Running Head: PHYSICIAN-ASSISTED SUICIDE
1
Do Terminally-Ill Patients Have the Right to Request and Receive Physician-Assisted Suicide?
Alivia R. Lamb
Liberty High School
PHYSICIAN-ASSISTED SUICIDE
2
Physician-assisted suicide has become a largely recognized ethical issue. There are
good arguments for both sides of the case. The purpose of this study was to go more in depth
with the claims that are made for and against it to see why people feel the way they do on this
topic. This was done by thoroughly reading through multiple articles with data and statements
on how people feel about physician-assisted suicide and how states that have already legalized
it have handled it. Although about two-thirds of the population (Janine Fiesta 1997) does believe
it should be legal, there are reasons for why it has not happened yet. Using all of this
information, America’s population needs to come to a decision on whether or not the terminallyill patients should be allowed to request and receive physician assisted suicide without the fear
of their fellow American’s thinking they are doing something morally wrong. This paper allows
people to read about the personal and religious views on this topic instead of focusing solely on
the legal aspects.
PHYSICIAN-ASSISTED SUICIDE
3
There is a great deal of thought that goes into a terminally-ill patient’s decision to
consider physician-assisted suicide. Although there are many moral and ethical concerns on
whether a terminally-ill patient should be allowed to make this choice, in the end, it’s their life
and their decisions. One thought that causes a lot of discussion on this topic is who owns their
body. There are many people who feel that religion answers this. There are also currently three
states, Oregon, Washington, and Vermont, which have legalized physician-assisted suicide in
the United States. They all have set laws, requirements, and regulations for both the patient and
physicians. These states have opened a floodgate of arguments on whether or not this should
be allowed. Surprisingly, even though more states have made this process illegal, statistics from
a survey done by the Pew Research Center in 2013 say 66% of US adults believe there are
certain situations in which patients should be allowed to die. Although they hold the majority,
that same survey says 31% believe physicians should always do everything possible to help the
patient stay alive and be comfortable. Determining whether or not terminally-ill patients should
be allowed to receive physician-assisted suicide is still an ongoing, controversial debate in the
USA.
In a study done by Jammo Tarkki (2004), the concept of owning one’s body is analyzed
from a religious point-of-view, along with motives for individual and group suicide. The answer to
who owns one’s body is a key aspect in physician-assisted suicide, or really any form of suicide.
If the general consensus is that humans have complete ownership of their bodies; therefore it is
expected that they can choose whether they live or die. According to Tarkki (2004), many
arguments against this thought are based on religious beliefs. They claim that God owns people
and he has the ultimate authority over human life (109). Some religions are more allowing than
others. Judaism does allow suicide, but only when it is the only way to avoid serious harm. In
Tarkki’s study (2004), he mentions a time during the Second World War when a group of Jewish
girls and women, now known as the ninety-three maidens, all agreed to commit mass suicide to
PHYSICIAN-ASSISTED SUICIDE
4
avoid being taken advantage of by the Nazi Gestapo. That is not the same as a terminally-ill
patient requesting a physician to end their life, but there is correlation. It was a decision made to
end one’s own life to avoid being in pain and distress.
Currently, Oregon, Washington, and Vermont have all realized that these patients should
not have to suffer. Each of these states have passed their own version of the Death with Dignity
Act. They are all very similar but there are slight changes in how the medication used to end the
life is administered. Oregon was the first state to pass this law, enacting it on October 27, 1997.
Since then, it is believed to have helped Oregon’s health care system, and facilities, in multiple
ways. The way this act is set up makes it possible for a patient who requests it to change their
mind at many points in the process. In Oregon, the requesting patient must be eighteen years of
age or more, be an Oregon resident, be able to make and communicate health care decisions,
and be diagnosed with a terminal illness that will lead to death within six months. If a patient
meets these requirements, they then go through a very thorough process before receiving lethal
medication. The requesting patient must make two oral requests to their physician. These
requests must be separated by at least fifteen days. After the oral requests, the patients must
then make a written request while in the presence of two witness’. The patient’s diagnosis and
prognosis then needs to be confirmed by the physician, along with a second, consulting
physician. After that, the physicians then have to determine if the patient’s judgment is impaired
by a psychiatric or psychological disorder. Once all of these steps are completed, the physician
must inform the patient of other alternatives such as pain control and hospice care as well as
request, but not require, the patient to inform their next-of-kin of their decision. Once the final
steps are completed, the prescription is given. This process has proven to be effective and
surprisingly, is only seldom used. There is also evidence that shows that passing this act has
significantly helped Oregon’s health system. Susan Tolle did a study on the effects that passing
this act has had on Oregon. According to Tolle (1998), after the act was first brought to
attention, Oregon has shown an increased attention to comfort measures. Tolle (1998) also
PHYSICIAN-ASSISTED SUICIDE
5
states that out of all of the states in the USA, Oregon has the lowest in-hospital mortality rate.
