The Hippocratic Oath provides an ethical code that all practicing medical doctors must swear to, following graduation from medical school. While this oath outlines ethical expectations that doctors are supposed to follow, it does not explicitly bar physicians from prescribing lethal medication to terminally ill patients.  Physician assisted suicide, known commonly to advocators as “Death with Dignity” or “The Right to Die”, believe that this practice is a human right that should be granted to everyone. Although this practice is currently being performed legally in six states, this terminal patients have yet to receive protection from federal legislation. A survey of 2649 doctors in Oregon conducted prior to PAS legislation reported that 51% of doctors support PAS legalization, and 20% have already administered medication with or without a patient’s consent (Physicians' Experiences with the Oregon Death with Dignity Act). Legislation legalizing the practice of physician assisted suicide must be passed in order to protect the rights of patients suffering with terminal illness. Americans, healthy and terminal, have the constitutional right to refuse unwanted medical treatment, a right that even extends to the removal of life-sustaining equipment. Therefore, terminal patients’ rights must be extended to allow physician-assisted suicide, the only cure to the pain from a terminal disease.

Physician-assisted suicide is a very complex ethical issue, and to form an educated opinion it is necessary to review where medical ethics first originated. The Hippocratic Oath was created in the late 5th Century BC by Hippocrates with likely the help from his students. Hippocrates conducted extensive research and advancements in the field of medicine as well as teaching new medical ethics (M. Steven). When new physicians are sworn in as medical professionals a step they must take is swearing to uphold this Oath. In its original form, the Oath required new physicians to swear by many healing gods to uphold specific ethical standards (M. Steven). Although the basic ethics within this Oath remain the same, due to its ancient origins it has received minor edits in order to be adopted for modern day ethical standards. John Hopkins website provides both ancient Hippocratic codes and modern ones adapted for current practices. 

Proponents and opponents of physician-assisted suicide cite the Hippocratic Oath as evidence to support their arguments. A line from the Oath that many use to defend against physician assisted suicide measures is “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly, I will not give to a woman an abortive remedy. In purity and holiness, I will guard my life and my art.” This original version of the Oath clearly outlines that physician-assisted suicide is against the ethics of medicine. Specifically, a physician’s job is to help alleviate patients of ailments and Hippocrates did not view death as a cure to terminal illness. Although the Hippocratic Oath is not legally binding, any adaptations must be  approved by institutions such as the World Medical Association (WMA). Opponents to physician-assisted suicide suggest that doctors who take part in prescriptions must have their licenses revoked. However, progressive doctors and lawmakers have created modern adaptations the Hippocratic oath. A section revised by Louis Lasagna, the Academic Dean of the School of Medicine at Tufts University, now reads “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.” (M. Steven) This adaption of the oath has been adapted by the World Medical Association (WMA) and is used in medical schools across the country. The softer language used in this version puts emphasis on the importance of the doctor-patient relationship. Physician-assisted suicide is about the comfort of the patient and what kind of recoveries are possible with modern day medicine. The original Hippocratic Oath reflects values from past ancient medical techniques. Adaptations that are currently used are so far from the original oath that the use of it in any argument is invalid. The medical community's knowledge of terminal illness has evolved with time, and our laws must therefore evolve as well to protect new rights, specifically physician-assisted suicide. 

Movements for the legalization of physician-assisted suicide and similar measures date back to as early as 1937 when a bill legalizing physician-assisted suicide was introduced in Nebraska’s senate. Although this measure did not pass, it provides evidence for the first interest in the legalization of this practice. A timeline created by ProCon.org shows that this movement did not see any progress until only until 1973, with the creation of the “Patient’s Bill of Rights” (ProCon.org). This bill was shortly adopted by the American Hospital Association granting patients the right to refuse treatment. A small step in the direction of legalizing physician assisted suicide. The right to have life-support removed can be considered as the first legal form of physician-assisted suicide. However, legalization granting prescription of fatal medications was not passed until 1994, nearly 21 years after the continued success of DNR’s and life support. Oregon’s “Death With Dignity Act” provides a model for laws of this nature, and has led to five more states adopting similar legislation.  

Arguments both for and against physician assisted suicide use emotional testimonies as well as expert medical opinions from renowned doctors to support their cause. Dan Brock’s article “Life-Sustaining Treatment and Euthanasia: Ethical Aspects” published to the Encyclopedia of Bioethics further explains the physician’s role in physician assisted suicide. 

The choice rests fully with the patient, and the patient can change his mind up until the moment the lethal process becomes irreversible. The only difference need be who performs the last physical action of administering the lethal dose… this small difference in the part played by the physician in the process leading to death does not support a substantial moral difference between physician-assisted suicide and voluntary euthanasia. (B. Dan)

Brock explains that the moral difference between euthanasia and a patient self-administering lethal medication is significant. When a patient self-administers, there are taking full responsibility for the resulting death, taking moral responsibility for the patient’s death away from the physician.

