The Ethics and Implications of Assisted Suicide

Eligibility Criteria and Procedural Steps

When someone hears “assisted suicide,” you rethink what you heard and make sure what you heard is correct. Your brain must process not just the suicide part but the assisted part as well. You try and understand, but your brain cannot process why anyone would want to do that. Or why would they choose to end their life? Who would be willing to help them? What kind of human being is that person? We are quick to put our animals down because we don’t want them to suffer. So, then why can’t we give the same courtesy to human beings? If someone is in pain and we’ve exhausted all options, then we should at least be able to provide a way out. Those in the medical field are supposed to end pain and suffering, not prolong it. Yes, physicians have taken an oath to protect life; but how can they protect it when the patient is already dead?

What makes people cringe when they hear assisted suicide? Would it be suicide? Or the assisted? It would mainly be the assisted part. Nobody can believe that a human being would be willing to help another human being kill themselves. People that can agree with assisted suicide are the ones who are more understanding and willing to listen to the reasoning behind someone willing to die before their illness kills them. It’s their decision, and we need to respect it. We, as people, need to stop putting our two cents in everyone else’s business. Don’t give out your opinion until it’s asked for or unless it’s affecting you personally.

For someone to be eligible for assisted suicide, they would need to have a terminal illness and have exhausted all of their options. If your dignity and pride are to be stripped away from your personality, then they should at least have the option for assisted suicide. Terminal illnesses such as cancers, leukemia (cancer), aids, heart disease (severe coronary artery disease), and Parkinson’s disease are eligible for assisted suicide.

The rest is just a long list of requirements, like being a resident of the state granting the patient to proceed with assisted suicide. The person must be an adult; to even submit a request for assisted suicide, the patient must be 18 or older. Must have a terminal illness and be diagnosed with a six or less-month prognosis by not just one physician but two. Must be mentally competent and aware of what is going on. The patient must say out loud to their physician that “they want to die.” It must be verbally said if it is written in a will or any other document, it will be denied. The patient must say “they want to die” twice, 15 days apart, not a day before and not a day later; if they fail to do this, then they will have to start the process all over again.

Assessment, Distinction, and Outcomes

Furthermore, the patient will need to submit a written request; they will need to have two witnesses with them who believe the patient is indeed sick and not capable of living the rest of their short life in pain. They need to also believe the patient is voluntarily “wanting to die”; one of the witnesses cannot be a relative by blood, marriage, or adoption. They can’t be the patient’s physician or medical assistant, nor can they be included in the patient’s will. The patient must be able to administer his/her own medication. The patient may cancel the process at any given time; they have the right to stop the assisted suicide process whenever they want. If they choose not to go through with it, that is their decision.

Next, the physician must refer the patient to a psychiatrist, so the psychiatrist can do an evaluation to make sure the patient’s mental competency is intact. The mentally competent patient then can have the medication prescribed to them. The physician is then able to fill the prescription by either hand delivering it to the pharmacy or mailing it in. The patient is not allowed to pick it up until 48 hours after the prescription has been delivered and/or received. If there is any doubt, the physician has the right to stop the request.

The physician must report every step and process to the medical board. “Anyone who falsifies a request destroys a rescission of a request, or who coerces or exerts undue influence on a patient to request medication under the law or to destroy a rescission of such a request commits a class A felony. The law also does not limit liability for negligence or intentional misconduct, and criminal penalties also apply for conduct that is inconsistent with it” (Physician-Hastened Death).

People who make the decision to go through with assisted suicide are not suicidal. They do not want to die, but they choose to. The patients that choose to go through with assisted suicide are not necessarily suicidal, they want to live, but they don’t want to live with their disease. Physicians have encountered patients who are “terminally ill who request assistance in the voluntary self-extermination of life. Patients experience chronic, intolerable pain and suffering” (Biskup 34). If the patient doesn’t want to live with their disease, then they shouldn’t have to. Assisted suicide should be offered and convenient to every patient in every state with a terminally ill disease. No one should have to live with that kind of pain or suffering. No one should have the right to tell someone how to live otherwise.

