The French philosopher Jean-Jacques Rousseau proclaimed, "Man was born free but he is everywhere in chains" (Quffa, 261). In today's society, shackles are tightly wound around those who are terminally ill or incurable. Though their right to live has been compromised and death is imminent, the ability to choose how they die is most often not a choice they can freely make. These decisions include the right to die by assisted suicide or euthanasia. Assisted suicide is defined as a healthcare provider knowingly and intentionally providing the means of death to a terminal patient so they can end their life. The suicide is carried out with a lethal dosage of a prescription drug. Euthanasia occurs when a physician intentionally, knowingly and directly causes the death of another person by giving a lethal injection (Quffa, 261). Assisted suicide and euthanasia have long been contentious issues worldwide (Barbuzzi, 16). However, in the United States where freedom is of the utmost importance, there are only a few states that permit terminally ill patients the right to die by assisted suicide. These states are Oregon, Washington, Vermont, and soon to be California; Montana remains the only state where euthanasia is legal. Long-term care patients, however, do not benefit from the existing Death with Dignity and Right-to-Die laws because they are technically not terminal. Because of this, many of these patients will travel abroad to euthanasia clinics to commit suicide. In Switzerland, two major euthanasia clinics exist: Dignitas and Exit (Quffa, 264). Because there are very few laws in regards to allowing terminal patients the right to die and no laws permitting other incurable patients the right to end their lives on their own terms, the American people seeking a tolerable end to life do not receive the closure they merit.

The Fourteenth Amendment of the United States Constitution declares " ... nor shall any state deprive any person of life, liberty, or property, without due process of law" (14th Amendment). Both living and dying are fundamental freedoms of the people. By stating so clearly and authoritatively that each citizen is entitled to the right to their life, the Fourteenth Amendment is acknowledging that the right to an individual's death is a liberty protected by law. Excessive healthcare costs continue to tear through the country (Messerli). In addition to high healthcare costs, nurses and physicians are overworked in hospitals. This indicates that patients are not receiving the treatment fully desired (Messerli). The United States should advocate for legalizing assisted suicide and euthanasia because it will acknowledge the many terminal and incurable patients that live in constant suffering and will permit them the right to die on their own terms, while lowering healthcare costs and giving doctors and nurses more time to focus on curable and treatable patients. 

The most ethical motive for legalizing assisted suicide and euthanasia coincides with allowing the suffering patients who do not wish to exist in anguish any longer, the right to die. Canadian born Gloria Taylor, a former victim to Lou Gehrig's disease and an advocate for medically assisted dying, stated "Whose body is it? Who owns my life?" in a press conference when first going against the British Columbia Supreme Court in the Carter v. Canada case to earn her right to die with dignity (The Trouble with Dying). Countless others seek resolution for these same posed questions. The terminally ill and incurable patients plead for relief that only Death with Dignity laws or similar laws could provide. California anesthesiologist Dr. Daniel Swangard is not an exception. In March of 2013, Dr. Swangard was diagnosed with pancreatic cancer. Even though he is now in remission, he knows that the cancer can return with a blink of an eye. Swangard wants the ability to choose. If the cancer does reoccur, he wants to be able to die comfortably while surrounded by loved ones in his place and time of choice, not in a hospital bed strapped to an IV, uncomfortable and in agony (Sanburn, 49-50). In contrast to Dr. Swangard's potential desire for assisted suicide, Me Before You, a novel by Jojo Moyes, broaches the subject of euthanasia. The novel conveys the life of Will Traynor, a 35-year-old C5-6 quadriplegic man, who has to endure twenty-four-hour care because he cannot perform simple tasks by himself and lives in constant pain due to his injury. Will favors death over continuing to live his life as a dependent, so he decides to end his life at the Dignitas Clinic in Switzerland (Moyes, 362). When Linda Jarett who lives with multiple sclerosis is introduced in "The Trouble with Dying" she declares, "This is my life and it should be my death." Wanda Morris, the Executive Director of Dying with Dignity, claims, "It's not a question of cutting their lives short. It's a question of 'are they going to die horribly or can we offer a peaceful, a gentle, a humane way to die'" (The Trouble with Dying). The patients should be given the right to die with pride if that is their chosen path.     

A major controversy in the debate over the legalization of assisted suicide and euthanasia pertains to the resulting lower healthcare costs due to fewer dying patients in hospitals. The majority of the dying reside in hospitals and end-of-life facilities (The Trouble with Dying). Records confirm that nearly 70% of healthcare expenses are acquired during a patient's final six months (Lusetich). The need for palliative care skyrockets toward the end of life as pain levels increase and the ability to do for oneself decrease (The Trouble with Dying). Expenses could be reduced by eliminating unnecessary x-rays, lab tests, and drugs unless the patient chooses to die naturally. In addition, salaries for hospital overhead, medical staff salaries, etc. will consequentially be reduced (Messerli).  In a 1995 experiment attempting to discover the approximate savings that legalizing assisted suicide would entail, an estimated $4.67 billion was saved. Three factors played a role in the calculation of the likely cost savings due to legalizing physician-assisted suicide: (1) the quantity of patients who will take benefit from the legalization of physician-assisted suicide and commit suicide; (2) the ratio of medical expenses that might be protected by way of physician-assisted suicide, which correlates to the shortened lifespan of a patient; and (3) the total cost of medical care for patients who die (Ezekiel). This clearly indicates that legalizing assisted suicide and euthanasia all across the United States would aid in any cost deficits the hospitals may experience. 

