Deathwith Dignity: An Investigation of Physician Assisted SuicideNickLeonSociology450Universityof Delaware             Deathwith Dignity: An Investigation of Physician Assisted SuicideIn the past few decades Physician assistedsuicide (PAS) in the United States has become a controversial yet increasinglyapplicable concept. The debate falls between whether or not a dying individualhas the right to die with the assistance of a physician through calculated andpainless lethal injections. Factors including moral, religious, medical, andpolitical have all played a role in influencing society’s relationship withthis practice. It is difficult to distinguish between relieffrom suffering, with simply killing. One of the most substantial concerns withassisted suicide lies with the competence of the terminally ill.

More peopleare discussing and considering physician assisted suicide as a viable optionthan ever before (Bruinius, 2015). Essentially it is a series of calculatedinjections or pills administered by a medical professional to purposefullyinduce a painless death. In the U.S. it varies by state law, but as of todayonly four of fifty states have legalized the “Death with Dignity Act”(including Oregon, Vermont, Washington, and California with Montana allowingit only under a court ruling) (Bruinius, 2015).

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The patient also has to be amentally competent individual at least 18 years old and be diagnosed with aterminal illness that would otherwise result in death within the next 6 months.In all other states and scenarios, aiding in suicide is considered a felony,however public pressure is rendering certain states either undecided or inlegislation review. California is such as state, most recently adopting a”death with dignity act” that allows for any state residing and critically illindividual to partake in physician assisted suicide (Bruinius, 2015).PAS has also made a significant markinternationally. In April 2002, the Netherlands became the firstcountry to legalize assisted suicide.

Countries such as the Switzerland, Germany, and recently Canada havemade profound strides in supporting these practices as well. In2013, according to the latest data, 4,829 people across the Netherlands choseto have a doctor end their lives. That’s one in every 28 deaths and triple thenumber of people who died this way in 2002.

Here, people can choose euthanasiaif they can convince two physicians they endure “unbearable” suffering, adefinition that expands each year. Residents can choose euthanasia if they’retired of living with Lou Gehrig’s disease, multiple sclerosis, depression orloneliness. In contrast, within the few states that allow for it, the U.S. hasmuch stricter regulations as to what constitutes reason for PAS. Othercountries are now edging closer to the Dutch model. On February 6, the SupremeCourt of Canada struck down a ban on physician-assisted suicide, joiningLuxembourg, Belgium and Switzerland on the list of Western countries where PASis fully legal. This has undoubtedly encouraged “suicide tourists” from othercountries to book one-way tickets there.

Since a limited number of nationsallow it, those with the financial means and physical ability have beenskirting around their own nation’s bans and utilizing the freedom to killthemselves in foreign places (as long as they meet the standards set forth bythe nation they travel to). The march toward euthanasia mirrors a trendspanning continents today: a growing number of countries are placing more valueon individual freedom. This worries religious leaders, ethicists and disabilityadvocates. Assisted suicide may ease suffering, they say, but it threatens ourmost vulnerable citizens—the elderly and the disabled, who already struggle tojustify their lives.Financial considerationscould also creep into discussions that should never involve money. In theNetherlands, as in many developed countries, the number of elderly citizens isexpected to increase by 30 to 40 percent in the coming two decades. Euthanasia,critics say, adds a dangerous option in this context: a way for societies tonudge the elderly to quicker deaths.

In the U.S., euthanasia opponents contendthe profit-driven health care system and its slow takeover by cost-cuttingmanaged-care companies pose major ethical risks. “There’s a lot of pressure inthe system already,” says Diane Coleman, the president and CEO of Not Dead Yet,a disability rights group that lobbies against the legalization of assistedsuicide and euthanasia. “We see people denied the care they need for economicreasons. Assisted suicide is the cheapest kind of treatment that could beoffered by the system. These pressures are a reason for concern” (Not DeadYet).

