FINAL REPORT: Physician Assisted Suicide

Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act. Internationally, physician-assisted suicide is available in Australia (Victoria and Western Australia) Austria, Belgium, Canada, Columbia, Finland, Germany, India, Luxemburg, Netherlands, and Switzerland. Even if a patient requests physician-assisted suicide and they meet the legal criteria, their physician may not oblige. A physician does not have to provide PAS just because it is legal in the state where they practice medicine. They may believe that engaging in such an act would do more harm than good, or that such an act is incongruous to their primary role as a healer. For example, the physician provides sleeping pills and information about the lethal dose, while aware that the patient will commit suicide). It is different than pulling the plug and allowing a patient to dehydrate. Unlike physician-assisted suicide, withholding or withdrawing life-sustaining treatments with patient consent (voluntary) is almost unanimously considered, at least in the United States, to be legal.

Reasons for physician suicide

Loss of autonomy and loss of ability to enjoy activities were less common reasons among patients in this study compared with other jurisdictions. According to the relative, in 92% of patients, EAS had contributed favorably to the quality of the end of life, mainly by preventing or ending suffering. ALS (ALS is amyotrophic lateral sclerosis, is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord), health care providers support the SCC (Supreme Court of Canada) decision and the majority believe PAD should be available to patients with moderate to severe ALS with physical or emotional suffering. However, few clinicians are willing to directly provide PAD( is physician-assisted death) and additional training and guidelines are required before implementation in Canada.

According to a Canadian study of 112 patients who received medical assistance in dying, the main reasons people requested it included: 2 Loss of control and independence Loss of ability to participate in enjoyable and meaningful activitiesIllness-related suffering (for example, pain or nausea)Fear of future suffering

Based on additional research, other possible reasons for requesting physician assistance with dying include:3 Loss of sense of purpose, Unacceptable quality of life, unable to enjoy life with less ability. 

Opposition to Euthanasia

Reasons for the opposition to Euthanasia include inherent moral reasons (religious). Physicians that disagree and refuse service could have a conscience violation which leads to the toll these deaths would have on doctors (It may restrict Dr‘s freedom to work per their conscious- if they object it would lead to a referral which violates their conscience). PAS disincentives palliative care societally and individually. In Holland. PAS is mainstream and people ask for euthanasia because of fear of poor palliative care. The mainstream idea of euthanasia being considered healthcare has led to patients being refused treatment and offered euthanasia (stemming from financial reasons). Speaking of mainstream, areas that legalize PAS see a 6-12% increase in general suicide rates (affecting vulnerable groups), hinting at an increased inclination of suicide to other individuals. Legalizing PAS puts substantial pressure on vulnerable people to end their lives. The number of people who choose PAS for the reason they think they are a burden has exponentially increased (2 in the first year to 91 in the third)

Why it is a slippery slope

Once the gates are open for doctors killing their patients it is difficult to see how economic pressures would not impose. Those for physician-assisted suicide give autonomy, compassion, and economic arguments (If autonomy is the driving motivation, then why should we impose any limits on euthanasia other than consent? If children or healthy adults or adults with eating disorders want to end their lives, who are we to get in the way of their autonomy? Likewise, if compassion is the driving motivation, it is difficult to see why we should impose any limits at all, even the requirement for a voluntary decision). These have so much power. Side effects come with the regulation of the practice of PAS (Holland had 3200 cases of voluntary euthanasia, and 900 cases of involuntary euthanasia. Belgium had 1800 people die from euthanasia without consent 2 years after implementing PAS. Half are unreported despite legal mandate). The untouchable human rights (Our basic human rights are untouchable such that we are not even entitled to surrender them ourselves. Take, for example, the right not to be enslaved. Most people are agreed that we do not have a right to sell ourselves into slavery as chattel slaves – to do so would be to degrade ourselves and disrespect our own humanity, as well as to set an unacceptable precedent for how human beings may be treated. Likewise, since the right to life is the most basic right, it is reasonable to suppose that we may not violate our own right to life). The intrinsic value of life (Life is measured intrinsically not extrinsically. You can’t be worth more, all people and time is infinitely valuable). Difficult to distinguish between euthanasia and Inegalitarian thinking (Inegalitarians accept inequality, laws will indicate some lives are worth more than others), (90 cases of euthanasia for newborn babies with disabilities mainly spina bifida. Since the passing of physician-assisted suicide in Holland there are attempts to legalize euthanasia for those entirely healthy but tired of life, and already euthanasia for patients with depression and eating disorders). The persuasion of patients with chronic illnesses becomes a threat (as discussed in class, plenty of malpractice- physicians being warped into thinking more lives and less suffering is good. And also the idea OK physician making that his forte). Limits have been expanding in countries that have introduced EPAS, including extending EPAS to patients without their consent (Holland cases that were deemed to be murder were treated with impunity). In Belgium, over 3% of all deaths are from euthanasia without consent, Nearly 1800 cases. In 1998, in 2007 it decreased to 1.7%. The case of Dutch GP, Dr van Oijen, was one of the few to actually be investigated for widespread illegal euthanasia. He breached every single guideline and was convicted of murder (There was no explicit request – in fact, the patient had declared that she did not want to die; there was no unbearable suffering (she was comatose at the time); there was no consultation with another physician; the drug had exceeded its expiration date after being leftover from euthanizing a previous patient; and he lied when reporting the death, saying it was by natural causes.) Dr van Oijen was given a fine( for lying on the report), a short suspended jail sentence, and was given only a warning by the medical authorities. Physician-assisted suicide puts a lot of faith into medicine which has performed as a business. When these patients die, the doctors will not visit their graves. The families will. This obviously puts a lot of responsibility on the government and healthcare workers alike- who may not have the best interests of the patient at heart. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135145/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135118/#b11-064e380 

https://pubmed.ncbi.nlm.nih.gov/17131559/ 

https://n.neurology.org/content/87/11/1152 

https://www.nybooks.com/articles/1997/03/27/assisted-suicide-the-philosophers-brief/ 

https://pubmed.ncbi.nlm.nih.gov/25628351/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847835/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913834/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510045/ 

https://pubmed.ncbi.nlm.nih.gov/29395542/

https://plato.stanford.edu/entries/euthanasia-voluntary/ 

https://www.bmj.com/content/341/bmj.c5174

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882450/

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2614587 

What kind of psychological diagnosis/screening allows a patient to be approved for such a decision?

Could you relate putting an animal down because they are suffering to putting a person to rest?

Is Suffering worse than losing lives?

Could you draw a line on a viable diagnosis that allows the choice of PAS? 

Would a chronic diagnosis for someone under 18 be under their parents jurisdiction? 

Would quality of life being impacted call for the option of physician-assisted suicide?