
One of the most heatedly debated topics in the United States is the idea of physician assisted suicide (PAS). PAS is “The voluntary termination of one's own life by administration of a lethal substance with the direct or indirect assistance of a physician. Physician-assisted suicide is the practice of providing a competent patient with a prescription for medication for the patient to use with the primary intention of ending his or her own life” (MedicineNet). When it comes to a human life, there are many strong opinions that come along with anything that includes it. For example, people are either strongly against the idea of PAS, strongly for it, or both. Those who are against PAS say so primarily due to religion and ethics, while those who are for it say so because of autonomy and freedom of choice. Then there are those who are for it while against it at the same time believing there are certain circumstances where ending one’s life is necessary.  

PAS should be made legal in all states of the U.S. in order to satisfy both parties – only available to competent individuals. In order to be able to receive the lethal medication, one must be a citizen of the United States, an age minimum of eighteen years old, mentally competent, and suffering from a terminal illness.


Hippocrates, the father of Western medicine, was the first to understand and teach that the intentional quickening of death is not compatible with the alleviator – the one who aids in easing the pain. Since the fifteenth century, society has viewed suicide or intentional death as immoral primarily due to their religious affiliations. It was not until the twentieth century that these “immoral” attitudes were challenged. Today, the American Medical Association maintains a position on the issue: “Physician assisted suicide is fundamentally incompatible with the physicians’ role as healer, would be difficult or impossible to control, and would pose serious societal risks” (2). As of 2016, the Netherlands, Belgium, Luxembourg, and Colombia have unambiguously legalized direct assisted dying. Canada, Japan, and Germany undergo a process of either a judicial or legislative decision. Currently some states in the United States, like Oregon, Washington, Vermont, Montana, and California, allow PAS through the same process of either a judicial or legislative decision. That leaves forty-five states out of the progression. The right to assisted suicide is a significant topic that concerns citizens all throughout the United States; the debating goes back and forth. Some believe PAS is wrong due to religious or moral reasons. Others believe it should be made available because of their compassion and respect for dying. After studying both sides of the issue, an empathetic individual should conclude that under certain circumstances, adequately terminally ill patients should be granted the option and right to PAS in order to end their intolerable suffering, minimize financial effects, and give patients independence. 


In 2014 at only twenty-nine years old, Brittany Maynard was diagnosed with an aggressive terminal brain cancer. She underwent surgery and treatment, but the cancer continued to grow. At the time of diagnosis, Maynard lived in California where PAS had not yet been made legal. Therefore, she was left unable to receive the assistance she had hoped for. As a result, she and her family relocated to Portland, Oregon where she would be granted access to the death-with-dignity law. Maynard eventually received the lethal prescription but an unexpected outcome came about – she never took the drug. Maynard said:

“Now that I've had the prescription filled and it's in my possession, I have experienced a tremendous sense of relief. And if I decide to change my mind about taking the medication, I will not take it. Having this choice at the end of my life has become incredibly important. It has given me a sense of peace during a tumultuous time that otherwise would be dominated by fear, uncertainty and pain” (Egan, 2016). 

The oppositions to legalizing PAS include several viewpoints of concern. The main and most prominent point is that legalizing PAS is morally unjust. According to the article “Physician Assisted Suicide is Always Wrong" author Ryan Anderson states, “Doctors may help their patients to die a dignified death from natural causes, but they should not kill their patients or help them to kill themselves “(2). This quote exemplifies the opposing side and central point of PAS – Anderson displays a moral opinion. Sworn by every physician is the oath “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan” (US National Library). Therefore, another argument of the opposing party is the physician’s oath of “Do No Harm” would be hypocritical if PAS were to be made legal. Other arguments include lack of control over who is receiving the lethal medication, potential physician abuse of power, endangerment of the weak and vulnerable, and relationship compromising. In an article written by author Robert Orr states, “The medical profession as a whole, and pain specialists in particular, have an obligation to use all available means to relieve pain. That obligation includes continued research to develop new drugs and new means to accomplish this goal” (136). Orr believes that excellent palliative care, specialized medical care for patients with serious illness, is the better route amongst the topic of PAS rather than making a lethal drug available. Another article, “Mercy and Physician-Assisted Suicide” discusses the Catholic side of the argument. Author Kathryn Harvey states, “God is the author and giver of life, it is morally wrong to purposely end one’s life or the life of another directly or indirectly” (2). Harvey further describes the central argument of those against PAS – that is morally incorrect. Although many people’s opinions rise from their beliefs and morals, other people have opinions due to a personal experience on the topic. Obviously there are numerous moral opponents to PAS, but what about how it affects real people?  

