There is a stigma around the word suicide. It sounds weak, daunting, and cowardly. However, for some it is the only option. Physicians assisted suicide is a long debated topic within the medical community. Assisted suicide refers to a terminally ill patient asking a physician to help them end their life with a prescription. In recent years there has been a push for assisted suicide to become a more widespread option, this is being done with a campaign referred to as Death With Dignity. Availability of physicians assisted suicide depends on where a patient lives. There are currently five states that have laws legalizing physicians assisted suicide. Many feel that if it is an option to some it should be available to everyone. Some patients have felt so strongly that death by assisted suicide was their only choice, so they have picked up their lives and moved all while suffering from their terminal illness. There should be a nationwide set of laws detailing death with dignity to guarantee equal access to all US citizens and standardize the process of any physician prescribing the drugs used in this procedure. This will give terminally ill patients to have some control over their last days. 

This topic is widely debated and extremely important to me. When I was 12 years old my grandfather was diagnosed with cancer and given 6 months to live, he was 62 at the time. He considered physicians assisted suicide luckily he lived in Vermont, one of the few states physicians assisted suicide is legal; so the choice was available to him. Instead he choose to fight and ended up celebrating two more birthdays and making countless memories. However, the fact that he was sick did take a toll. I am extremely grateful that I got the extra time to spend with him but it gives me peace of mind that he had the choice to die with dignity if he had wanted to. 

Within the United States there are variations on the legality of physicians assisted suicide. Four states, including California, Oregon, Vermont, and Washington, have legislation legalizing physicians assisted suicide. Montana allows assisted suicide only with a court ruling. Nevada, North Carolina, Utah, and Wyoming do not explicitly state the legality or illegality of physicians assisted suicide. The last 41 states either prohibit it by common law or standard legislation (State-by-state). Each state that allows it has their own set of guidelines regarding timelines and the process the patients and physician must go through. There are many similarities, including all requiring the patient having 6 month or less to live, but there are also some large differences. In Washington the physician is required to contact the next of kin of the prescription request however this is not required in any other state (Physicians-Assisted). It would be beneficial if there were a nationwide standard of practice to ensure that everyone receiving this treatment is being treated fairly. Another factor that could be better monitored if physicians assisted suicide were a national practice would be psychological evaluation. This would ensure that each patient is aware of the severity of the choice they are making and ensure that they have not been coerced into making this decision. This could be implemented in the states that already practice physicians assisted suicide but having it the same across the board would be beneficial.

Physicians assisted suicide is a debated topic all over the world. Switzerland is one of few countries that has legalized physicians assisted suicide. However, Swiss law regarding this subject is somewhat unique in that "the Swiss penal code considers assisting suicide a crime if and only if the motive is selfish" (Hurst). Therefore, as long as a person is acting in an unselfish manner they wont be found guilty of breaking any laws. By not addressing physicians first hand in the law civilians can have a role in physicians assisted suicide (Hurst). The openness and acceptance of assisted suicide has also lead to a phenomenon called "suicide-tourism" meaning people will often travel to Switzerland with the sole intention of ending their life. Part of this phenomenon is the fact that assisted suicide laws are " ... strictly restricted  ...  [and] existing laws have been extended in recent years" these countries include both France and the United Kingdom (Gauthier). The changing laws caused a wave of suicide tourists in Switzerland. United States citizens have also been known to go to Switzerland to die with dignity due to the face that establishing a residence in a new state may be harder than flying to Switzerland. There is reasoning behind a country not wanting to legalize physicians assisted suicide but if people can simply achieve their goal by traveling to a different country there that reasoning becomes somewhat irrelevant.

One of the many benefits of physicians assisted suicide is the ability for a person to have control over their death. Brittany Maynard spearheaded an effort to raise awareness for death with dignity before she ended her own life through physicians assisted suicide. Only 29 at the time of her diagnosis Maynard didn't want to suffer a slow painful death as cancer ate at her brain and everything that made her the person she was. To go through assisted suicide Brittany Maynard and her husband decided to move to Oregon but " ... establishing residency in the state to make use of the law required a monumental number of changes" including new physicians, finding a new home, and getting a new drivers license. All so she didn't have to suffer for months on end. . Throughout this entire process Maynard was rallying support within legislature to approve assisted suicide legislation within her home state of California. She even went as far as "sharing her story with Brown by phone, personally appealing to him to support the bill," Brown being the governor of California, who eventually did sign a bill allowing assisted suicide (Calefati).  Once she received her prescription she did not take the drugs as soon as she received them, she was not eager to die, she wasn't excited about ending her life but she saw it as the best option for her. After having the pills to end her life for weeks she decided to "die upstairs in [her] bedroom with [her] husband, mother, stepfather and best friend by [her] side and pass[ed] peacefully" (Maynard). She felt so strongly about the fact that she had the chance to do what she felt was right that she spoke out on multiple platforms and sent a powerful message. If Brittany Maynard had the chance to die on her own terms rather than a debilitating illness why shouldn't everyone have the same opportunity.