As euthanasia becomes more and more a prevalent aspect ofhuman culture, it is important to note the struggling dynamic between thepublic and private life of people within society. What role should legislationand the state play in what some consider a very private decision? How muchpower should the government have over PAS? Activistsoften claim that laws against assisted suicide are government mandatedsuffering. However, this is tantamount to claiming laws against sellingcontaminated food are government mandated starvation. We will all eventuallydie, but in an age of increased longevity and medical advances, death can besuspended, sometimes indefinitely, and no longer slips in according to its ownimmutable timetable. So, for both patients and their loved ones, real decisionsare demanded. When do we stop doing all that we can do? When are we allowingwondrous medical methods to perversely prolong the dying rather than theliving? These intensely personal and socially expensive decisions should not beleft to governments, judges or legislators better attuned to highway funding. Thestate would argue that assisted suicide is not a private act – since it involvesone person facilitating the death of another. In this way, it is viewed as amatter of public concern that can potentially lead to abuse, exploitation anderosion of care for the most vulnerable populations.

Although the legality and ethics surrounding assistedsuicide have been pondered since the establishment of civilization, theseissues were brought to the forefront in the U.S. during the early 1970s (Pesch,2015). The goal of this movement was to increase the rights of people withterminal illnesses and to give them more control over their own mortality.People with these advanced and often vicious health problems seek refuge in theoption of escape with the choice of death peacefully (usually through a seriesof calculated injections) by a physician.

Brittany Maynard is a prime andtopical example of how these laws are changing the concern for Americansnationwide. She was diagnosed with terminal brain cancer at age 26 and had sixmonths to live, but instead chose assisted suicide (Pesch, 2015). The issue ofdeath with dignity is important not just in our country but worldwide becauseof individuals such as Brittany.

As long as there is human existence, therewill be human death. This death will not always come neatly or comfortably andin some cases, such as this one, it can drag out and be excruciatingly painful.This type of pain, both physically and psychologically, can make living lifejust not worth it (Sweet, 2015). Our willingness to accept or participate insomething as unnatural as choosing to die is the problem here. The option toescape this fate and the stakes at hand is what makes assisted suicide an imperativeissue worldwide. It is quite literally a matter of life and death and at the endof the day, those tasked with decided on these laws are not the ones that are sufferingto begin with. This disconnect even further complicates the relativity ofpurposeful death.Euthanasia carries a negative connotation, often beingconsidered comparable to murder.

Religious and medical communities tend tofirmly stand against the act of assisted suicide. Articles such as the onepublished by the Australian news group “The Daily Telegraph” use religion ormedical references in order to build a case against allowing this practice.This news group stated in their article title Dying with dignity is just a lie, “The Judeo-Christian tradition has always claimed thatevery person is made in the image and likeness of God.

” (Comensoli, 2015). Inthis light, the issue of assisted suicide and its allowance is framed injuxtaposition with religious beliefs. Religion, a widely used and influentialmotivator towards reasoning in many capacities, was used as a way to make anargument that assisted suicide is wrong. It is creating a message thatessentially says “if you believe and follow religion (in this caseChristianity) then you must believe that assisted suicide is wrong and that ahigher power is the only being that can take life away” (Comensoli, 2015). While many faith traditions adhere to ancienttraditions and understandings of physical life’s final journey, modern medicaltechnology has opened the door for faith leaders to actively reconsider somebeliefs.

Death with Dignity laws offer dying individuals an opportunity toponder an important final life question: “What is the meaning of my life?” Formany, this is a profoundly spiritual question to which answers come, not whenan individual is consumed by a flurry of doctor’s appointments, treatments, orchronic disability and pain, but in the comfort of solitude when an individualfeels at peace. Death with Dignity is not only a legal issue, but a culturaland spiritual one as well. This means that all care at the end of life shouldbear in mind the patient’s spiritual well-being alongside physical. Some faithtraditions have embraced Death with Dignity as an ultimate act of compassion,and others reject it is as morally bankrupt practice.

