When a person is suffering physically and mentally and is given an estimate of a few months to live, should they have the choice to control their own death? Physician assisted suicide (PAS) has become a controversial issue of debate recently, especially with the presidential election and the Right to Die movement in California. PAS is the process in which a doctor is involved in an activity that directly or indirectly leads to a patient’s death; the patient has requested this treatment and is usually physically or mentally ill (Levy 402). Some people think that it is beneficial to medical care that PAS be legalized in all states, but others, based on their religious beliefs and morals, think that no one should be able to take their own life. PAS should be made legal in all states, but it should have limitations. People should have the opportunity to be comforted in the last days of their life by having the choice to control their own death. By looking at the issue of PAS, one can see the beneficial effects of it easing the pain and suffering at the end of a patient’s life, and making it legal could bring about a positive outcome in future medical care.


There are two types of physician assisted suicide, active and passive. In active PAS, the cause of a patient’s death is from the action performed by a physician or by the patient with a physician’s help. Passive PAS is when the physician has done everything they can, and the cause of the patient’s death is because of their condition (Varelius 665). Active physician assisted suicide is what people are fighting for to become legal in all states. PAS is legal in five US states: Oregon, Washington, Montana, Vermont, and California (Emanuel 79). In 1947, Dr. Ezekiel Emanuel and John Urwin conducted a survey of the public and physicians of the US. They found public support for PAS was 37%, and it increased to 53% in the early 1970s. Since then researchers have been studying the practices and effects of PAS (80). They have found that 75% of people who choose this treatment are dying from cancer and less than 15% are suffering from a neurodegenerative disease. The patients are normally older, white, and well-educated. Using end of life care on patients who are minors or who have dementia are small minority cases (88). Surprisingly, pain is not the main motivator for patients when requesting PAS. Less than 33% of patients experience insufficient pain control. The most common motive is loss of autonomy and dignity and not being able to experience pleasant life activities. 97.2% choose PAS because they have lost their dignity, and 88.9% say they are no longer able to participate in enjoyable activities (Berry 17). Losing the ability to do normal physical tasks of everyday life without the help of someone can become depressing and self-demeaning. It is essential for the physician to respect the patient’s values when it comes to the last few months of their life. 


To be administered PAS in states where it is legal, it is required for the patient to have a prognosis of survival of six months or less, meaning the patient must be terminal. The Oregon Death with Dignity Act, The Washington Death with Dignity Act, and The Assembly Bill No. 15 of California define terminal disease as “an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months” (Varelius 664). However, the patient does not have to be in unbearable pain or have any symptoms of such and this should be a rule for legalization of PAS in other states. The system also permits a fifteen day waiting period between two oral requests. In addition, a forty eight hour waiting period is required between a final written request and the administration of the prescription (81). Many other countries have similar extensive processes that one has to go through before the choice of PAS is final. In the UK, The Assisted Dying Bill of 2013 was introduced, and it requires that any terminal prognosis should be reevaluated and confirmed by a second registered practitioner. The practitioner checks the accuracy of the prognosis, sees if the patient meets the criteria to consider PAS, and makes sure that the patient has taken all of their options into consideration (Frost 2). This decision is not taken lightly in the US and in other countries, and serious consideration goes into this process before administering. Lesley Close, who works for an organization called Dignity in Dying, states, “I believe that one of the most loving acts you can perform for someone who is dying and suffering intolerably is to help them die with peace and dignity” The choice of PAS gives people comfort in the last few moments of their lives because it gives them a sense of control over living and dying. If PAS is made legal in all states in the US, similar cautious evaluations should be done on patients when making this decision.  


The physician’s job in the process of PAS is significant. Each should take this role seriously when dealing with the last months of their patient’s life. Many people think that when a physician takes part in PAS, it is a form of medical harm and it strips their reputation as a healer, but this is not true. Preventing patients from dying on their own terms when they are suffering physically or mentally is a type of medical harm (Warraich). When a physician cannot do anything else to treat their patient’s illness, it should be their number one priority to make them as comfortable as possible, even if it is fulfilling their end of life wishes. Haider Warraich, a fellow in cardiovascular medicine at Duke University Medical Center, states that physicians need to look at how they can help their patients achieve their goals. Having the option of PAS will give them control. Dr. Daniel Mirda says that physicians need to go through and discuss all options of treatments with the patient and their family. The patient’s clarification of alternative treatments is imperative, and it is the physician’s job that they understand all other options (Johnson). When a physician talks about treatment options with the patient, PAS should not be immediately discussed, and if anything it should be the last choice in consideration. Also, the physician should not persuade the patient in any direction in the decision of choosing PAS. This choice should be based on the patient’s own values and beliefs rather than on the physician’s medical expert opinion. The physician is there for support and helping their patient in their final moments. 


