A mere mention of the word euthanasia draws everyone’s attention to the assisted suicide battle that featured in 1990, the main antagonist being Jack ‘Doctor Death’ Kevorkian. The question of whether doctors or any other person should really help others die has elicited emotive debates since time immemorial. The Hippocratic Oath that medical doctors take when they become practitioners is thought to have been written in the fourth century B.C. The oath has an unambiguous statement that goes, “I will not give a lethal drug to anyone if I am asked nor will I advise such a plan”. In the oath, doctors also promise not to further any courses of abortion. Some of the issues that have been raised during the course of discussions that have characterized assisted suicide is an individual’s right to die especially when they are terminally ill. In fact, four members of a group called the Final Exit Network were recently arrested for helping a man commit suicide in Atlanta as the move was considered a violation of the Georgian State Laws. Those who consider assisted suicide illegal often allude to the assertion of the Biblical Commandment that considers killing a sin. However, it is quite paradoxical that it is the Judeo-Christian societies that have allowed this practice to go on unabated. Assisted suicide was legalized in Australia in 1995 only for the decision to be rescinded two years later. In Switzerland and the Netherlands, it is legal to take part in activities related to assisted suicide (Pickert, 2009). In fact, this prompted Craig Ewert, a Briton, to travel to Zurich with the intent of taking away his life. This event was highly publicized in British Televisions. Even though it is illegal to help somebody to commit suicide in Britain, authorities chose not to prosecute Ewert’s wife and others who aided him to travel abroad to commit suicide. Other issues that have characterized assisted suicide debate relate to imminent death as with the case of Terri Schiavo, a Florida woman who was in a vegetative state and whose feeding tube was removed leading to death. Her case was characterized with fierce and protracted legal battles. Her husband, Michael, claimed that Terri would not have wished to be kept alive while her parents maintained that Terri’s mental health would have been improved through therapy. An Italian woman, Eluana Englaro, who was also in a vegetative state added to the debate of assisted suicide. The questions that many continue to ask is whether people should have right to control when they die. While acknowledging that Americans do not have constitutional rights to doctor-assisted suicide, US Supreme Courts observed that such cases should be left to the individual states. The state of Oregon has since instituted a Death with Dignity law that allows terminally ill patients to take away their lives through injection of a lethal dose. Consequently, 46 people died through the same process in Oregon in 2007. Washington also has a legislation that allows patients with six or fewer months to live to inject themselves with lethal doses. This essay will tackle the issue of assisted suicide by reviewing past and present researches about the issue.
Review of Literature
Snyder and Caplan (2000) state that the debate on euthanasia used to be a preserve of academics. After Oregon legalized physician-assisted suicide, other states began championing for similar legislation. By statute, common law, or homicide statute, seven states still consider assisted suicide illegal. Questions have always been asked to the effect of other states following in the footsteps of Oregon. Legislation on assisted suicide were introduced in 26 states in 1997 and 1998. However, these bills were defeated. Voters in Michigan and Washington shot down initiatives that would have made physician-assisted suicide legal. Many states later approved a ban on assisted suicide including Iowa and Virginia. Practice of medicine has however been impacted by the undertakings in Oregon. The Pain Relief Promotion Act of 1999 has kept physician-assisted suicide a part of legislative agenda.
Burt (1997) attests that the Supreme Court ruling that there is no constitutional right to physician assisted suicide only served to uphold New York and Washington statutes that declared assisted suicide illegal. All states were however required to ensure that the laws they instituted did not distract provision of adequate palliative care to those with symptoms of persons facing death. The plaintiffs had demanded for a right to die with physician’s assistance and not the right to palliative care.
Hurst and Mauron (2003) concur that altruistic assisted suicide is legal in Switzerland. Debate on allowing assisted voluntary death has not been as rife in Switzerland as it is in other countries. However, the debate has brought into perspective the professional ethos of physicians. Acceptance of assisted suicide has gained currency in Switzerland just like other issues surrounding end of life. The fact that foreign nationals have taken Switzerland to be the ideal destination to take away their life has led to increased regulation.
Orentlicher (1997) notes that the Supreme Court’s decision to reject the constitutional right to physician assisted suicide in 1997 appeared to preserve the distinction between withdrawal of life sustaining treatment and assisted suicide. This, it was noted, was not true because the court undermined the distinction by endorsing terminal sedation which is a form of euthanasia.
Lee et al (1996) posited that Oregon physicians had favorable attitude towards legalized physician assisted suicide and were more willing to participate in the act than physicians in other states in the United States. However, a sizable minority objected to legalization of the practice on moral grounds.
Emanuel et al (1998) found out that physicians who look after dying patients were likely to be asked by the patients to assist them in their death. This was found to be very common in the United States. They found out that 3.3 per cent of the physicians likely yielded to their patients’ demand and prescribed a lethal dose of medication compared to 7% in 1995 in Oregon, 13.5 % among New England oncologists in 1994, and 18% among Michigan oncologists in 1993. The national prevalence of provision of lethal dose stood at 4.7% in the study. Physicians chose to participate in hastening their patients’ deaths depending on the region they were practicing, the religion they subscribed to, and their areas of specialty. The nature of debate on whether assisted suicide should be legalized in California, Oregon, and Washington, was the idea behind a higher frequency of requests received by physicians practicing in those states hence the willingness of the physicians to participate in assisted suicide. The study suggested that Jewish physicians were more willing to take part in assisted suicide than other physicians. This was contrary to previous studies that indicated that Jewish and Catholic physicians were reluctant to take part in the practice. Moreover, th study showed that it was not only oncologists who received such requests, but other specialists as well. The study found that despite the fact that lethal injection is supposed to be primarily intended to end a patient’s life, some confused it with terminal sedation. The study underscored the need for education efforts to prepare physicians to explore the meaning of request for assisted suicide. This education will help the physicians to assess the patient’s mental health and the adequacy of palliative care before administering a lethal dose to them. The study pointed out that legalization of assisted suicide could trigger doctors’ willingness to participate in hastening of death and make assisted suicide more prevalent. The researchers also noted that many of the patients who requested for assisted suicide satisfied the criteria put in place as regulatory safeguards for assisted suicide. The study’s finding that 54 per cent of patients did not give their consent on whether they should be assisted to die implies that doctors and family members were forced to intervene with a decision to hasten the death of such patients. Many of the patients had less than 24 hours to live and were in excruciating pain. Sedation could therefore only be appropriate for refractory symptoms in the last hours of life. However, lack of comprehension of circumstances surrounding the requests and actions calls for a lot of caution.
