In 1988, Dr. Jack Kevorkian administered a lethal medication to a terminally ill patient in Michigan, broadcast the recording on CBS, and was charged with first-degree premeditated murder (Euthanasia and Physician-Assisted Suicide, 1). In 1990, Dr. Kevorkian set up a machine for a fifty-four year old woman suffering from Alzheimer's disease that had lethal poison pumped into her veins with the touch of a button. Michigan passed an assisted suicide bill in 1992 in an effort to stop Dr. Kevorkian's activities but with question about its constitutionality, the bill was delayed. There is disagreement about the humanity of Dr. Kevorkian's activities as some individuals believe that his procedures led to a large amount of unnecessary deaths that could have been helped by other means and believe that the process could lead to the genocidal killing of undesirable or vulnerable individuals. Others perceive him as a hero who allowed suffering patients to die with dignity.

Physician assisted suicide, a topic often avoided by society, confronts social, political, and religious values disputed globally.. Physician assisted suicide or often named voluntary passive euthanasia is defined as a physician supplying or providing the means of committing suicide. These forms of information or means of committing suicide include sleeping pills, carbon monoxide gas, and prescriptions for lethal medications. Contrary to general public knowledge, there are many forms of palliative care that go beyond improving the lives of terminally ill patients. Examples of medical assistance include active and passive euthanasia and are based on the intentional termination of a patient's life in the hands of another individual. Active euthanasia is the providence of a substance that ends the life of an individual through natural bodily processes such as through the bloodstream while passive euthanasia is the alteration or discontinuation of medical support that would prevent the patient from dying. Examples of this include morphine to suppress respiration and hasten death, the withdrawal of medications, and the discontinuation of food and water. Individuals who receive these procedures are often terminally ill, in a persistent vegetative state or individuals with "massive brain damage or in a coma from which they likely will not regain consciousness" (The Free Dictionary 1). With intricate terminology, discussions concerning physician assisted suicide often fail to progress and thus, the complicity of the topic discourages individuals from discussing it. In countries throughout the world, solutions to the argument cannot be universalized to fit the cultures, beliefs, and needs of every community. The religious, political, and cultural complexities of physician assisted suicide require further discussion in society on a global scale and can be achieved effectively using modern media sources.  

Those that believe physician assisted suicide is ethically justifiable argue for individual rights, compassion, and legal justice. In contrast, individuals who believe that physician assisted suicide is ethically impermissible argue that religious beliefs prohibit suicide, the process damages professional integrity, and there is potential to abuse unwanted individuals (Starks, Dudzinski, White, 1) Supporters believe that there should be respect for autonomy and individuals should have the personal liberty to choose the timing and manner of their death (Starks, Dudzinski, White, 1). Since the 1970s, medicine has focused progressively on the patient as an individual while "being strongly influenced by the movement for patients' rights and the rising importance of the ideal of patient autonomy" (Weir 1543). These individual rights for terminally ill patients include the right to refuse treatment or medication that may prolong pain, however, some argue that it desensitizes the public to killing and attacks weak and elderly individuals in society rather than protecting individual rights (The Free Dictionary 1). Vulnerable populations that lack care and support may be pushed into the process as a means to reduce medical costs and an emotional burden on family members.

 Physicians have the responsibility to reduce patients' loss of independence, psychological strain, and lack of functional capabilities. But, there is concern that doctors have a great amount of unchecked power and have the ability to alter a patient's life without the government knowing. The choice between assisted suicide and euthanasia is often made by the doctor and there is no regulatory system that investigates after a patient's death (Weir 1543). In Oregon and Washington, doctors are trusted to report what they have done to the government and others have no choice but to believe them. Supporters believe that physician assisted suicide can also support individual liberty versus state liberty by allowing individuals to make independent decisions concerning their bodies in opposition to society's interest in preserving life (Starks, Dudzinski, White, 1). Some individuals against PAS cherish religious beliefs such as Catholicism that argue the protection of innocent human life and deem physician assisted suicide a crime that cannot be legitimized by human law. 

