Physician Assisted Suicide: The Right to Life

For my English 201 class at BYUI, I had to write a researched argument that related to my major, which is Nursing.  This is the paper that I wrote on Physician Assisted Suicide. 



The Right to Life
Anna Howe
Brigham Young University - Idaho


Abstract
In her paper, “The Right to Life,” Anna Howe discusses the controversial topic of physician assisted suicide and the effects it has on society.  She first gives background information and defines necessary words pertaining to the subject.  She then introduces her claim that physician assisted suicide should not be legal in the United States, and provides reasons in support of her argument.  After providing sufficient evidence that supports her views of the topic, she then goes on to address the opposing views of the argument.  She gives each point, the reasons that people view the topic in such a way, and then provides a counter-claim in support of her argument.  She uses facts, real-life stories, and opinions to convince the audience of why she does not support physician assisted suicide.  Howe concludes that physician assisted suicide has negative, damaging, life-altering effects on not only the patient and doctor, but also the family and friends of the patient. 



The Right to Life
“I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug” (Maxwell & Pope, 1910, p. 17).  These words precede out of the mouth of every person to graduate medical school, so why is it that in four of the fifty United States, physicians can assist their patients in suicide by administering a lethal dose of medication?  Oregon, Washington, Vermont, and Montana all have laws that support physician-assisted suicide, and with each new state adopting this law, more lives are ending before their time.  In 2012, Oregon alone had 115 prescriptions written for the lethal amount of barbiturates needed to result in death.   Of those, 77 lives were ultimately taken due to suicide (Schadenberg, 2013).  Jeannine Young says that “Doctors told my father that he would not live through the winter of 1962-63, so my eldest sister moved her wedding date up from June 1963 to December 1962, so he could walk at least one of his six daughters down the aisle…In 1978, when my husband’s job was taking us to California, I said good-bye to my father in intensive care at the hospital in Burlington. I thought I would never see him alive again,” (Riel et al., 2013).
Background
In order to be eligible to pursue physician assisted suicide, a patient must be a mentally competent adult diagnosed with a terminal disease.  There are also several rules before a prescription for the lethal drugs can be received.  For example, the patient must make two oral requests, 15 days apart.  He or she must make a written request under the supervision of two witnesses.  Additionally, the physician must inform the patient of alternatives to assisted suicide (Norman-Eady, 2002).  Sometimes physician assisted suicide is referred to using different terms such voluntary active euthanasia.  The connotation of these two phrases are very different, and can even entail two separate meanings.  According to the World Federation of Right to Die Societies, “physician-assisted suicide entails making lethal means available to the patient to be used at a time of the patient’s own choosing,” while “voluntary active euthanasia entails the physician taking an active role in carrying out the patient’s request, and usually involves intravenous delivery of a lethal substance” (“Difference,” 2011).
Cases of physician assisted suicide can be seen as far back as 500 BC.  During this time, the ancient Greeks and Romans, although bound by the Hippocratic Oath, are thought to have often performed voluntary mercy killings as well as support the idea that voluntary killing was better than prolonged agony.  Between the twelfth and fifteenth centuries, support for euthanasia diminished due to an ascendancy in Christianity.  As time passed, controversy over the church’s right to interfere in ethical matters arose, but the rejection of suicide and euthanasia remained firm (“Timeline,” 2013).
In the United States, it wasn’t until 1828 that the first United States statute was enacted that outlawed assisted suicide in New York.   In the 1900’s, debate over physician assisted suicide became a more prominent issue as advances in technology allowed the debate to be addressed on television, radio, and even movies such as The Black Stork in 1917.  As time passed, groups both in support of and opposing physician assisted suicide were organized, rates of support continuously fluctuated, and new rules and regulations were put in place regarding the act.  In November of 1994, Oregon became the first state to legalize the Death with Dignity act, or the right to physician assisted suicide, followed by Washington and Montana in 2008, and most recently Vermont in 2013 (“Timeline,” 2013).  Despite the legalization of physician assisted suicide in four states, it should not be legal in the United States because it removes all chances of that person ever getting better, it introduces a double standard between physical and mental suffering, and it also causes more pain and grief of the patient’s loved ones.
