Physician-assisted suicide is a practice where an attending doctor has the legal authority to offer a lethal prescription medication to someone who is terminally ill. The patient must usually be in a state of suffering, and it is often required to make the request of their doctor more than once to have it become a solution.
Most states in the U.S. prohibit a physician-assisted suicide, although Oregon, Washington, Vermont, California, and Colorado have all legalized the practice if a specific set of steps are followed. Hawaii joins this group of states in 2019. Even though it is considered illegal, The Hastings Center notes that empirical studies have shown the act of PAD (physician-assisted death) to be an underground practice that is not actively prosecuted if it is not actively discussed.
Alternatives to a lethal prescription include sedation to keep someone unconscious until their bodies cease to work because of their terminal illness. Some patients even decide to voluntarily stop eating and drinking to prevent their end-of-life suffering.
Because we should be offering people with a terminal illness the state-of-the-art palliative care they deserve, the pros and cons of legalizing physician-assisted suicide in the United States and around the world deserve some consideration.
List of the Pros of Legalizing Physician Assisted Suicide
1. The right to die should be a matter of choice instead of legislation.
We can choose numerous aspects of life without government interference, but the right to die is not generally one of them. Whether it is due to societal stigma or a religious view of suicide that is unfavorable, those with a terminal illness lose the ability to stop their own suffering. People should have the choice to dictate what happens to them. Some people want to live as long as they possibly can, but if a severe medical condition makes that life unbearable, there should be options which allow it as well.
2. It is used as a last resort option in all cases.
Many doctors favor the legalization of physician-assisted suicide for those who are already dying on the condition that their suffering cannot find relief in any other way. It is much more humane than the alternatives which some people might choose to avoid a protracted death.
Dr. Marcia Angell was one of the first 14 petitioners in Massachusetts to place the Death with Dignity Act on the ballot. Her father decided to kill himself with a firearm rather than endure metastatic cancer of the prostate because of the laws concerning death. PAD would allow healers to continue to do their job as well as possible, with the understanding that their actions would help to bring peace.
3. There are specific legal requirements that must be met first.
In Washington State, the Death with Dignity Act requires a patient to be terminally ill with less than six months to live according to the diagnosis from their doctor. Only qualified patients can make a written request for medication that they must self-administer to end their life. If an adult patient is not competent because of a mental illness or altered state, then it would still be illegal to offer a lethal prescription – even if the written request was offered.
If the competency of the patient is established, then there must also be two witnesses who sign the request as well. The witnesses cannot be a relative, someone entitled to a portion of their estate, or an individual employed by the facility where the patient is receiving care.
4. Doctors take a minimal role in the physician-assisted suicide process.
When Americans think about the issue of PAD, the name that comes to mind for them is Dr. Jack Kevorkian. This man would become infamous because of his strange proposals and unorthodox experiments, earning the nickname of “Dr. Death.” Kevorkian would voluntarily help people to take their lives, although 60% of them were not terminally ill. He would eventually spend time in prison for his activities.
The reality of legalizing physician-assisted suicide is that doctors play a minimal role in this process. In the State of Oregon, there were only 374 physicians participating in the Death with Dignity Act program, representing 0.6% of the state’s total doctors. 62% of them had only written one lethal prescription without any knowledge of who had decided to take the medication or not.
5. It allows a patient to have control over their final decisions.
When a terminal illness is present, then the quality of life for the individual can drop severely and rapidly. It can also be an exceptionally painful experience. Even if medication can help to control the discomfort that they experience, the drugs can change how an individual interacts with their loved ones. If the disease takes a prolonged time to finally cause the physical body to succumb, the toll it takes on the physical, emotional, and financial health of the family can be significant. Legalizing physician-assisted suicide can help to provide relief for everyone in this situation while preserving the dignity of the patient.
6. There is no longer any burden of guilt experienced by the patient.
When someone receives a diagnosis which is terminal, there can be an element of shock at first. It can be challenging to come to grips with the idea that one only has six months or less to live. Then the emotional reaction occurs, which often includes guilt because the patient feels like the care that they require to stay alive provides a tremendous burden on their family. By legalizing physician-assisted suicide, the hardships of this transitory time for everyone can be reduced because the patient is taking control over their circumstances.
