Death
with Dignity: An Investigation of Physician Assisted Suicide

Nick
Leon

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Sociology
450

University
of Delaware

 

 

 

 

 

 

 

 

 

 

 

 

 

Death
with Dignity: An Investigation of Physician Assisted Suicide

In the past few decades Physician assisted
suicide (PAS) in the United States has become a controversial yet increasingly
applicable concept. The debate falls between whether or not a dying individual
has the right to die with the assistance of a physician through calculated and
painless lethal injections. Factors including moral, religious, medical, and
political have all played a role in influencing society’s relationship with
this practice.

It is difficult to distinguish between relief
from suffering, with simply killing. One of the most substantial concerns with
assisted suicide lies with the competence of the terminally ill. More people
are discussing and considering physician assisted suicide as a viable option
than ever before (Bruinius, 2015). Essentially it is a series of calculated
injections or pills administered by a medical professional to purposefully
induce a painless death. In the U.S. it varies by state law, but as of today
only four of fifty states have legalized the “Death with Dignity Act”
(including Oregon, Vermont, Washington, and California with Montana allowing
it only under a court ruling) (Bruinius, 2015). The patient also has to be a
mentally competent individual at least 18 years old and be diagnosed with a
terminal 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 in
legislation review. California is such as state, most recently adopting a
“death with dignity act” that allows for any state residing and critically ill
individual to partake in physician assisted suicide (Bruinius, 2015).

PAS has also made a significant mark
internationally. In April 2002, the Netherlands became the first
country to legalize assisted suicide. Countries such as the Switzerland, Germany, and recently Canada have
made profound strides in supporting these practices as well. In
2013, according to the latest data, 4,829 people across the Netherlands chose
to have a doctor end their lives. That’s one in every 28 deaths and triple the
number of people who died this way in 2002. Here, people can choose euthanasia
if they can convince two physicians they endure “unbearable” suffering, a
definition that expands each year. Residents can choose euthanasia if they’re
tired of living with Lou Gehrig’s disease, multiple sclerosis, depression or
loneliness. In contrast, within the few states that allow for it, the U.S. has
much stricter regulations as to what constitutes reason for PAS. Other
countries are now edging closer to the Dutch model. On February 6, the Supreme
Court of Canada struck down a ban on physician-assisted suicide, joining
Luxembourg, Belgium and Switzerland on the list of Western countries where PAS
is fully legal. This has undoubtedly encouraged “suicide tourists” from other
countries to book one-way tickets there. Since a limited number of nations
allow it, those with the financial means and physical ability have been
skirting around their own nation’s bans and utilizing the freedom to kill
themselves in foreign places (as long as they meet the standards set forth by
the nation they travel to). The march toward euthanasia mirrors a trend
spanning continents today: a growing number of countries are placing more value
on individual freedom. This worries religious leaders, ethicists and disability
advocates. Assisted suicide may ease suffering, they say, but it threatens our
most vulnerable citizens—the elderly and the disabled, who already struggle to
justify their lives.

Financial considerations
could also creep into discussions that should never involve money. In the
Netherlands, as in many developed countries, the number of elderly citizens is
expected 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 to
nudge the elderly to quicker deaths. In the U.S., euthanasia opponents contend
the profit-driven health care system and its slow takeover by cost-cutting
managed-care companies pose major ethical risks. “There’s a lot of pressure in
the system already,” says Diane Coleman, the president and CEO of Not Dead Yet,
a disability rights group that lobbies against the legalization of assisted
suicide and euthanasia. “We see people denied the care they need for economic
reasons. Assisted suicide is the cheapest kind of treatment that could be
offered by the system. These pressures are a reason for concern” (Not Dead
Yet).

As euthanasia becomes more and more a prevalent aspect of
human culture, it is important to note the struggling dynamic between the
public and private life of people within society. What role should legislation
and the state play in what some consider a very private decision? How much
power should the government have over PAS? Activists
often claim that laws against assisted suicide are government mandated
suffering. However, this is tantamount to claiming laws against selling
contaminated food are government mandated starvation. We will all eventually
die, but in an age of increased longevity and medical advances, death can be
suspended, sometimes indefinitely, and no longer slips in according to its own
immutable timetable. So, for both patients and their loved ones, real decisions
are demanded. When do we stop doing all that we can do? When are we allowing
wondrous medical methods to perversely prolong the dying rather than the
living? These intensely personal and socially expensive decisions should not be
left to governments, judges or legislators better attuned to highway funding. The
state would argue that assisted suicide is not a private act – since it involves
one person facilitating the death of another. In this way, it is viewed as a
matter of public concern that can potentially lead to abuse, exploitation and
erosion of care for the most vulnerable populations.