Position
Doctors are human, and humans make mistakes.  There have been millions of cases worldwide where patients are diagnosed with a terminal illness, only to outlive their prognosis by five, ten, or even fifty years.  If a doctor were to misdiagnose a patient with a terminal illness, and that patient decides to take advantage of physician assisted suicide, they will have given up not only years of their life, but time and memories that could have been made with family, friends, and loved ones.  They could have grown into the doctor that discovers a cure for cancer, or the officer that stops a serial killer in his tracks.  There is so much potential in one person’s life and physician assisted suicide eliminates all chance of said potential becoming a reality.  Erica Riel from Barre, Vermont was diagnosed with a terminal illness three separate times by doctors in Vermont.  She was pursuing the route of physician assisted suicide until her family convinced her otherwise and she tried one more doctor.  This doctor informed her that not only would she live, but she could live to be 80 years old.  Her question after her accurate prognosis was “How many other people are getting wrong diagnoses?”  Erica is only one of the 12 million approximate people who are misdiagnosed each year in the United States (Whiteman, 2014). Erica is now fighting to illegalize physician assisted suicide in Vermont (Riel et al., 2013).
A common assumption of those who turn to physician assisted suicide is that they are in agonizing pain.  However, it is said that many of the patients who use physician assisted suicide in Oregon are not in pain, but rather they want to control the timing and experience of their death.  Isn’t this something that people, even those without terminal illnesses, naturally want?  No one wants to die in a vegetative state or while having to depend on everyone else to do things for them.  So why is it that those with terminal illnesses get to decide when and where they die, but not those who simply want to avoid the complications and frustrations that come towards the end of life?  There is no logical reason that people with the exact same concerns regarding death should be given different options based on their medical status.  This is not the reason that all patients turn to physician assisted suicide, but it has been said that for many, this is a leading factor (Jeffery, 2009).
Another issue that results from the legalization of physician assisted suicide is that it gives people – both doctors, families, and patients – more power, power which could be easily abused.  The National Center on Elder Abuse estimates that one to two million Americans aged 65 or older “have been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection,” (Harned, 2012, p. 516-517).  Many family members who have families and lives of their own are given the responsibility of caring for an elderly relative.  After years of putting their lives on hold, the family member may, consciously or unconsciously, suggest that the relative pursue the path of physician assisted suicide.  Their reasoning may sound totally innocent to them, but the underlying reason for their suggestion may simply be that they want their life back.  Abuse of the system can also take place when a patient who has a terminal illness, but also suffers from a mental illness such a depression, is given the option of physician assisted suicide.  The patient could use their terminal illness as an excuse for why they want to pursue physician assisted suicide, when in reality it may be their mental illness swaying them to that option.  Mary Harned, staff council for Americans United for Life, states that physician assisted suicide “creating yet another path of abuse against older individuals—abuse which is often subtle and extremely difficult to detect. In fact, legalized physician-assisted suicide may hide abuse of elderly and disabled Americans by providing complete liability protection for doctors and promoting secrecy,” (2012, p. 517).
