the activities that make life worth living’” (335-338).
This report notes that the top reasons for a patient to choose physician-assisted suicide as the final option don’t even include an escape from the physical pain. Being terminally ill makes life simply un-enjoyable. The number one reason given for physician-assisted death is a loss of autonomy. To lose the ability to have control over one’s life can be psychologically devastating. The loss of dignity and the ability to enjoy life came in closely behind to round out the top three reasons for wanting death as a final escape. When palliative care doesn’t sufficiently ease the pain experienced on a daily basis, last-resort options should be made available to a patient. When chronic pain and illness take away one’s ability to enjoy life, take away one’s dignity, and take away the human right of autonomy, an option to end the suffering once and for all should be made available. Even the sick deserve to maintain some semblance of their former selves and die with a little dignity.
Those who are against physician-assisted suicide have a valid argument, there are always options to ease suffering and control symptoms. Both hospice and palliative care are viable options in the case of terminally ill patients. While discussing alternative options to physician-assisted suicide and euthanasia, Sylvia Dianne Ledger discusses how far end-of-life care programs have come in helping the terminally ill cope with their disease. She notes that “with the rise of the hospice movement and the availability of its knowledge and experience in the control of distressing symptoms in terminal disease, there is no longer any real indication for euthanasia” (81-94). Ledger notes that both forms of end-of-life care have improved greatly over the years, becoming more and more viable when considering end-of-life options. She notes that they have improved in ease of access, becoming more available to patients through reimbursement programs due their growing popularity. Hospice and palliative care are not only more easily accessible to patients with a need for end-of-life treatment, but their mode of delivery has become more efficient; nurses can now come to nursing homes, hospitals, even patient homes, in order to provide care specific to each patient’s needs.
While these programs continue to improve the quality of care they provide, Ledger notes that they also remain a standard among end-of-life care programs and that their implementation leave no room for more drastic options. With such wonderful programs in place and so easily accessible, E. Dahl and N. Levy note that the topic of physician-assisted suicide can actually lead into a discussion about other end-of-life options. They state that “a request for a prescription can be an opportunity for a medical provider to explore with patients their fears and wishes around end of life care, and to make patients aware of other options” (335-338). This means that when a patient believes that their suffering requires a more direct and aggressive action, perhaps suicide shouldn’t be the first option. For a patient to request aid in dying opens up the chance to discuss other options for end of life care. These options are, more often than not, palliative and hospice care. A patient has access to medication to control pain as well as a wide variety of other symptoms.
Only after discussing these options should a patient consider ending their life. While discussing how talks about physician-assisted suicide have shed a new light on the palliative care option, Wesley J. Smith addresses the ideas of suicide among patients who are currently enrolled in such programs. He states that “[…] suicide prevention, when needed, is an essential part of the package, crucial to fulfilling a hospice’s call to value the lives and intrinsic dignity of each patient until the moment of natural death” (85-86). The argument with this phrase is that hospice care programs are aware of the suffering, and realize that patients who are already enrolled in their programs are possibly contemplating an end to their lives. He notes that suicide prevention is actually one of the many services offered by hospice programs. This service is offered because the idea of a hospice is to make a patient as comfortable as possible before their lives end of natural causes. He continues by saying that suicide prevention is crucial to maintaining the values of hospice care: to value the life and basic dignities of patients enrolled in their programs.
There are several wonderful arguments for why patients should choose a long (or short) term care program over suicide, these programs are set up to control pain and other symptoms. These programs have improved greatly over the last several years, and are now able to provide better care; reimbursement programs have also become available, as both hospice and palliative care have become a very widely accepted form of last-resort treatments among the terminally ill. While end-of-life care programs are excellent, and offer relief from many of the symptoms affecting patients, these programs seem to do little to overcome the underlying issues causing a patient to desire a final escape. The biggest issue with the ever-expanding hospice and palliative care programs is a lack of manpower. Timothy Quill addresses this issue when discussing last resort options. He states that “there remain serious challenges.
