Death with Dignity: An Argument in Favor of Physician Assisted Suicide Allow me to present you with a hypothetical situation: A patient walks into his oncologist's office at Tacoma General Hospital. His body has been ravaged by cancer and the aggressive treatments used to combat it. The patient has done everything that the doctor has suggested; chemotherapy, radiation therapy, and investigational drug therapy, and all have failed. Both doctor and patient agree that there is nothing else that can be done. The patient is forced to take medication to combat the pain the cancer causes and cannot do the things they were once able to due to the effects of these drugs. In effect, this patient is waiting to die.
At the appointment this patient asks the doctor, "How long do I have left?" The doctor responds, "Months... maybe six months at most". The patient replies, "Doctor, I've had it. I can't take the pain anymore. The pain medication you " re giving me isn't working. My quality of life is zero. I am in constant pain.
Can you help me end my life?" What should the doctor do? What can the doctor do? In the State of Washington the answer is - not much. The doctor might refer the patient to a hospice for end of life care and wash his hand of the problem.
The doctor may suggest that once at the hospice the patient could decide to refuse food and liquids, and that he (the doctor) could sedate him to the point of unconsciousness (a process called terminal sedation and dehydration) and inform the patient that it might take as long as two weeks to die using this method, which is considered to be legal in all 50 states. The doctor, if compassionate, may prescribe a lethal overdose of some type of sleeping pill or barbiturate to the patient. This last scenario takes place everyday in this country and is illegal in every state but Oregon. Physicians who chose this path put themselves in legal peril. In an article in the Washington Post, Marcia Angell, a physician and executive editor of the New England Journal of Medicine, wrote, "Compassionate doctors have always helped their patients to end their lives. They do so not only by turning off life supports but by giving large doses of morphine or by prescribing more sleeping pills than necessary.
The problem is the practice is secret and unpredictable". (A 19) I believe that patients should have all of these options available to them safely and legally. If this patient happened to be a resident of Oregon and his physician practiced medicine in Oregon, the physician would be able to assist his patient in carrying out his final wishes legally and safely. I believe that the State of Washington should implement a Death with Dignity law as soon as possible based on the model currently used in the State of Oregon.
Opponents of physician assisted suicide argue that Death with Dignity Laws are a slippery slope that will lead to the eventual killing of the retarded and disabled, and that people will use it when they have many years to live. These allegations have been proven false. The Oregon law went into effect in 1997. From that date to the end of 2001 - 91 patients have opted to end their lives using this method. (OR Department of Human Services 16) There are strict requirements that must be met in order prevent abuse. To request a prescription for lethal medication, the Death with Dignity Act requires that a patient must be an adult (18 years of age or older).
Additionally, the patient must be a resident of Oregon capable of making an informed health care decision and has to have been diagnosed with a terminal illness that will lead to death within six months. Having met these criteria the patient then must make two oral requests to their physician for lethal medication, separated by at least 15 days. The patient then must provide a written request for lethal medication to their physician, signed in the presence of two witnesses who are not members of their family or care givers. The physician and a consulting physician then must confirm the patient's diagnosis and prognosis and determine if the patient is indeed capable of making such a decision. If either physician believes that the patient's judgment is impaired by a psychiatric or psychological disorder, the patient must be referred for a psychological examination.
The prescribing physician then must inform the patient of other existing health care alternatives including comfort care, hospice care and pain control. The physician must also request, but not require, that the patient notify their next of kin regarding the prescription request. Once the prescription for lethal medication has been issued the physician must report it to the Oregon Department of Human Services, which monitors this practice in Oregon. (OR Department of Human Services 5-7) The adversaries of physician assisted suicide argue that if you allow physician assisted suicide, euthanasia of the disabled and retarded will be the inevitable result. No one in Oregon is advocating the extermination of the retarded or disabled. I find such arguments specious and undeserving of a response.
However, with reasonable safeguards in place, such as those in Oregon, this would be illegal and unthinkable. In fact, since the Oregon law was enacted there has only been one change. This change had to do with informing pharmacists when a prescription for lethal drugs has been written. I don't believe that the majority of Washington residents would ever agree to the inclusion of the physically disabled or retarded in a Death with Dignity Law in this state.
The argument that the Death with Dignity Act would cause a rush on physician's offices is also inaccurate. In his article, "The Positive Virtues of Physician Assisted Suicide", which appeared in The Humanist, author Peter Rogatz states that "Despite dire warnings, there was no precipitous rush by Oregonians to embrace assisted suicide". (34) I find it difficult to believe that implementing such a law in Washington would cause the infirm to rush to their physicians for their lethal dose. In fact, Rogatz comments on a study conducted by the University of Washington School of Medicine which queried over 800 Washington physicians about patient requests for assisted suicide. This report states that "Of the respondents, 12 percent reported receiving one or more explicit requests for assisted suicide, and one-fourth of the patients requesting such assistance received prescriptions". (34).
These numbers hardly constitute a rush on physician's offices. I find it difficult to believe that legalizing assisted suicide in Washington using the Oregon guidelines would increase these numbers radically and, as the U of W study shows, physician assisted suicide is already going on here secretly. Opponents of Death with Dignity laws also argue that proper pain management can alleviate a patient's desire for a hastened death and that if a person makes the choice to die terminal sedation and dehydration is a perfect legal alternative to physician assisted suicide. While the idea that proper pain management can alleviate a patient's desire for a hastened death has it merits, it is not currently the practice in this country; in fact, the majority of physicians in this country have not been properly trained to manage their patient's pain.