Opposition
Many people do support physician assisted suicide as an end-of-life option, and rightfully so.  It is hard to imagine that anyone would want to take away a person’s right to end suffering, especially when that suffering is long, slow, and painful.  As stated previously, pain is not always the reason that patients seek physician assisted suicide, but it most definitely can be.  Let’s look at those patients with illnesses that do in fact cause unmanageable and unbearable pain and suffering.  People don’t believe that they or others should have to live a life suffering each day because of pain.  This is a seemingly reasonable argument in support of physician assisted suicide.  But what about diseases that aren’t terminal, but that cause a lifetime of daily pain and suffering?  What about those who have been diagnosed with mental disorders such as depression, bipolar disorder, or schizophrenia?  Although it is not physical pain, these illnesses cause emotional pain that is just as real and felt just as strongly as physical pain.  It is said that in the brain, physical and emotional pain share much of the same circuitry (Szalavitz, 2013).  It is a commonly-known fact that these disorders are contributing factors towards many of the suicide cases in the United States each year.  What is interesting though, is that someone who is diagnosed with depression, who will suffer from it for the rest of their life, cannot request physician assisted suicide as an end of life option because depression is not terminal.  Someone who experiences pain that will last no longer than six months can request to die before their time, but those who have pain that will last the rest of their life cannot request the same treatment.  Another strange contradiction in this case is that those who pursue the route of physician assisted suicide want to be recognized as someone who has “died with dignity” because they did not let their illness overtake them.  It would make sense that someone who doesn’t let depression take over their life would be recognized in the same manner, however, that is not the case whatsoever.  Those who commit suicide due to mental and emotional pain are often times considered cowards who “took the easy way out.”  They are selfish for leaving their families behind and for only thinking of their own pain.  This is a double standard that works in favor of those with physical illnesses and shames those with mental and emotional ones.
Another reason that many people are in support of the legalization of physician assisted suicide is because it will help lower health care costs.  If someone is terminally ill, but has six more months to live, that is six more months of hospital bills that are going to pile up on the family that they leave behind.  Some people wonder why it is necessary to pay outrageous prices for medications, hospital stays, or procedures that aren’t going to change the fact that their loved one is dying.  Physician assisted suicide allows the patient to end their suffering without the guilt of becoming a financial burden to their families.  The problem with this logic, however, is that because of this guilt, patients may become more likely to pursue physician assisted suicide rather than fighting their disease.  Felicia Cohn, PhD, Associate Professor at the School of Medicine, University of California, Irvine, and Joanne Lynn, MD, MA, MS, Director of The Washington Home Center for Palliative Care Studies, Washington, DC, wrote in their chapter "Vulnerable People: Practical Rejoinders to Claims in Favor of Assisted Suicide" that for the economically disadvantaged, as well as those without health insurance, “…physician-assisted suicide may not merely be a choice, one option among others; rather, it may become a coercive offer. If physician-assisted suicide becomes a more popular choice, ending one's own life could come to be perceived as an obligation, that is, a societally endorsed course of action that is the only way to avoid suffering, indignity, and impoverishment," (2008).  Legalizing physician assisted suicide would ultimately endanger those of low socio-economic status because of the guilt they would have of becoming a financial burden to their families, thus making physician assisted suicide seem like the only option they have.
When a patient is considering physician assisted suicide, often times they are not only thinking of what it will do to them, but also what it will do to their families.  Many say that pursuing physician assisted suicide will not only ease their suffering, but their families as well.  The families can be at peace knowing that their loved ones are no longer suffering and they can know that their loved one chose the route of physician assisted suicide for themselves.  If the patient is kept alive, but eventually goes into a vegetative state, the family would then have to make the decision of whether or not and when to end the patient’s life.  People don’t want to be left with the burden of choosing life or death for their loved one and would rather have the family member make that choice themselves, as they do with physician assisted suicide.  While this is a valid argument to consider, physician assisted suicide is a permanent choice.  There is no going back once the family realizes that they would have rather had the extra time to spend with their family member and enjoy the final moments.  Feelings of guilt and depression often flood the minds of the family left behind.  That is especially the case if they later learn that the diagnoses was false, as one daughter did. “After Rebecca Badger…killed herself, her daughter Christy discovered the diagnosis of Multiple Sclerosis was wrong. The autopsy showed that her mother did not have MS and, if she had sought a second opinion instead of assisted suicide, might still be alive today,” (“Impact,” 2012).  Physician assisted suicide may relieve some of the families suffering at the time, but the devastating feelings and emotions will last for the rest of their lives.