The medical community is probably the most split on its opinion of physicians assisted suicide. Often it depends on how they view death, whether they consider it a failure on their part or a natural part of life. It also calls into question the oath they take upon receiving their medial degree to do no harm. One physician spoke out after reading Brittany Maynard's story. Sandeep Juahar, a cardiologist, is split on the issue of physicians assisted suicide. He even states "As a doctor, I would like assisted suicide to be safe and available, but rare." This is a valuable opinion because there is other option for those that are terminally ill. including hospice care, but sometimes "palliative or hospice care cannot adequately address the anxiety and suffering of dying patients" (Juahar). Therefore, even if it is rare, assisted suicide should be standardized to account for the shortcomings of hospice care. Sandeep Juahar has never had the option to provide physicians assisted suicide, because he practices in New York, even when a fully competent patient in heart failure requested it.

Another group that has a unique perspective on this situation is nurses. They are not qualified to actually prescribe assisted suicide but they are often very involved. Nurses work with patient's day in and day out and sometimes become emotionally involved in a case. A medical background with personal involvement may affect an opinion on assisted suicide.  Other factors also affect their opinions in face "results suggest that support for assisted suicide among nurses is strongly correlated with religious affiliation" (Evans). This shows that even medical professionals could be letting things like religion cloud their feelings on assisted suicide. Another factor is workplace a nurse who works in the nursery is less likely to deal with assisted suicide while those who work in an intensive care unit or oncology may deal with it quite often. This could affect opinions in the manner that they feel compassion toward their dying patients. When a comprehensive study was preformed it was reported that 49% of nurses supported assisted suicide, 40% was opposed to it, and 11% claimed to have no opinion or chose not to answer (Evans). While not an overwhelming majority this does show that there are more people out there, who work in the medical field, that ultimately support assisted suicide. 

People who go as far as saying physicians assisted suicide should be considered murder are somewhat out of line. The actual procedure for assisted suicide is extremely dependent on the patient. Most often the physician is not present the day of their patient's death. The basic premise is that ""assisted suicide" is literally what the phrase states: suicide with assistance, not only because it is the patient who makes the request but because it is she who is responsible for the final deed" (Salem). The patient, most often, is required make two verbal and one written request before the physician will even consider writing the prescription (State-by-state). Once the prescription is written it is completely out of the doctors hands. It is the patient, or a family member, who gets the prescription filled and picks it up. Lastly the patient has the autonomy of when to take the life ending dosage.

While there is an enormous amount of support for the death with dignity campaign there are also a large amount of people who strongly disagree with the idea. Some feel that it takes a certain role out of the medical field of actually trying to save lives. One major idea is that by allowing physicians assisted suicide "it will be declaring decisively that "physicians" are mere providers of services, to be guided only by the desires of the individual patient ... " and by doing this it makes physicians obsolete in a way (Yang). However, at the same time part of a physicians job should be listening to their patients desires and making them as comfortable as possible. If having this option available to them would but them at ease of mind who is a physician to deny that request. The main goal of the physician is to make a patient better but if the patient is already dying it is a different story. This calls into the question of the role of physicians and some say "there can be no practice of medicine if patients do not trust physicians to care for them when they can- not care for themselves" (Yang). This statement is somewhat valid but at the same time if a physician can no longer care for the patient the situation is bound to change. Death with dignity simply allows a solution for people who feel they have no other option. Even if physicians assisted suicide becomes legal across the United States physicians would still have to choice to not practice it but there would be a greater number of places for people seeking physicians assisted suicide to go in general. 

While there are many patients who are fighting for the right to die with dignity and lobbying for physicians assisted suicide there are some who don't care to partake in the idea of ending their life early. There are a multitude of options for those who wish to live as long as possible no matter the side effects of their disease. Peter Sauls, an emergency room physician from Australia, addresses some of these options. He is an advocate for having a plan of action if death is imminent. Many people don't plan ahead and this is a problem because it should be up the patient themselves and not their family to make these choices. A person who is terminally ill has options; there is palliative care within hospitals, hospice care, trying to prolong their life as much as possible with chemotherapy and radiation, and simply spending as much time with their loved ones before their death. Hospice care is often a great option and "focuses on pain management and dying with some comfort and dignity" (Juahar). Key word being some dignity. If people have all of the options to fight or go through a painful death, why should assisted suicide be kept off the list. Offering a procedure doesn't mean every patient is going to take it. Otherwise everyone would fight or everyone would choose to utilize hospice care. There is no harm in simply having assisted suicide as an option because it truly does allow a patient to die with dignity and in control. 

Physicians assisted suicide is not a bad thing. It is hard, difficult, and unsettling to think about. Possibly because it makes people think of death, which we spend more of our life trying to avoid, and it forces people to think about what they truly want. Death with dignity should only be a last resort and should only be done when a person can be 100% confident in saying that it is what they want. However, it should also be a nationwide option. Giving the choice to some and not other is simply unjust. The benefits of nationalizing the right to death with dignity outweigh the repercussions. Partially because it would help standardize the provisions required to go through physicians assisted suicide to make sure the process is fair and just in all cases. Some use religious or personal beliefs to say that assisted suicide is wrong or bad but legalizing it nationally doesn't mean it will affect them in any way. Legalizing it wont require doctors to fill prescriptions of lethal medicines on a daily basis; it wont make people who are apposed to it go through the process. It will simply give people an option. People who would rather be in control than wither into shells of themselves. People who would rather die surrounded by loved ones than be too in pain to notice who is there with them. There is no need to make these people pick up their lives and move just to be given this option, it should be readily available once they have followed the correct protocol to get there. The fight for death with dignity could change the lives of many terminally ill patients and possibly lessen the rate of suicides on a national basis by providing a safer option for those who are sick and ready to end their lives.