Anna, a forty-six-year old woman dying of breast cancer, asked her doctor for a lethal injection to end her pain. Her doctor, Orr, felt that his failure to provide adequate pain management led her to the idea of lethal injection. Doctor Robert Orr said, “Anna is the only patient in my thirty-four years of practice who has asked me for a lethal injection. And I am certain that it was my failure that led to the desperate request” (131). The situation that Doctor Orr had experienced led him to recognize a change he believes should be implemented. A change that he believes should include bettering palliative care by enhancing relief programs and de-stressing of a serious illness. Orr then discusses in his article, “Pain Management Rather Than Assisted Suicide: The Ethical High Ground” that patients suffer when their physical, psychological, social, and spiritual needs are not addressed in end of life care (3). Thus, Orr voices if Anna received all these aspects of excellent end of life care, she would not have felt the need to request physician assisted suicide. This further shows Orr’s positioning of physician assisted suicide; patients may not think about it if given better palliative care.

PAS strikes as a controversial topic of discussion. Thus, searching for a common ground in any solution regarding the topic is necessary. John Donovan, one of the debate participants in the podcast “The Great Debate,” commented on general statistics by saying, “"they don't tell a simple story, and they don't answer the essential question of the rightness and wrongness, the morality and the practically of what is called 'physician-assisted suicide' or sometimes 'assisted dying'" (Donovan). Donovan believes that the numbers are not indicative of any moral reasoning; for they only illustrate the amount of the lethal drug administered by a physician or non-professional. Both, and all, sides of the commonly debated topic are parties that hope the best for the patient and others involved. Although both parties want what is best for the patient, the families, physicians, and anyone else involved, their differences in what is believed to be best is exceedingly unlike one another. For example, many of those who oppose legalization of PAS argue that intentional killing is unethical; in contrast, those in favor argue that letting a patient suffer in pain is unethical. These two bold viewpoints lead to a common ground of patient and doctor choice. Legalization with professional involvement (i.e. physiatrist and physician), seems to be the most practical and plausible solution to finding a middle ground.

On the other side of the highly debated topic of PAS is the call for it to be federally sanctioned. Those who support the legalization of assisted death typically either believe there should be no restrictions in place, making it free to anyone, or believe there should be certain restrictions (i.e. six-month prognosis, mentally stable, etc.). Legalization of PAS would allow patients to avoid the pain of a terminal illness that would eventually lead them to be unrecognizable to loved ones and allow for a planned death for those wishing to escape the pain of the disease causing them pain. A terminal illness is defined as, “where death as a consequence of that disease can reasonably be expected within 6 months” (Segen’s). Teresa Yao, author of “Can We Limit a Right to Physician Assisted Suicide?” discusses palliative care as, “If this specialty acknowledges that mental and spiritual anguish merits the same serious treatment as physical pain, why would an option to end great suffering apply only to the physical kind?” (387). Yao is pointing out that physical suffering should not be the only determinant for who receives PAS, but also mental suffering. As mentioned, those who oppose PAS say it encourages distrust amongst the doctor and patient. Cheryl Smith, author of “Should Active Euthanasia Be Legalized: Yes,” rejected that notion by stating, “Patients who are able to discuss sensitive issues such as this are more likely to trust their physicians” (409). Smith discusses a terminal patient that gives consent to assisted dying and is aware that the physician’s job is to relieve his or her pain; giving consent shows trust. 

