Assisted suicide

1. AN ANALYSIS OF THE ETHICAL ISSUE BEHIND
PHYSICIAN-ASSISTED SUICIDE
Stephanie Galliera
Health 2030
Fall 2014

2. Physician-assisted suicide is one of the most controversial issues in medicine and society. In assisted suicide, a
physician or other healthcare provider makes a barbiturate prescription available for a terminally ill patient.
The patient then uses it to end his or her own life. In all 50 states, we have the right to refuse treatment even
though that refusal will ultimately lead to death; however, assisted suicide is only legal in five states: Oregon,
Vermont, New Mexico, Washington and Montana. Oregon was the first US state to legalize assisted suicide;
the law took effect in 1997, and allows for terminally ill, mentally competent patients with less than six months
to live to request a prescription for life-ending medication. In 2013, roughly 300 terminally ill Americans were
prescribed lethal medications, and around 230 people died as a result of taking them – some patients choose not
to take the medication. Guidelines exist to direct practitioners who participate in assisted suicide where it is
legal. The American Nurses Association Code for Nurses clearly specifies that nurses should not deliberately
terminate the life of any person. Involvement in assisted suicide remains a complex, controversial and very
personal decision (Siminski, 2010).
Assisted suicide continues to be a debated issue in law, in churches and in the homes of patients. Every
healthcare provider needs to explore and assess his or her own beliefs about the act. Every day, healthcare
providers are challenged with questions about end-of-life care and assisted suicide. They need to be aware of
the laws and the ethics surrounding the issue in order to be fully prepared for such situations. NPs and PAs
should start by investigating the specific reasons why the patient is requesting assisted suicide. The care of
terminally ill patients requires an interdisciplinary holistic approach that encompasses all patient needs and
wishes as life comes to a close. NPs and PAs should be armed with a variety of options to help patients meet
their needs (Siminski, 2010).
The decision to end one’s life usually does not stem from just one attribute, but various perceptions about what
is yet to come to him or her. A common reason is a sense of lost control - lost control over the time and manner
of death, over future events, over body functioning and over oneself. A second major concern is loss of dignity.
Patients anticipate and fear humiliation, odors and embarrassing behaviors. Another reason is the worry about
becoming a burden to others. Patients also fear they will financially and physically wear down the people they
love. If the burden becomes too great, they fear being placed in a nursing home, hospital or other facility to die.
Another concern is a lost sense of self. Patients do not want to lose their personality, and fear being
remembered as frail or ill. Finally, patients fear the actual and anticipated physical symptoms of their illness,
including fatigue, weakness, nausea, vomiting and pain (Siminski, 2010). As with any program of treatment,
consent for palliative care must be obtained from patients with the capability to make their own decisions; it
cannot be assumed (Pellegrino, 1998).

