Scientists and researchers are continuously discovering innovative ways of preserving and extending life, largely as a result of advances in modern medicine and biotechnology. Accordingly, the quality of human life has improved dramatically and many people are now living longer than ever before. Thus, one would tend to assert that there is consensus among the general population that prolonging life is a blessing.
However, there are many, particularly those with a terminal illness, who do not view a prolonged life as a benefit, but rather as an infringement, an intrusive postponement on their rightful journey to death. This distinctive, yet increasingly prevalent perception has brought about a critical debate among medical and religious ethicists, doctors, lawmakers, and the populace regarding an individual’s right to die.
While the right to die issue encompasses numerous moral dilemmas, such as euthanasia, refusal of treatment and advanced directives, much of the contention surrounding the issue involves the ethicality and legality of physician-assisted suicide (PAS). Although PAS and euthanasia have been profound issues confronting doctors since the birth of Western medicine more than 2000 years ago, during the last decade the PAS debate has evolved into one of the most controversial and compelling issues of our times (Emanuel, 1997).
The latest controversy has been generated, in large part, by the state of Oregon’s Death with Dignity Act, as well as similar legislation proposed in other states. Viewpoints both for and against the legalization of PAS are significant and deserving of consideration. But the arguments in favor, in the end, will reveal that PAS should be legalized in the United States with the adoption of the model provided by the state of Oregon. PAS for the terminally ill is ethical, humane, compassionate, and worthy of legalization. Furthermore, the arguments made against PAS are inadequate to impede upon broad legalization.
Before the arguments for and against PAS can be fully understood, however, it must be established as to what PAS is, and most importantly, what it is not. As the phrase indicates, there is no denying that PAS is suicide, and suicide itself is a legal act in the United States. PAS involves a doctor providing the means or information enabling a patient to end his or her life, most commonly by a lethal dose of pills (Robinson, 2002).
PAS is not euthanasia. Euthanasia, often referred to as mercy killing, is defined as “the act or practice of ending the life of an individual suffering from a terminal illness or an incurable condition, as by lethal injection” (American Heritage Dictionary). In a word, euthanasia is murder, regardless of the circumstances. The best way to illustrate euthanasia is to imagine an animal being “put to sleep.”
By meaning alone, it is apparent that euthanasia and PAS are clearly distinct acts, yet in much of the debate regarding PAS, the terms are often used interchangeably, which does a terrible injustice to the cause for legalization. While the intent of both PAS and euthanasia is ultimately death, it is important to consider the disparity in method by which the objective is accomplished: murder and suicide. Though suicide, or attempted suicide, is a non-criminal act throughout the nation, thirty-eight states have statutes explicitly prohibiting assisted suicide and seven states have laws making it a criminal offense to assist or to even supply the means, for a competent adult to engage in this non-criminal act.
And while four states do not have statute or law specifically prohibiting assisted suicide, the state of Oregon has taken the lead as the only state to enact a law, known as the Death with Dignity Act, making PAS a legal option for the terminally ill (Americans United for Life). Despite the outlaw of PAS by the greater part of states, by a 61% to 34% majority, adults across the U.S. are in favor of an individuals right to physician-assisted suicide for anyone with less than six months to live, and said that they would support a law such as Oregon’s in their own state (Taylor, 2002).
The first argument in favor of PAS has to do with personal autonomy. Every individual has the right to control their life and to decide how they live. In the same way, individuals also have the right to control their death. They have an inherent right to choose death over pain and indignity. The terminally ill and their families should not be forced to suffer through a long and painful death, even if the only way to alleviate the suffering is through suicide.
Advocates of PAS have been increasingly vocal during recent years, sparked by the highly publicized cases of Drs. Jack Kevorkian and Timothy Quill. These cases have centered on the plight of dying patients with terminal illnesses. But it is more than just the well-known cases that deserve a voice. Across the country, thousands of virtually unknown cases speak just as loudly. Sue Hess (2001), in a letter to the Vancouver Sun movingly writes:
“I have multiple myeloma…a rare bone marrow cancer…[that] destroys the blood, bones, immune system, kidneys and sometimes liver and spleen. The worst of it is the disintegration of the skeleton…Unless one is lucky enough to die of sepsis first, the death is long and agonizing. The act of sitting up can fracture the vertebrae and lifting the dinner tray can fracture both forearms. Who deserves that? For what principle?” (p. A16) Ms. Hess has the questions right, and for all she must endure on a daily basis, I for one believe that she has deservingly earned the right to end her suffering, if she so chooses. But for some non-believers, that may not be enough to help them see the morality in PAS, so I will persist and explore the legal facets of PAS.
PAS is a natural extension of personal autonomy, and one aspect of that autonomy is the right to determine what treatments are accepted or refused. Refusal of life-sustaining medical interventions such as respirators, ventilators, artificial nutrition and hydration, is legal, widely accepted and commonly practiced. So one is effectively permitted to commit suicide by refusing treatment. And it is not only the refusal of treatment that is accepted and practiced; it is the withdrawal of treatment.
One has to stretch the mind to perceive an ethical difference in unplugging a machine and prescribing a lethal dose of medication for the terminally ill patient. And though the U.S. Supreme Court has refuted this observation, it is clear that in both cases, the primary goal can be seen as the prevention of suffering at the end of life. Moreover, proposals for legalization frequently have more specific safeguards incorporated than do existing regulations on the withdrawal of treatment (Sobel ; Lavon, 1997).
Another argument is that simply knowing that one can control the timing and manner of death serves as a form of psychological “insurance” for the dying. Recognizing there can be an escape from the suffering of their illness may alleviate some of the stress associated with the dying process. This argument is clearly illustrated in a letter by Gayle Stelter (2001): “For almost seven years I have been living with cancer, mostly joyously and gratefully, but gradually seeing the disease encroaching relentlessly on my once healthy body. Throughout these years, I have thought long and hard about death and I’ve discovered that it’s not the prospect of death itself that is so frightening, but the process of dying.
So to give myself courage, I have held an option in reserve. When I can see no quality ahead, when I am capable of bidding my loved ones a coherent farewell, when I am still in control of my resources, I will enlist someone’s help to speed me on my journey… For those of us who may choose to leave while there is still an element of control, of coherence, may we be fortunate to have a friend, a loved one, a health professional who will use their gifts in order that we may be excused. To deny such expert guidance in this last rite would be both heartless and inhuman.” (Vancouver Sun, p. A16)