The Death with Dignity Act has caused Oregon to make changes to their health system so
patients choose to use their comfort facilities and pain medications instead of using this act.
Along with Oregon, Washington has also tried to improve their health facilities. Serena Gordon
(2014) did a study to see just how many people actually use the Death with Dignity Act in
Washington. Washington passed this law in 2009 and according to Gordon (2014) in just three
years, only 255 have received the medication to speed up their deaths but an even smaller
amount actually go through with it. She claims that more than fifty thousand people die in
Washington so the number of people who use this law to die is miniscule. The data Gordon
(2014) found has evidence that shows how many people’s fears are misplaced when they
thought a large number of people would use this act to end their life for reasons other than what
it’s actually for. Washington and Oregon have both shown evidence that this act can be passed
and not misused.
In states where this act is not legal, many different studies have shown that the majority
of the population would prefer a law like this to be passed. Janine Fiesta (1997) conducted a
study that said if Michigan residents were given a choice between legalizing or banning
physician-assisted suicide, two-thirds of them prefer legalization. Fiesta (1997) also said that in
a study of over 1,000 oncology nurses in the United States, 47% said that they would vote to
legalize it, while 16% said that they would, under a physician’s order, administer a lethal
injection to a competent, terminally-ill patient who requested such assistance. Many people
believe it should be legal like Ezekiel Emanuel (1999). Emanuel did a study on the benefits of
legalizing physician-assisted suicide. Emanuel states that there are three main benefits to
legalizing it: realizing individual autonomy, reducing needless pain and suffering, and providing
psychological reassurance to dying patients. Autonomy is essentially independence, or selfgoverning. In this study, Emanuel (1999) says that, while individual autonomy may not be
enough to justify the legalization of physician-assisted suicide, it is an essential American value
PHYSICIAN-ASSISTED SUICIDE
6
and should not be dismissed. Emanuel also mentions that pain and suffering, whether that be
physical or mental, is the most widely agreed upon and publicly endorsed justification for
legalization. According to his study, approximately 2.3 million Americans die each year. Of those
2.3 million people, only one million would fit the requirements for the current Death with Dignity
Act. All but 5 percent of these patients can effectively treat their pain with optimal palliative care.
Slightly over 10 percent of patients with significant pain have seriously thought about physicianassisted suicide for themselves. Based on those numbers, Emanuel (1999) says that
approximately 5,000 to 25,000 of the total 2.3 million Americans may fit the requirements,
desire, and follow through with their requests for physician-assisted suicide. This means that
anywhere from 5,000 to 25,000 Americans truly believe that they are suffering and in enough
pain to end their own lives. In his study, Emanuel (1999) also has data that states 41.6 percent
of cancer patients and 44.4 percent of the general public believe that discussing with their
physicians about end-of-life care, including physician-assisted suicide, would increase the trust
they have in their physicians. While there are also many other reasons people have for justifying
the legalization of physician-assisted suicide, the ones heard the most are the idea of individual
autonomy, or who owns one’s body, and in regards to pain and suffering. Studies done by
multiple different people state that the majority of the American population believe physicianassisted suicide should be legal. While this may be the case, the other side of this debate has
reasons for keeping it illegal that are just as understandable.