An investigation into a terminal patient Brittany Maynard provides evidence to the intent of physician-assisted suicide. In a TIME Magazine special, Josh Sandburg interviews Brittany Maynard, a patient with terminal brain cancer, who legally could not receive lethal medication in the state of California. This article provides a personal and emotional video and contains a goodbye Facebook post: 

Goodbye to all my dear friends and family that I love, today is the day I have chosen to pass away with dignity in the face of my terminal illness, this terrible brain cancer that has taken so much from me … but would have taken so much more. The world is a beautiful place… Spread good energy. Pay it forward! (M. Brittany) 

Josh Sandburg’s article shows a much lighter and positive view towards PAS initiatives, a contrast to past negative views of suicide. As the public becomes educated on terminal patient’s such as Brittany, they discover the slow and painful death that similar patients will be forced to endure. Oregon lawmakers specifically address their promotion of patient autonomy on Oregon’s Public Health webpage. Their webpage explains “When PAS is legal, a person has the choice of deciding whether to end his/her own life by taking a pill, self-autonomy is a key right and value.” Although PAS can be debated using facts, the use of emotional testimonies, such as Brittany Maynard, provides a more convincing argument.  When controversial issues such as gun control, or abortion are debated, many times religion divides proponents and opposition. American’s have always fought for the rights that they personally believe in, even when an issue does not directly affect them. Opposition to physician-assisted suicide argue that PAS directly infringes on their personal religious beliefs. Discrepancies between secular and religious law have existed for thousands of years. The National Catholic Bioethics Center wrote an article in 2009 titled “A Catholic Guide to End-of-Life Decisions” explicitly outlining their beliefs towards suicide. It reads, “Human life is an inviolable gift from God. Our love of God and His creation should cause us to shun any thought of violating this great gift through suicide or euthanasia. (L. Joseph) Suicide is defined specifically as a mortal sin and is therefore not tolerated in any form. This idea has been continued by the new pope, Pope Francis, who when asked about the Church’s view on PAS responded: 


Even other religions such as Islam and are explicit on their stance on assisted suicide. Yusuf al-Qaradawi writer of “Living Sharu’ah: Fatwah Bank” wrote in 2005:

This act is Islamically forbidden for it encompasses a positive role on the part of the physician to end the life of the patient and hasten his death via lethal injection… or any other way. It is a major sin and thus forbidden in Islam (Yusuf al-Qaradawi).

Yusuf al-Qaradawi explains in his article that euthanasia, mercy killings, and even the removal of life support are considered assisting in the suicide of the patient. Due to both major religion’s firm stance towards physician assisted suicide, opposition towards death with dignity laws use holy text to preach against legalizing this practice. This is an effective method as the PewForum.org cites that in 2014 over 80% of Americans affiliated with some form of religion are also opposed to physicians assisting in end of life procedures (W. Benjamin).

The bond between doctors and patients is outlined in the Hippocratic Oath dating back to the late 5th Century BC. In the oath, it describes the sacredicity of this bond and key aspects of it, such as doctor-patient confidentiality as well as being transparent and honest with patients. Opponents argue that by giving a physician the ability to prescribe lethal medication will break the bond between patients and doctors. In a survey of physicians in Michigan, 52% responded that they would not participate in prescribing lethal medication. The majority of physicians do not feel comfortable with aiding in death. When a patient asks for relief from pain from a terminal illness in the form of lethal medication, the physician is put into an ethical dilemma. Physicians are being asked to violate their own personal beliefs by assisting in suicide, as well as the oaths they swore to when they first became a physician. However, in contrast to the physician’s response to this survey, 48% of the public responded that they definitely or probably would request assisted suicide if they faced a short-term terminal illness (Schmidt). When a prescription is written, and signed, it is a doctor’s order that a patient should follow. However, prescribing lethal medication to assist in dying is considered suicide because a patient is choosing to take the medication. The rights of terminal patients who ask for assistance in dying must come before a physician’s own personal religious beliefs.

Opponents of Death with Dignity laws argue that PAS is a slippery slope, and the rights of others are being jeopardized by the passing of these laws. The decision to end life-support and other life sustaining treatment is a serious one that requires a competent patient to consent to death. However, because of the severity of terminal illnesses, patients are often not competent enough to make this decision for themselves. In the event of no prior documentation, such as a will or DNR order, the responsibility of making a decision usually falls on a close family member. While a choosing a close family member promotes patient’s self-determinism, Felicia Cohn, associate Professor at the University of California Irvine warns that: 

Physician-assisted suicide conjures fear that someone else will determine what is to be considered excessive suffering or costs, and that others might seek to eliminate the suffering or the costs by eliminating those persons who are perceived to be suffering or costly. The elderly are particularly vulnerable to the effects of inadequate health care resources (C. Felicia)

The elderly, those mental illnesses, and even minorities are being put at risk by physician- assisted suicide because they can be viewed as burdens to our healthcare system. Those with severe disabilities are subjected to becoming labeled as terminally ill in order to take advantage of PAS. Undoubtedly, physician-assisted suicide would benefit competent patients. However, it would put the elderly and severely disabled at risk to the ultimate form of discrimination.

For thousands of years, physicians have grappled with the ethical issue of physician-assisted suicide. The Hippocratic Oath, an ancient code that provides basic ethical guidance explicitly warns against prescribing lethal medication to patients. However, as times have changed so have the ethical codes of medicine. Modern adaptations of this code now put a reinforced emphasis on patient care and comfort, giving physicians the ability to consider physician-assisted suicide without breaking oath. Physician-assisted suicide is a human right that should be inherently granted to every human. Terminal patients have the right to the pursuit of happiness outlined in the constitution, along with other amendments. Opponents of Death with Dignity laws present strong arguments such as the religious beliefs of patients and doctors, and protection of the rights of the disabled and elderly. Advocates continue to appeal to the public through emotional testimonies of those who suffer from terminal illness.  Americans believe in granting more rights, particularly those related to self-autonomy. My research combined with my pre-existing knowledge of medical ethics have led to me to the take a stance that physician assisted suicide is a legal right. I believe that laws similar to Oregon’s “Death with Dignity” should be enacted nationally. A patient who suffers from a terminal illness must have the right to choose death with dignity. 
