Physician-assisted suicide (PAS) is the intentional termination of a human’s life, at the explicit request of the one who dies, with the aid of a physician. The so-called “Doctor Death,” Dr. Jack Kevorkian, brought attention to PAS when he assisted several terminally ill patients end their lives. Kevorkian was imprisoned for his activities.
Related to PAS is euthanasia, from the Greek term for “good death.” Euthanasia is generally defined as including active euthanasia and passive euthanasia. Passive euthanasia is the hastening of death by withdrawing or altering a form of support. This includes removing life support, stopping medical procedures or medications, cutting off food and water, and not giving cardiopulmonary resuscitation (CPR) to a person whose heart has stopped. Active euthanasia is the causing of death of a person by way of a direct action, in response to a request from that person. Active euthanasia is usually accomplished by supplying the person wishing to die with the means to end life, often with the help of a medical doctor. The means may include barbiturates, carbon monoxide gas, or coma inducing levels of the drug morphine.
The U.S. Supreme Court ruled in two companion cases that the states have the right to decide individually on the legality of assisted suicide. The cases were Vacco v. Quill and Washington v. Glucksberg, both decided in 1997. Although the Court did not hold that there is a constitutional right to assisted suicide, it did hold that states can pass their own laws dealing with the subject. The Court wrote that patients did have a right to palliative (pain-reducing) care, even if that care resulted in the hastening of death of the patient.
In the United States, only Oregon has legalized physician-assisted suicide. Oregon’s Death with Dignity Act, passed in 1996, is a comprehensive piece of legislation outlining the steps patients and physicians must follow to end the life of a terminally ill patient.
From 1998 through 2003, 171 terminally ill patients were reported to have died after ingesting lethal doses of medications. Efforts to pass similar legislation in other states have failed. Thirty-eight states have laws that specifically ban assisted suicide by statute. Six states have no laws regarding assisted suicide; other states criminalize assisted suicide through the common law. Of the states that have no laws regarding assisted suicide, most do have laws prohibiting euthanasia.
According to statistics released by Oregon, men and women were equally likely to use PAS in Oregon. Terminally ill younger patients were much more likely to request and receive PAS than older citizens;18to 34-year-olds were 5 times more likely to use PAS than were those 85 or older. Oregon Asians were about 3 times as likely to die by PAS than whites in Oregon. Divorced and never married citizens were about 2 times more likely to use PAS than married and widowed citizens. The use of PAS has been strongly associated with a higher level of education; Oregonians with a bachelor’s degree or higher were more than 7 times more likely to use PAS than those who did not graduate from high school. People with amyotrophic lateral sclerosis (ALS), HIV/AIDS, and malignant neoplasms were most likely to use PAS.
The American Medical Association and the American Nurses Association both have official stances against assisted suicide. Both organizations state that allowing health care providers to assist in death violates the ethical traditions of physicians and nurses. No major religions in the United States condone the practice.
Internationally, only the Netherlands allows PAS. Although there is no legislation officially condoning PAS, the laws of the country are written to ensure that physicians who assist a terminally ill patient in dying will not be prosecuted.
References:
- Dworkin, G. (1998). Euthanasia and physician-assisted suicide. Cambridge, UK: Cambridge University
- Jamison, (1997). Assisted suicide: A decision-making guidefor health professionals. San Francisco: Jossey-Bass. Marker, R. L. (n.d.). Assisted suicide: The continuing debate.Retrieved from http://www.internationaltaskforce.org/cd.htm
- Moreno, (1995). Arguing euthanasia: The controversy over mercy killing, assisted suicide, and the “right to die.” New York: Touchstone.
- Urofsky, I. (2000). Lethal judgment: Assisted suicide and American law. Lawrence: University Press of Kansas.