The Morality and Legality of Physician Assisted Suicide

Adam Capriola 3/25/09

Dr. Moody

Philosophy of Death – Term Paper

“The Morality and Legality of Physician Assisted Suicide”

It has oft been debated whether or not there is justification behind the taking of a human being’s life via the assistance of a physician. This procedure has been reserved for unique situations, but even still, the allowance of this practicehas opened a Pandora’s Box; there are innumerable legal and moral questions that have arisen and foreseen problems that have developed. Currently, physician assisted suicide is only legal in the Netherlands, and in the United States it is has limited practice in Oregon with the state’s Death with Dignity Act (Dieterle 2007, 127). The Supreme Court has ruled that there is no right for physician assisted suicide in the Constitution, but individual states have the right to decide whether or not to allow it (Hendin 2008, 121). By studying the effect of permitting the procedure in these limited samples, the experts on the subject have drawn some conclusions regarding the morality and legality of physician assisted suicide.

J.M. Dieterle, a specialist on the topic, argues that even though he cannot provide any affirming arguments for legalizing physician assisted suicide, there are not enough sufficient arguments against it, so therefore it should become legalized. Dieterle first says that using Netherlands, which has been practicing physician assisted suicide for over four decades, as a model to draw predications from is not valid, for a few reasons. He states that the Netherlands has a socialized medical system, which makes extraordinary situations involving physician suicide less likely. The United States has a free-market health care system, thus making it unreasonable to draw predictions from results in the Netherlands; it would be like comparing apples and oranges. Secondly, he points out that euthanasia was legalized at the same time physician assisted suicide was legalized in the Netherlands. This fact may lead to more extreme situations than when only physician assisted suicide is allowed. However, Dieterle argues that the studies from Oregon’s Death with Dignity Act are perfectly acceptable for formulating predictions on the implications of legalizing physician assisted suicide in the United States (Dieterle 2007, 128).

The basic requirements to become eligible for physician assisted suicide in Oregon are that the patient much be at least 18 years old, capable of making and communicating health care decision, and have been diagnosed with a terminal illness that gives them less than six months to live (Dieterle 2007, 128). There are a few nuances in the law and process, but those are the general requirements. One of the arguments that naysayers of physician assisted suicide provide is the thought that nonvoluntary and involuntary euthanasia will undoubtedly arise from a result of legalization of the procedure (Dieterle 2007, 129). They say that the next step from allowing the patient to make a decision about their own life is that someone else will gain the power to make that decision. Dieterle argues that there have been no signs of anything like this happening in Oregon. There are specific rules in place to prevent euthanasia from occurring. The patient must make two oral and one written request for physician assisted suicide, and the doctors take other precautions to make sure the patient is thinking with a clear head. In over ten years, there have yet to be any problems of this sort in Oregon.

Opponents of physician assisted suicide also argue that the law will likely be abused if it is legalized (Dieterle 2007, 131). One specific breach of law discussed is that patients might be pressured by family members or insurance companies to undergo the procedure. Family members and insurance companies may rather not pay the expenses to take care of a terminally ill person and would rather they die. Inspecting studies in Oregon, Dieterle says that there are precautions in place to make sure this does not happen. Data shows that 36% of the persons seeking a lethal dose of medication cited “burden on family, friends/caregivers” as one of their reasons for undergoing the procedure, but that does not necessarily mean they were pressured by those peoples. Additionally, almost all patients cited their poor quality of life as one of the primary reasons for undergoing physician assisted suicide (Dieterle 2007, 132). Thus, it does not appear that any of the patients in Oregon sought death solely because of pressure from others.

Another argument made against the legalization of physician assisted suicide is that it will lessen the value of life, thus making it in a way less harsh to kill someone, so homicides will rise (Dieterle 2007, 133). Dieterle says that if this were true, then it would be expected to see a rise in homicide rates in Oregon since the passing of the Death with Dignity Act. However, the opposite if found; homicide rates have decreased. Of course, it is difficult to draw a direct correlation between the two instances. It is pointed out that homicide rates have not dropped as much in states surrounding Oregon, and that homicide rates in the Netherlands are very low compared to most countries (Dieterle 2007, 134). These facts seem to dismiss the argument.