Many people believe that suicide and assisted suicide are the same things. However, they are completely different. Suicide is usually used when a person feels they have no way out and they choose to die. It’s a choice for them; it may not have anything to do with a terminal illness but perhaps depression. As with assisted suicide, the patient knows they’re not alone, and the physician knows they’re not alone. They need to pass a psychiatric evaluation and make sure they are not depressed and are more than competent to make this decision without any depressing thoughts weighing them down. However, both have one common outcome “death” with the terminally ill and depressed. So, the process in both is different, just not the outcome.

Ethical Considerations and Patient Choices

So, is being assisted with suicide better than going through it by yourself? Meaning telling someone, then just attempting suicide on your own. The answer is “No.” If you’re a patient and you have a terminally ill disease, by all means, let your physician and loved ones know what’s going through your mind. It’s better to let your loved ones or someone know instead of just going off somewhere and committing suicide. It’s better to let your loved ones know your plans so they have a chance to say goodbye. So please do see a physician if you’re thinking of using this route. Suicide doesn’t take away the pain. It just passes it to someone else. So, don’t leave anyone wondering.

Do go to a physician and talk with them, do not let anyone other than a physician help you with assisted death. New York law states, “A man is guilty of manslaughter in the second degree when they intentionally aid another person to commit suicide” (Biskup 34). In New York, they consider this as a class C felony. Should assisted suicide be offered to suicidal patients as a solution rather than having them commit suicide on their own? The answer is “no.” No, this should not be used as a way out.

Assisted suicide should just be for the use of the terminally ill. There is always help for people who are actually suicidal. People who seek assisted suicide are already dead; they’re dying and in pain. It should only be offered to the terminally ill. There are hotlines, psychiatrists, and loved ones who would be more than willing to help you out with your problem and get you the help you need. Nobody should ever be afraid or ashamed to ask for help.

Opinionated people seem to think that assisted suicide should be considered under the same category as murder. Is assisted suicide really murder, though? Absolutely not; nowhere are physicians physically putting pills down their patient’s throats or holding a gun up to their heads and pulling the trigger. As stated above, the patient has complete control over the situation; if he/she decides not to go through with the assistance, that is completely up to them. Their fate is completely in their hands if they choose to die quickly and without pain or to die slowly and suffer.

Physicians are not at fault and should not be blamed, they’re doing their best to help their patients in the best way possible, and they don’t need negative feedback from angry people who think it’s okay to put their two cents in wherever they feel they need to. Physicians are the ones with THEIR patients’ best interests. They know what they’re doing, and obviously, they don’t want to do it; who would want to do that? But then again, who wants to watch someone suffer for the rest of their short, painful life? Jack Lessenberry states, “This is not about ‘the right way to die.’ This is about personal anatomy, about denying that the state has the right to compel innocent, competent adults to suffer needlessly. It’s the right to be free of state interference in the most intimate and personal decision of all” (38).

If a patient is terminally ill, the patient’s physician should already know. If the patient is seeking assisted suicide, they should be honest and explain to their physician that they would like to inquire about more information and then choose to either proceed with assisted suicide or proceed with the time they have left to live. What kind of doctors can patients go to seek help on assisted suicide? They can turn to any doctor and ask for help, from a hospice doctor to even a neurologist. They can make an appointment with their care provider and tell them this is what they’re interested in and they would like to proceed. The patient would then have to go through all the requirements to proceed with assisted suicide.

Legal and Geographic Perspectives on Assisted Suicide

Current laws state that no physician should ever offer or agree to a medical procedure unless they are certain that it is in the best interest of the patient. They would need to be convinced that the situation was intolerable and that nothing else could be done for the patient. That the patients’ best interest is an easier death (Biskup 91). After the patient meets all the requirements, they will then either get a prescription or euthanasia.

The difference between the two is one is in a pill form, either Pentobarbital or Secobarbital. Euthanasia is a lethal injection a physician will physically administer to the patient. Biskup says in his book, “Hypocrisy of the double effect physicians have, by definition, killed patients to relieve suffering. The difference between euthanasia and withdrawal life support treatment is the double effect. They accept as not ‘killing’ but normative acceptance of the latter two medical practices”.

