Running head: PHYSICAN ASSISTED SUICIDE 1

Special Health Topic- Written Analysis: Physician Assisted Suicide

Team 4: Victoria Carlson, Jennifer Tayler and Sletta Mata

HCA-412A

Professor: Jorge Melendez

Warner Pacific University

October 2, 2019
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PHYSICAN ASSISTED SUICIDE

Imagine sitting in physicians office and getting the news that that foreign illness will end

your life in the following months; there is nothing that can be done, no treatment or surgery that

will cure or slow the progression of this fate but the bad news doesn’t end there. Next you’re told

how painful and awful it will be, what you can expect your body to do or stop doing while this

illness takes you. This is the situation people are in when they get this news. They have no say or

any way out of this fate. These are the people who need and want a Physician Assisted Death.

In 1994, Oregon State legislature passed a law allowing for terminally ill patients with

less than 6 months to live the end of life option that gives them the voice and power to meet their

end on their terms. This involves physicians help to prescribe medication to cause the death of

the patient. It is known as Physician assisted death, death with dignity, aid in dying and other

terms. The organization that supported the law and help pass it in other states since 1994 are

various and available in many states throughout the country. They’re giving the patients back the

power over their lives or more specifically their choice in how to meet their end.

The ethical and moral issues that are presented and debates is whether the assistance by

physician is considered murder or if the whole idea of giving a patient’s the right to die on their

terms is considered suicide both options being against the laws in every state in America.

In the bare terms of the actions it can be argued that yes it taking a life and goes against a

physician's oath to do no harm to patients. This oath is known as the Hippocratic Oath. This oath

is an ancient Greek document that is used to “establish the practitioner of medicine give

deference to the creators, teachers, and learners of medicine. This ensures that the practitioner
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does not forget his place in the long line of tradition in health. The oath serves as a contract for

doctors to work towards the benefit of the health of the public.”(The Hippocratic Oath, N.D.)

The Hippocratic Oath was promise made by providers to make the best decisions they

can for the betterment of a patient’s health. One famous line in the oath reads as “do no harm”; in

the last few decades the oath itself has changed to include excluded exceptions like abortions,

euthanasia and end of life choices. In the newer oaths taken it is not mentioned that these acts are

not be upheld or performed. As times and laws have changed the oath is updated as well as it

follows the current needs of the patients providers serve. While some argue that it goes against

the philosophy of medicine and health having a choice is a patient's rights; these rights have been

affirmed and defended by several states in America.

As of 2019 there are currently nine states that defend the patient’s right to choose the

manner of their death. The laws vary in names but overall the movements and right is widely

known as death with dignity. The basic concept of the act is applied to terminally ill patients who

want to choose their life with assistance rather than suffer from their illness. The requirements

are an adult resident of a state where such a law is in effect (CA, CO, HI, ME, NJ, OR, VT, WA

+ DC); mentally competent, i.e. capable of making and communicating your healthcare

decisions; diagnosed with a terminal illness that will lead to death within six months, as

confirmed by two physicians; and capable of self-administering and ingesting medications

without assistance. (Frequently Asked Questions- Death with Dignity (n.d.)

The first state to uphold and pass the law was Oregon in 1994. Since it passed

movements to repeal the act have tried over several years to get it nullified but have been

unsuccessful. The act was implemented in 1998 and in the years since over fifteen hundred
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terminally ill patients have received prescription by physician to aid in their passing. Of those

fifteen hundred under one thousand have used the medications to aid their passing.(Oregon-

Death with Dignity (n.d.)

The state of Washington Death with Dignity Act has been in effect since March of 2009.

The model of the act is similar to Oregon’s act but in 2017 a legislative action proposed an

addition to the bill which added “the treatment for the purpose of cure and the treatment for the

purpose of extending the patient’s life”. (Washington- Death with Dignity (n.d.) This means the

providers would have to inform a patient of the act under the Washington Death with Dignity

act.

The state of Vermont voted to have the act enacted in 2013 and went into effect

immediately after making Vermont the third state to pass patients’ rights law of this kind.

Religious groups in Vermont submitted a lawsuit against the act in July of 2015 stating the law

infringes on the physicians’ freedom of speech by requiring them to discuss with patients all

their end of life options including aid in dying.. The lawsuit was dismissed in April of 2017 on

the grounds that a physician has the duty of informing all patients about their choices and options

relevant to their medical treatment. (Vermont- Death with Dignity (n.d.)