Physician assisted-suicide opens doors for individuals to die with dignity without the prolonged suffering that builds over time with terminal illness. Doctors can easily alleviate pain by treating patients with tenderness and sympathy to protect the emotional and physical well-being of patients. Supporters believe that medicine alleviates the suffering that a patient undergoes and "the only thing that medical technology does for a dying patient is give that patient more pain and agony day after day" (De La Torre, 1). On the other hand, people who are against PAS believe that depression and anxiety affect a patient's judgment in times of temporary stress and errors in diagnosis can be made in the "treatment of depression or inadequate treatment of pain" (Starks, Dudzinski, White, 1). A doctor could kill a patient who is affected by depression and may be treating the portrayal of pain thinking the patient is unaffected psychologically. With many patients suffering from anxiety and depression, there is emotional instability that leaves doctors to determine the pain of other individuals. How can doctors and patients determine the extent to which the pain suffered is worth the termination of life? An example of this is shown through the Oregon Death With Dignity Act. The United States' first assisted suicide bill allows doctors to prescribe a lethal dose of drugs to mentally ill or depressed patients. If a patient is found to have "impaired judgment," Oregon's law doesn't stop a health provider or family member from making the patient be evaluated by other doctors until one is found who "declares that the patient is capable of choosing assisted suicide" (Marker 1). This process of searching for a medical professional empowers family members while adding to the patient's helplessness. Kate Cheney, an eighty-five-year-old woman who suffered from early dementia and breast cancer, is an example of "doctor shopping." After her physician declined to give her a lethal prescription, she visited a psychiatrist to determine if she was capable of making clear decisions. The psychiatrist stated that Ms. Cheney was not eligible as she was not explicitly pushing for the medication and an additional psychologist deemed that she was under the influence of her coercive daughter who was coaching her throughout the process. Finally, the two saw another doctor and were granted a prescription for lethal drugs. This specific case demonstrates the ways in which family members and doctors promote the vulnerability of patients and empowerment of individuals not directly involved in the suicide. Individuals against PAS believe medical errors can lead to the fallibility of the profession and inevitable mistakes in determining solutions to terminal illnesses. 

Supporters believe that individuals have the right to be treated for illness and refuse treatment if they choose to do so. The freedom to choose whether or not to be treated for illness allows the decision to not be influenced by doctors or outside sources. On the other hand, opponents to the issue think the process empowers doctors and does not carefully measure the stability of patients. Oregon's Death With Dignity Act contains no penalties for doctors who do not report prescribing lethal medication for the intention of suicide. The co-author of Oregon's three official reports, Dr. Katrina Hedberg, stated that the Oregon Health Division "has no regulatory authority or resources to ensure compliance with reporting requirements" (Marker 1). The OHD also acknowledges that the information on official reports may be incomplete or inaccurate. The power of doctors in the event of physician assisted suicide is so great that a state's health division may never discover the possible murder of a patient. Although some believe the negatives outway the benefits, most can agree that the legalization of physician assisted suicide would promote open discussion about assisted death between doctors and patients and could potentially provide better care when voicing concerns and opinions. 

As a multitude of philosophies originate from the argument, it is crucial to note their influence on impacting law. Before exploring the implementation of the law globally, these philosophical arguments must be understood in entirety. Many individuals have contrasting viewpoints and the power of these viewpoints can be observed through changes in modern day law. In order to understand complications with the implementation of philosophy globally, it is necessary to grasp the contrasting viewpoints of physician assisted suicide. This argument confronts religious, social, and political disagreements. By first establishing these disagreements, it is possible to view the disputes in laws enacted around the world. 

While many medical definitions of physician assisted suicide exist, individuals often misinterpret convoluted terminology and fail to understand the argument in its entirety. Even though physician assisted suicide has recently come to the public's attention with Brittany Maynard's dying with dignity monologue, the religious and political arguments are not openly discussed in society. Rather than expressing the disagreements between pro-PAS and anti-PAS, individuals do not challenge the beliefs of other countries in efforts to avoid confronting the religious and political values deeply rooted in cultures and upbringings. Since November of 2014, the media has enabled individuals to view information about Oregon's Death with Dignity Act through the personal form of video. With Brittany Maynard's intimate video about her tragic suffering, viewers can experience open discussion about a topic that has been hidden for years. But why can't society hold a productive discussion about the topic? Does our shared fear of death cause apprehension to confront opposing views? With open discussion, humankind could build upon arguments, question ideals, and become knowledgeable about other countries' policies. 

