Written By: Nadia Mifsud
Physician-assisted suicide (PAS) is a highly debated and emotionally charged topic that involves complex ethical, moral, and legal considerations. The practice entails a physician providing a terminally ill patient with the means to end their own life, typically through a lethal dose of medication. While some argue that it is a compassionate response to alleviate suffering, others raise concerns about the sanctity of life and the potential for abuse. In this blog post, we will delve into the various aspects of physician-assisted suicide which I learned from my previous studies, examining the arguments for and against its legalization.
In the United States, 11 states have legalized the practice of PAS under the Death with Dignity Statute that outlines that adults with a terminal illness with 6 or less months to live are eligible to receive a prescription. These states include California, Colorado, District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington.
Advocates of PAS argue that it is rooted in the fundamental principle of patient autonomy, the right for individuals to make decisions about their own lives, including the choice to end it. They believe that in cases of unbearable suffering and impending death, patients should have the right to die with dignity and control over their own fate. By offering the option of a peaceful and painless death, proponents assert that PAS provides a compassionate alternative to prolonged suffering.
Proponents also claim that it is primarily about relief and dignity, not suicide, nor depression. They believe that no one should be coerced into dying, but they should not be denied the right either. It is also important to note that people often resort to back end ways to kill themselves because they cannot access the medication where they’re from.
Nicole Linares, a good friend and nursing major at Molloy University, is a proponent of PAS. She stated, “As nurses, we work with physicians to support patients as best we can. When we can’t anymore, we should continue to support patients in death.”
Opponents of PAS often emphasize the importance of comprehensive end-of-life care and improved access to palliative care services. They argue that by investing in palliative care, we can address the physical, emotional, and psychological needs of terminally ill patients, alleviating their suffering and enhancing their quality of life. Providing robust palliative care options can reduce the desire for PAS by ensuring that patients receive appropriate pain management, emotional support, and compassionate care until their natural death.
Opponents prioritize palliative care over PAS because they believe that allowing it would cause unjustified killings. It is thought that the widespread implementation of PAS can lead to a gradual expansion of eligibility criteria beyond the initially intended scope, reaching vulnerable populations like those with mental illness and minors.
Additionally, physicians say that patients may live a longer life had they not taken a drug to end their life, because a prognosis only has a fifty-fifty chance of being accurate. It also breaches the Hippocratic Oath that physicians swear to, and goes against the principle of nonmaleficience, or doing no harm.
Finally, those against PAS patients who are terminally ill can have depression and can be coerced into dying early as it becomes a widespread practice. However, patients go through psychological evaluations to determine whether or not they are fit to receive such medication. Besides the aforementioned arguments, some physicians also fear that it gives them the power to play god and holds them accountable for a patient's death, despite the patient committing the final act.
The “Slippery Slope Argument” argues that the legal right to death will be abused and cannot be properly regulated nor prevented, therefore it should be withheld. Physicians are concerned that its implementation can lead to unnecessary deaths of people of vulnerable populations who cannot express an interest in PAS, such as those with mental incapacities, disabilities, or infants. This “slippery slope” leads to their deaths and even the deaths of people who are not terminally ill, causing euthanasia to be used more casually than it should.
In my opinion, PAS should be a right that everyone has access to. I would argue that the potential for it to be abused is not basis enough to deny people that right. It would 100% be necessary to instill strict regulations to prevent unnecessary deaths, but if one person should have the right to PAS, every person who meets the criteria should be eligible for such medication.
I also think we cannot judge practices for their likelihood of abuse. If it was a justification to inhibit certain practices, more things would have to be banned. Driving? Using the logic that most opponents have, driving would have to be banned because it is a right that is abused with ineffective safeguards: people speed, run red lights, don't wear seatbelts, and drive under the influence, all activities that can lead to unnecessary fatalities. Then alcohol consumption? Gambling? The list goes on.
Just because some people abuse certain rights often does not mean that others cannot have access to them. So why should it be the same for assisted death? Regulation of such a practice will be undoubtedly difficult, as each patient’s case is different, but it's always better that a practice is legalized and regulated as opposed to demoralized and unmonitored.
Jocelyn Lovera, also a nursing major at Molloy, said something that resonated with me. She stated, “As a nursing student, we learn heavily about patient autonomy. The definition of autonomy is that a patient determines their plan of care… they approve or disapprove of medical interventions… Having this choice in life should also apply in death. You make decisions your whole life but can't control your own death?”
People with terminal illnesses should have the right to decide their death. A physician who honors their patient's request for assisted death respects their right to self-determination and upholds their value as a human with a final wish. People who choose to opt for assisted death do so in order to end suffering that may be unbearable for them. Every person should have the freedom to live and die of their own accord. Every person should have access to a supportive mechanism for dying, something that quite literally everyone is afraid of.
The legalization and regulation of medical assisted dying is a controversial topic that raises ethical, legal, and moral questions. Advocates argue for individual autonomy and the right to end suffering, while opponents emphasize the sanctity of life and potential risks. Legalization allows for compassionate options and the establishment of safeguards, but concerns exist about the slippery slope and the impact on palliative care. Different countries have adopted varying approaches to assisted dying. As society navigates this complex issue, critiquing current practices with open dialogue and consideration of diverse perspectives are necessary to reach a conclusion.
While there are currently no prominent cases regarding physician-assisted suicide, the future of this practice in the United States remains uncertain. It is unclear whether more states will legalize it in the coming years. Moving forward, it is essential to focus on establishing monitoring mechanisms for PAS, potentially through the creation of dedicated branches within state governments. Also, we must regulate and evaluate the implementation of PAS in states where it is already legal to investigate the likelihood and prevalence of abuse. Doing so may give us a grip on that slippery slope.