The role of a psychiatrist in PAS is one of the most important factors involved in this process. The psychiatrist is there to check the mental capacity of the patient and to see if they are in their right mind to be making such a drastic decision. This is in effect already in the states where PAS is legal. It is also his or her job to make sure the patient understands all options and the consequences of their request (Levy 403). The physician and the psychiatrist need to be able to work together in the patient’s best interest. It should be a requirement in future states and countries where PAS is legalized for the patient to go through a mental test to make sure they are capable of making this choice. In Great Britain, The Legal Test of Competence to Consent to Medical Treatment was made. This mental capacity test has three main requirements: the patient must understand and retain treatment information, weigh the information and reach a final decision, and be able to communicate that final decision. This is a general mental test for patients who are dealing with different medical decisions, but when one is dealing with life and death that patient should be tested more rigorously. These patients need to be able to communicate their choice, have factual understanding of the issue, understanding of their situation and the consequences, and the ability to retain and control that information (Stewart 34). When making PAS legal in more states, each should be required to request a psychiatrist’s help and do a mental capacity test. The US requires a certain amount of waiting time between the individual patient’s request and the administration of PAS, but this does not test the competence of the patient. Unfortunately, in Oregon and Washington, less than 5% of patients and only 4% of patients received psychiatric evaluations (Emanuel 86). This is not good because the physician will not know for sure if the patient understands alternative treatments. In every state PAS is legalized, a psychiatrist needs to be involved. Knowing the patient’s mental capability of understanding this serious end of life wish is crucial when they are being allowed to choose the time of their death. 


Huntington’s disease (HD) is an inherited progressive disease that involves symptoms of chorea, hypokinesia, psychiatric symptoms, and dementia. HD can be used as an example when thinking about end of life care and decisions because it is a declining disease. Eventually each person with HD will have to be dependent on someone to perform their daily life activities for them. In the Netherlands, a survey was done with fifteen physicians who were experts in dealing with this specific illness. There are about seventeen thousand HD patients in the Netherlands (Booij 621). Most of the physicians felt that talking with patients about end of life wishes could bring peace and make the subject of PAS less pressing. There are three reasons why a physician should be required to discuss end of life care with a patient with a terminal disease like HD. From a legal point of view, the physician should inform the patient of all treatment options. Also, a physician should act in the most beneficial interest of the patient (623). Talking about PAS is also a moral obligation that the physician should have towards the patient. 

Another important thing that should be done with people who have HD or other terminal illnesses is the creation of an advance directive. This is a conversation between the patient and the physician about end of life wishes. The wishes are documented by the patient or by the physician after the conversation and should be then attached to the medical record. A letter of intent should also be drawn up, which is a letter in which the patient and the physician agree on a commitment of best intents. This is the time when the physician can explore the patient’s morals, values, and beliefs (Booij 623). Patients who have HD are slowly losing natural physical abilities and developing psychological effects. Some people do not want to live the rest of their life to half of its potential by having to have others do simple everyday tasks for them. This is why PAS needs to be addressed with patients experiencing this. HD is a physically and emotionally involved declining disease, and physicians should be prepared when it comes to end of life care with any terminal illnesses. 


Andrew Heenan has worked in different hospitals for many years as a nurse and has seen the impact of pain that terminal illnesses have on families. He states, “Too many people with terminal diseases will face problems too great to bear and challenges that are unfair to them, their families, and their friends” (Cartwright 144). Nurses have positively impacted terminally ill patients. Heenan has seen the worst when it comes to these situations which he claims, “Poorly managed pain will inevitability lead to a wretched life, and the expression ‘poor quality of life’” (108). When Heenan talks about pain he is not only talking about physical pain but mental pain as well. The mental pain of the disease can be more unbearable than the physical pain that some terminal illnesses entail. Caregivers and nurses are an important part of this process, because they are the ones who spend the most time with the patients. Each terminal patient should have someone experienced in dealing with end of life care to walk through this mentally straining time in their life. In the end, PAS can be the best option because the patient is put out of their suffering and is able to rest peacefully. 


