Physician-Assisted Death in America: Legal and Moral Struggles
Death with dignity is the belief that a terminally ill patient should be allowed to die naturally and comfortably, rather than a slow painful death. However, despite the rapid development of medicine, the symptoms of an incurable disease can remain intolerable. In a 2015 issue of the New York Times Magazine, there was an article entitled “The Last Day of Her Life”. The article chronicled the story of Sandy Bem, a woman who chose to take her own life before her disease became unbearable. In the article, Bem is quoted as saying “What I want is to die on my own timetable and in my own nonviolent way” (Henig). The article concludes by describing Bem’s peaceful death, surrounded by her family. This is just one of many stories about people who died with dignity, rather than suffering a slow painful death with their families helplessly watching.
Euthanasia is when a physician performs a death-causing act after determining that the patient wishes to end his or her life. Physician-assisted suicide is when a physician provides medication to a terminally ill patient so they can end their lives in their own time and on their own terms. Euthanasia is illegal in the United States; however, there are seven states, plus the District of Columbia, where physician-assisted suicide is now legal. There are many opposing views regarding physician-assisted suicide. In addition to the fact that the U S. Supreme Court has found it to be unconstitutional, there are moral and ethical issues that must be considered. Also, there is the “slippery slope” theory where if physician-assisted suicide is allowed, euthanasia will follow, the fact that physicians take an oath that they will do no harm to their patients, and the fact that end-of-life care is available through palliative care programs. Despite the opposition, physician-assisted suicide must be an option for everyone who is facing a life-ending illness to assure they do not suffer and to assure peace for their families.
On June 26, 1997, the U. S. Supreme Court ruled on two arguments regarding physician-assisted suicide. The unanimous decisions heard under the “due process” and “equal protection” clauses of the U. S. Constitution, stated that physician-assisted suicide is unconstitutional. Washington v. Glucksberg was a case where the Court held that a right to assisted suicide in the United States is not protected by the due process clause, and that “no fundamental right was at issue before the Court” (Bradford 138-39). Vacco v. Quill was a decision of the Court regarding the equal protection claim. It ruled that a New York ban on physician-assisted suicide was constitutional, even for those patients who are terminally ill and in great pain. The Court pointed out that a physician-assisted suicide death “results from a lethal dose of drugs, not the disease” (Bradford 138-39).
While the U S. Supreme Court decided that no right exists for physician-assisted suicide, it did say that the individual states could pass legislation which would rule on whether physician-assisted-suicide could be permitted or prohibited in their state (Bradford 147). There are currently seven states, plus Washington DC, that have legalized physician-assisted suicide. The most recent is Hawaii who in April 2018 passed the Our Care, Our Choice Act (Russell). Each state’s legislation has its own unique name; however, except for Montana, they are very similar as far as specific regulations. In Montana physician-assisted suicide is allowed only by court order (Russell). Patients see these laws as a way for them to have autonomy when it comes to ending their lives. Because they are most worried about pain and suffering, they now have peace of mind knowing that if their suffering is too great, they have the option to end it. Over the past several years society has become more inclusive regarding personal liberties. Abortion, sexual preference, and marital rights have become constitutionally protected. Physician-suicide should become constitutionally protected right as well.
Opponents of physician-assisted suicide argue that because God gives people life, God should be the only one who has the right to take it away. They further argue that terminally ill people are vulnerable and can be easily manipulated; therefore, their individual autonomy is compromised. These are just two moral positions against physician-assisted suicide; therefore, it can be argued that if we pass laws permitting assisted suicide we have created a sound moral controversy. Furthermore, opponents of physician-assisted suicide believe that society has a moral duty to protect and preserve life; therefore, assisting people to destroy their lives violates the fundamental respect for human life. A society committed to preserving and protecting life should not allow people to destroy it.
On the other hand, there are people of faith who think that God would support offering a way for people in pain to welcome death. Proponents of physician-assisted suicide also believe that everyone has a moral right to choose freely what they will do with their lives if they impose no harm on others. This right of free choice includes the right to end one’s life when one chooses. The argument for physician-assisted suicide should be contingent on the patient’s autonomy. Suffering means more than pain, it also means loss of independence, loss of self, and loss of functional capabilities. Competent people should have the right to choose the timing and manner of death, thus relieving them of never-ending pain and suffering. Just like the recognition for same-sex marriage, which was once condemned, society must recognize that everyone has the God-given, moral right to choose what they want to do with their lives, even the right to end it.
Many people believe in the slippery slope theory when they voice their opinion against physician-assisted suicide. They believe that if it becomes acceptable behavior, then euthanasia and other morally wrong actions are not far behind. For instance, believers of the slippery slope theory feel that there will be instances when a terminally ill patient will be unable to take the life-ending medicine received from their doctor, therefore, family members would administer it. This is considered euthanasia, which is totally unacceptable, not to mention murder. Believers of the slippery slope theory feel that if the U. S. Supreme Court had considered physician-assisted suicide a homicide, it would not have given the states the right to legislate this issue.