7. The outcome is typically the same, no matter what the process is at the end of the day.
When there is a debate about the pros and cons of legalizing physician-assisted suicide, the different key points usually involve the process that is “ethical” or “moral” for someone to have their life end. The reality for patients in this situation is that they are already facing an end-of-life scenario. Even if they decide against a PAD, there is still an excellent chance that death will be coming for them soon. The family will still be grieving for that person. Shouldn’t it be left to those involved to make the choice instead of an oversight committee or government?
8. The rates of people who decide to take this option are stable throughout history.
There has been data collected on the process of legalizing physician-assisted suicide and euthanasia since 2002. Some nations have unofficially practiced this option for patients since 1990. What we have discovered is that the rates of people who choose to take their life in this manner are relatively stable. Those who qualify for legal PAD represent 0.2% to 0.3% of the overall population. If voluntary active euthanasia is permitted, then that rate is typically between 1.8% to 2.5%. This population group may be a small figure compared to the rest of society, but they still should have the right to be in control of their final decisions.
List of the Cons of Legalizing Physician Assisted Suicide
1. It could force some doctors to perform this act without their consent.
The legalization of physician-assisted suicide only works when doctors are willing to provide this service for their patient. Some in the profession believe that when healing is no longer possible for a patient, then the quality of their death should become a priority. Finding a way to relieve that person’s suffering should be the role of the physician. No patient should ever be coerced into the idea of taking their life in this manner, just as a doctor should be have the option to opt out of this service if it goes against their moral code. Requiring a physician to write a lethal prescription goes against the nature of this idea in the first place.
2. Offering to help someone die goes against the code of healing.
If legalizing physician-assisted suicide occurs, then the role of the doctor changes in the healthcare industry. Offering to help someone die is fundamentally incompatible with the idea that a doctor should be a healer. There would always be the threat of having PAD one day extend to other population groups other than the terminally ill, including patients who are vulnerable or classified as incompetent. Placing the responsibility to end the life of a patient in the hands of a physician is a step from which we can never really go back.
3. The medication given in a physician-assisted suicide does not always work.
Oregon’s Health Authority tracked the number of people who took a lethal prescription through the legalizing of physician-assisted suicide from 1998 to June 2017. The government found that only 0.2% of the population was using this law as a way to take their life because of their terminal illness. There were 1,857 residents in total who received a prescription. From that number, 1,186 decided to take the medication. Seven of then regained consciousness after ingesting the drugs, and one of them was still alive and combating their disease.
Although the prescription is lethal a significant majority of the time, legalizing physician-assisted suicide does not guarantee that the action will complete itself successfully. Many laws do not know how to cope with this circumstance when it occurs either.
4. People choose death over life for reasons other than their health.
Oregon’s Health Authority also surveyed the residents who chose to approach a participating physician with the idea of a lethal prescription about their reasons for wanting to die. 91% said that a loss of autonomy was the primary reason why they were thinking about taking their life. 90% said that their terminal illness made it challenging to enjoy their usual activities. Pain was cited as a reason only 26% of the time, while just 4% of patients said that there were financial considerations for their decision. The fact that people are using the Death with Dignity Act to choose suicide because of necessary life changes instead of their actual physical health can set a dangerous precedent for other groups who might seek this right one day.
5. It would require a change to governing laws at the national level.
There were two cases sent to the Supreme Court of the United States in 1997 that challenged the constitutionality of the prohibitions against a physician-assisted suicide. The cases were Quill vs. Vacco and Washington vs. Glucksberg. In both instances, the judges found that there is no constitutional right for a patient to request a lethal prescription. They punted the issue back to the states, which means the U.S. would need to change legislation at a national level to legalize this practice. It may even require an amendment.
The Netherlands was the first country to pass laws that permit national-level physician-assisted suicide. According to CBS News, 4.5% of the deaths in the country today are now from euthanasia after making it legal for doctors to help people die. An increasing number of requests are coming from people who are not terminally ill. Over one-third of the people who choose this option are above the age of 80.
6. There may not be a second opinion involved in the process.
Medicine is an inexact science. Anyone who has ever had to undergo surgery will have signed a waiver form which states that the outcome of the procedure may not meet their expectations. Individual reactions to illnesses, medications, and treatments make it impossible to predict how each case may react in any situation. Without the presence of a second opinion, it may be impossible to know what the potential outcome of an illness might be.