It is a perspective thatvaries from belief to belief all over the globe; making a universal acceptanceof physician assisted suicide a very unlikely possibility in this context.This same framing is used from a medicalperspective as well. Across the globe, medical groups utilize the media toadvocate against assisted suicide just the same. From this standpoint, the actis wrong and that if you are a doctor, you should not condone it. This supportsthe notion that doctors are meant to keep people alive, not kill them, nomatter what the circumstances are (O’Connell, 2015). Assisted suicide in thenews is often seen as a problem, for which the solution is to ban altogetherand prevent more states and nations worldwide from allowing it throughlegislation.

This conjures up the question as to how much power to our medical practitionershave? What is their role in society and how do they fit in with the assistedsuicide movement? Individuals specially trained to prolong and sustain life nowbeing asked to take it away. It seems contradictory, however the greatestargument is that medical practitioners are the only individuals with theexperience and training that is sufficient enough to make assisted suicidehumane and even ethically possible. An overdose of sleeping pills or a bulletto the head is just simply not appropriate for these chronically ill people andit could resort to just that if physician assisted suicide is not allowed forthose with this type of suffering.Furthermore, the medicalcommunity generally sees legalizing physician-assisted suicide as causingpressure on terminal patients who fear their illness is burdensome–physically,emotionally, or financially–to their families or caretakers. They seephysician-assisted suicide as going against thousands of years of medicalethics.

The problem is that physician-assisted suicide is seen as fundamentallyincompatible with the physician’s role as healer. This is where the socialmovement of assisted suicide takes hold. It is here that it is important torationalize and normalize something like human euthanasia and to broadensociety’s standards as to what constitutes the duties of a healer. Theeuthanasia movement is asking the medical, political, and public realms toinclude the taking away of life as an option for healing. It is saying that thetaking away of life is a viable option that can coincide with other healingprocesses conducted by medical practitioners.Physician assisted suicide, although a universalconcept, is often seen to apply to certain demographics.

Due to the cost,availability, and education needed for a such a new and arguably optionalpractice, it is only really available to the middle and upper classes ofpeople.  Since it is an expensive andrelatively new practice that has limited sponsorship, most individuals withinlesser socio economic statuses cannot afford nor even consider assisted suicideas an option.  These factors are whatkeep people of varying races and SES from partaking in assisted suicide.          In 2013 alone,0.39% of all deaths in Oregon were due to the Death withDignity Act and the PAS patients who took advantage of it were 94.4percent white and 53.

3 percent held undergraduate degrees (Oregon Deathwith Dignity Act: Annual Reports, 2015).  While 65 percent of white respondents saidthey would “cease all medical treatment” in cases of incurable disease orextreme pain, sixty percent of African-American respondents and 55 percent ofHispanic-American respondents prefer that doctors save their lives at all costs. Whenreligion is held constant, there are still visible differences across race. ThePew Research Center conducted a survey in 2013 andasked what Americans would do “if they had a disease with no hope ofimprovement and were suffering a great deal of pain.” Sixty-six percent ofwhite Protestants preferred the option of “stopping treatment so they coulddie.” Only 32 percent of black Protestants preferred to stop treatment.

AmongCatholics, 65 percent of white respondents and 38 percent of Hispanicrespondents elected to stop treatment.Approval ofdoctor-assisted suicide laws differs by race and ethnicity as well. US adultswere asked to either disapprove or approve of “laws to allow doctor-assistedsuicide for terminally ill patients.” Compared to the 53 percent ofwhite respondents that approve of PAS laws in recent surveys, 32 percent ofHispanic respondents and 29 percent of black respondents approved of theselaws. Inthis way, the stigmatization of racial minorities in health care has resultedin skepticism of assisted suicide.

