March 16, 2005
The Legalization of Assisted Suicide
Oregon, the Netherlands, and Belgium are the only three jurisdictions in the world that permit assisted suicide and/or euthanasia. Oregon became the leader of the United States in assisted suicide, when the Oregon legislation passed the Death with Dignity Act in 1994, permitting "physicians to write prescriptions for a lethal dosage of medication to people with a terminal illness" (Department of Human Services). Oregon's act specifies who is permitted to assist a terminally ill patient in their time of choosing between life and death. But in the event that the United States as a country legalized assisted suicide, who would determine which patients qualified as terminally ill, and who would be permitted to "assist" these "terminally ill" patients? With questions still arising as to how and who on a topic such as assisted suicide, one can only prohibit the action until all aspects have been considered, eliminating confusion.
Assisted suicide is considered as someone providing another person with information, guidance, and/or means to take his/her own life. It is only considered to be physician assisted suicide (PAS) when a doctor is the provider. In many cases it is the physician who assists a current patient with their final wish of ending his/her life, but what about in other cases? In "Last Right," by Carrie Carmichael, Carmichael is asked by her best friend if she (Carmichael's friend) can jump out of Carmichael's window. While planning out the action, Carmichael began second-guessing, asking, "Could I sleep in my room after my friend plunged to her death from my window" (Carmichael, 98)? Not only was Carmichael considering her own emotions, and her own life, but she also considered how the action would affect others: "Nothing to break her fall. But nothing to protect pedestrians either" (Carmichael, 98). When a person who wishes to commit suicide pursues assisted suicide, not only is that person affecting themselves, but also those people around them. Carrie Carmichael's friend had been diagnosed with esophageal cancer, prohibiting her from committing suicide via an over dosage of pills. Carmichael's friend wanted to commit the suicide before she had became too weak to perform the suicide on her own. In Carrie Carmichael's case, the "assistance" provided to her friend was limited because Carmichael drove her friend to the hotel where she would leap from the building, in opposition to those people who injected loved ones with medications or provided the medications for over dosage, only to be provoked to suffocate the family member in time of mishap. Although Carmichael's friend herself was too weak to drive herself anywhere, or take an overdose of medications, she placed her best friend in an uncomfortable position of making a decision to whether or not assist her friend. Now, not only is Carrie Carmichael haunted by the fact that the last time she saw her friend, she was driving her to her death, but the friend's family is confused as to why she would have chose to go that way. Carmichael's friend made a selfish decision, making her friends and loved ones suffer after the completion of her act, while she would no longer have anything to worry about.
Even in the event that the assistant to a suicide is a physician, physicians are also people with feelings, and many physicians are attached to their patients. Although those in favor of physician assisted suicide claim that it would provide compassion (PAS may be the compassionate response to unbearable suffering) and the respect for autonomy (competent persons should have the right to choose the time of their death), there is a major issue that would prevent a physician from assisting a patient with his/her suicide: the Hippocratic oath. The Hippocratic Oath states, "I will not administer poison to anyone where asked," and "Be of benefit, or at least do no harm" (University of Washington). The connotation of physicians and hospitals has become that of a positive nature: doctors give and restore lives, not take them. But in certain cases, doctors may sometimes feel like they are between a rock and a hard place; "should I give my patient what he/she desires, or should I do what I know to be morally correct?" In "A Question of Mercy," by Richard Selzer, Selzer speaks about a time when he was asked to assist a patient who was dying of HIV, in committing suicide. When ill man's partner asked Dr. Selzer if he would help, Selzer's original answer was, "NoI'm trained to preserve life, not end it. It's not in me to do a think like that" (Selzer, 32). After Dr. Selzer investigates the body of the patient, R, he changes his mind. "I see that his anus is a great circular ulceration, raw and oozing blood. His buttocks are smeared with pus and liquid stool. With tenderness, L. R's partner bathes and dresses him in a fresh diaper" (Selzer, 36). After seeing the suffering that R is enduring, Dr. Selzer decides to assist him, but just as quickly as he changed his mind because of the visual of R, he can have a change of heart after R's death.
Another significant point that should be addressed when considering legalizing assisted suicide, is the question of who qualifies as "terminally ill?" In "The Ethics of Suicide," written by Vicki Brower, Brower states that, "Ninety-five percent of those who kill themselves have been shown to have a diagnosable psychiatric illness in the months preceding the suicide.' And ... some may voice suicidal thoughts in response to depression or severe pain" (Brower, 26). Should patients that suffer from depression or any other psychiatric illnesses be permitted to make choices on behalf of their lives? These are the people who are basing their decision(s) upon the quality of life as it stands that very minute. A person could desire suicide at 3:50pm when he/she is not being visited by their family, but at 4:00pm, when the person's family is there, the person has no more complaints. Mistakes are not only made on behalf of the patient, but on behalf of the doctor as well. Physicians make mistakes, show uncertainty in diagnosis and/or prognosis, and may also provide a mistreatment. Patients such as the ones described above can not be expected to make major decisions, such as taking his/her own life, and some patients may be misdiagnosed, but because the diagnosis was not what he/she wanted to hear, the patient now wants to consider other options (i.e. - assisted suicide).
Patients not only make unwise decisions because of current conditions, but they also sometimes see death as an escape route, or easy way out. An example of this would be in Dr. Timothy Quill's, "Death and Dignity." Dr. Quill talks about his patient, Diane, who was suffering from acute leukemia. Diane refused to take medications that Dr. Quill would offer her that provide "comfort care." Diane had heard of other people lingering on, on medications, and through chemo therapy, but she figured it was her time to go, and she had not desire to prolong it. If she had not committed suicide, her "immediate future held what she feared most - increasing discomfort, dependence, and hard choices between pain and sedation" (Quill, 693). But the question arises of whether or not she even qualified, if she still had a chance to live. Neither the physicians nor Diane knew if the therapy would be successful, but as opposed to even attempting it, Diane began asking questions about assisted suicide.
Assisted suicide provides an easy way out for those patients who may have a possibility to live, a means for terminally ill patients to end their lives and suffering, but it comes with a price to others when the suicide becomes assisted. Not only are the assistants faced with the burden of having done in immoral act, but in some cases, the assistants actually murder the suicidal patient. Not only that, but questions arise as to who is eligible to assist, and who is eligible to commit suicide. Assisted suicide has joined the extensive list of controversial issues that should be prohibited for the time being, until further investigation, removing kinks and confusion, can make it less controversial.
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Brower, Vicki. "The Ethics of Suicide." Utne Reader July/Aug 1994: 22-26.
Carmichael, Carrie. "Last Right." The New York Times Magazine 22 May 2001: 98.
Oregon Division of Public Health. "FAQs About Physician-Assisted Suicide." Oregon. Department of Human Services. Mar 15, 2005 .
Quill, Timothy. "Death and Dignity: A Case of Individualized Decision Making." New England Journal of Medicine 324 (1991): 691-694.