Many in favor of PAS argue that it should be made available to save autonomy. A study conducted about Oregon’s Death with Dignity Act in 2008 sought to learn from family members why their loved ones requested PAS. The study was designed as a cross sectional survey of family members of eighty-three Oregon decedents who requested PAS. Included in the eighty-three decedents were fifty-two participants who received prescriptions for lethal medication, and thirty-two who actually died from PAS. Twenty-eight possible reasons for opting for PAS were listed and presented to each family. Family members rated the importance of the twenty-eight reasons from one to five – a higher score representing a more important reason. The results of this survey indicated that the most important reasons for requesting PAS were wanting to control the situation of death and die at their home, fret about loss of dignity and independence, reducing quality of life, and having the ability to take care of oneself (1). These results are indicative of families’ desires for autonomy in that they show the major wishes for receiving the lethal medication. 

Legalization of PAS is necessary; however, there should be several qualifications a patient must meet prior to receiving a lethal drug. These qualifications include, a citizen of the United States, an age minimum of eighteen years, mental competence, and suffering from a terminal illness. The guidelines to ensure effectiveness of the proposal are as follows: the patient must meet all qualifications, all patient requests for lethal drugs must be examined by a board of medical and mental health professionals, and paperwork to be signed by all parties involved, including consent forms. The current laws of today dictate that physicians do the administering of lethal drugs and not mental health professionals. This leads Roland Kipke, the author of "Why Not Commercial Assistance for Suicide? On The Question of Argumentative Coherence of Endorsing Assisted Suicide," to believe that there is a non-medical profession, a commercial form of assistance, that is able to assess patients perhaps better than a physician – a psychologist. Kipke states, “The decision for or against suicide is indeed not a medical decision in a strict sense. Rather, it is a decision mainly based on psychological, philosophical, ethical, and – depending on the person – spiritual dimensions” (519). With that being discussed, the current laws of administering a lethal drug to a patient who qualifies for assisted suicide must be altered to address needs beyond the physical. Physicians and psychologists should both be involved in each patient’s case of assisted dying. According to the article, “Assisted Suicide: Why Psychiatrists Should Engage in the Debate” there are three main areas where psychiatrists’ expertise is informative and relevant to the issue. Authors Hotopf, Lee, and Price list the main areas as:

 “(a)the extent to which safeguards to limit the availability of assisted dying to target groups can be applied safely and fairly, including to individuals with psychiatric disorders; (b) the complexities inherent in assessing mental capacity; and (c) the degree to which individuals adapt or change their desires, particularly in relation to suicidal behaviours” (1). 

These three main ideas presented in the article further illustrate the benefits of having a mental health professional involved in PAS.

It is critical that mental health professionals are involved in any situation regarding the assessment and administering of PAS. Along with the proposed solution is specific guidelines psychologists must follow in the process of physician-assisted suicide. The steps of the procedure should go as follows: (1) Thoroughly examine medical records with psychologist, physician, and patient, (2) mental competence examination, (3) discuss financial plans with patient and/or family members involved, (4) sign consent forms with patient and/or family members, (5) administer lethal medication. Proper following of the protocol for administering the lethal medication must be taken in order to satisfy the new proposal. By following these steps, the patient will be carefully viewed as an adequate patient that meets the correct criteria. 

PAS must be freely bestowed upon those who meet the qualifications of treatment. The right to die would allow patients to have a death with dignity, save families from financial burdens, relieve the patient from insufferable pain, and allow autonomy. Due to the difficulty discussing this topic, it is necessary to aid in satisfying both sides of the issue as much as possible. If legalization with specific qualifications was enacted in all states of the U.S., then those who wish to receive lethal medication can obtain it after comprehensive consideration by patient, physician and psychologist.