It is also widely known that there are still a small percentage of patients whose pain cannot be relieved even in the best hospices with the most excellent palliative care. Recent steps taken by Attorney General John Ashcroft a in an attempt to counter Oregon's Death with Dignity Act also threaten physicians. Palliative care physicians now fear that they will be prosecuted if they over-prescribe pain medication to their patients. Bob Egelko wrote in the San Francisco Chronicle that "In California, where assisted suicide is against the law, there is a concern that physicians treating pain in dying patients may be prosecuted for assisting in a suicide. Drug agents, acting under Ashcroft's edict might later look at what the physician did and determine that the primary concern was assisting in a suicide". (A-3) The argument for terminal sedation and dehydration which requires the patient to forgo food and liquids while their physician medicates them to the point of unconsciousness until death, also suffers greatly when held up to the light.
While this practice is still considered legal, it is seldom utilized. This may be due to the fact that this practice, while tentatively approved by the Supreme Court, has never been tested in court. In an article in The Journal of the American Medical Association titled "Seven Legal Barriers to End-of-Life Care: Myths, Realities, and Grains of Truth" the authors assert that "there is some debate about whether such practice represents 'slow euthanasia' or is simply a combination of standard palliative practices. In legal application, the biggest stumbling block is the physician's intention: whether it is the relief of suffering (legal) or the active hastening of death (illegal)".
(Meisel, Snyder, Quill 2501). Recent actions by John Ashcroft make physicians very wary of assisting patients opting for this method. If opponents to a Death with Dignity Act really believe that terminal sedation and dehydration is anything but "slow euthanasia", when a patient who opts for this method clearly wishes to perish, they are deluding themselves. This procedure, which can take as long as two weeks, is cruel and unusual. Even in the worst cases reported in Oregon, patients that have opted for physician assisted suicide lasted no longer than 37 hours after self administering their lethal dose of medication with an average time between ingestion and death of 30 minutes. (OR Department of Human Services 17) The final argument in opposition to a Death with Dignity Act that will be investigated in this paper is the idea that this act allows people to "play God".
They believe that dying is a process and that the Oregon law circumvents it. They believe that only "God" can determine when people die. They further believe that the potential for closure and healing that might occur between the patient and their family and friends could be affected by this process. I choose not to assault another person's religious beliefs. This being said, I would like to add that I prefer not have another's religious beliefs effect how I live my life, and many other people feel the same way. I would argue that people who have religious objections to physician assisted suicide don't have to practice it.
Physician Assisted suicide is not a mandatory practice, it's entirely voluntary. Physicians who have philosophical, moral, or religious objections to this practice can pass the care of patients seeking such a remedy on to a colleague who does not harbor such feelings. This is the practice under current Oregon law. If such a law were to be enacted in Washington I would argue strongly for this particular component.
Ultimately, I believe that physician assisted suicide is all about self determination. I have never believed that some "God" in heaven had some divine master plan for me. I have been personally responsible for the majority of the decisions that have affected me in my adult life both good and bad. I don't believe that the state or anyone else has the right to tell me how, when and where I can live my life, and I don't believe they have the right to tell me how, where or when I can die. In conclusion, I believe that a Death with Dignity Act based on the Oregon model should be enacted by the Washington State legislature as soon as possible. We have a working model and five years of data from the State of Oregon which shows that a plan can be enacted with strict safeguards to prevent abuse.
The Oregon experience has shown that patients do not flock to their physician's offices seeking suicide as a final release from depression, physical disabilities and other disorders. In fact, the data shows that a very small percentage of the sick and dying in Oregon opt for this method when their life is coming to an end. What it really does is offer the people of Oregon another plausible legal alternative - self determination in death. It would be preposterous to believe that everyone in Washington would want to end their lives this way. However, I believe that individuals who wish to end their lives by their own hand via physician assisted suicide should have this option available to them. I have no idea how I am going to die.
However, if I was told by my doctor that I had six pain filled months to live, in which I would have no quality of life, and I was going to be medicated and entirely reliant upon some stranger in a hospice, I would like to have this particular option available to me.
Angell, Marcia. "No One Trust the Dying". Washington Post 7 Jul. 1997, national ed.
A 19. Di Loreto, Stacy. "The Complexities of Assisted Suicide". Patient Care 30 Nov. 2000: 65-86.
Egelko, Bob. "Needless Pain Feared by Doctors: Rebuttal to Ashcroft on Assisted Suicide". San Francisco Chronicle 14 Nov. 2002: Morning ed.
A-3. Meisel, Alan. Lois Snyder, Timothy Quill. "Seven Legal Barriers to End-of-Life Care: Myths, Realities, and Grains of Truth". The Journal of the American Medical Association 15 Nov. 2000: 2495-2501.
Oregon Department of Human Services. Fourth Annual Report on Oregon's Death with Dignity Act. Salem, Oregon Department of Administrative Services Office of Publication and Distribution. Rogatz, Peter. "The Positive Virtues of Physician Assisted Suicide". The Humanist Nov. /Dec. 2001: 31-34.