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Should Physicians Assist Patients Who Wish to Commit Suicide?

A balanced view on a torrid subject.

The legal ramifications reach all the way to the United States Supreme Court. "On January 26, 1997, the United States Supreme Court unanimously held that New York's prohibition on assisting suicide does not violate the equal protection rights of terminally ill adults seeking physician assistance in committing suicide." (Vacco V. Quill, 1998). If a person is terminally ill, is there a difference between physician assisted suicide and refusing life saving medical treatment? Chief Justice William Rehnquist, writing for the Supreme Court, rejected the notion that ending or refusing lifesaving medical treatment 'is nothing more nor less than assisted suicide.' The distinction, the court declared, is "widely recognized and endorsed in the medical profession and in our legal traditions, is both important and logical," and "is certainly rational." (Vacco V. Quill, 1998).

If it is widely recognized in the medical community, then obviously definitions should be attached. The distinction "comports with fundamental principles of causation and intent," the Chief Justice continued. "When a patient refuses life sustaining medical treatment he dies from an underlying fatal disease or pathology; but if a person ingests lethal medication prescribed by a physician, he is killed by that medication." (Vacco V. Quill, 1998).

When you put the semantical definition aside, what is the government's view?

"First", the Court wrote, "Washington has an unqualified interest in the preservation of human life." The Court noted that assisted suicide ban, "like all homicide laws, both reflect and advance its commitment to this interest. (Washington v. Glucksberg, 1998).

The governments decree to ban physician assisted suicide runs parallel to the Supreme Court rulings. What is the theological perspective? The late Pope John Paul II, in his Encyclical Evangelism Viate, understood humanity as facing a sharply dichotomous choice between "The culture of life and the culture of death." After arguing that assisted suicide and euthanasia, no less than abortion, are always impermissible, the Pope contended that "Laws which legitimize the direct killing of innocent human beings through abortion or euthanasia are in complete opposition to the inviolable right to life proper to every individual; they thus deny the equality of everyone before the law." (Kaveny, M. C. 1997).

Furthermore, studies link people who want to commit suicide with depression. "In one study of terminally ill patients, of those who expressed a wish to die, all met diagnostic criteria for major depression. Like other suicidal individuals, patients who desire suicide or an early death during a terminal illness are usually suffering from a treatable mental illness, most commonly depression." (Bopp, James Jr., et al, 1995).

Conversely the "right to die advocates are campaigning for the decriminalization of euthanasia and physician assisted suicide or at least more leniency towards those who help, out of compassion, to end a life." (Driedger, D., et al, 1998). Furthermore, one must take note of the pain associated with illness. "There is nothing simple about facing impending death" as Richard Holmes, 72, can attest. Diagnosed in 2000 with colon cancer, which spread to his liver this year. Holmes, a retired salesman from Portland Oregon, has been told he now has less than six months to live. His skin is yellow-tinged from the cancer, he tires easily, and he has started to have some discomfort in his abdomen. But Holmes knows the day is coming when the pain will intensify, and it fills him with dread. The one thing he is trying to do is to get his legal prescription written and filled. He isn't sure when or if he will use it, but he said he would feel more secure just having the drugs. "Let me drink a bit of stuff and go to sleep. It makes more sense than trying to shoot myself or drive off a bridge or gas myself in the garage" he said, tears welling in his eyes. "The God I believe in says that's okay." (Hewitt, et al, 2001).

Indeed, such cases like that occur in Oregon, the only state in the nation that has a physician assisted suicide law. What does the law entail? Here is a brief excerpt; "Under Oregon law, two physicians must confirm that a patient has less than six months to live. The patient must then wait 15 days and consult again with his or her doctor before getting a lethal prescription, usually for barbiturates such as Seconal. If at any time either of the doctors believes that the patient's judgment is impaired by depression, the patient must see a licensed psychologist or psychiatrist of his or her choosing. When the patient decides to take the drug, a doctor may be present but is not required to be. The law stipulates that the legal dose must be self-administered." (Hewitt, et al, 2001).

How has the law worked thus far? Initially even some experts sympathetic to the notion of assisted suicide had qualms about the Oregon legislation. Their concern was that doctors might be to willing to hand out lethal doses of medication. "But those of us who were a little skeptical have been proved wrong." Says Dr. Sherwin Nuland, a bioethicist and clinical professor of surgery at Yale University, and author of 1995's best selling book 'How We Die: Reflections on Life's Final Chapter'. "It turns out the law has worked beautifully." (Hewitt, et al, 2001).

Likewise, a book appeared in the late 1990's espousing practical guidelines for assisted suicide. It is entitled 'Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying' by Derek Humprey. One of the reviews gave this brief synopsis: "A controversial guide advocating assisted suicide for the terminally ill and dying also provides practical advice on how to plan and carry out a suicide." (Final Exit: ).

In conclusion both sides of this polemical topic have an enormous stake in what will transpire in the future. How well one side prevails will be largely based in the public arena, and that in turn will influence public opinion. Never the less, the topic of physician assisted suicide is here to stay.

References:

Bopp, James Jr. amp; Coleson, Richard E. (1995, December 1st). The Constitutional case against permitting physician assisted suicide for competent adults with "terminal conditions." Issues in Law amp; Medicine.

Hewitt, Bill, Hardy amp; Alexandra, Arias amp; Ron in Portand, Clark, Champ in Los Angeles amp; Billups, Andrea in Washington, D.C. People, Issue: Sexist Man Alive 2001 Publication date: (2001, November 26) page 62: Last Wish Defending Oregon's Assisted suicide law, four terminally ill patients try to stop federal government from taking their right to die with dignity.

Driedger, S.D. amp; Hunter, Jennifer amp; Morris, Nomi: Maclean's (1998, March 9th): Cover/Justice: 'Everyone Knows It Happens': Taking sides on the right to end life.

Kaveny, C.M. (1997, March 1st): Assisted suicide, euthanasia, and the law.; Theological Studies.

Washington v. Glucksberg; (1998, February 1st): Issues in Law amp; Medicine.

Vacco v. Quill; (1998, February 1st): Issues in Law amp; Medicine.

Humphry,Derek. (1997, April) gt; Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying. ; Retrieved 2003, March 27th.