Physician-assisted suicide is a controversial topic in the aspect of whether it should be legal or illegal. To fully understand physician-assisted suicide, it is important to understand and realize some background information of what is legal in the United States currently. In the article, Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care, it states the definition of physician-assisted suicide. It says, "PAS is defined as follows: a physician intentionally helping a person to terminate his or her life by providing drugs for self-administration, at that person's voluntary and competent request." (Board Members of the EAPC 109). It is also important to know that physician-assisted suicide is not legal in all states in the United States. It is legal by law in four states: Oregon, Vermont, Washington, and California. It is also legal by Court Ruling in Montana (CNN Library). 

There are many reasons why it shouldn't be legal, but there are also many reasons as to why it should be legal. It should be legal in the United States, but there should be certain guidelines for it and it should be decided based on each individual patient. Along with that, each patient should have to meet certain criteria. 

The main reason why physician-assisted suicide should be legal is so that the patient can die with dignity. If a patient is so terminally ill that they can't live their life to the fullest anymore, then they should be able to have the right to decide that it is their time to go. Many patients get to the point in their illness, where they can no longer fully function on their own and aren't even fully mentally there anymore. Also, if there is no longer anymore treatment available to stop this from happening, then the patient should be able to decide their next steps. In an article from theatlantic.com called From Doctor to Patient to Assisted-Suicide Advocate, a physician describes his battle with a fatal illness and how it then affected his view on physician-assisted suicide. The author of the article, Anna Gorman, states what Dan Swangard, a California physician, told her in an interview. She says, "When he dies, Swangard said, he wants to be surrounded by people he loves. He doesn't want to be in a drug-induced haze, nor consumed by worry about what's next." (Gorman). Swangard wants to be able to die with dignity and know that he is dying. He doesn't want to make his loved ones suffer by not being able to say goodbye or not being fully there due to the illness. There is another alternative to physician-assisted suicide that some may argue is a better option. This option is called Palliative Sedation. In an article by Bert Broeckaert, called Palliative Sedation, Physician-Assisted Suicide, and Euthanasia: "Same, Same, but Different"?, the intention of palliative sedation is described as, "the intention is to relieve refractory symptoms, never to kill the patient." (Broeckaert). Broeckaert also describes it by saying, "In the case of palliative sedation, terminally ill patients die as result of their illness;". This could be an alternative to physician-assisted suicide, but it would have to depend on the patient's illness and how it would affect their day-to-day lives. As Swangard, the physician with a fatal illness, had stated, he wouldn't want to be in a "drug-induced haze", he would want to be able to live his normal life (Gorman). In an article by Jessica Keating called On Dying Well, she states that dying with dignity is controversial. Keating also says that, " ... euthanasia and physician-assisted suicide are as much about unseemliness and fear of suffering as they are about death." (Keating 1). Like Keating, some may think dying with dignity is actually giving into the fear of death, but in the end it should be the patient's sole decision on what is best for them. 

Another reason why physician-assisted suicide should be legal is to put the patient out of their pain. If a patient's illness is causing them so much pain that it is hard for them to live their everyday lives and there aren't anymore options of pain-reducing treatment, then a patient should be able to decide if they want to continue to suffer or not. There is another alternative to physician-assisted suicide and it is called VSED. This stands for the voluntary stopping of eating and drinking. In the article Voluntary Stopping of Eating and Drinking: An Ethical Alternative to Physician-Assisted Suicide, the author, Vicki D. Lachman, states that VSED takes up to 1-3 weeks while physician-assisted suicide is effective within minutes-hours (Lachman 2). Therefore, if the patient wanted to end their life due to pain then they would then still end up suffering longer with VSED than they would with physician-assisted suicide. 

If physician-assisted suicide is going to be legal at all in the United States, it must be legal in all fifty states. It is currently legal in five of the states: Montana, Oregon, Vermont, Washington, and California (CNN Library). With physician-assisted suicide only legal in these five states, this leads to some problems. The main issue with this is that for example: If a patient in Nevada is terminally ill and wishes to partake in physician-assisted suicide but it is illegal in Nevada. So, this patient will then go to California to partake in medical care there and therefore will then be able to participate in physician-assisted suicide. Physician-assisted suicide being legal in all fifty states will eliminate patients from hopping across states to receive this "treatment". There could be restrictions on who is eligible to partake in physician-assisted suicide in each state based on residency, but there would be ways to get around this policy as well. For example, say the same patient who lives in Nevada is terminally ill. Now, she can't hop across the state border and go straight to a medical professional ask for physician-assisted suicide, but she could buy a house or rent an apartment in California and then become a resident. She would then be allowed to participate in physician-assisted suicide. 

For physician-assisted suicide to be legal, there should be guidelines and rules put in place. Also, patients must meet certain criteria before being considered as a candidate for physician-assisted suicide. Before considering a patient for physician-assisted suicide, it should be completely proven that there is absolutely no other treatment available to cure the patient from their fatal illness. Everything possibly should have been tried or at least spoken of between the patient and the doctor. This will prevent any legal aspects from being questioned or even being a concern. 