3. A study was done in Washington in which 1355 questionnaires were sent out via mail to a variety of physicians
and general practitioners. This survey was conducted in 1994, before any legalizations of phsyciian0assisted
suicide had occurred. Of these, 938 were completed by willing, qualified recipients. This self-administered
survey depicted the opinions of these professionals about the use of physician-assisted suicide and euthanasia.
Thirty-nine percent of respondents agreed with the statement that physician-assisted suicide is never ethically
justified, and fifty percent disagreed. The attitudes toward physician-assisted suicide and euthanasia of
physicians in Washington State are polarized. A slight majority favors legalizing physician-assisted suicide and
euthanasia in at least some situations, but most would be unwilling to participate in these practices themselves
(Cohen et al., 1994).
The opposing view to the acceptance of allowing physician-assisted suicide is of course, in favor to not allow
physician-assisted suicide. Reasoning behind this includes the fact that there is an elevated rate of clinical
depression among those with serious medical illness. Depression can influence the patient’s perception to the
point that a difficult situation may seem hopeless prematurely. Also, for clinicians who work with the
terminally ill, it would seem that the effort should always be to make the necessity of decisions about ending
life as infrequent as possible. In addition, there exists a significant concern that out society could become
suicide permissive; if suicide is presented as a rational option, an ideological change might occur in which
suicide is seen as more socially acceptable. Finally, there is a fear that terminally ill patients will be coerced
into choosing suicide either by caregivers or family members – for example, if the patient knows that the family
does not have the money to afford ongoing care (Kleespies et al., 2000).
When a patient is diagnosed with a terminal disease, professionals will do their best to keep them alive as long
as possible. Technological advances in medicine have made it possible to sustain life beyond the point where it
is meaningful. Improvements in the treatment of diseases have extended life expectancy to the point where
seventy to eighty percent of people now die later in life; however, death occurs more slowly and essentially of
degenerative disease rather than of acute disease. Many of these deaths are prolonged and agonizing, and the
prospect of dying in this way has raised alarm. Third, such prolonged deaths often become “medicalized” in
that they occur in hospitals and nursing homes with attendant medical procedures that can deprive the individual
of dignity and privacy (Kleespies et al., 2000).
Brittany Maynard, a young woman with terminal brain cancer, made headlines in 2014 when she moved to
Oregon to end her life with medication, seeing as though Oregon is one of five states that has enacted the Death
with Dignity Act. This act allows terminally ill residents of Oregon to "to end their lives through the voluntary
self-administration of lethal medications, expressly prescribed by a physician for that purpose." Ms. Maynard,

4. after learning about her terminal illness, chose to live to the fullest until her condition became unbearable. In a
statement about her choice, Maynard said, “Having this choice at the end of my life has become incredibly
important. It has given me a sense of peace during a tumultuous time that otherwise would be dominated by
fear, uncertainty, and pain.” After taking the barbiturates, Ms. Maynard passed away peacefully surrounded by
those who she loves (Westermann, 2014). Religious conservatives oppose assisted death on the basis of their
beliefs about the worth of life and the meaning of suffering. For example, Kara Tippetts, a devout Christian
who is terminally ill, acknowledged in a letter to Maynard the pain of knowing one’s days are numbered. “But
it was never intended for us to decide when that last breath is breathed,” wrote Tippetts. “Brittany, when we
trust Jesus to be the carrier, protector, redeemer of our hearts, death is no longer dying. My heart longs for you
to know this truth, this love, this forever living.” As with most religious opponents of assisted suicide, Tippets
applies her own definitions of the transcendent value of suffering and the existence of an afterlife on others,
including those with differing views (Zakaria, 2014).
In order to solve this ethical dilemma between those who find it just and those who do not, rules need to be
implemented. A terminally ill patient should have the option to undergo physicians-assisted suicide or
euthanasia. Physicians who consider such treatment “unethical,” must be free not to participate. They should
explain why they cannot use these methods respectfully and courteously. If agreement cannot be reached, the
patient may discharge the physician, or the physician may respectfully withdraw as soon as another physician
agrees to undertake care.

5. References
Cohen, J. S., Fihn, S. D., Boyko, E. J., Jonsen, A. R., & Wood, R. W. (1994). Attitudes
toward assisted suicide and euthanasia among physicians in Washington State.
New England Journal of Medicine, 331(2), 89-94.
Kleespies, P. M., Hughes, D. H., & Gallacher, F. P. (2000). Suicide in the medically and
terminally ill: psychological and ethical considerations. Journal of clinical psychology, 56(9), 1153-
1171.
Pellegrino, E. D. (1998). Emerging ethical issues in palliative care. Jama, 279(19), 1521
1522.
Siminski, L. (2010). Assisted Suicide: Get Informed.
Westermann, D. (2014). Death with dignity. Nursing Management.
Zakaria, R. (2014, October 24). Assisted suicide should be legal. Retrieved December 1,
2014, from http://america.aljazeera.com/opinions/2014/10/assisted-
suicidebrittanymaynardoregondeathwithdignity.html.