California passed the End of Life Option Act and it took effect in June of 2016.The state

of California has the same basic layout of others states but because of California statues

modifications has to be made and amended to protect physicians from legal issues. In 2018

Governor Brown signed in to law AB-282 which amends the California penal code to “prohibit a

person whose actions are compliant with the End of life Option Act from being prosecuted for

deliberately aiding, advising or encouraging suicide. (California- Death with Dignity (n.d.)
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Colorado act is called the End of Life Options Act. Passed in November of 2016 it went

into effect in December of that year. Colorado was one of the first state after Oregon to bring

legislature forward to advocate for this patient's right but was rejected in 1994 and 1995 and was

not reintroduced again till 2015. Recently an amendment have been submitted to allow rather

than require the attending physician or hospice medical director to sign the death certificate of

someone who used and au-in dying medication but was never passed. (Colorado- Death with

Dignity (n.d.)

The District of Columbia passed the D.C. Death with Dignity Act in February of 2017

and implemented in June of 2017.Simialr model as the other laws apply. A federal budget

proposal was presented to the US House of Representatives in 2019 which included a rider

repealing the death with dignity act. The bill passed in 2018 without the rider included. (District

of Columbia- Death with Dignity (n.d.)

The state of Hawaii had presented several legislations going back almost two decades to

get their Our Care, Our Choice Act passed. In January of 2019 the act was made effective.

(Hawaii- Death with Dignity (n.d.) New Jersey is another state that has also very recently passed

a similar law. In New Jersey it is known as the New Jerseys’ Aid in Dying for the Terminally Ill

Act. It was made effective in August of 2019 but is halted after a restraining order was placed on

the law to stop the implementation. In August the restraining order was lifted and the New Jersey

Supreme Court denies the option of appealing the decision. (New Jersey- Death with Dignity

(n.d.)

The state of Maine passed the death with Dignity Act into law in June of 2019 becoming

the ninth state in America to allow this right for patients. The Civic Christian League of Maine

filed a petition to repeal the new law but in September announced they did not gather the
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required amount of signatures to put the initiative in Maine to repeal a law. In 2017 Public Policy

Polling survey reported that seventy three percent of Maine residents support the legislature.

(Maine- Death with Dignity (n.d.)

The Death with Dignity Act is still controversial. There are many pros and cons when

evaluating the topic. Some pros of the Death with Dignity Act include giving a terminally ill

patient the right to choose to die, it ends end of life suffering, allows the patient to choose to end

life support, legal requirements must be met first, it is used as a last resort option, end of life care

is still in place. Giving a terminally ill patient the right to choose to die allows them to choose to

end their suffering and pain caused by the illness. Some argue that a terminally ill patient’s right

to choose to die is the same as a “person’s right to live, get married, have children and refuse

medical treatment if he or she deem appropriate” (Regoli, 2015). Denying a terminally ill patient

the right to choose to die could also be seen as denying that patient their liberty. The Death with

Dignity Act also ends end of life suffering. Terminal illness can quickly deteriorate a patient’s

quality of life as well as cause an excess of physical and emotional pain.

Even if medication can help to control the discomfort that they experience, the drugs can

change how an individual interacts with their loved ones. If the disease takes a prolonged time to

finally cause the physical body to succumb, the toll it takes on the physical, emotional, and

financial health of the family can be significant. Legalizing physician-assisted suicide can help to

provide relief for everyone in this situation while preserving the dignity of the patient. (Regoli,

2019)

Another pro to the Death with Dignity Act is that a terminally ill patient can choose to

end life support. This choice reduces the suffering that the patient experiences. Life support does

not heal or cure the patient or improve the patient’s quality of life. The Death with Dignity Act
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requires that legal requirements must be met. “In Washington State, the Death with Dignity Act

requires a patient to be terminally ill with less than six months to live according to the diagnosis

from their doctor. Only qualified patients can make a written request for medication that they

must self-administer to end their life” (Regoli, 2019). If a patient makes a written request but is

not of a sound mind due to mental illness or being in an altered state, it is illegal for a physician

to offer a prescription for the patient to fulfill their wishes. If a patient is of sound mind it is

required that two witnesses sign the patients written request. The witnesses can not be affiliated

to the patient in any way. They can not be related to the patient, be entitled to part of the patient’s

estate, or employed at the facility where the patient receives care. The Death with Dignity Act is

a last resort. “Many doctors favor the legalization of physician-assisted suicide for those who are

already dying on the condition that their suffering cannot find relief in any other way” (Regoli,

2019). This gives patients a dignified way to pass rather than seeking other alternatives. Another

pro to the Death with Dignity Act is that it does not replace or remove end of life care.

“Allowing a person with terminal illness who has six months to live to spend the last days doing

things he or she loves, choosing when he or she wants to die and dying in the comfort of his or

her home, surrounded by loved ones is what the Death with Dignity Act entails” (Regoli, 2015).