Doctor-prescribed suicide or doctor-assistedsuicide is just as it sounds—a prescription from a doctor that a patientchooses to take. The mediacan use this as a way to shame the practice, seeing that it is not somethingwidely needed or wanted and has only been catering to a certain group of people(Henry, 2015). It supports the idea that assisted suicide is not something mostpeople want and only a few people can get. This creates a false belief ofmajority, making it seem as though there is only a minority of individuals who believeand participate in assisted suicide, when in reality it is the financial,educational, and legislative restrictions that are keeping the people from receivingit to begin with (Henry, 2015).There is a stigma in allowing or aidingsomeone’s death despite the wants or needs of that person.

It is seen asimmoral and wrong, in some cases being against religious or medical practices.Either way, people suffering from advanced and terminal illnesses that have noway out other than prolonged pain and suffering are the ones being looked over.Those who oppose assisted suicide are almost always not the sick themselves.They do not understand and cannot fully comprehend the pain and the decisionthat goes into taking your own life because they themselves are not sick.  Experts in the articles I have found mostcommonly supported the practice of assisted suicide and feel as though everyperson should have the ability and choice to end their own lives to escapeserious terminal illness. However, from a rigid medical standpoint, it opposesthis and believes that a physician’s duty is to keep the patient alive nomatter what.

Treating these patients is out of the question since euthanasia initself is a way to escape treatment to begin with. Experts such as Dr. PhilipNitschke and well known physician Dr. Jack Kevorkian championed the idea ofhelping patients escape long, painful, inevitable deaths. They do not supporttreatment to begin with, but instead support voluntary escape altogether.

Thosewho oppose assisted suicide and the doctors who participate, do not support theactual suffering of the individual, but is support the ideas of life being aprecious gift that is given by God or that a patient should keep fighting untilthe very end. These solutions tend to be easier said than done, which is whymany of the individuals suffering and the media articles supporting euthanasiacontinue to fight for the right to die in more areas worldwide: California andGermany being recent examples of this enactment of “right to die” legislature.The issue of whether human beings have the rightto help others die been in the public discourse since before the birth ofChrist. The Hippocratic Oath, which scholars estimate was written in the fourthcentury B.C.

, includes the unambiguous statement: I will not give a lethal drug to anyone if I am asked, nor will Iadvise such a plan (Pickert, 2009). The idea of assisted suicide wassomething relatively uncharted in American history. Whether it was due to alack of technology or lack of demand for the service, the right to die was nota common practice in medical and public arenas. As medicinal technologiesadvanced over time and a tolerance for such progressive ideas grew, so too didthe opinions on the issue (Pickert, 2015). Practices such as abortion that wereonce punishable by death or jail time, are now more common today and in manyways accepted altogether. As people begin to loosen ties to what theyconsidered as right and wrong, new ideas like this become possible for thosewho need it. It isimportant to point out that banning a practice in our society requires greatereffort and argument than allowing one.

This is a result of the value we placeon the rights and liberties of the individual, because individual liberty is soimportant, a compelling reason must be given to override it. Because the resultof a decision on PAS is so intensely personal, this state of ‘innocent untilproven guilty’ must be emphasized. The individual has a basic right todetermine the course of their own life, and obviously death is a part of thatcourse. So then, in order to show that PAS should be legalized, one must simplyshow that there is no reason for them to be deemed illegal.

One ofthe arguments which is often used in favor of banning PAS is that the state hasa paternalistic interest to keep its citizens alive. This is based out of theidea that all killing of humans is immoral and unfair to the person who dies,and thus PAS is immoral (Arras, p. 275). The disparity here is a result ofdifferences in defining paternalism.

The traditional view of western societyhas been that paternalism must always act to keep an individual alive, nomatter what. But in fact, I believe that paternalism must also consider thequality of the life which it is forcing on the individual. The UnitedStates government believes all citizens should have rights to life, liberty,and the pursuit of happiness.

