Death with Dignity: AnInvestigation of Physician Assisted SuicideNick LeonSociology 450University of Delaware Death with Dignity: AnInvestigation of Physician Assisted SuicideInthe past few decades Physician assisted suicide (PAS) in the United States hasbecome a controversial yet increasingly applicable concept. The debate fallsbetween whether or not a dying individual has the right to die with theassistance of a physician through calculated and painless lethal injections. Factorsincluding moral, religious, medical, and political have all played a role in influencingsociety’s relationship with this practice. Itis difficult to distinguish between relief from suffering, with simply killing.One of the most substantial concerns with assisted suicide lies with thecompetence of the terminally ill.
More people are discussing and consideringphysician assisted suicide as a viable option than ever before (Bruinius, 2015).Essentially it is a series of calculated injections or pills administered by amedical professional to purposefully induce a painless death. In the U.S. itvaries by state law, but as of today only four of fifty states have legalizedthe “Death with Dignity Act” (including Oregon, Vermont, Washington, andCalifornia with Montana allowing it only under a court ruling) (Bruinius,2015). The patient also has to be a mentally competent individual at least 18years old and be diagnosed with a terminal illness that would otherwise resultin death within the next 6 months.
In all other states and scenarios, aiding insuicide is considered a felony, however public pressure is rendering certainstates either undecided or in legislation review. California is such as state, mostrecently adopting a “death with dignity act” that allows for any state residingand critically ill individual to partake in physician assisted suicide(Bruinius, 2015).PAShas also made a significant mark internationally. In April 2002, the Netherlands became the firstcountry to legalize assisted suicide.
Countries such as theSwitzerland, Germany, and recently Canada have made profound strides insupporting these practices as well. In 2013, according to the latest data, 4,829 peopleacross the Netherlands chose to have a doctor end their lives. That’s one inevery 28 deaths and triple the number of people who died this way in 2002.Here, people can choose euthanasia if they can convince two physicians theyendure “unbearable” suffering, a definition that expands each year. Residentscan choose euthanasia if they’re tired of living with Lou Gehrig’s disease,multiple sclerosis, depression or loneliness. In contrast, within the fewstates that allow for it, the U.S. has much stricter regulations as to whatconstitutes reason for PAS.
Other countries are now edging closer to the Dutchmodel. On February 6, the Supreme Court of Canada struck down a ban onphysician-assisted suicide, joining Luxembourg, Belgium and Switzerland on thelist of Western countries where PAS is fully legal. This has undoubtedly encouraged “suicidetourists” from other countries to book one-way tickets there. Since a limitednumber of nations allow it, those with the financial means and physical abilityhave been skirting around their own nation’s bans and utilizing the freedom tokill themselves in foreign places (as long as they meet the standards set forthby the nation they travel to). The march toward euthanasia mirrors a trendspanning continents today: a growing number of countries are placing more valueon individual freedom. This worries religious leaders, ethicists and disabilityadvocates. Assisted suicide may ease suffering, they say, but it threatens ourmost vulnerable citizens—the elderly and the disabled, who already struggle tojustify their lives.
Financial considerations could also creep intodiscussions that should never involve money. In the Netherlands, as in manydeveloped countries, the number of elderly citizens is expected to increase by30 to 40 percent in the coming two decades. Euthanasia, critics say, adds adangerous option in this context: a way for societies to nudge the elderly toquicker deaths. In the U.S., euthanasia opponents contend the profit-drivenhealth care system and its slow takeover by cost-cutting managed-care companiespose major ethical risks. “There’s a lot of pressure in the system already,”says Diane Coleman, the president and CEO of Not Dead Yet, a disability rightsgroup that lobbies against the legalization of assisted suicide and euthanasia.”We see people denied the care they need for economic reasons.
Assisted suicideis the cheapest kind of treatment that could be offered by the system. Thesepressures are a reason for concern” (Not Dead Yet).As euthanasiabecomes more and more a prevalent aspect of human culture, it is important tonote the struggling dynamic between the public and private life of peoplewithin society.