It is speculative to assume that if we allow A to happen, then Z will happen, so A should not happen. Therefore, people who believe the slippery slope theory is just dealing in hypotheticals and trying to appeal to people’s emotions. In an article entitled “Slippery Slope Arguments Imply Opposition to Change” several case studies were done on the slippery slope theory, all of which indicated that slippery slope arguments implied opposition to change. Simply stated, the findings on both valid and invalid arguments revealed:
They strongly imply opposition to a possible action, and they raise the perceived probability of an undesirable outcome. Regardless of their reputation, SSAs are an effective rhetorical device that can be asserted with high conversational relevance in situations in which the speaker’s attitudes permit the opposition to the proposed action.” (Haigh et al. 831)
The slippery slope becomes slippery only when regulations are removed. The current death with dignity state laws in effect have enough legal restraint to prevent slippery slopes from becoming slippery.
Physicians take the Hippocratic Oath where they swear to uphold specific ethical standards, namely “I will neither give a deadly drug to anybody who asked for it, nor will I suggest to this effect” (Tyson). The main idea of the Hippocratic Oath is that during a doctor’s career they will never harm a patient intentionally, they will respect the privacy of their patient, and they will always act in an ethical manner. This Oath is one of the oldest documents in history and is still held sacred by physicians. Therefore, physician-assisted suicide should not be an option when discussing dying with dignity.
Although the Hippocratic Oath is still used today, through the years many physicians have believed that the oath should be revised to reflect scientific, economic, political and social changes. There have been many revisions, the most recent being the Modern Physician Oath, written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University. The sixth paragraph is notable as it pertains to physician-assisted suicide:
Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. (Tyson)
Nowhere in the Modern Physician Oath does it state “do no harm” or “never give a lethal medicine, therefore physician-assisted suicide must be considered for those people who wish to die without pain and suffering
The last stages of a serious illness are difficult for the patient, as well as their family. There are many alternative-care options that can assist with in-home care, respite care being one of them. Respite care is a temporary care service which gives a much-needed break to caregivers. If the patient is in a respite facility it gives them an opportunity to interact with new people and surroundings while still receiving the care needed. Hospice care is an in-home service provided to patients who are terminally ill. Skilled caregivers are available 24/7, depending on the patient’s needs. If the patient does not need 24-hour care, the family is given support regarding medical care and equipment. Palliative care improves quality of life for both the patient and the family.
While deciding on palliative care options; however, it is important to be aware of the drawbacks. Respite care has additional costs that need to be considered. Also, if patients are not being cared for by their usual caregiver, they can become agitated and depressed. Hospice care also has its problems. Originally designed for diseases that killed quickly, many people in hospice care now have slow-progressing disorders and as a result, it is uncertain when they will die. This uncertainty can put a strain on the family who must be available 24 hours a day for an unknown length of time. Take into consideration the story of Dr. Robert E. Martin. Dr. Martin was enrolled in hospice care when his prostate cancer spread to his brain. On a long holiday weekend, as he lay moaning in pain, his wife, Patricia, was unable to reach the doctor in charge of his care. It took three calls and several days before she could get the liquid pain medicine her husband needed. After her husband’s death, Patricia shared the feelings of her journey with hospice care. “I thought if I had hospice, I would get the support I needed. They basically said they would provide 24/7 support” she says, still shaking her head in disbelief, three years later. “It was a nightmare” (Aleccia 50). Even if Patricia could have reached the doctor and suggest that her husband is transferred to a hospice care facility to assist in pain-control, the Medicare fee structure does not allow these patients to go to a hospice house. Until the American health care system catches up with the expanding needs of the hospice patient and their exhausted families, hospice care may not be a viable option for everyone (Kenen).
Twenty-nine-year-old Brittany Maynard was a young woman who was diagnosed with a terminal brain tumor and was given months to live. As the treatment offered to her could have possibly caused blindness, and other significant impairments, she and her family started searching desperately for other treatment options. In her search, Brittany came across an article on Oregon’s death-with-dignity law. Suffering daily excruciating pain, the idea of physician-assisted suicide made sense to her. Maynard, her husband, and the family moved to Oregon to take advantage of their laws. She chose November 1st as the day she would possibly put an end to her suffering (Egan 66-67). “I don’t want to die, but I am dying.” says Maynard. She goes on to say:
My cancer is going to kill me, and it’s a terrible, terrible way to die. So, to be able to die with my family with me, to have control of my own mind, which I would stand to lose – to go with dignity is less terrifying. When I look into both options I have to die, I feel this is far more humane. (Egan)
On November 1, 2014, as planned, Brittany Maynard took her own life. It was a peaceful death surrounded by the people she loved.
Death is a mystery that we will all confront sooner or later. The dying process is the most intimate, private and fundamental part of our life. If we want peaceful deaths, surrounded by family, then we need to ask ourselves if we are willing to challenge the status quo for that right. Physician-assisted suicide does not mean that a suffering person will kill themselves, it merely means that when a person has reached the end of their life, they have the option to make the decision that is right for them. Do terminally ill people look forward to the years when they are fed, bathed, and toileted by strangers? Physician-assisted suicide is the answer for those people who do not want to live that way.