Not all doctors will be willing to help a patient or agree with the patient’s decision; they then will refer them to another doctor that would be willing to help the patient. Patients will have to understand and respect the physician’s decisions. Some physicians don’t want that responsibility or that on their subconscious. “Physicians do not fulfill the role of a ‘killer’ by prescribing drugs to hasten death any more than they do by disconnecting life-support systems” (Biskup). Every physician should read this so that they are reassured they are not killers, nor are they doing wrong. They are helping someone in need and ending their patient’s pain and suffering than letting them live with a terminal illness for such a short time they must live.

There are currently six states that allow assisted suicide; Hawaii will be alongside those 6, making it seven states in 2019. The states that currently allow them are and in order: Oregon 1997, Washington 2009, Vermont 2013, California 2016, Colorado 2016, and Hawaii will go into effect in 2019. Oregon became the first state to legalize “assisted death” in 1997 (States that allow Death with Dignity). In 2014 one patient case was a 29-year-old woman named Brittany Maynard made it public that she would be moving to Oregon to seek assisted suicide due to her being terminally ill and did not want to spend the rest of her life in pain. She was a California resident, and California at the time denied her request for assisted suicide (My Right to Die with Dignity at 29). Soon making California the fourth state to allow assisted suicide.

Switzerland became one of the first countries to look into assisted death and offer it to their patients. Switzerland believes in patients’ rights; therefore, assisted suicide is legal there. “There are no direct legal laws about physician assistance, and most assisted suicides are provided by ‘The Right to Die Associations’” (Hurst, Mauron). A few other countries allow euthanasia and assisted suicide: Belgium, Netherlands, Canada, and Luxembourg. There are currently six states out of the fifty states in the United States that allow physician-assisted suicide. “Assisted death in Canada requires two different doctors to evaluate the patient and confirm that they have a serious and incurable disease” (Proudfoot). Canada made it legal in 2015 after the Medical Assistance in Dying movement showed initiative in getting it legal.

The Role of Religion in End-of-Life Decisions

Should Religion affect the patient’s decision? There are multiple religions that disagree with suicide, no matter what the cause is. Most religions believe if you commit suicide, then you’re doomed to eternity in hell, so they would not agree with this way of dying. Although there might be a few understanding church leaders that do understand and will comfort the patients, there are others out there that might even exile them from their church altogether. Christianity and Catholicism are the two most common religions in the United States. Both believe that you will be condemned to hell if anyone should commit suicide. Those are the patients’ personal problems, and they should be resolved before they die.

There are a few scriptures in the Bible that don’t agree with dying but don’t necessarily say, “Whoever kills themselves will go directly to hell.” The first one is Deuteronomy 32:39 “Now see that I, even I, am He, and there is no God besides me; I kill, and I make alive; I wound, and I heal; Nor is there any who can deliver from my hand.” In this scripture, God is saying that he is the only one who can take away life and that he can heal you; there should be no one else who does that besides him.

The next one is 1 Samuel 2:6 “The Lord kills and makes alive; He brings down to the grave and brings up.” Here it says that he is the only one who can kill and bring him back to life. The third one is from 1 Corinthians 6:19-20 “Or do you not know that your body is a temple of the Holy Spirit within you, whom you have God? You are not your own, for you were bought with a price. So, glorify God in your body”. So out of these scriptures, you understand that God is a jealous God, and there should be no other than heals and brings to life. No other being should kill because only he can take it; everyone’s body is a temple, and it should be treated as such.

God is supposed to be a forgiving God, so if someone were to take their own life, he should be able to forgive them. As it states in 1 John 1:9, “If we confess our sins, he is faithful and just to forgive us our sins and to cleanse us from all unrighteousness.” Along with Hebrews 8:12, “For I will be merciful toward their iniquities, and I will remember their sins no more.” Religion should not be a factor in the patients’ decisions because if they really do believe in the word of God or whoever they believe in, they, too, should believe in forgiveness and that they will be forgiven for their sins. That alone is not a decision for any human being other than the patient and their Religion, so again, it’s more of a personal problem that should be managed before they die.