Although the legality and ethics surrounding assisted
suicide have been pondered since the establishment of civilization, these
issues 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 with
terminal illnesses and to give them more control over their own mortality.
People with these advanced and often vicious health problems seek refuge in the
option of escape with the choice of death peacefully (usually through a series
of calculated injections) by a physician. Brittany Maynard is a prime and
topical example of how these laws are changing the concern for Americans
nationwide. She was diagnosed with terminal brain cancer at age 26 and had six
months to live, but instead chose assisted suicide (Pesch, 2015). The issue of
death with dignity is important not just in our country but worldwide because
of individuals such as Brittany. As long as there is human existence, there
will be human death. This death will not always come neatly or comfortably and
in 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 life
just not worth it (Sweet, 2015). Our willingness to accept or participate in
something as unnatural as choosing to die is the problem here. The option to
escape this fate and the stakes at hand is what makes assisted suicide an imperative
issue worldwide. It is quite literally a matter of life and death and at the end
of the day, those tasked with decided on these laws are not the ones that are suffering
to begin with. This disconnect even further complicates the relativity of
purposeful death.

Euthanasia carries a negative connotation, often being
considered comparable to murder. Religious and medical communities tend to
firmly stand against the act of assisted suicide. Articles such as the one
published by the Australian news group “The Daily Telegraph” use religion or
medical 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 that
every person is made in the image and likeness of God.” (Comensoli, 2015). In
this light, the issue of assisted suicide and its allowance is framed in
juxtaposition with religious beliefs. Religion, a widely used and influential
motivator towards reasoning in many capacities, was used as a way to make an
argument that assisted suicide is wrong. It is creating a message that
essentially says “if you believe and follow religion (in this case
Christianity) then you must believe that assisted suicide is wrong and that a
higher power is the only being that can take life away” (Comensoli, 2015).

 While many faith traditions adhere to ancient
traditions and understandings of physical life’s final journey, modern medical
technology has opened the door for faith leaders to actively reconsider some
beliefs. Death with Dignity laws offer dying individuals an opportunity to
ponder an important final life question: “What is the meaning of my life?” For
many, this is a profoundly spiritual question to which answers come, not when
an individual is consumed by a flurry of doctor’s appointments, treatments, or
chronic disability and pain, but in the comfort of solitude when an individual
feels at peace. Death with Dignity is not only a legal issue, but a cultural
and spiritual one as well. This means that all care at the end of life should
bear in mind the patient’s spiritual well-being alongside physical. Some faith
traditions have embraced Death with Dignity as an ultimate act of compassion,
and others reject it is as morally bankrupt practice. It is a perspective that
varies from belief to belief all over the globe; making a universal acceptance
of physician assisted suicide a very unlikely possibility in this context.

This same framing is used from a medical
perspective as well. Across the globe, medical groups utilize the media to
advocate against assisted suicide just the same. From this standpoint, the act
is wrong and that if you are a doctor, you should not condone it. This supports
the notion that doctors are meant to keep people alive, not kill them, no
matter what the circumstances are (O’Connell, 2015). Assisted suicide in the
news is often seen as a problem, for which the solution is to ban altogether
and prevent more states and nations worldwide from allowing it through
legislation. This conjures up the question as to how much power to our medical practitioners
have? What is their role in society and how do they fit in with the assisted
suicide movement? Individuals specially trained to prolong and sustain life now
being asked to take it away. It seems contradictory, however the greatest
argument is that medical practitioners are the only individuals with the
experience and training that is sufficient enough to make assisted suicide
humane and even ethically possible. An overdose of sleeping pills or a bullet
to the head is just simply not appropriate for these chronically ill people and
it could resort to just that if physician assisted suicide is not allowed for
those with this type of suffering.

Furthermore, the medical
community generally sees legalizing physician-assisted suicide as causing
pressure on terminal patients who fear their illness is burdensome–physically,
emotionally, or financially–to their families or caretakers. They see
physician-assisted suicide as going against thousands of years of medical
ethics. The problem is that physician-assisted suicide is seen as fundamentally
incompatible with the physician’s role as healer. This is where the social
movement of assisted suicide takes hold. It is here that it is important to
rationalize and normalize something like human euthanasia and to broaden
society’s standards as to what constitutes the duties of a healer. The
euthanasia movement is asking the medical, political, and public realms to
include the taking away of life as an option for healing. It is saying that the
taking away of life is a viable option that can coincide with other healing
processes conducted by medical practitioners.