If these are indeed the rights which the statedeems valuable for its citizens, then a paternalistic cause must act in supportof a majority of these rights. Obviously, allowing PAS eliminates a patient’sright to life by killing them. However, the banning of PAS and euthanasia maylead to the elimination of a patient’s right to the pursuit of happiness.Happiness is not simply the state of being happy, it also is the state of notbeing unhappy. In the case of many of those who would seek PAS, ‘the pursuit ofhappiness’ involves removing the physical or mental pain that causes them to beunhappy on a daily basis. It is very difficult to pursue anything, much lesshappiness or even easing of unhappiness, when you are lying intubated in ahospital bed against your will.

With the rights of life and the pursuit ofhappiness contradicting each other, all that is left is liberty, and libertydemands that the patient be given a choice. This view ofpaternalism only supports allowing PAS if a patient’s ability to pursuehappiness is removed by their illness altogether. As such, although it arguesin favor of allowing PAS, it also inherently limits the cases where they arelegal. Paternalism insists that life be chosen unless there is no cause tobelieve that happiness is possible, and so limits PAS to terminal and incurableillnesses and injuries. Even in those cases, because liberty is the decidingfactor in the choice between life and happiness, the patient must clearlyindicate that they wish to die. In an ideal ethicalenvironment, each decision could be made by the physician and the patient (orpatient’s family) on a case by case basis.

The medical, psychological, andsocial complexities of any situation in which PAS is seriously considered woulddemand this. Legislation can provide only an approximation of where to draw theline between a patient eligible for PAS and one who is not. The legislationwould have to be open enough so as to allow patients the freedom to act ifnecessary, but regulated enough to minimize abuse. As such, it may take severalrounds of legislation, review, and refinement before the optimum level ofconstraint is found, although existing cases where the practice is allowed inthe Netherlands or Oregon would seem to indicate that a good approximationcould be made from the start. Thefuture of PAS seems to be increasingly progressive. As more and more populations adopt PAS laws and practices, it isbecoming much more of a commonplace in the public and private sectors.

When we look at what the right-to-die movement hasachieved, against what it has wished to do, an honest person would agree thatthere is still a long, long way to go. But the euthanasia movement is strong and itsorganizations are well financed. Thus the only sure thing about the future ofassisted suicide is that there will be political trench warfare over the issuefor years to come. Happily, we do not live in a country where our mostcontentious social issues are decided in the ivory tower by courts orregulators imposing the views of “experts” on the rest of society. For betteror for worse, the future of assisted suicide and euthanasia will likely bedecided via democratic debate in the public square.

Like any social movement, it takes time to beaccepted. Despite growing medical knowledge and lessened emphasis on religiousideals, a majority of people all over the world would still strongly opposeacts of purposeful death in any form. Assisted suicide is still seen as a newdevelopment that is breaking boundaries in both positive and negative ways. Anexample of this is the notion of suicide itself. Killing oneself purposefullyis viewed as wrong for many reasons. It is in human nature and in all lifeforms a desire to live and keep living. When someone breaks this boundary bydevaluing life or not desiring it, it becomes hard for others to understand theaction. Assisted suicide challenges nature by saying to society that theindividual has control over whether they live or die.

By involving anotherindividual and assisting in the death, it becomes harder for the public todistinguish what is suicide from what is homicide. For these reasons, the practiceof human euthanasia is still a grey area in modern society; something that camefrom banishment or nonexistence through history and has since grown into aviable option for those who find themselves painfully trapped within their ownbodies.In the end, physician assisted suicide andlegislature such as the Death with Dignity Act will continue to be pursued byall types of people worldwide. Death can be a vicious and excruciatingexperience for all of those involved.

The influences of the assisted suicidemovement worldwide and in the United States has been taken to new heights. Thispractice is establishing itself in the medical, political, and social worlds,proving that we can have control over our lives no matter what disease orillness can inflict upon us.