There are a number of people who are strongly against the thought of legalizing
physician-assisted suicide. Some arguments come from surprising sources. For example,
Richard Radtke conducted a study for the Journal of Disability Policy Studies in 2005. Radtke
(2005) suffers from multiple sclerosis and yet, still believes that this process should be illegal. In
his study, he says that people with illness and disability are statistically more likely to have
feelings of suicide. He says this is especially common in the early stages due to emotional
stress and psychosocial issues such as feeling like a burden on friends and family and fear of
PHYSICIAN-ASSISTED SUICIDE
7
the future outcomes of their disability. Radtke (2005) believes that the country needs to work
towards a better life, not towards ways to end it. He says that fear and perception can do a great
disservice to everyone’s lives and need to be alleviated. Radtke has considered suicide himself
due to severe pain and depression. He now claims, though, that all he really needed was
support and ways to manage his pain. He believes that more money should be spent on new,
more effective pain management methods and medications instead of spending it on ways to
end the lives of patients. While Janine Fiesta did have some statements that support legalizing
it, she also has a few things to say that support Radtke’s belief of keeping it illegal. According to
Fiesta (1997), one main fear that is keeping people from believing in legalization is the fear of
criminal prosecution. Many healthcare providers fear being prosecuted when the deal with endof-life decisions. She also mentions how a frequent thought that people not in favor have is the
concern about euthanasia being a step away. In other words, ending a patient's life without
their, or their families, consent. In general, people who are not in favor of legalizing physicianassisted suicide have fears of what may happen if it is legalized, feel that the country’s time and
money could be spent on making end-of-life care and treatment better to extend the lives of
patients, or feel that ending one's own life is morally wrong.
With plenty of statements and data to back up both why physician-assisted suicide
should be legalized and why it should not be legalized, this debate is still currently happening
and it is fairly controversial. Many people believe they do own their own body but if they are not
allowed to decide whether or not they can end their own life, which is not complete ownership. A
large portion of the population does believe that God has ultimate authority over all human life
(Tarkki 2004). In other words, God owns the bodies of everyone. These people believe that it is
not appropriate to purposefully harm, or kill, one’s own body as they are just borrowing it as a
vessel for their soul. While that may be true to some people, there a few states that currently
believe terminally-ill patients have the right to escape their pain and suffering by making a
request for physician-assisted suicide. These states are Washington, Oregon, and Vermont.
PHYSICIAN-ASSISTED SUICIDE
8
They all currently have passed the Death with Dignity Act which is a very thorough process that
has shown evidence of greatly improving the health systems of these states. Although this act
was only passed in three states, there is data that shows about two-thirds of the population
does believe it should be legal. These people mainly believe that patients should not be forced
to go through the pain and suffering that many terminal illnesses bring. On the other hand, the
one-third that do not believe it should be legal feel strongly about how instead of spending time
and resources on this end-of-life procedure, they should be spent on improving pain
medications and making terminal patients comfortable, happy, and relaxed. Taking all of these
statements into consideration, there must be a decision made on whether or not the terminally-ill
patients in America that are suffering both physically, and mentally, should be legally allowed to
request and receive physician-assisted suicide.
PHYSICIAN-ASSISTED SUICIDE
References
Byock, Ira. "The Right to Die Is Not a Civil Right." The Right to Die. Ed. Tamara Thompson.
Farmington Hills, MI: Greenhaven Press, 2014. At Issue. Rpt. from
"Physician-Assisted Suicide Is Not Progressive." The Atlantic (25 Oct. 2012).
Opposing Viewpoints in Context. Web. 7 Nov. 2014.
Emanuel, E. (1999). What Is the Great Benefit of Legalizing Euthanasia or Physician-Assisted
Suicide? Ethics, 629-642.
Fiesta, J. (1997). Legal Aspects Of Physician-Assisted Suicide. Nursing Management
(Springhouse), 17-21.
Gordon, Serena. "Physician-Assisted Suicide Laws Are Actually Seldom Used." The Right to
Die. Ed. Tamara Thompson. Farmington Hills, MI: Greenhaven Press, 2014. At Issue.
Rpt. from "Physician-Assisted Suicide Program Rarely Used, Study Finds."
www.healthday.com. 2013. Opposing Viewpoints in Context. Web. 7 Nov. 2014.
Lipka, M. (2014, January 7). 5 facts about Americans’ views on life-and-death issues.
Retrieved December 10, 2014, from
http://www.pewresearch.org/fact-tank/2014/01/07/5-facts-about-americans-views-on-lif
e-and-death-issues/
Radtke, R. (2005). A Case Against Physician-Assisted Suicide. Journal of Disability Policy
Studies, 16(1), 58-60.
Tarkki, J. (2004). Assisted Suicide: Do We Own Our Bodies? Dialog: A Journal of Theology,
107-112.
Tolle, S. (1998). Care of the Dying: Clinical and Financial Lessons from the Oregon
Experience. Annals of Internal Medicine, 567-568.
9