Physician assisted suicide, although a universal
concept, is often seen to apply to certain demographics. Due to the cost,
availability, and education needed for a such a new and arguably optional
practice, it is only really available to the middle and upper classes of
people.  Since it is an expensive and
relatively new practice that has limited sponsorship, most individuals within
lesser socio economic statuses cannot afford nor even consider assisted suicide
as an option.  These factors are what
keep 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 with
Dignity Act and the PAS patients who took advantage of it were 94.4
percent white and 53.3 percent held undergraduate degrees (Oregon Death
with Dignity Act: Annual Reports, 2015).  While 65 percent of white respondents said
they would “cease all medical treatment” in cases of incurable disease or
extreme pain, sixty percent of African-American respondents and 55 percent of
Hispanic-American respondents prefer that doctors save their lives at all costs. When
religion is held constant, there are still visible differences across race. The
Pew Research Center conducted a survey in 2013 and
asked what Americans would do “if they had a disease with no hope of
improvement and were suffering a great deal of pain.” Sixty-six percent of
white Protestants preferred the option of “stopping treatment so they could
die.” Only 32 percent of black Protestants preferred to stop treatment. Among
Catholics, 65 percent of white respondents and 38 percent of Hispanic
respondents elected to stop treatment.

Approval of
doctor-assisted suicide laws differs by race and ethnicity as well. US adults
were asked to either disapprove or approve of “laws to allow doctor-assisted
suicide for terminally ill patients.” Compared to the 53 percent of
white respondents that approve of PAS laws in recent surveys, 32 percent of
Hispanic respondents and 29 percent of black respondents approved of these
laws. In
this way, the stigmatization of racial minorities in health care has resulted
in skepticism of assisted suicide. Doctor-prescribed suicide or doctor-assisted
suicide is just as it sounds—a prescription from a doctor that a patient
chooses to take. The media
can use this as a way to shame the practice, seeing that it is not something
widely 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 most
people want and only a few people can get. This creates a false belief of
majority, making it seem as though there is only a minority of individuals who believe
and participate in assisted suicide, when in reality it is the financial,
educational, and legislative restrictions that are keeping the people from receiving
it to begin with (Henry, 2015).

There is a stigma in allowing or aiding
someone’s death despite the wants or needs of that person. It is seen as
immoral and wrong, in some cases being against religious or medical practices.
Either way, people suffering from advanced and terminal illnesses that have no
way 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 decision
that goes into taking your own life because they themselves are not sick.  Experts in the articles I have found most
commonly supported the practice of assisted suicide and feel as though every
person should have the ability and choice to end their own lives to escape
serious terminal illness. However, from a rigid medical standpoint, it opposes
this and believes that a physician’s duty is to keep the patient alive no
matter what. Treating these patients is out of the question since euthanasia in
itself is a way to escape treatment to begin with. Experts such as Dr. Philip
Nitschke and well known physician Dr. Jack Kevorkian championed the idea of
helping patients escape long, painful, inevitable deaths. They do not support
treatment to begin with, but instead support voluntary escape altogether. Those
who oppose assisted suicide and the doctors who participate, do not support the
actual suffering of the individual, but is support the ideas of life being a
precious gift that is given by God or that a patient should keep fighting until
the very end. These solutions tend to be easier said than done, which is why
many of the individuals suffering and the media articles supporting euthanasia
continue to fight for the right to die in more areas worldwide: California and
Germany being recent examples of this enactment of “right to die” legislature.

The issue of whether human beings have the right
to help others die been in the public discourse since before the birth of
Christ. The Hippocratic Oath, which scholars estimate was written in the fourth
century B.C., includes the unambiguous statement: I will not give a lethal drug to anyone if I am asked, nor will I
advise such a plan (Pickert, 2009). The idea of assisted suicide was
something relatively uncharted in American history. Whether it was due to a
lack of technology or lack of demand for the service, the right to die was not
a common practice in medical and public arenas. As medicinal technologies
advanced over time and a tolerance for such progressive ideas grew, so too did
the opinions on the issue (Pickert, 2015). Practices such as abortion that were
once punishable by death or jail time, are now more common today and in many
ways accepted altogether. As people begin to loosen ties to what they
considered as right and wrong, new ideas like this become possible for those
who need it.