It is argued that the legalization of physician assisted suicide will make doctors less willing to “do their job” and work to save the patient, but instead encourage the patient to simply let go and die (Dieterle 2007, 133). However, as Dieterle points out, evidence from cases in Oregon and the Netherlands seems to dismiss this as a possibility. Data shows that 88% of physicians polled in Oregonhad sought to improve their knowledge of medicine for the terminally ill, and 86% had some measure of confidence in medicines designed for the terminally ill. Studies in the Netherlands show improvement in terminal care. Thus, the argument that doctors will put less effort into aiding the terminally ill appears to be invalid.

Yet another case against physician assisted suicide is made stating that patients will lose hope too soon with suicide as an option, and will want to take “the easy way out” (Dieterle 2007, 134). Again, studies show that the actual number of terminally ill patients that request lethal medications is almost negligible. In Oregon between 1998 and 2004, only 208 terminally ill patients elected for physician assisted suicide while 64,706 other patients suffered from the same diseases and chose not to undergo the procedure. Interviews with doctors show that the patients that requested physician assisted suicide were described not as being depressed and without hope, but “feisty” and “unwavering.” It is noted that patients often have more hope in Oregon and the Netherlands because physician assisted suicide is an option, so they are comforted by the fact that in the future if the pain ever becomes unbearable, they know they will not have to suffer longer than needed.

Dieterle then dismisses the argument that improvement in palliative and terminal care will cease is physician suicide is legalized (Dieterle 2007, 134). He highlights the fact that of the 208 patients in Oregon that underwent the procedure, 86% of them were enrolled in hospice programs. This seems to suggest that because there still is a need for palliative care, it will improve. Palliative care in the Netherlands is said to have been continually improving, and they have allowed physician assisted suicide for several decades. These facts refute the argument quite handily. Finally, Dieterle puts down the argument that citizens will begin to fear hospitals and medical personnel if physician assisted suicide is allowed (Dieterle 2007, 135). Opponents say that people will fear going to the hospital in anxiety that they will be killed against their own will. It has difficult to gauge exactly how people would react if the procedure were to be legalized, but the limited cases in Oregon show no signs of this possible apprehension.

Of course, there is limited data to draw inferences from, but Dieterle seems convinced that all the arguments made against the legalization of physician assisted suicide can logically be refuted. He uses data from studies in the Netherlands to support his arguments, even though one of his first statements is that the situation in is not entirely comparable to the United States. The results from the Death with Dignity Act are in all likelihood too limited to drawn any definite conclusions. Still, Dieterle is adamant that all opposing arguments are weak. In conclusion, he admits he does not have any positive arguments for making physician assisted suicide legal, but since the opposing arguments are not strong, that it should be legalized (Dieterle 2007, 139). Dieterle seems to take the approach that the procedure is innocent until proven guilty, in a way; that is it should become legalized and stay legalized unless it becomes a problem.

I agree with Dieterle that physician assisted suicide should become legalized, but for different reasons. I feel that the needs of the patient should be first and foremost, so therefore if they want to put an end to their suffering, they should be able to make that choice. If patients are allowed to refuse treatment, then why should they not be allowed to take lethal medication? The end result of death would be the same, but the path leading up to it would be much different. If the patient refuses treatment, they would likely endure a drawn out period of much pain and suffering before they actually die. If the patient is given a dose of lethal medication, the death would be much swifter and peaceful. The patient should be allowed to have that freedom; after all, they are the one that is ill, not the doctors or authorities.

People may argue that allowing physician assisted suicide will create a mess and lead to involuntary euthanasia, but I believe that as long as proper measures are put in place, this will never happen. Oregon has plenty of nuisances built into the Death with Dignity Act to prevent exploitation of the procedure. As long as these rules and regulations are strictly followed, there should be no foreseen problems of misuse. Physician assisted suicide should be viewed in a positive light. In a world where it is considered a failure when a doctor in unable to save a patient, it should be seen as a success when a patient is allowed to die on their own terms.

Bibliography

Dieterle, J.M.. "Physician Assisted Suicide: A New Look at the Arguments." Bioethics 21(2007):

127-139.

Hendin, Herbert. "Physician-Assisted Suicide In Oregon: A Medical Perspective." Issues in Law

& Medicine 24(2008): 121-145.