From computer screens and mobile devices, it is often challenging to view the opinions of individuals from across the world. When searching physician assisted suicide in a toolbar on the internet, information concerning any country other than the United States is omitted. A topic embodying strong religious and political ideals is hidden from the world rather than highly disputed in comparison to social debates today. Why does the United States, a country projected to hold strong relationships with countries worldwide, not support discussion about the topic? In an age of free speech and personal liberty, individuals should seize the moment and accompany the debate in casual conversation, school systems, and political gatherings such as presidential debates. By encompassing morals, culture, and religious and political views, physician assisted suicide does not provoke a simple argument. The Canadian doctor Dr. Harvey Max Chochinov underwent an intensive eleven day study of the ways in which the implementation of physician assisted suicide has affected the Netherlands, Belgium, and Switzerland. Through this study, he "saw people from such diverse perspectives  --  people who still continue to struggle with the issue of physician-hastened dying" (Ubelacker, 1). Others were much more comfortable with the idea and described death and dying as part of their cultural experience. With the acceptance of physician assisted suicide in various countries, modern perspectives of personal liberty and free choice have combated the traditional religious opposition to the concept of suicide (International Perspectives, 1). 

In 2002, Belgium passed a law that states doctors have the ability to help patients end their lives or perform euthanasia when a wish to die is freely expressed in unbearable pain. Similar to all political issues, physician assisted suicide has not received undivided support in Belgium. Cardinal Godfried Danneels, a leading Catholic official, expressed that the Catholic Church is opposed to expanding legalized assisted suicide to include mentally disabled individuals and children who are unable to make their own medical decisions. In February of 2014, Belgium became the first country to legalize euthanasia for children so that lethal injections require no age limit. This legalization welcomed ethical scrutiny with a rising number of requests from vulnerable populations such as nursing homes and poorly educated communities (Rapaport, 1). Dr. Kontorovich, a professor at Northwestern University School of Law, noted juveniles' incapacity to understand the implications of their actions when agreeing or disagreeing to euthanasia. Belgium, however, presumes children of all ages fully capable to comprehend the implications of requesting or consenting to the process but does not take into account the naivete of children (Leach, 1).

 In Germany, the term euthanasia is associated with the eugenicist policies of Nazi era and is replaced with the phrase active assisted suicide in efforts to avoid social controversy. Active assisted suicide, described as a doctor prescribing and distributing a lethal drug, is illegal in Germany and Switzerland while assisted suicide is legal in Germany if the lethal drug is taken without assistance such as guiding or supporting a patient's hand (Euthanasia Laws, 1). Two opinion polls revealed that about one third of the German population was in favor of physician assisted suicide and euthanasia in the case of terminal illness, but the Swiss assisted suicide organization named Dignitas has provoked controversy over providing information and advice to individuals wanting to commit suicide. The German branch of Dignitas does not distribute drugs for the organization's purpose in contrary to the group's main office in Switzerland. Since 1942, physician assisted suicide has been legal in Switzerland while direct active euthanasia is forbidden. Passive euthanasia and active euthanasia are not treated as criminal offenses if certain conditions are fulfilled unlike other countries who condemn the process (International Perspectives, 1). While Switzerland has developed a strong relationship between doctors and organizations to support the wellbeing of patients, EXIT, an aid in dying organization, assists individuals in planning for the end of life with information in support of family and friends (Ubelacker, 1). When a Canadian research panel visited Switzerland to observe the complexities of physician assisted suicide, they discovered the connection between EXIT and Dignitas "seem[ed] to facilitate the ability in Switzerland." Values such as compassion and sympathy have molded Switzerland and Germany's continuation to support terminally ill patients with organizations and guidance. 