The patient can choose to receive care in a hospital or their home. The Death with Dignity Act is

meant for patients suffering from a terminal illness, there are requirements that patients must

meet to be eligible for the Death with Dignity Act. The Death with Dignity Act is meant to allow

a terminally ill patient the option to end their pain or suffering.

Although, it was meant to bring good for those suffering there are still cons with the

Death with Dignity Act. Some of the cons related to the Death with Dignity Act include going

against the Hippocratic Oath, it’s morally unethical, patients could be guilted or courased into it,
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the federal government is not in agreement, and terminally ill patients receive inaccurate survival

estimates. It has been argued that the Death with Dignity Act goes against the Hippocratic Oath

to do no harm. Even though a patient has to make a request and meet requirements before they

can be prescribed the medication to end their life it is argued that, “it is against the Hippocratic

Oath, particularly the part where it states, “I will neither give a deadly drug to anybody if asked

for it nor will I make a suggestion to this effect”” (Regoli, 2015). The Hippocratic Oath is taken

by doctors when they begin their career, when taking the oath they swear to uphold ethical

standards. The Death with Dignity Act is also viewed as morally unethical. It is believed by

many, especially by religious and moral leaders, that life was given and is taken by God. It is

Him who decides when we are born and when we pass. Assisting a person to end their life is not

in our human authority according to religious and moral leaders. Another con to the Death with

Dignity Act is that a patient could feel guilted or be courased into ending their life. A patient

may feel guilty for, or like a burden to their family that take care of them. They may also feel the

burden of the finances that add up during the end of their life. These patients might use the Death

with Dignity Act as a way to end their lives and relieve their family from suffering or to relieve

their families from the financial burden of their illness.

Oregon’s Health Authority also surveyed the residents who chose to approach a

participating physician with the idea of a lethal prescription about their reasons for wanting to

die. 91% said that a loss of autonomy was the primary reason why they were thinking about

taking their life. 90% said that their terminal illness may it challenging to enjoy their usual

activities. Pain was cited as a reason only 26% of the time, while just 4% of patients said that

there were financial considerations for their decision. (Regoli, 2019)

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Unfortunately, the Death with Dignity Act may not be seeked for the manner and reasons

in which it was meant to be used and help. The Death with Dignity Act is not part of a federal

agreement. Individual states can decide to enact Death with Dignity, but it is not a federal law.

“As of this writing [January, 2016], only Oregon, Washington, Vermont, Montana and New

Mexico allow physician assisted death. But even if this is the case, the federal government is

against this act” (Lombardo, 2016). This can make it hard for nationwide support for the act.

Another thing that can make it hard to support the act is that terminally ill patients don’t always

get accurate survival estimates. “A 2001 study from the University of Chicago found that

patients received an accurate diagnosis in only 37% of the cases where a terminal illness was

diagnosed. 23% of doctors in the study refused to even give an estimate. 40% said that they

would intentionally offer an overestimate” (Regoli, 2019). This makes it hard for patients

because they need to have a terminal illness and a life expectancy of six months or less to qualify

for the Death with Dignity Act. The Death with Dignity Act is in place for those suffering from a

terminal illness. If a patient is considering the use of the act to end their life they sound have

trusted friends and family help them to remain aware of both the pros and the cons while

considering their decision.

Not just anyone and everyone qualify for Physician Assisted Suicide (PAS), or the Death

With Dignity Act. Currently, there are only nine of the official 50 United States that legally

allow a person to opt to die with PAS. Those states are: California, Colorado, District of

Columbia, Hawaii, Maine, New Jersey, Oregon, Vermont and Washington. (“Take Action,”

N.D). However, simply residing in one of these states does not automatically allow one to choose

PAS to end their life. Laws surrounding The Death with Dignity Act are derivatives of the basic

principle that terminally ill people have a right to choose when and where they die. This choice is
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to be on their own terms without government interference. (“States that allow assisted deaths,”

N.D).

While many states believe it is a patient’s right to choose how much they wish to suffer from a

terminal illness, there are still many laws surrounding the act.

Death with dignity statutes allow mentally competent adult state residents who have a

terminal illness with a confirmed prognosis of having 6 or fewer months to live to voluntarily

request and receive a prescription medication to hasten their inevitable, imminent death. (“States

that allow assisted deaths,” N.D. para 2).

But, to qualify, there is a substantial process in place that requires a minimum of two

physicians confirming patient’s residency, diagnosis, prognosis, mental competency and

confirmation that the patient is in fact, making the choice voluntarily. Furthermore, there are two

separate waiting periods of 15 days. The first period comes after the oral request for PAS and the

second comes after receiving the prescription for the lethal dose of medication. (“States that

allow assisted deaths,” N.D).

