Physician Assisted Suicide

As part of my Master's program, I am taking a course in Public Policy and Health. As you can probably guess I would, I seem to find ways to bring my interest in the end-of-life into all of my other classes. For this class, we had to present a public policy issue and argue either in favor or against it. I try to keep this blog as politically neutral as possible. Death and dying are relevant to everyone, therefore I would not want anyone to feel excluded by my personal political beliefs. That said, this is a hot debate and I found some interesting facts in the process of preparing this presentation. I welcome your thoughts and opinions - either in support or against physician assisted suicide.

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In the U.S., our society reinforces the notion that each individual has a right to die. This philosophy is supported by the existence of measures such as durable power of attorneys, living wills, and advanced directives.

In this regard, passive physician-assisted suicide is already legal in the U.S. It is legal to hasten the death of a person by altering some form of support and letting nature take its course. For example, by:

-Removing life support equipment, turning off a respirator or
-Stopping medical procedures and medications or
-Stopping food and water or
-Not delivering CPR and allowing a person, whose heart has stopped, to die.

Who has the right to die?

As law now stands, when a competent patient with a terminal illness makes an informed decision to withdraw or refuse life-sustaining treatment, there is virtual unanimity in state law and in the medical profession that this wish should be respected (See reference).

Although patients can be hospitalized against their will on a 5150 for doing so, committing suicide or attempting to commit suicide is legal.

However, active physician-assisted suicide whereby a doctor provides a prescription for a lethal dose of a medication that the patient may take to terminate their own life is not legal in most states.

What does this mean for people whose illnesses will cause their health to decline excruciatingly slowly, causing prolonged suffering, possibly over a period of years? People who have no life-sustaining treatments to withhold?

One example I will use is a patient I had who had chronic obstructive pulmonary disease. At the point I met him, he reported that he was no longer able to engage in the activities that made life worthwhile for him due to the severity of his difficulty breathing. He admitted to me that he was contemplating suicide. Not having given much thought to physician-assisted suicide before, I followed the standard suicide protocol. I assessed that he did not have a plan in place. We made a contract that he would not try to kill himself while in the hospital, with the hopes that the treatments we provided would relieve his suffering enough that he might no longer wish to end his life. My approach made it clear that at that time, I did not believe that suicide was an acceptable option. Were the contract and the negotiation helpful or were they isolating him even further in his suffering? Might I personally want to die if I felt that I was slowly suffocating, breathing becoming more and more difficult over time?

Physician-assisted suicide has been legal in the state of Oregon for over seven years now. It has been legal in the Netherlands for over twenty years. It has been legal in Japan since 1962. It has been legal in Switzerland since 1941. It has been legal in Germany since the year 1751 (See reference).

Why might People Choose Suicide?

Let’s take a look at the statistics in Oregon for some answers:

Is it because they are not aware of other options?
86% of patients who utilized physician-assisted suicide in Oregon over the past seven years were enrolled in hospice. In 2004, that percentage increased to 89%. Hospice is generally the best thing we have to offer people at the end of life. What other options are there?

Who is using physician assisted suicide? Is it the poor and disenfranchised, whom nay-sayers suggest?

Of the 208 patents who have utilized PAS in Oregon, 98% were white; 99% had insurance. Oregonians with a baccalaureate degree or higher were 8.3 times more likely to use physician-assisted suicide than those without a high school diploma.

What diseases are these people dying from?

Patients with ALS are by far the most likely to utilize physician assisted suicide.

The life expectancy with ALS is 2 to 5 years. During these two to five years, slowly progressing paralysis and muscle wasting occur.

My aunt had ALS. She had saved all of her prescription pills for many years before her diagnosis, perhaps having some premonition of what would come. Her diagnosis with ALS came after she went to the doctor because she was unable to swallow. Unfortunately, her first symptom took away the only option she saw for herself. Instead of being able to end her life before becoming debilitated, as she had planned, she rode out the following three years until she was able to move nothing more than her eyes. If she had the option to kill herself, her sister believes that she would have. And I would have supported her in making that decision.

Suicide has been decriminalized for many decades in most jurisdictions in North America (See reference).

So why make it unavailable to those who need our compassion the most?

Physician Assisted Suicide is about:
1. Respect for autonomy
2. Justice
3. Compassion for suffering
4. Individual liberty
5. Openness of discussion

Assisted death already occurs, albeit in secret. Keeping it illegal prevents open discussion between patients and physicians. Legalization of PAS would promote open discussion. It would assure patients that they would not be put in a hospital on a 5150 for even saying they’re contemplating suicide.

Although much of the opposition to physician assisted suicide has come from religious organizations, some religions have issued statements in support of physician assisted suicide including:

· The Unitarian-Universalist Association,
· the United Church of Christ,
· the Methodist Church on the US West coast,
· The "Episcopalian (Anglican) Unitarian,
· The Presbyterian church,
· and the Quakers.



References
1. http://www.religioustolerance.org/euthanas.htm
2. http://depts.washington.edu/bioethx/topics/pas.html
3. http://soeweb.syr.edu/chs/OnlineField/suicide/beknowledgeable.htm
4. http://www.focusas.com/Suicide.html