Questions & Answers

 

Physician Assisted Suicide

Adopted from the University of Washington, School of Medicine, List of Bioethics Topics

 

Physician-assisted suicide (PAS) generally refers to a practice in which the physician provides a patient with a lethal dose of medication, upon the patient's request, which the patient intends to use to end his or her own life.

 

Is physician-assisted suicide the same as euthanasia?

No. Physician-assisted suicide refers to the physician providing the means for death, most often with a presciption. The patient, not the physician, will ultimately administer the lethal medication. Euthanasia generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient's life. Some other practices that should be distinguished from PAS are:

 

Is physician-assisted suicide ethical?

The ethics of PAS continue to be debated. Some argue that PAS is ethical (see arguments in favor). Often this is argued on the grounds that PAS may be a rational choice for a person who is choosing to die to escape unbearable suffering. Furthermore, the physician's duty to alleviate suffering may, at times, justify the act of providing assistance with suicide. These arguments rely a great deal on the notion of individual autonomy, recognizing the right of competent people to chose for themselves the course of their life, including how it will end.

Others have argued that PAS is unethical (see arguments against). Often these opponents argue that PAS runs directly counter to the traditional duty of the physician to preserve life. Furthermore, many argue if PAS were legal, abuses would take place. For instance, the poor or elderly might be covertly pressured to chose PAS over more complex and expensive palliative care options.

 

What are the arguments in favor of PAS?

Those who argue that PAS is ethically justifiable offer the following sorts of arguments:

 

What are the arguments against PAS?

Those that argue that PAS should remain illegal often offer arguments such as these:

 

Is PAS illegal?

In most nations and in most states in the US, aiding in a suicide is a crime. However, suicide or attempted suicide itself is not illegal, although an attempted suicide will often result in a short term involuntary psychiatric commitment for a psychiatric assessment and evaluation. The state of Oregon is the only state within the United Statres that currently has legalized PAS. A constitutional challenge to the Washington State law was dismissed by the US Supreme Court in 1997, with the court refusing to recognize PAS as a constitutional right. The Supreme Court left it to individual states to address the legality of PAS through legislation, but encouraged efforts to improve care of the dying.

Despite the apparent illegality of PAS in most states, no physician has ever been convicted for PAS. Dr. Timothy Quill was investigated but not indicted for his participation in the suicide of a patient after he published his account of the incident. Jack Kevorkian was convicted for second degree murder for an act that more closely approximated active euthanasia.

 

What does the medical profession think of PAS?

Surveys of individual physicians show that half believe that PAS is ethically justifiable in certain cases. However, professional organizations such as the American Medical Association have generally argued against PAS on the grounds that it undermines the integrity of the profession.

Surveys of physicians in practice show that about 1 in 5 will receive a request for PAS sometime in their career. Somewhere between 5-20% of those requests are eventually honored.

 

What do patients and the general public think of PAS?

Surveys of patients and members of the general public find that the vast majority think that PAS is ethically justifiable in certain cases, most often those cases involving unrelenting suffering.

 

What should a physician do if a patient asks him or her for assistance in suicide?

One of the most important aspects of responding to a request for PAS is to be respectful and caring. Virtually every request represents a profound event for the patient, who may have agonized over his situation and the possible ways out. The patient's request should be explored, to better understand its origin, and to determine if there are other interventions that may help ameliorate the motive for the request. In particular, one should address:

 

What if the request persists?

If a patient's request for aid-in-dying persists, each individual clinician must decide his or her own position and choose a course of action that is ethically justifiable. Careful reflection ahead of time can prepare one to openly discuss your position with the patient, acknowledging and respecting difference of opinion when it occurs. Organizations exist which can provide counseling and guidance for terminally ill patients. No physician, however, should feel forced to supply assistance if he or she is morally opposed to PAS.