A video clip from Ted Talk entitled “Beyond Life: Managing Your Right to Die,” by Dr. Allan Saxe, talks about how having the choice of PAS is comforting to people who currently have a terminal illness and to all people who could potentially be diagnosed with a disease later in life. He speaks from personal experience as he watched his mother die a long, slow, painful death from kidney failure. Dr. Saxe said she was a strong woman who could handle anything, but he recalls talking to her in the hospital saying, “I want to end this. I can’t take it!” He said that one of the worst things in life is to see your own mother suffer in pain because a choice to control her own life was not available to her (Saxe). Imagining a close family member or friend experiencing hurt and being helpless is difficult to comprehend. Having the choice of PAS does give comfort to the patient when death is near, but it also gives a peace of mind to the family and friends because at least they know their loved one is not suffering anymore. 


There are many concerns and opposing opinions when it comes to the issue of PAS. The reasons people are against PAS are based on their morals, values, and beliefs. Some believe that a group promoting PAS is still just promoting suicide, which has always been considered a tragedy. This is thought to be a bad message sent to teenagers who are struggling with depression or suicidal thoughts. They then might think ending one’s life early is acceptable. Also, a physician participating in this act is incompatible with the known role as a physician being a helper and a healer (Ferguson). Overall most people are worried that patients who want to have this treatment are choosing it based on two things. First, the patient makes a hasty and irrational decision to end their life without thinking through the situation and consequences. Second, patients who are not willing to die are pressured into this decision by either the physician’s thoughts and medical knowledge or some other outside source like a family member (Varelius 666). These are understandable reasons on why people are against PAS. By having strict rules and requirements for patients to meet when going through this process, this will eliminate the fears of the patient making an influenced or rash decision to choose death.   

Also, there has been abuse of the definition of terminal illness. In some cases, physicians have declared a patient terminally ill because proper treatments have not been given, and this is something patients should be careful of. The senior policy advisor for The Catholic Association, Maureen Ferguson, shares a personal story about her mother-in-law who was diagnosed with advanced bone marrow cancer and was given a few months to live. Her mother-in-law went on to live longer than expected as Ferguson recalls wonderful memories when she said, “They were two incredibly precious years, in which she took her three grandchildren to Disney World, saw her eldest son married, her youngest daughter graduate from high school, and made Christmas dinner that year in her high heels.” People against PAS state that physicians are not omniscient, and they cannot accurately predict death (Ferguson). This is true but physicians can only do so much, and in the end it should ultimately be up to the patient to decide want he or she wants. 

One alternative to PAS that many people consider more ethical is the voluntary stopping of eating and drinking. When a person stops eating and drinking completely death normally happens within one to three weeks. A caregiver or nurse has to constantly be with the patient during this process because the patient slips in and out of an unconscious state (Lachman 57). Care Not Killing is an organization of over fifty religious and pro-life groups. This organization does not support the legalization of PAS and claims to protect the rights of life for patients. People against PAS claim that the laws should protect the most vulnerable amongst the people; PAS would destroy the elderly, disabled, and the young (Ferguson). Again, by having limitations on who can be administered PAS, it will protect all people and their rights as human beings.  

PAS can be most beneficial to medical care when taking the right steps and precautions in making it legal. Based on the research, evidence, and stories found, the legalization of PAS in all states of the US should be made a federal law. A bill needs to be made proposing this law, and given to a Congressional representative where it will then be discussed in Congress. With the legalization of PAS in some US states, Congress can look at this research and see that this can and will be a benefit in medical care. Precautious laws should be passed to make PAS legal. This is a serious choice, and it cannot just be open to everyone. The patient needs to be terminal and have a prognosis of six months or less, and it should not be required that the patient be in unbearable physical pain. It should be required that a psychiatrist be involved with the patient when making this choice. A mental capacity test needs to be done, no matter if the patient or physician thinks that they are capable of considering this option. By having strict rules and requirements when requesting PAS, this will accommodate the concerns that people against PAS have. It is important that PAS is legalized because patients are resorting to difficult ways of dying, like voluntary stopping of eating and drinking. This is an uncomfortable way of dying, and a person should be in peace with no pain when they go. 

With the extensive research done, people and the government need to see that physician assisted suicide can be the best option for people with terminal diseases. Comfort and control have the most positive impacts on the patient during their last months of life. PAS is not a choice for all terminal patients to consider, but knowing that if things take a turn for the worst, family and loved ones will be able to pass on peacefully on their own terms and wishes. 
