Is Physician Assisted Suicide Ethical?

​Physician-assisted suicide, also known as physician-assisted death or PAD, has been an ongoing controversial issue within the medical field. In 1997, there were two Supreme Court cases to determine whether PAD should be considered constitutional. In the first case, Vacco v. Quill, the Supreme Court ruled it constitutional for the state of New York to ban the procedure as it was not considered constitutionally protected by the Equal Protection Clause of the Fourteenth Amendment (Constitutional Law Reporter). In the second case, Washington v. Glucksberg, the Supreme Court was challenged once again over the same issue by Dr. Glucksburg and came to the same conclusion deciding that "the right to die" as Dr. Gluscksburg put it is not a right that is constitutionally protected. 

Author

Alanna Ward
​Outbreak!2020

Although the Supreme Court's ruling was strictly based on whether someone had the constitutional right to PAD or if it were up to the state to decide, people found the issue controversial for other reasons, particularly how ethical the practice was. To decide whether something is ethical or not, one must first understand what ethical means.  As defined by the Oxford Dictionary, ethics is "moral principles that control or influence a person's behavior." Essentially, to decide if something is ethical or not is subjective because it is dependent on one's moral compass and what they consider right or wrong. The next step to deciding if something is ethical is to understand in depth what it is.
Physician-assisted suicide is the death of a suffering patient by lethal drugs provided by a doctor (Oxford Dictionary). A patient only qualifies for PAD if they have been diagnosed as terminally ill, are expected to die in six months or less, and possesses the mental ability to make decisions regarding their health. The patient then has to thoroughly discuss all the details of the process and other end of life options with their physician. The physician must also go over all alternative options to PAD, including pain management and comfort care (Stanford School of Medicine). If the patient still wants to continue with the process, they must make two verbal requests for the treatment 15 days apart, as well as a written request—all of which must be documented. Although the attending physician does provide the lethal prescription of barbiturates, the patient must take the drug themself, which can only be taken orally.
PAD may sound enticing to a patient for many reasons. Many of these patients, knowing they will die soon anyway, do not want to put the financial stress that comes with their diagnosis on their families. Others ask for this procedure with the argument of wanting to die with dignity.  One argument on behalf of PAD is that these terminal illnesses provide patients with a low quality of life. With some diseases, patients know that within their last few weeks, they will not be themselves. They may be forced to spend most of this time sleeping due to extreme drowsiness and be too tired to spend time with their families or doing much in general. Some will have developed dementia at this point and not remember where they are, why they are there, or who is around them. Although patients who have already developed dementia cannot receive this procedure, those who meet the other qualifications and know that they will develop dementia might opt for it because of that. After already saying their goodbyes and preparing to die, they can rest easy knowing their families' last memories will not be of them suffering.
Opponents of PAD object to the procedure for a variety of reasons. One of those reasons is that there is a difference between letting a patient refuse treatment versus actively helping them die by prescribing them a lethal drug (JCO Oncology Practice). Others reason that if assisting a friend in suicide with the exact same qualifications is illegal, then it should not be legal as a doctor to do the same thing. Some also argue that there is still a chance that a patient could have been misdiagnosed. There are many instances where people were given a prognosis of a certain amount of time to live that turned out inaccurate. A famous example is Stephen Hawking, who was told he would die in his early twenties but ended up living until age 76. In addition to these other reasons, numerous people also object to PAD on religious grounds.
Regardless of whether one thinks PAD is ethical or not, there is still an issue concerning the ethics of the current healthcare system. A primary driver for patients to choose PAD is that they do not want to become a financial burden on their families in their last few months of living. One argument is if the health care system were modified so that these financial pressures did not exist, many patients would most likely not take this extreme step. Under the current system, insurance companies could interfere with what should be a personal decision by turning patients towards PAD as a cheaper alternative for both the patients and the company. Another point of contention is that there are not enough safeguards to identify and prevent patients with mental illness from asking for PAD.
Whether physician-assisted suicide is ethical or not can only be answered by you based on your personal beliefs. Regardless of your opinion on the ethics of PAD, there goes without saying that there are flaws within our healthcare system.
  
References
SUPREME COURT UPHOLDS PROHIBITIONS ON ASSISTED SUICIDE, biotech.law.lsu.edu/cases/pro_lic/vacco_glucks_brief.htm.
The Right to Assisted Suicide, www.lonestar.edu/rightto-assist-suicide.htm.
“Article Tools.” Journal of Oncology Practice, ascopubs.org/doi/10.1200/JOP.2017.021840.
“Assisted Suicide Laws.” Disability Rights Education & Defense Fund, 21 July 2020, dredf.org/public-policy/assisted-suicide/.
“Assisted Suicide: Definition of Assisted Suicide by Oxford Dictionary on Lexico.com Also Meaning of Assisted Suicide.” Lexico Dictionaries | English, Lexico Dictionaries, www.lexico.com/en/definition/assisted_suicide.
“Frequently Asked Questions.” Palliative Care: Education & Training, 23 July 2016, palliative.stanford.edu/physician-assisted-death/frequently-asked-questions/.
“Vacco v. Quill: The Right to Die and the U.S. Constitution.” Constitutional Law Reporter, 22 Oct. 2016, constitutionallawreporter.com/2014/10/15/vacco-v-quill-right-die-u-s-constitution/.
“Ethic Noun - Definition, Pictures, Pronunciation and Usage Notes: Oxford Advanced American Dictionary at OxfordLearnersDictionaries.com.” Ethic Noun - Definition, Pictures, Pronunciation and Usage Notes | Oxford Advanced American Dictionary at OxfordLearnersDictionaries.com, www.oxfordlearnersdictionaries.com/us/definition/american_english/ethic#:~:text=noun-,noun,work ethic the Protestant ethic.