What role should legislation and the state play in what someconsider a very private decision? How much power should the government haveover PAS? Activists often claim that laws againstassisted suicide are government mandated suffering. However, this is tantamountto claiming laws against selling contaminated food are government mandatedstarvation. We will all eventually die, but in an age of increased longevityand medical advances, death can be suspended, sometimes indefinitely, and nolonger slips in according to its own immutable timetable. So, for both patientsand their loved ones, real decisions are demanded. When do we stop doing allthat we can do? When are we allowing wondrous medical methods to perverselyprolong the dying rather than the living? These intensely personal and sociallyexpensive decisions should not be left to governments, judges or legislatorsbetter attuned to highway funding. The state would argue that assisted suicideis not a private act – since it involves one person facilitating the death ofanother. In this way, it is viewed as a matter of public concern that canpotentially lead to abuse, exploitation and erosion of care for the mostvulnerable populations.
Although the legality and ethics surrounding assisted suicide have beenpondered since the establishment of civilization, these issues were brought tothe forefront in the U.S. during the early 1970s (Pesch, 2015). The goal ofthis movement was to increase the rights of people with terminal illnesses andto give them more control over their own mortality. People with these advancedand often vicious health problems seek refuge in the option of escape with thechoice of death peacefully (usually through a series of calculated injections)by a physician. Brittany Maynard is a prime and topical example of how theselaws are changing the concern for Americans nationwide. She was diagnosed withterminal brain cancer at age 26 and had six months to live, but instead choseassisted suicide (Pesch, 2015).
The issue of death with dignity is importantnot just in our country but worldwide because of individuals such as Brittany.As long as there is human existence, there will be human death. This death willnot always come neatly or comfortably and in some cases, such as this one, itcan drag out and be excruciatingly painful. This type of pain, both physicallyand psychologically, can make living life just not worth it (Sweet, 2015). Ourwillingness to accept or participate in something as unnatural as choosing todie is the problem here. The option to escape this fate and the stakes at handis what makes assisted suicide an imperative issue worldwide. It is quiteliterally a matter of life and death and at the end of the day, those taskedwith decided on these laws are not the ones that are suffering to begin with.This disconnect even further complicates the relativity of purposeful death.
Euthanasia carries anegative connotation, often being considered comparable to murder. Religiousand medical communities tend to firmly stand against the act of assistedsuicide. Articles such as the one published by the Australian news group “TheDaily Telegraph” use religion or medical references in order to build a caseagainst allowing this practice. This news group stated in their article title Dying with dignity is just a lie, “TheJudeo-Christian tradition has always claimed that every person is made in theimage and likeness of God.” (Comensoli, 2015). In this light, the issue ofassisted suicide and its allowance is framed in juxtaposition with religiousbeliefs.
Religion, a widely used and influential motivator towards reasoning inmany capacities, was used as a way to make an argument that assisted suicide iswrong. It is creating a message that essentially says “if you believe andfollow religion (in this case Christianity) then you must believe that assistedsuicide is wrong and that a higher power is the only being that can take lifeaway” (Comensoli, 2015). While many faithtraditions adhere to ancient traditions and understandings of physical life’sfinal journey, modern medical technology has opened the door for faith leadersto actively reconsider some beliefs. Death with Dignity laws offer dyingindividuals an opportunity to ponder an important final life question: “What isthe meaning of my life?” For many, this is a profoundly spiritual question towhich answers come, not when an individual is consumed by a flurry of doctor’sappointments, treatments, or chronic disability and pain, but in the comfort ofsolitude when an individual feels at peace. Death with Dignity is not only alegal issue, but a cultural and spiritual one as well. This means that all careat the end of life should bear in mind the patient’s spiritual well-beingalongside physical.
Some faith traditions have embraced Death with Dignity asan ultimate act of compassion, and others reject it is as morally bankruptpractice. It is a perspective that varies from belief to belief all over theglobe; making a universal acceptance of physician assisted suicide a veryunlikely possibility in this context.Thissame framing is used from a medical perspective as well. Across the globe,medical groups utilize the media to advocate against assisted suicide just thesame. From this standpoint, the act is wrong and that if you are a doctor, youshould not condone it. This supports the notion that doctors are meant to keeppeople alive, not kill them, no matter what the circumstances are (O’Connell,2015). Assisted suicide in the news is often seen as a problem, for which thesolution is to ban altogether and prevent more states and nations worldwidefrom allowing it through legislation.