There are several ways physician assisted dying can be implemented. When a physician

assists in the death of a patient, they are simply supplying the means, but not administering. The

options for hastening death in the states where the act is legal include: terminal sedation, or

sedation a person to the point of unconsciousness, withholding life-saving support or a lethal

dose of pain medication prescribed by a physician can be taken by a competent patient ultimately

ending their life. (“For Healthcare Providers,” N.D.)

As these means of ending life are options in only select states, anyone, anywhere can opt

into and benefit from alternative methods of end-of-life care. These methods are considered
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palliative care. Palliative care includes programs like hospice that can be received in-home, in-

hospital or other long-term care facilities.

Palliative care focuses on improving a patient’s quality of life by alleviating pain and

other distressing symptoms of a serious illness. Palliative care is an option for people of any age

at any stage of illness, whether that illness is curable, chronic, or life threatening. (Anderson,

2015. para. 4)

Without doubt, the PAS or, Death with Dignity Act is controversial. “The ethics of

assisted death continue to be debated,” (“For Healthcare Providers,” N.D. para 4). Some choose

to believe that PAS is ethically justified as a person should have their own right to choose to end

their suffering as well as the grounds that it is a physician’s duty to relieve suffering, that at

times, justifies physician assisted suicide. On the opposition, many choose to believe the act is

unethical as it is a physician’s job to preserve life. (“For Healthcare Providers,” N.D.).

Furthermore, this act is also perceived as “essentially utilitarian and fail to consider the inherent

value of human life,” (Erdek, 2015. para. 2).

Personally, I see both sides of the argument. While I believe this will always be a

controversial subject, I think we as humans who have compassion for other humans, should

educate ourselves on the topic and consider the ethical thing to do, just might be to allow a

person to decide for himself.

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References

Anderson, R. (n.d.). The Alternative to Physician-Assisted Suicide: Respect Human Dignity

and Offer True Compassion. Retrieved October 13, 2019, from

https://www.heritage.org/health-care-reform/report/the-alternative-physician-assisted-

suicide-respect-human-dignity-and.

Erdek, M. (2015, May). Pain medicine and palliative care as an alternative to euthanasia in

end-of-life cancer care. Retrieved October 13, 2019, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434784/.

Death with Dignity Acts - States That Allow Assisted Death. (n.d.). Retrieved October 13,

2019, from https://www.deathwithdignity.org/learn/death-with-dignity-acts/.

For Healthcare Providers - Aid in Dying Medication. (n.d.). Retrieved October 13, 2019, from

https://www.deathwithdignity.org/learn/healthcare-providers/.

Lombardo. (2016, January 15). Pros and Cons of the Death with Dignity Act. Retrieved

October 13, 2019, from http://visionlaunch.com/pros-and-cons-of-the-death-with-dignity-

act/.

Regoli, N. (2015, July 24). 8 Far-Reaching Pros and Cons of the Death with Dignity Act.

Retrieved October 13, 2019, from https://connectusfund.org/8-far-reaching-pros-and-cons-

of-the-death-with-dignity-act.

Regoli, N. (2019, April 15). 19 Main Pros and Cons of Legalizing Physician Assisted Suicide.

Retrieved October 13, 2019, from https://connectusfund.org/8-main-pros-and-cons-of-

legalizing-physician-assisted-suicide.
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Take Action - Advocate for Death with Dignity in Your State. (n.d.). Retrieved from

https://www.deathwithdignity.org/take-action.

Frequently Asked Questions- Death with Dignity (n.d.) Retrieved from

https://www.deathwithdignity.org/faqs/

Oregon- Death with Dignity (n.d.) Retrieved from

https://www.deathwithdignity.org/states/oregon

Washington- Death with Dignity (n.d.) Retrieved from

https://www.deathwithdignity.org/states/washington

Vermont- Death with Dignity (n.d.) Retrieved from

https://www.deathwithdignity.org/states/vermont

California- Death with Dignity (n.d.) Retrieved from

https://www.deathwithdignity.org/states/california

Colorado- Death with Dignity (n.d.) Retrieved from

https://www.deathwithdignity.org/states/colorado

District ofColumbia- Death with Dignity (n.d.) Retrieved from

https://www.deathwithdignity.org/states/district of columbia

Hawaii- Death with Dignity (n.d.) Retrieved from

https://www.deathwithdignity.org/states/hawaii

New Jersey- Death with Dignity (n.d.) Retrieved from

https://www.deathwithdignity.org/states/new jersey

Maine- Death with Dignity (n.d.) Retrieved from

https://www.deathwithdignity.org/states/maine
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The Hippocratic Oath- The Evolution Of Medical Ethics (n.d.) Retrieved from

https://owlspace-

ccm.rice.edu/access/content/user/ecy1/Nazi%20Human%20Experimentation/Pages/Hippocratic

%20Oath.html