Van der Maas et al (1996) present a reliable overview on medical decisions that pertain to life in the Netherlands. In their 1990 study, they registered increased incidence of euthanasia. This study noted that between 1990 and 1995, there was a 37% increase in the number of requests for doctor assisted death by patients who were in the latter stages of their illnesses. 9 % of the requests were more explicit at a particular time. The total number of deaths registered an increase of more than 5%. In addition, incidences of euthanasia shot from 1.7 percent to 2.4 percent in a death certificate study. However, in an interview study, euthanasia incidences increased from 1.9 percent to 2.3 percent. Patient autonomy made the rate of physician assisted suicide to remain constant and low. In the Netherlands, physicians play the same roles in physician assisted death as that in euthanasia. The study noted that circumstances under which life was ended without request had decreased since 1990. The decrease was notable in interviews and death certificate studies. Proportions of deaths occasioned by opioid administration remained constant from 1990 until 1995. The study notes that euthanasia or assisted suicide still remains a debatable issue and its acceptability, whether on grounds of explicit request by critically ill patients who are competent or not, will still draw emotive debates across the divide. The study notes that the length of time under which the research has been conducted is too short for cultural changes to be observed hence the results may only have a minor impact on the Dutch culture and their healthcare system. Dutch physicians accepted euthanasia as part of medical practice in 1990. The number of people who request for assisted suicide has since increased. However, some requests are never granted. In the Netherlands, physician assisted suicide does not encapsulate patients with less severe illnesses. There has been no indication that decision making has become less powerful. Better documentation and increased frequency of consultation is a pointer to better decision making. An important finding is that Dutch physicians have taken to participating in studies related to physician assisted suicide to enable them demystify this issue to the public.
In their study of legalized physician assisted suicide in Oregon, Chin et al (1999) note that one year after physician assisted suicide was legalized in Oregon, many people took advantage of the decision to request and use a prescription for lethal medication. Financial loss or fret about intractable pain did not feature here. Moreover, a patient’s decision to ask for a physician to assist in hastening their deaths was not influenced by one’s level of education or their health insurance coverage.
Cohen et al (1994) noted that attitudes towards assisted suicide and euthanasia among Washington state physicians were polarized. Some of them were positive about legalization of physician assisted suicide and euthanasia under certain circumstances. However, most of the physicians were not willing to participate in physician assisted deaths.
Discussion and Conclusion
Assisted suicide remains a controversial issue and coming up with legislation to shape the course practice can either be productive or counterproductive. The Supreme Court’s intervention to decipher between individual right to physician assisted suicide and provision of palliative care to critical ill patients has not been significant in addressing the issue. In any case, it has helped champion for the administration of a terminal sedative, which is still a form of euthanasia. Whenever issues relating to assisted suicide are debated, it is pertinent that patients’ consent is sought but only when they are in right frame of mind to make sound decisions.
Burt, R.A. (1997). The Supreme Court Speaks — Not Assisted Suicide but a Constitutional Right to Palliative Care. The New England Journal of Medicine, 337, pp.1234-1236.
Chin, A.E., Hedberg, K., Higginson, G.K. M.D., and Fleming, D.W. (1999). Legalized Physician assisted suicide in Oregon-The first years experience, New England Journal of Medicine, 340. 577-583.
Cohen, J.S., Fihn, S.D., Boyko, E.J. Jonsen, A.R., and Wood, RW. (1994). Attitudes towards assisted suicide. New England Journal of Medicine, 331. 89-94.
Emanuel, E.D., Daniels, E.R, Fairclough, D.L and Clarridge, B.R. (1998). Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. The Lancet, 347(9018). 1805-1810.
Hurst, S.A. and Mauron, A. (2003). Assisted suicide and euthanasia in Switzerland: allowing a role for non-physicians, BMJ, 326. 271.
Lee, M., Heidi D. N., Tilden, V.P., Ganzini, L., Schmidt, T.A., and Tolle, S.W. (1996). Legalizing Assisted Suicide — Views of Physicians in Oregon. The New England journal of medicine, 334. 310-315.
Orentlicher, D. (1997). The Supreme Court and Physician-Assisted Suicide — Rejecting Assisted Suicide but Embracing Euthanasia. The New England journal of medicine, 337. 1236-1239.
Pickert, K. (2009). Assisted Suicide. Web.
Snyder, L., and Caplan, A. (2000). Assisted Suicide: Finding Common Ground. Annals of internal medicine, 132(6). 468-469.
Van der Maas, P.J., van der Wal, G., Haverkate, I., de Graaff, C.L.M., Kester, J.G.C., Onwuteaka-Philipsen, B.D., van der Heide, A., Bosma, J.M. and Willems, D.L. (1996). Euthanasia, Physician-Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990–1995. The New England Journal of Medicine, 335. 1699-1705.