This conjures up the question as to howmuch power to our medical practitioners have? What is their role in society andhow do they fit in with the assisted suicide movement? Individuals speciallytrained to prolong and sustain life now being asked to take it away. It seemscontradictory, however the greatest argument is that medical practitioners arethe only individuals with the experience and training that is sufficient enoughto make assisted suicide humane and even ethically possible. An overdose ofsleeping pills or a bullet to the head is just simply not appropriate for thesechronically ill people and it could resort to just that if physician assistedsuicide is not allowed for those with this type of suffering.Furthermore, the medical community generally seeslegalizing physician-assisted suicide as causing pressure on terminal patientswho fear their illness is burdensome–physically, emotionally, orfinancially–to their families or caretakers. They see physician-assistedsuicide as going against thousands of years of medical ethics. The problem isthat physician-assisted suicide is seen as fundamentally incompatible with thephysician’s role as healer.
This is where the social movement of assistedsuicide takes hold. It is here that it is important to rationalize andnormalize something like human euthanasia and to broaden society’s standards asto what constitutes the duties of a healer. The euthanasia movement is askingthe medical, political, and public realms to include the taking away of life asan option for healing.
It is saying that the taking away of life is a viable optionthat can coincide with other healing processes conducted by medicalpractitioners.Physicianassisted suicide, although a universal concept, is often seen to apply tocertain demographics. Due to the cost, availability, and education needed for asuch a new and arguably optional practice, it is only really available to themiddle and upper classes of people. Since it is an expensive and relatively new practice that has limitedsponsorship, most individuals within lesser socio economic statuses cannotafford nor even consider assisted suicide as an option. These factors are what keep people of varyingraces and SES from partaking in assisted suicide. In 2013 alone, 0.39% of all deaths in Oregon were due to the Death with Dignity Act and thePAS patients who tookadvantage of it were 94.4 percent white and 53.
3 percent held undergraduatedegrees (Oregon Death withDignity Act: Annual Reports, 2015). While 65 percentof white respondents said they would “cease all medical treatment” in cases ofincurable disease or extreme pain, sixty percent of African-Americanrespondents and 55 percent of Hispanic-American respondents prefer that doctorssave their lives at all costs. When religion is held constant,there are still visible differences across race. The Pew Research Centerconducted a survey in 2013 and asked what Americans would do”if they had a disease with no hope of improvement and were suffering a greatdeal of pain.” Sixty-six percent of white Protestants preferred the option of”stopping treatment so they could die.
” Only 32 percent of black Protestantspreferred to stop treatment. Among Catholics, 65 percent of white respondentsand 38 percent of Hispanic respondents elected to stop treatment.Theexperts who often collect this data usually support the practice of assistedsuicide and feel as though every person should have the ability and choice toend their own lives to escape serious terminal illness. However, from a rigidmedical standpoint, it opposes this and believes that a physician’s duty is tokeep the patient alive no matter what. Treating these patients is out of thequestion since euthanasia in itself is a way to escape treatment to begin with.
Theissue of whether human beings have the right to help others die has been in publicdiscourse since before the birth of Christ. The Hippocratic Oath, whichscholars estimate was written in the fourth century B.C., includes theunambiguous statement: I will not give alethal drug to anyone if I am asked, nor will I advise such a plan (Pickert,2009). The idea of assisted suicide was something relatively uncharted inAmerican history. Whether it was due to a lack of technology or lack of demandfor the service, the right to die was not a common practice in medical andpublic arenas. As medicinal technologies advanced over time and a tolerance forsuch progressive ideas grew, so too did the opinions on the issue (Pickert,2015). Practices such as abortion that were once punishable by death or jailtime, are now more common today and in many ways accepted altogether.
As peoplebegin to loosen ties to what they considered as right and wrong, new ideas likethis become possible for those who need it. It is important to point out thatbanning a practice in our society requires greater effort and argument thanallowing one. This is a result of the value we place on the rights andliberties of the individual, because individual liberty is so important, acompelling reason must be given to override it. Because the result of adecision on PAS is so intensely personal, this state of ‘innocent until provenguilty’ must be emphasized.
