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November 12, 2012 | Posted By Wayne Shelton, PhD

 

The issue of physician suicide has been on the public agenda in the United States for the past 25 years or more. Legitimate worries about medical overtreatment, unnecessary suffering and loss of dignity have motivated a growing number of Americans to consider this issue more favorably. People are rightly concerned about loosing control over what happens to them once they enter the hospital when the are very sick and risk dying. Instead of being at the mercy of technological forces beyond their control, free individuals want to have a say over how they make the final exit from life. The key factor, in my opinion, is more about self-control than it is about actually the strong desire to take a lethal dose of medications at the time of the patient’s choosing. But let’s be clear what we are talking about. 

Oregon was the first state to legalize physician-assisted suicide, which occurred in 1994 in the Death With Dignity Act. This law gives patients with capacity facing a clearly diagnosable terminal illness within 6 months or less to live the right to receive (and the right of the physician to prescribe) a prescription for a lethal dose of medication for the expressed purpose of ending their lives at the time of their choosing. Because we have had many years to collect empirical data about the effects of this law, we can use Oregon as a case study. As of 2011, 935 people have had prescriptions and 596 have died from ingesting medications they received based on this law. For about 90% of these patients, the primary concern about end of life care was “loss of autonomy”, but “inability to make life enjoyable” and “loss of dignity” were also major concerns. Moreover, based on the data, there is no evidence of any kind of abuse to any particular segment of the population, as some feared might happen. In fact the utilization rate of hospice care is up.  Following Oregon, Washington and Montana also have legalized physician-assisted suicide and we will have to wait and see the data of these laws continue to yield generally positive results. But overall the data gathered so far supports physician-assisted suicide a beneficial service. 

We just saw an attempt to expand to Massachusetts fail by a narrow margin. We should be prepared for slow expansion of legalized physician-assisted suicide to more states, since there is a cautious attitude about this service. This is as it should be since we cannot forget the fact that the essence of this law is the legalized, intentional ending of human life. It’s appropriate that we take the expansion of this law slow and deliberately, and carefully understand the empirical data about the risks and benefits from the states where it is currently legal. 

My own view is that I favor the expansion of physician-assisted suicide in more states. In terms of how I justify it ethically, I do not see any important moral tenet that should in principle prohibit it. That is, I do not see individuals directly ending their lives at the time of their choosing as inherently wrong or even morally problematic within carefully circumscribed circumstances as the Death With Dignity Act spells out. Nor do I see a moral problem for physicians who participate in his activity: I do not think that their participation undermines their professional role to protect and preserve life in the vast number of cases in which they serve patients. No sacred trust in the physician-patient relationship is necessarily broken. So long as, on balance, the benefits greatly outweigh the possible harms, which they do, and no one’s rights are transgressed, we should move forward. 

But there is one point that causes me to have a sense of caution: I find it odd that we go too far toward establishing assistance in suicide as a right of dying patients when it is still the case that not all patients, including some dying patients, have access to health care. It would seem to me that from a moral point of view the right to health care, that is, the right to access medical care and to have a relationship with a caring physician, should be a precondition for physician-assisted suicide. So let’s move forward with physician-assisted suicide, but let’s get our moral priorities straight: let’s first establish the right for all patients to have a right to health care. We are moving in the right direction with the Affordable Care Act, but we still will likely be short of universal coverage. Achieving that end will reduce the risks for those who may be most vulnerable at the end of life and allow them to make decisions with the support they need.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

 

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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