Conclusion
While physician assisted suicide may initially seem like an option that should be given to those suffering from a terminal illness, it creates too many consequences that far outweigh the positives.  It causes grief and regret in the families of those who choose it.  It gives power of life to those who don’t need it.  It gives the idea that suicide is okay for some, and not for others.  The elderly, as well as the poverty-stricken, may be persuaded to take the route of physician assisted suicide when it’s not what they want to do.  Ultimately, physician assisted suicide creates problems that aren’t necessary, and it should not be a legal method of dying in the United States.
To conclude the story from the introduction, Jeannine’s father “…not only walked [Jeannine’s sister] down the aisle, he walked all six of his daughters down the aisle and attended the weddings of two of his three sons… he lived 20 years longer than predicted,” (Riel et al., 2013).  Had Jeannine’s father chosen physician assisted suicide as his end-of-life option, he never would have seen those daughters and son’s weddings, he never would have seen the grandchildren that he did, and he would have missed out on nearly 20 years of his life.  Physician assisted suicide takes away more than it could ever give back.




References
Harned, M. E. (2012).  “The Dangers of Assisted Suicide: No Longer Theoretical.” Americans United for Life: Defending Life 2012.  Retrieved from: http://www.aul.org/wp-content/uploads/2012/04/dangers-assisted-suicide.pdf
Historical Timeline: History of Euthanasia and Physician-Assisted Suicide.” (Jul 23, 2013) Euthanasia: Pros and Cons. Retrieved from: http://euthanasia.procon.org/view.timeline.php?timelineID=000022
“Impact of Euthanasia on the Family.” (2012). A New Zealand Resource for Life Related Issues. Retrieved from: http://www.life.org.nz/euthanasia/euthanasiakeyissues/impact-on-family/
Jeffery, D. (2009).  Against physician assisted suicide: A palliative care perspective.  Oxford, New York: Radcliffe Publishing.
 Maxwell, A. C., & Pope, A. E. (1910). "The Florence Nightingale Pledge". Practical Nursing: A Text-book for Nurses and a Handbook for All who Care for the Sick. G.P. Putnam's Sons. p. 17. Retrieved December 5, 2014.
Norman-Eady, S. (Jan 22, 2002). “Oregon’s Assisted Suicide Law.” OLR Research Report. Retrieved from http://www.cga.ct.gov/2002/rpt/2002-R-0077.htm
Riel, E., Young, J., Schoppe, C., Carlson, R., Caulfield, J., & Caulfield L. (2013). “Doctors Often Misdiagnose the Terminally Ill.” Vermont Alliance for Medical Care. Retrieved from: http://www.vaeh.org/resources/DoctorsOftenMisdiagnose.htm
Schadenberg, A. (2013).  “Oregon Assisted Suicide Deaths Hit Record High in 2012”. Life News. Retrieved from http://www.lifenews.com/2013/01/30/oregon-assisted-suicide-deaths-hit-record-high-in-2012/.
Szalavitz, M. (May 6, 2013). “New Test Distinguishes Physical From Emotional Pain in Brain for First Time.”  Time. Retrieved from: http://healthland.time.com/2013/05/06/a-pain-detector-for-the-brain/
“What is the Difference Between Assisted Dying and Euthanasia?” (2011).  The World Federation of Right to Die Societies. Retrieved from http://www.worldrtd.net/qanda/what-difference-between-assisted-dying-and-euthanasia
Whiteman, H. (Apr 17, 2014).  “1 in 20 American adults 'misdiagnosed in outpatient clinics each year.’”  Medical News Today.  Retrieved from http://www.medicalnewstoday.com/articles/275565.php
“Would Legalizing Physician-Assisted Suicide Endanger the Poor?” (Jun 11, 2008). Euthanasia: Pros and Cons. Retrieved from: http://euthanasia.procon.org/view.answers.php?questionID=000210          





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