Along with this, the cost of treatment and the cost of physician-assisted suicide should be considered and corrected. In an article on time.com by Christopher J. Hale called There's Nothing Progressive About Physician-Assisted Suicide, Hale states, " ... many lower-income residents in Oregon might qualify for assisted-suicide drugs, but not qualify for basic treatments or even hospice care under Medicare and Medicaid." (Hale). All patients should be eligible for treatments and then be eligible for assisted-suicide drugs. In this same article, an example of a patient and resident of Oregon, who was diagnosed with advanced lung cancer, had an issue with the costs of treatments versus the cost of assisted suicide drugs. The article describes the situation, "The Oregon Health Plan office refused to pay $4,000 per month because it wasn't within its narrow guidelines of appropriate treatment. But it did offer to $50 for lethal prescription drugs to end her life." The numbers shouldn't be completely flipped but they shouldn't have that drastic of a difference between the two. There should be an equal opportunity for treatments and physician-assisted suicide across the board, and it starts with money. As Hale quotes in the time.com article, "we'll pay for you to die, but not pay for you to live ... " ("There's nothing progressive" Hale); this is not what should be followed when making physician-assisted suicide legal. 

Also, a patient's age should be considered before coming to the conclusion of physician-assisted suicide. If a patient is under the age of eighteen, a parent consent must be required. It is proven that a child's brain is not fully developed under the age of eighteen and therefore should not be able to make life-altering decisions. In the article Euthanizing Life by John F. Kavanaugh, it is stated that in The Netherlands, "Children between 12 and 18 are required to have parental consent." (Kavanaugh 1). For children under the age of twelve, physician-assisted suicide shouldn't be available at all. For those over the age of eighteen, age shouldn't have any limits on the availability of physician-assisted suicide to them. This idea of age restrictions should be followed in the legalization of physician-assisted suicide. 

On the physician aspect, some physicians may not agree with the idea of physician-assisted suicide and whether or not it should be legal, as well. Therefore, physicians must sign a contract before receiving their license agreeing 100% that they will partake in physician-assisted suicide if and only if the prior criteria and guidelines are met. If they do not sign this contract, then they will therefore not be allowed at any time to participate in physician-assisted suicide in any way. In the article from theatlantic.com, Gorman states this, "Swangard is among those who believe that taking care of patients means letting them choose how their lives should end." 

("From Doctor to Patient" Gorman). This is a physician who is agreeing with the idea of physician-assisted suicide. He interacts with patients everyday and understands what patients wants and the pain that they are going to. Swangard was also diagnosed with cancer so he understands their mind set and emotions that they are experiencing during this time. 

Another aspect that must be taken into consideration before deciding upon physician-assisted suicide is the degree of the patient's pain and illness. If the patient is terminally ill, then they should have the right to participate in physician-assisted suicide. If the patient is in severe pain and there is no other treatment to help their illness, they should be allowed to partake in physician-assisted suicide. But if the patient isn't in severe pain and doesn't have a fatal illness, then they should not be considered for physician-assisted suicide because they would still have a full life to live. In the article Voluntary Stopping of Eating and Drinking: An Ethical Alternative to Physician-Assisted Suicide, it says that after the administration of the drugs used for physician-assisted suicide, results happen within minutes-hours (Vicki D. Lachman 2). Therefore, if a patient is in a lot of pain and will be for the rest of their life, this would be a procedure that would be helpful and realistic for them.

Lastly, a patient should be required to undergo a mental stability test before being considered eligible for physician-assisted suicide. A patient who is mentally unstable, should not be allowed to make a life-threatening decision. An example of a patient who shouldn't be allowed to make this decision, is described in the article called Euthanizing Life. It describes this patient as, "Weighing 42 pounds ...  She was 25 years old. For 14 of those years she had been suffering from anorexia. 'I only punish myself. My entire life is a slow torture. And now I see the only way is death." This woman would be considered a patient who should not be eligible for physician-assisted suicide due to her lack of mental stability. She wants to die because she is anorexic which is considered a mental illness. Along with this, a mental health professional such a psychologist shouldn't be involved in the decision making unless the patient is considered mentally unstable. In the article The Role of and Challenges for Psychologists in Physician Assisted Suicide, it says, "As the law is written, a mental health professional should only become involved in requests for PAS when either the attending or consulting physician believes the patient is 'suffering from a psychiatric or psychological disorder or depression causing impaired judgment.'" (Johnson et. al. 2). This is one of the guidelines that should be followed when deciding upon physician-assisted suicide. Also, in the article Assisted Suicides in Oregon Jump 44 Percent as Abuses Continue, it states, " ... only 3 people received a psychiatric evaluation. An Oregon study found that 26% of those who request assisted suicide are depressed." ("Assisted Suicides in Oregon" Schadenberg). This is a main reason why a mental stability test must be mandatory before deciding upon physician-assisted suicide. Depressed patients shouldn't be allowed to partake in it due to their unstable mindset. 

Physician-assisted suicide is a controversial topic. Some believe it should be legal and some do not. Physician-assisted suicide should be legal but with guidelines and criteria for the patient's set into place. This way, patients aren't taking advantage of physician-assisted suicide being legal. 