It is
important to point out that banning a practice in our society requires greater
effort and argument than allowing one. This is a result of the value we place
on the rights and liberties of the individual, because individual liberty is so
important, a compelling reason must be given to override it. Because the result
of a decision on PAS is so intensely personal, this state of ‘innocent until
proven guilty’ must be emphasized. The individual has a basic right to
determine the course of their own life, and obviously death is a part of that
course. So then, in order to show that PAS should be legalized, one must simply
show that there is no reason for them to be deemed illegal.

One of
the arguments which is often used in favor of banning PAS is that the state has
a paternalistic interest to keep its citizens alive. This is based out of the
idea 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 of
differences in defining paternalism. The traditional view of western society
has been that paternalism must always act to keep an individual alive, no
matter what. But in fact, I believe that paternalism must also consider the
quality of the life which it is forcing on the individual.

The United
States government believes all citizens should have rights to life, liberty,
and the pursuit of happiness. If these are indeed the rights which the state
deems valuable for its citizens, then a paternalistic cause must act in support
of a majority of these rights. Obviously, allowing PAS eliminates a patient’s
right to life by killing them. However, the banning of PAS and euthanasia may
lead 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 not
being unhappy. In the case of many of those who would seek PAS, ‘the pursuit of
happiness’ involves removing the physical or mental pain that causes them to be
unhappy on a daily basis. It is very difficult to pursue anything, much less
happiness or even easing of unhappiness, when you are lying intubated in a
hospital bed against your will. With the rights of life and the pursuit of
happiness contradicting each other, all that is left is liberty, and liberty
demands that the patient be given a choice.

This view of
paternalism only supports allowing PAS if a patient’s ability to pursue
happiness is removed by their illness altogether. As such, although it argues
in favor of allowing PAS, it also inherently limits the cases where they are
legal. Paternalism insists that life be chosen unless there is no cause to
believe that happiness is possible, and so limits PAS to terminal and incurable
illnesses and injuries. Even in those cases, because liberty is the deciding
factor in the choice between life and happiness, the patient must clearly
indicate that they wish to die.

In an ideal ethical
environment, each decision could be made by the physician and the patient (or
patient’s family) on a case by case basis. The medical, psychological, and
social complexities of any situation in which PAS is seriously considered would
demand this. Legislation can provide only an approximation of where to draw the
line between a patient eligible for PAS and one who is not. The legislation
would have to be open enough so as to allow patients the freedom to act if
necessary, but regulated enough to minimize abuse. As such, it may take several
rounds of legislation, review, and refinement before the optimum level of
constraint is found, although existing cases where the practice is allowed in
the Netherlands or Oregon would seem to indicate that a good approximation
could be made from the start. The
future of PAS seems to be increasingly progressive.

As more and more populations adopt PAS laws and practices, it is
becoming much more of a commonplace in the public and private sectors. When we look at what the right-to-die movement has
achieved, against what it has wished to do, an honest person would agree that
there is still a long, long way to go. But the euthanasia movement is strong and its
organizations are well financed. Thus the only sure thing about the future of
assisted suicide is that there will be political trench warfare over the issue
for years to come. Happily, we do not live in a country where our most
contentious social issues are decided in the ivory tower by courts or
regulators imposing the views of “experts” on the rest of society. For better
or for worse, the future of assisted suicide and euthanasia will likely be
decided via democratic debate in the public square.

Like any social movement, it takes time to be
accepted. Despite growing medical knowledge and lessened emphasis on religious
ideals, a majority of people all over the world would still strongly oppose
acts of purposeful death in any form. Assisted suicide is still seen as a new
development that is breaking boundaries in both positive and negative ways. An
example of this is the notion of suicide itself. Killing oneself purposefully
is viewed as wrong for many reasons. It is in human nature and in all life
forms a desire to live and keep living. When someone breaks this boundary by
devaluing life or not desiring it, it becomes hard for others to understand the
action. Assisted suicide challenges nature by saying to society that the
individual has control over whether they live or die. By involving another
individual and assisting in the death, it becomes harder for the public to
distinguish what is suicide from what is homicide. For these reasons, the practice
of human euthanasia is still a grey area in modern society; something that came
from banishment or nonexistence through history and has since grown into a
viable option for those who find themselves painfully trapped within their own
bodies.

In the end, physician assisted suicide and
legislature such as the Death with Dignity Act will continue to be pursued by
all types of people worldwide. Death can be a vicious and excruciating
experience for all of those involved. The influences of the assisted suicide
movement worldwide and in the United States has been taken to new heights. This
practice is establishing itself in the medical, political, and social worlds,
proving that we can have control over our lives no matter what disease or
illness can inflict upon us.