In addition to reduced healthcare spending, doctors and nurses will be able to focus on savable and curable lives rather than terminal and incurable patients who wish to die. Due to a lack of peace for some patients suffering from their terminal diseases, many people will starve themselves to death (Cassity).  This personifies the need for action. Shortages in medical staff pose detrimental threats to the quality of healthcare that patients acquire (Messerli). The remainder of patients in the hospital will receive the care needed. This is not implying that the assisted suicide/euthanasia patients are sacrificial lambs or that they should be pressured into doing something they do not want to do.  Rather, this only pertains to the terminally ill and incurable who desperately do not want to live anymore. In this way, hospitals would become less crowded and hospital staff would be able to focus on treatable patients.    

The most common opposing argument insists that suicide devalues life. This belief stems from the Christian outlook on life and that suicide is morally wrong (Quffa, 265). Will Tranynor's mother in Me Before You insinuated that the accident that indefinitely placed her son in a wheelchair held " ... some great cycle, some pattern that it was only God's purpose to understand" (Moyes, 107). In other religions the afterlife and the unknown plays a significant part in many religious beliefs. By preventing suicide, the government is impressing its views on religious practices by implying that suicide is a sin (Messerli). Contradicting the imposed argument, merely existing on this earth does not guarantee an abundant life, and a life unlived degrades how life is meant to be lived, not the action of assisted suicide and euthanasia that diminishes the pain and heartache. Dr. Richard MacDonald, Sr. Medical Advisor and firm advocate for the Final Exit Program stated, "Many patients wish for the kind of dying process where they are remembered for what they were, not for how badly they died" (The Trouble with Dying). Kevin Drum's "My Life to Leave" makes excellent points in relation to why the claim is false. This article discusses the rights of the terminally ill and the debate over assisted suicide and euthanasia. Drum first refers to his father-in-law, Harry, who was diagnosed with multiple myeloma; later in his illness committed suicide by placing a bag of helium over his head. Harry, who was also a retired physician, knew that he did not want to live once life became an agonizingly painful existence for everyone, not just himself. That is why he chose to die. This happened because in California no such Dying with Dignity laws were in place; death by helium or death in a hospital were really the only two options. The Hemlock Society -- known today as Compassion and Choices -- rallied the idea of inhaling helium when assisted suicide was not an option. The article goes into detail as to why Americans are hesitant towards accepting assisted suicide and euthanasia. Religious views remain the primary adversary in allowing compassionate opinions. Kevin Drum was diagnosed with multiple myeloma as well. He is an advocate for Dying with Dignity and Right to Die. Drum once stated, "I suspect that taking your own life requires a certain amount of courage, and I don't know if I have it." This just means that, unlike Harry, he has the chance to take advantage if the time does come that his life becomes an unbearable existence and he no longer wishes to live on (Drum, 27-60). In addition, Cindy Cowan, who suffered from late stage ovarian cancer before she passed away, constantly repeated that she was not suicidal. Rather, like most people in her position, she wanted to die on her own terms (The Trouble with Dying). It is an invalid argument to say that someone is devaluing their life when they are doing what is best for them. Another way to view death by assisted suicide or euthanasia as valuing instead of devaluing life is that they open up the opportunities for doctors to save the patient's vital organs so that other lives can be saved. This is a way of envisioning assisted suicide and euthanasia as giving life to life as opposed to taking life away from life.

Another conflicting view on assisted suicide and euthanasia claims that patients will take advantage of the system. While this is not a poor argument and does raise the question of "how far could this go," refutable evidence does abolish this claim. There are laws already constructed to prevent abuse while still protecting the value of human life. Oregon's Ballot Measure 16 (Death with Dignity Act) allows terminally ill adults to obtain lethal dosages of drugs to end their lives. The Death with Dignity Act follows strict guidelines and protocols to ensure the legitimacy of the process and the seriousness at which it is being taken. These protocols and guidelines include patient eligibility which states that the patient must be: 18 years of age or older, a resident of Oregon, capable of making and communicating health care decisions for him/herself, have been diagnosed with a terminal illness that will lead to death within six months, and physically and mentally capable of self-administering the aid-in-dying drug. Not only must the patients pass by the patient protocols, they must also be eligible after being seen by a physician with the physician protocol which declares: the attending physician must be licensed in the same state as the patient and have a current United States Drug Enforcement Administration (USDEA) certificate, the physician's diagnosis must include a terminal illness, with six months or less to live; the diagnosis must be certified by a consulting physician, who must also certify that the patient is mentally capable of both communicating and making the right healthcare decisions, and if either doctor concludes that the patient's judgment is compromised, the patient must be referred for a psychological examination. Once this takes place, the attending physician must inform the patient of alternatives, including palliative care, hospice and pain management options. There is also a timeline that occurs before a patient can be granted permission from a physician. A patient request timeline includes: the first oral request to the physician, followed by a fifteen day waiting period. After fifteen days, a patient can orally request to a physician a second time. Following the second oral request, the written request to the physician is made. A forty-eight-hour waiting period follows before the patient can pick up his or her medication from the pharmacy (State-by-State Guide to Physician-Assisted Suicide). California, whose bill will go into effect in June of 2016, Washington, and Vermont each hold different laws pertaining to assisted suicide or in Montana's case, euthanasia. As with Oregon's Death with Dignity Act, each state enforces protocols and guidelines in order to protect the people from compromised decisions and impetuous actions.

A quote by the 19th Century German philosopher Friedrich Nietzsche states, "There is a certain right by which we may deprive a man of life, but none by which we may deprive him of death; this is mere cruelty" (Nietzsche). Not only will allowing man the right to decide upon his or her own death change the lives of those advocating for it, it will modify the cost of healthcare, and will provide doctors and nurses to lives that can be saved. The movement for assisted suicide and euthanasia resonates around the world because the people are fighting for their rights to their own lives and deaths. If every state in the United States took that leap and legalized assisted suicide and/or euthanasia, the rest of the world would follow. This could be the change where men and women no longer live in chains; the people will live free and will die free because it is a right to choose. 

