
For years the legalization of physician assisted suicide has been a highly controversial topic discussed in both the medical and legal fields in the United States. In 1997, the legalization of assisted suicide by means of the “Death with Dignity Act” sparked public interest in other states and was followed by the legalization in four states including Washington, Vermont, Montana, and most recently California (Medina par. 1-2). This law allows a patient to request a life ending drug from a licensed physician under the conditions that the patient is competent enough to make the request themselves and has a terminal illness with a diagnosis of only six months left to live (Span par.7). With the growing awareness and use of physician assisted suicide, public acceptance has risen in the United States and the legalization of assisted suicide has been entering ballots in more states (Span par. 11). With the legalization of physician assisted suicide in more states, it should be discussed that the laws passed on assisted suicide fail to protect patients from factors that have the potential to influence the patient’s decision to partake in physician assisted suicide. For years, in fact, the government has seemed to overlook the ethical concerns that the law poses to patients and physicians. 

By law, a patient who is interested in physician assisted suicide must be competent enough to make three requests to die, two verbal and one written (Frank 36). This law intends to protect a patient from making an irrational decision and from being taken advantage of by a physician. Though the law intends to protect a patient’s right to autonomy, the law’s definition of competency essentially states that if a person is clearly able to state the consequences of their choice and discuss other options, then they are considered competent enough to make the decision to partake in physician assisted suicide (Callahan par. 10). This definition of competency fails to recognize that a patient who is, for example, depressed is still capable of each of these requirements, but their mental stability is not factored in as a potential hindrance to the rational decision making process. A study conducted with 44 terminally ill patients showed that only ten patients had thought about ending their life or considered suicide. Each of these ten patients were diagnosed with clinical depression out of the eleven patients total who were diagnosed with depression (Callahan par. 24). This study proves that depression appears to have an undeniable impact on the patient’s judgment capabilities. A patient with a mental illness may be able to consider and weigh their options, but their rationale may be compromised as a result of their illness which can and should be treated through proper diagnosis and medical attention before discussing end of life options. 

 It is important to note that the law does intend to safeguard those with mental illnesses from making misguided decisions by requiring the patient to meet with multiple physicians and to undergo a mental analysis (Span par. 7). This safeguard fails to validate laws on competency because mental illness is extremely subjective and in many patients has been misdiagnosed or for some patients has gone entirely undiagnosed (Luper 192). Because of the potential of patient misdiagnosis, many physicians refuse to assist a patient in suicide because of the potential for interference with a life that could be otherwise helped through more extensive medical treatment and proper diagnosis (Luper 192). 

On top of the question of patient competency, controversy grows with the discussion of a doctor’s role in ending a patient’s life. The law itself, described by Medina, does not require a physician to comply with a patient’s request to be prescribed the life ending drug (par. 5), but some doctors may still feel pressured to comply with a patient’s demands despite their right to deny such a request. One might imagine oneself in a physician’s place. A physician is being forced to consider compromising their religious beliefs and personal morals with the concern that if they deny a patient’s request they will potentially compromise their integrity as a doctor and sacrifice patient relationships. Many physicians and associations, including the American Medical Association, who are critics of the legislation to legalize physician assisted suicide argue that it contradicts the Hippocratic Oath, an ancient guideline for the medical community that promises a physician should essentially do no harm (Luper 189). The American Medical Association defends their position with the argument that physician assisted suicide puts vulnerable patients at risk and contradicts the idea “the physician’s role as a healer” (Luper 189). In fact, assisting a patient with suicide hinders all potential for future healing.

Patient competency is a slippery slope because, even with current medical laws, patient competency and right to self-determination are case specific. The National Association of Social Workers has a code of ethics that states “The social worker should make every effort to foster maximum self-determination on the part of clients,” but social workers are also empowered to protect and intervene when they believe a patient is unable to make a safe decision on their own (Callahan par. 4). For example, a hospital has the right to force feed an anorexic patient in order to save their life even if the patient states that they do not want to be fed. The question this brings forward is, at what point is it acceptable for a physician to intervene on the decision making process of a patient? The law unfortunately does not define this line, instead it expects that doctors, physicians, and social workers are able to make the most ethical decision based on the patient’s circumstances. This is a tricky situation because a social worker or physician’s moral code may differ from the patient’s, which could lead to disagreement. A doctor may feel that what is right for a dying patient who is unable to communicate is to aid them in suicide or active euthanasia despite the patient’s previously stated desires. While the law does not currently allow a doctor to prescribe a life ending drug to patients who are not competent enough to make the decision themselves, as physician assisted suicide becomes more accepted in society it may be easier for a doctor to argue that the most desirable and ethical choice for a dying patient who cannot make the choice themselves is to undergo physician assisted suicide.  