Physicians are not playing God; they just see someone in need and help them out in whatever way they can. Like it says in Hebrews 13:16, “Do not neglect to do good and to share what you have, for such sacrifices are pleasing to God.” Same with Philippians 2:4 “Let each of you look not only to his own interests but also to the interests of others.” They’re doing what the Bible says to help others in need; the patients are already dying. Are they supposed to watch them suffer until they die? Is that what God wants? “What can be said about human suffering? This much, at least: No one wants to suffer. No one wants a death marked by suffering. Only tyrants and those who are pathologically cruel want others to suffer. Medicine is dedicated to the relief of suffering, and we proclaim ourselves to be a society that will not knowingly countenance the relievable misery of any group” (Weir, 69).

Pain, Costs, Ethics, and Autonomy

Patients are not afraid of just the disease but also the pain, family members and loved ones, and money. Money is a big issue, medication is expensive, and health care is also expensive. Robert F. Weir states that “Suffering not only brings pain, physical and mental (just as pain can bring suffering), it can in its extreme forms seem to rob people altogether of their humanity” ( 69). If the patient is terminally ill and they will not be able to take care of themselves, they’ll need home health care or to be put in a nursing home to help them until they die. They don’t want to put themselves in debt or their loved ones in debt. “Patients are worried about becoming dependent and fear both symptoms of the disease and side effects if treatment” (Biskup 140). Before anyone makes a decision to receive assisted suicide, patients should talk to a psychiatrist to mentally prepare them for their outcome. Talk to their physicians to see if they have exhausted all solutions.

“Physicians take oaths to preserve life; patients and doctors themselves expect it” (Biskup 116). They take an oath to make sure they can do whatever they can to save someone’s life, not end it. They can’t just sit back and watch the patient be in pain and suffer; in the end, they will do what is best for their patient. Unfortunately, Biskup states that there are laws in thirty-six states prohibiting assisted suicide (102). We as people need to understand that we cannot control other people’s lives. Who are we to tell them how to live, or especially how to die? No one ever thinks about another human being helping another human being commit suicide.

They overthink it and disagree with the thought of it without the research or understanding of why someone would want that for another person. Or the person committing suicide they don’t stop to think why someone would want that. People don’t stop to think that it’s a personal choice; it’s their personal choice. Robert Weir states, “We do not choose to be born. Nor do we have a choice about whether we will die. Many of us will have no choice about when, where, or how we will die. We may die suddenly from an injury or unexpectedly from an illness” (224) again if we are so quick to put our animals down because we don’t want them to suffer. Why can we not do the same for our people? Instead, we put the blame on physicians that are not at fault, just doing their job.

References:

1. Biskup, E. (2017). A Life Worth Living: Euthanasia and Assisted Suicide. Georgetown University Press.
2. Physician-Hastened Death. (n.d.). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004116/
3. Lessenberry, J. (2014). “Assisted suicide is about personal autonomy, not ‘right way to die’.” Detroit Free Press.
4. States that allow Death with Dignity. (n.d.). Retrieved from https://www.deathwithdignity.org/learn/access/
5. My Right to Die with Dignity at 29. (2014). Retrieved from https://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/index.html
6. Hurst, S. A., & Mauron, A. (2003). Assisted suicide and euthanasia in Switzerland: allowing a role for non-physicians. BMJ, 326(7383), 271-273.
7. Proudfoot, S. (2015). Assisted dying: Law and practice in Canada. Canadian Family Physician, 61(10), 821-825.
8. Weir, R. F. (1998). Between Two Worlds: The Art of Preaching in the Twentieth Century. Cambridge University Press.
9. Physician Assisted Suicide: Information Sheet. (n.d.). Retrieved from https://www.deathwithdignity.org/wp-content/uploads/2015/08/2015-Information-Page-with-maps.pdf