In 2002, the Netherlands became the first country to legalize both euthanasia and physician assisted suicide. With 15,000 cases a year since 2005, palliative sedation has become a widespread practice in hospitals. Patients with a life expectancy of two weeks or less are put in a "medically induced coma" without nutrition or hydration. In order to legally assist with suicide, doctors must prove that the patient is making the request voluntarily, fully understands the situation, and has unbearable suffering (Rapaport, 1). The legislation has provoked debate over "the right to suicide" for individuals who disagree with the requirements and the law that euthanasia counts as a homicide (Euthanasia Laws). Statistics taken from the number of individuals who are euthanized in the Netherlands have raised red flags for physicians, citizens, and individuals worldwide. Dr. Eduard Verhagen has admitted to the killing of four babies in the last three years through the process of lethal intravenous drip of morphine and has not been prosecuted. Five hundred people are euthanized involuntarily in the Netherlands every year and seven percent of euthanasia requests made to the End-of-Life Clinic in 2012 were categorized as tired of living (Rapaport, 1). With many reasons other than unbearable pain for committing suicide, individuals question whether psychological conditions such as depression could affect the decision. While some individuals support compassion and relieving patients of unbearable pain, others believe that the issue attacks vulnerable populations and increases unnecessary death. 

In the United States, doctors are allowed to prescribe lethal doses of medicine to terminally ill individuals in four states. In 1997, Oregon was the first state to legalize assisted suicide for terminally ill, mentally competent patients with less than six months to live. A decade later, Washington State and Vermont approved a similar legislature. The "aid in dying" movement has increasingly spread throughout media when Brittany Maynard, a deceased twenty-nine-year-old woman who suffered from terminal brain cancer and fought for her right to "die with dignity," created a monologue for the world to see (Maynard, 1). When living with her husband in Portland, Oregon, doctors diagnosed her with brain cancer, told her she had six months to live, and prescribed her with full brain radiation. When she envisioned the pain and suffering her family would have to endure watching her deteriorate, she began researching death with dignity. Brittany felt she had the power to die on her own terms with control over physical and emotional pain stating: "Who has the right to tell me that I don't deserve this choice?" After requesting and receiving a prescription from a physician and self-ingesting it, she died peacefully in her bedroom. Brittany Maynard has sparked much controversy over her "dying with dignity" movement from supporters to outraged individuals who believe she is corrupting the minds of youth. 

Unlike the progressive nature displayed by the countries described above, the disapproval of physician assisted suicide has spread globally. In the Northern Territory of Australia in 1996, a cancer victim named Bob Dent became the first person to end his life using the world's first voluntary euthanasia law (International Perspectives). In March of 1997, only six months after the death, the Federal Government was afraid of what could result from the suicide and overturned the law. Similarly on June 15th, 2005 in Canada, Francine Lalonde introduced a bill that would have allowed a practitioner to aid another person in death. The measure failed to gain support but Canadian research groups are contemplating new perspectives on the issue. In Colombia, euthanasia was accepted in 1997 when the Constitutional Court ruled that an individual may choose to end his life and that doctors cannot be prosecuted for helping. In 2006 in Israel, a law enabled individuals of all ages to submit forms to the Health Ministry stating how they would like to be treated if they became terminally ill. The government initiated law was based off of recommendations from fifty-nine individuals in an effort to provide support and compassion. On the other hand, individuals in Spain who help someone else die can be punished for up to six months in prison. The Socialist government is hoping to legalize it as "liberal reforms have largely transformed this traditionally Roman Catholic country" and progressed from traditional ways (International Perspectives). Spain is slowly transforming from traditional religious values as modern, westernized views have influenced new thinking. In these countries, traditional values clash with modern beliefs and instead of entering new feats, the discussion remains at a standstill.

Physician assisted suicide and euthanasia are quite complex and unique to each country around the world while solutions to the debate cannot be universalized to fit the cultures, beliefs, and needs of every community. As each country specifies legalities differently to adhere to the variations in beliefs, there is no overarching government or medical organization that could create universal guidelines and qualifications for patients. Ineffective discussion often results from misinformed individuals arguing about the topic in the context of specific countries. A citizen of Belgium cannot productively argue the death of children to a citizen of Israel who knows nothing of physician assisted suicide laws simply from ignorance. If we, a disconnected nation, pursued the topic using modern media sources such as Facebook, blogs, and chatrooms, new advances in coming to an agreement could be discovered. With a genuine lack of discussion about the topic, opposing views in Europe, Canada, and the United States cannot exchange legal ideas and bring the topic of death into global news. By breaking down the social barriers that hinder productive discussion about the debate, America and the rest of the world can make the topic of physician assisted suicide a normality instead of a taboo topic. 