Already, the act of prescribing drugs to end pain that may potentially cause the death of a patient has become widely accepted as an ethical practice in United States medicine (Quill & Sussman par. 6). This practice gained acceptance despite the lack of patient agreement in many circumstances. Though this practice is essentially only accepted under the condition that a patient would die without the pain-killing drug anyway, growing acceptance of life ending treatments whether intentional or unintentional poses a concern to the future of assisted suicide. Legalizing assisted suicide eventually causes society to ask at what point is a human life no longer valuable? The law may currently define a life devalued with only six months to live, but where will the line be drawn in the future? The defense many bring forth is that when a patient has only six months left to live they will likely lose the ability to communicate and interact in society, but what about children born with these disabilities. Will the United States legalize the killing of a disabled child because they believe that life is no longer valuable? These questions may not be currently answered, but they are certainly consequences to consider.

With the changing roles of the physician that comes with the legalization of physician assisted suicide, potential for patient vulnerability poses a challenge to law enforcement. The American Medical Association argues that, with the legalization, doctors are given the opportunity to abuse the laws (Luper 193). While one may argue that with the strict enforcements and consequences regarding patient abuse that abuse would be extremely rare, who is to decide the value of one human life? By predicting the potential abuse that could occur to a few patients, and still overlooking such possibilities, the government essentially devalues a person’s life as only a potential statistic. Imagine being a family member or friend of such a patient. It likely would not matter if that loved one was one in a million or one in five. 

Not only do doctors have this opportunity, but the abuses could extend to family and even insurance companies. Patients who do not have the means to pay the medical bills throughout their end of life care may feel pressured to follow through with physician assisted suicide to avoid leaving more costs to family members after they pass away. In the future, insurance companies may even attempt to persuade patients to follow through with aid in dying to avoid paying expensive palliative care (Will par. 8). Along with the lack of ability to pay, some people do not have the means of proper palliative care as a result of they location they reside. Those who suffer from pain with no means of proper treatment may feel more pressured to ask for the life ending option. These abuses of the law would be difficult to protect patients from because most of the abuses would likely be through corrupt persuasion by companies and doctors or lack of means for better treatment rather than forceful or aggressive harm. Persuasion tactics prove to be difficult to detect and with such high vulnerability patients may unwillingly agree to go through with assisted suicide, an irreversible mistake. Also, with the consequence of physician assisted suicide being death, the victim would be unable to testify therefore making it nearly impossible to convict a physician of malpractice. 

To add onto financial vulnerabilities that may be associated with end of life care, health vulnerabilities are also a concern. Out of all Oregon patients who have been prescribed the life ending drug, one third have died before consuming the drug or been unable to take the drug due to health circumstance or by choice (Quill & Sussman par. 8). The law does not require that a qualified party must return the drug to a pharmacy or physician if not used, which could lead to the illegal sale or use of the drug in the future. With illegal prescription drug use already of high concern in the United States, making a new drug available in the market and at homes puts many individuals at risk.  Because physicians are not supposed to administer the drug, and patients are not required to take the drug under supervision of a physician, there is potential for an outside party to force the drug upon the patient without consent. This is especially concerning because many terminally ill patients will eventually lose the ability to communicate and thus are left even more vulnerable to abuse.

Though physician assisted suicide is gaining grounds for support by many populations, it is difficult to dismiss the glaring vulnerabilities presented in the current assisted suicide legislations in the United States. Not only does the law change the role of physician’s as a healer, but it spikes the potential of patient and family vulnerability and is extremely difficult to regulate. This essay does not discuss the moral and personal aspects of physician assisted suicide as moral code is highly subjective while flaws in the law cannot be easily disregarded. This essay does not intend to change the moral code of any one person, but hopes to increase the awareness of both advocates and opposing parties of the current ethical concerns regarding United States legislations. One must ask themselves if the government provides sufficient safeguards and open their minds to a change despite differing point of views on the legislation. With the growing acceptance of physician assisted suicide in the United States, lawmakers should put more effort into safeguarding innocent parties and preventing abuse. 