There are numerous inexplicable medical miracles that happen which doctors cannot explain. Greg Thomas has inoperable head and neck cancer that gave him searing headaches, ear aches, and pain in his jaw for more than a year in May 2009. He started working in a church, and four years later, his cancer was gone after receiving a terminal diagnosis. He was even able to have his feeding tube removed – something that doctors said would never happen for him.
“As I was restoring the church,” Thomas said, “God was restoring me.”
Michael Crowe had his heart begin to heal itself after it started pumping blood out at just 25%. Ruby Graupera-Cassimiro had her heart start to beat on its own after failing to work properly for over two hours due to an amniotic fluid embolism. The fact is that medical science cannot explain everything. Miracles can happen. Legalizing physician-assisted suicide eliminates this possibility altogether.
7. Studies show that most terminally ill patients receive an inaccurate survival estimate.
One of the ways that the Death with Dignity laws try to combat abuse is through a requirement that a terminal illness diagnosis offer less than six months of life. A 2001 study from the University of Chicago found that patients received an accurate diagnosis in only 37% of the cases where a terminal illness was diagnosed. 23% of doctors in the study refused to even give an estimate. 40% said that they would intentionally offer an over-estimate. If physicians are not offering open, honest, and frank conversations about the state of patient health, then physician-assisted suicide practices are managed in a state of constant uncertainty.
8. Most people do not go through with this process, even if it is legalized.
The fact remains that only a very small percentage of people actually take up the idea of legalizing physician-assisted suicide in the first place. In Oregon, about 1 in 6 people who are given a terminal illness say that they talk with their families about the possibility of taking their life through this process. The number of patients who actually speak with a doctor about going through with this practice is about 1 in 50. If most people are not going through with this option after legalization, then directing our resources toward possible cures might be a better use of our time.
9. It can result in the involuntary loss of life.
When countries start the process of legalizing physician-assisted suicide, they are also creating the circumstances where involuntary euthanasia can become a significant problem. Up to 0.8% of the deaths that are reported under PAD laws are for life-terminating acts without an explicit request. Even though patients were terminally ill with this disadvantage, they had lost their capacity to make decisions.
Physicians deciding to kill someone, even in an act of compassion, creates circumstances that could quickly spiral out of control. In The Netherlands, there is already a cultural bias in place where there is a responsibility to respond to patient suffering in a way that outweighs the obligation to obey the law.
10. PAD ignores the concept of palliative care.
Palliative care works to improve the quality of life for patients who are terminally ill or facing an illness that threatens their life. It works to relieve their suffering while treating their pain and other concerns, including spiritual and social problems. It can even be offered to those who have a potentially curable disease. Although there is an argument to be made that everyone should have the choice on how to manage their life, it also seems disadvantageous to give up on people when there is still the possibility of a recovery.
11. Some doctors may not offer an accurate diagnosis if PAD is legalized.
Knowing that there are specific restrictions in place for patients to request a lethal prescription, some doctors may take it upon themselves to not offer an accurate diagnosis to ensure that individuals are unable to take advantage of their PAD option. There are already plenty of physicians who admit that they lie about the seriousness of an illness to their patients already. This potential disadvantage would just be an extension of a practice that is already in place – especially in the United States.
A Final Thought on the Pros and Cons of Legalizing Physician-Assisted Suicide
The idea of taking one’s life is so foreign to some people that they cannot conceive of any circumstance where they would make this choice. We also know how quickly a person’s life can change, sometimes because of issues that happen outside of their control. It is essential that we look at the specific population group who is interested in PAD instead of trying to judge this activity from an outside perspective when evaluating the key points of this subject.
The pros and cons of legalizing physician-assisted suicide create deep divides in society. Some people see the act of prematurely shortening one’s life as being inherently sinful, while others feel that it is your right to take your life if necessary – especially if there is a terminal illness involved. Data from the United States suggests that when this practice is tightly controlled and available only to those with exact needs, then a small fraction decides to use it. Some even request a lethal prescription, and then decide against taking it.
Natalie Regoli is a child of God, devoted wife, and mother of two boys. She has a Master's Degree in Law from The University of Texas. Natalie has been published in several national journals and has been practicing law for 18 years.