There are not enough skilled palliative care clinicians to meet the growing needs […]” (17-22). This is definitely a problem with the end-of-life programs which are growing rapidly. With programs such as Medicaid who are willing to reimburse patients who truly need palliative care, many more patients who are actively dying will be enrolling in these programs. If these programs are not fully prepared and staffed to meet their growing clientele, there won’t be enough nurses available to treat patients. Quill goes on to state that even if a patient is fully educated on palliative care options, enrolled, and being treated by a nurse, this may not be a reason to rule out the final escape. He notes that “all last resort options, including physician-assisted death, make sense only if excellent palliative care is already being provided” (17-22). This argument directly refutes the opposition’s view that hospice and palliative care are acceptable alternatives to physician-assisted-death. He states that the last resort options only become acceptable if all other options have been exhausted. Once a patient has enrolled in hospice care and an aggressive pain management system has been implemented, what if they continue to suffer. At this point, once palliative care has failed to control the suffering, physician-assisted death is an option that should be considered. When discussing how physician-assisted suicide has corrupted palliative care programs, Wesley J. Smith provides data which further refutes the opposition’s claim.
He states that “according to the state, approximately 86 percent of people who died by swallowing poisonous overdoses under the Oregon law were receiving hospice care at the time they committed suicide” (85-86). It’s clear that the alternative to physician-assisted suicide is not doing a well-enough job of keeping patients’ suffering to a minimum. In Oregon, where physician-assisted death is legal, a vast majority of patients who take advantage of this option have already tried the alternatives. Hospice care may work, for a time, but if the suffering continues while the patient is receiving treatment to control the symptoms, there is still one option left. Through these examples it can be seen that, while hospice and palliative care are programs that are designed to control symptoms and comfort a patient in their last moments, they can’t be the absolute answer.
Pain is not the only thing causing patients to suffer. A terminally ill patient who has little control over what is left of their time deserve to maintain their dignity in death; legalizing physician-assisted suicide will give patients one last moment of control over their lives. A patient doesn’t have a lot of options when the prognosis is death, and the options on the list aren’t necessarily the best. When suggestions such as voluntarily stopping eating and drinking, or sedation into permanent unconsciousness are suggested, it seems almost unfair to deny a patient the option of a final, absolute escape. While hospice and palliative care have a come a long way, and are indeed viable programs for symptom management, there are still aspects of suffering that they cannot control.
Pain is just symptom of a terminally patient. Reports of loss of autonomy, loss of dignity, and an inability to enjoy life seem to be at the top of the list when patients begin discussing the desire for death. While the arguments against physician-assisted death hold weight, and make good points, the fact remains that denying someone one last option to control their life is unfair. When someone has lost the ability to enjoy life, lost the sense of control over their own destiny, the availability of a final escape is comforting. Physician-assisted death should be legalized, in order to provide patients just one more option on a list that is so incredibly short. The simple availability of this option should, at the very least, comfort patients if they know that they have a final resort should all other possibilities be exhausted.
Dahl, E. and Levy, N. “The Case for Physician Assisted Suicide: How Can It Possibly Be Proven?” Journal of Medical Ethics 32.6 (2006): 335-338. ProQuest Research Library. 10 Apr 2012 Ledger, Sylvia Dianne. “Euthanasia and Assisted Suicide: There is an Alternative.” Ethics & Medicine 23.2 (2007): 81-94. ProQuest Research Library. 10 Apr 2012. Smith, Wesley J. “Assisted Suicide and the Corruption of Palliative Care.” Human Life Review 34.2 (2008): 85-86. ProQuest Research Library. 12 Apr 2012 Quill, Timothy E. “Physician-Assisted Death in the United States: Are the Existing ‘Last Resorts’ Enough?” The Hasting Center Report 38.5 (2008): 17-22. JSTOR. 10 Apr 2012