The individual has a basic right to determine thecourse of their own life, and obviously death is a part of that course. Sothen, in order to show that PAS should be legalized, one must simply show thatthere is no reason for them to be deemed illegal. One of the arguments which is oftenused in favor of banning PAS is that the state has a paternalistic interest tokeep its citizens alive. This is based out of the idea that all killing ofhumans is immoral and unfair to the person who dies, and thus PAS is immoral(Arras, p. 275). The disparity here is a result of differences in definingpaternalism. The traditional view of western society has been that paternalismmust always act to keep an individual alive, no matter what.
But in fact, Ibelieve that paternalism must also consider the quality of the life which it isforcing on the individual. The United States government believesall citizens should have rights to life, liberty, and the pursuit of happiness.If these are indeed the rights which the state deems valuable for its citizens,then a paternalistic cause must act in support of a majority of these rights.Obviously, allowing PAS eliminates a patient’s right to life by killing them.However, the banning of PAS and euthanasia may lead to the elimination of apatient’s right to the pursuit of happiness.
Happiness is not simply the stateof being happy, it also is the state of not being unhappy. In the case of manyof those who would seek PAS, ‘the pursuit of happiness’ involves removing thephysical or mental pain that causes them to be unhappy on a daily basis. It isvery difficult to pursue anything, much less happiness or even easing ofunhappiness, when you are lying intubated in a hospital bed against your will.With the rights of life and the pursuit of happiness contradicting each other,all that is left is liberty, and liberty demands that the patient be given achoice. This view of paternalism only supports allowing PAS if apatient’s ability to pursue happiness is removed by their illness altogether.As such, although it argues in favor of allowing PAS, it also inherently limitsthe cases where they are legal. Paternalism insists that life be chosen unlessthere is no cause to believe that happiness is possible, and so limits PAS toterminal and incurable illnesses and injuries.
Even in those cases, becauseliberty is the deciding factor in the choice between life and happiness, thepatient must clearly indicate that they wish to die. In an ideal ethical environment, each decision could bemade by the physician and the patient (or patient’s family) on a case by casebasis. The medical, psychological, and social complexities of any situation inwhich PAS is seriously considered would demand this.
Legislation can provideonly an approximation of where to draw the line between a patient eligible forPAS and one who is not. The legislation would have to be open enough so as toallow patients the freedom to act if necessary, but regulated enough tominimize abuse. As such, it may take several rounds of legislation, review, andrefinement before the optimum level of constraint is found, although existingcases where the practice is allowed in the Netherlands or Oregon would seem toindicate that a good approximation could be made from the start. Thefuture of PAS seems to be increasingly progressive.
As more and more populationsadopt PAS laws and practices, it is becoming much more of a commonplace in thepublic and private sectors. When we look at what the right-to-die movement hasachieved, against what it has wished to do, an honest person would agree thatthere is still a long, long way to go. But theeuthanasia movement is strong and its organizations are well financed. Thus theonly sure thing about the future of assisted suicide is that there will bepolitical trench warfare over the issue for years to come. Happily, we do notlive in a country where our most contentious social issues are decided in theivory tower by courts or regulators imposing the views of “experts” on the restof society.
For better or for worse, the future of assisted suicide andeuthanasia will likely be decided via democratic debate in the public square.Likeany social movement, it takes time to be accepted. Despite growing medicalknowledge and lessened emphasis on religious ideals, a majority of people allover the world would still strongly oppose acts of purposeful death in anyform.
Assisted suicide is still seen as a new development that is breakingboundaries in both positive and negative ways. An example of this is the notionof suicide itself. Killing oneself purposefully is viewed as wrong for manyreasons. It is in human nature and in all life forms a desire to live and keepliving.
When someone breaks this boundary by devaluing life or not desiring it,it becomes hard for others to understand the action. Assisted suicidechallenges nature by saying to society that the individual has control overwhether they live or die. By involving another individual and assisting in thedeath, it becomes harder for the public to distinguish what is suicide fromwhat is homicide. For these reasons, the practice of human euthanasia is stilla grey area in modern society; something that came from banishment ornonexistence through history and has since grown into a viable option for thosewho find themselves painfully trapped within their own bodies.
Inthe end, physician assisted suicide and legislature such as the Death withDignity Act will continue to be pursued by all types of people worldwide. Deathcan be a vicious and excruciating experience for all of those involved. The influencesof the assisted suicide movement worldwide and in the United States has beentaken to new heights. This practice is establishing itself in the medical,political, and social worlds, proving that we can have control over our livesno matter what disease or illness can inflict upon us.