Physician-Assisted Suicide Physicians-Assisted Suicides: The Essay

In an article in the British journal Lancet, the doctor stated that he liked Helen right off the bat, and then issued this statement:

The thought of Helen dying so soon was almost too much to bear… on the other hand, I found even worse the thought of disappointing this family. If I backed out, they'd feel about me the way they had about their previous doctor, that I had strung them along, and in a way, insulted them (Hendin & Foley 2008, 1619).

This statement is shocking as neither hesitation nor a desire to not disappoint Helen's family should have been a factor in helping this woman take her life. This is a prime example of why people should not be allowed to help another in suicide -- physician or not. As humans, there are too many emotions ("Helen dying so soon was almost too much to bear") and abstract thoughts ("even worse the thought of disappointing this family") that are involved when caring for and treating other people. There isn't any way for our emotions or our thoughts to not get in the way and thus be able to make a sound and ethical decision; only God is able to do this.

In the article, "Oregon Hospice Chaplains' Experiences with Patients Requesting Physician-Assisted Suicide," Carlson et al. (2005) surveyed chaplains in Oregon hospices concerning their attitudes toward physician-assisted suicide (PAS). In the study, 50 of 77 hospice chaplains (65%) whom were contacted by the researchers returned the survey. Forty-two percent of the respondents were against the ODDA and 40% supported it (2005, 1160). Overall, the chaplains did not feel that they had any sort of impact on the patients' decisions about PAS (mean score of 4 on a 0 to 10 scale) (2005, 1160).

The fact that the views of PAS -- either against or opposed to -- were nearly equal amongst Oregon chaplains. The purpose of the chaplain in a hospice situation is to help provide patients with both emotional and spiritual support as the patients in a hospice are faced with the end of their lives and all of the emotional and spiritual questions that go along with it. Carlson et al. (2005, 1165) notes that hospice chaplains use their skills by helping the patient explore and come to terms with issues of faith and spirituality when it comes to making the decision for PAS. A strong religious belief is constantly shown as being related to the opposition to PAS. While one has to assume it is a necessity of a chaplain to have strong religious beliefs, it is surprising that the perspectives on PAS were equally divided.

There are a few problems related to Carlson et al.'s study. First of all, 35% of potential respondents did not reply and whether their perspectives are along the same lines as those reported in the study are unknown (2005, 1165). The overall sample size was also quite small. Another issue that raises potential bias is the fact that Oregon is quite original in its legislation for PAD and thus it is hard to say to what extent the study's findings may be generalizable to the experiences of hospice chaplains in other states where PAS might be requested (though not legalized) (2005, 1165). Another problem with the study is that it is not known how often Oregon hospice patients who want PAS refuse any kind of contact with a chaplain. Carlson et al. states that in other studies of terminally ill patients who want PAS, the refusal to meet a chaplain seems quite common. This may reflect not just PAS patients, according to Carlson et al., but Oregon residents, in general, who have low religiousness (2005, 1166).

Since Oregon passed its PAS law, Washington state has also joined its neighbor state in legalizing PAS, modeling its own Death with Dignity Act on the Oregon Act. Particularly frustrating about both of these Acts are the way in which they are termed. The euphemisms "death with dignity" and other terms are emotionally charged -- and judgmental (Steinbrook 2008, 2513). Furthermore, deaths under the Oregon Act and Washington Act are not deemed or called "suicides." If these deaths thus are not deemed suicide, then the only other name that they could be given is murders. There is either killing someone or not, or killing one's self or not. A doctor giving a patient whom he or she has deemed is sick enough to die is not a form of healing; it is only a form of killing.Though the patient who enlists a physician for their suicide is essentially the one injecting the medicine, the doctor is a key component in this death as it is one that would not happen without him or her.

Historically, the role of the physician has always been as a healer, not as a taker of life. Physicians study medicine as a way to treat their patient's symptoms with medications that will put an end to suffering as best as it can. The fact that it can only be to the best of their ability or the medicinal capabilities is because a physician's role is that of a human healer, not as a super-power who holds the keys to the end of suffering. The Death with Dignity Acts of Oregon and Washington state makes a definite division between the legal and the illegal, which for the legal requires the intent of the physician and the consent of the patient. However, it is impossible to discern intent and patients may offer consent when they are in a state of mind that doesn't leave them able to make a decision of this sort (Pickett 2008, 9). Therefore, how does one ever separate murder from medical care?

In the Netherlands, where euthanasia is legal, physicians are 19 times more likely to end a dying patient's life using procedures where they are not required to report (Pickett 2008, 11). Conversely, reporting in Oregon puts the patients requesting PAS into hospice care and promotes the treatment of pain (2008, 12). This dichotomy between what happens in the Netherlands where reporting is not required and Oregon where it is required shows that the more freedom physicians are given to utilize euthanasia, the more they will -- especially when they do not have to report.

As noted in the case of Helen earlier in this paper, physicians are not able to separate their emotional and cognitive processes from situations in which they deal with their patients. In end-of-life care, especially, how can doctors be sufficiently able to put aside their human feelings for a patient and make such a decision? or, in the cases of some doctors, how are they not able to consider the emotional side of the situation? While some doctors may be emotionally-invested in a patient's end-of-life care, others may not be.

In the article, "Attitudes Toward Assisted Suicide and Euthanasia Among Physicians in Washington State," Cohen, Fihn, Boyko, Jonsen, and Wood (2011, 89) found that of 938 physicians that completed surveys regarding their opinions on PAS, 48% of the responding physicians said they agreed with the statement that euthanasia is never ethically justified, and 42% disagreed. While 54% thought that euthanasia should be legal in some situations, only 33% stated that they would be willing to perform euthanasia themselves (2011, 90). There was slightly more supported for PAS: 39% agreed with the statement that PAS is never ethically justified, and 50% disagreed. Fifty-three percent thought that PAS should be legal in some situations, yet only 40% said that they would be willing to assist a patient in committing suicide (2011, 90).

Like the chaplains who were questioned in Oregon, these Washington physicians were also divided on the topic of euthanasia and PAS. The reasoning behind the division in beliefs may take form due to an individual's personal, professional, ethical, and/or religious beliefs, however, due to the nature of the topic, it is not surprising that so many of these chaplains and physicians are divided. What is suggests is that it is simply not right or ethical to give such power to an individual. This is not even considering the fact that these doctors took a Hippocratic Oath. In no way did this oath ever give a physician a right to kill another human being or to use his or her knowledge of medicine in order to carry out such an act.

The role of the doctor is as healer, not killer; this is the way it has been forever and this is the way that it must continue to be. To be a healer is to work in the best interest of the individual, which means finding ways to help them manage their pain and finding ways to improve palliative care. Giving physician-assisted suicide such a gentle name is wrong and manipulative as it makes.....