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Assisted suicide is the act of indirectly facilitating the death of another person per his or her request. The term is usually extended to describe physician-assisted suicide (PAS), which refers to a physician aiding a patient in taking his or her life, typically by prescribing a lethal dose of barbiturates. The physician may provide the means for suicide, while the patient is the one who actually performs the act (e.g., self-administers the medication). It is important to differentiate PAS from euthanasia, which occurs when a physician directly influences the death of a patient. There is significant controversy regarding whether assisted suicide constitutes interpersonal violence. Whereas some individuals have argued that assisted suicide is, in fact, one form of potentially lethal violence, others have argued that it constitutes an act of mercy for individuals enduring substantial suffering with otherwise terminal illnesses.
With the legalization of PAS in the Netherlands, Belgium, Switzerland, and recently in the state of Oregon, assisted suicide has become a contentious topic that highlights moral and ethical questions that do not have clear answers. Conservative religious groups that oppose PAS argue that it is morally wrong to take one’s own life. Those from the medical community who object to PAS claim that it violates a fundamental premise of the medical profession to heal and extend human life. The potential for certain groups of people (e.g., the disabled, the elderly) to be manipulated or coerced into PAS is another argument against decriminalizing the practice. This is a particular concern with the advent of managed health care and the fear that legalizing PAS would allow it to be misused in an effort to reduce health care expenditures associated with treating terminally ill patients.
Those who support PAS assert that people should have the ability to decide when, where, and under what circumstances they die. In this way, terminally ill people who have lost self-sufficiency and independence can still maintain a sense of autonomy. It is also argued that in some cases pain cannot be relieved with conventional pain management methods, and that PAS is a compassionate way to end intolerable suffering.
The most commonly cited reasons for requesting and utilizing PAS are unbearable pain, maintaining autonomy, losing control of bodily functions, loss of dignity, and decreased quality of life, though in most cases there is a combination of factors that motivate a patient to consider PAS. Although the literature on the association between clinical depression and requests for PAS is mixed, depression is not typically endorsed as strongly as other variables when opting for PAS.
Research suggests that underlying ethical beliefs regarding PAS govern both physicians’ and the general population’s attitudes toward when and under what circumstances PAS is appropriate and acceptable. Presently, the American Medical Association and the U.S. Supreme Court officially oppose PAS. Opinion polls given to the public and to medical professionals reveal that about half of both groups believe that PAS is ethically acceptable under certain circumstances, although support of PAS has been substantially lower when the issue has been subjected to a formal vote.
The Oregon Death with Dignity Act (ODDA) legalized PAS for citizens of Oregon. The ODDA has many guidelines and safeguards built in to ensure that patients are fully informed and are requesting PAS voluntarily and with rational judgment that is not impaired by a psychological disorder such as depression.
Despite the fact that the ODDA has various rules to protect against its misuse, PAS remains aggressively debated among the medical community, religious groups, and the general public. It will likely continue to be a highly controversial topic, as it is deeply intertwined with moral and ethical beliefs.
References:
- Oregon State Public Health, Department of Human Services. (n.d.). Physician assisted suicide. Retrieved September 20, 2006, from http://www.oregon.gov/DHS/ph/pas/
- Rurup, M., Onwuteaka-Philipsen, B., VanDerWal, G., VanDerHeide, A., & VanDerMaas, P. (2005). A “suicide pill” for older people: Attitudes of physicians, the general population, and relatives of patients who died after euthanasia or physician-assisted suicide in the Netherlands. Death Studies, 29, 519-534.
- Werth, J., Jr. (2004). The relationship among clinical depression, suicide, and other actions that may hasten death. Behavioral Sciences & the Law, 22, 243-253.
- Westfield, J., Sikes, C., Ansley, T., & Yi, H. (2004). Attitudes towards rational suicide. Journal of Loss and Trauma, 9, 359-370.
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