Discussing death is never simple or endearing, however, it is a necessary topic of discussion in 21st century America. As people grow older and possibly develop a debilitating  terminal illness, many look for a safe, painless way to die and have the chance to say goodbye to their loved ones. Physician assisted suicide (PAS), refers to

the physician providing the means for death, most often with a prescription. The patient, not the physician, will ultimately administer the lethal medication This is often confused with euthanasia, which generally means that the physician would act directly, for instance by giving a lethal injection, to end the patient's life. (The World Federation Of Right To Die Societies)

Even though the viewpoints on physician assisted suicides have changed drastically, in the past couple years, this newfound aid in dying still has a long journey towards legality, affordable costs to the taxpayer, and the many ethics involved with doctor- patient relationships. 

Personally, my goal since I was a young child was to go in the health field, and it still is today. After many classes in high school and college, I have learned it’s not all happy endings with all patients living healthy with speedy recoveries. Doctors and other healthcare workers often have to make hard decisions for the wellness of their patients. I believe this means allowing patients to have a choice about the end of their lives. I personally have never had to deal with a terminal illness, but I cannot possibly fathom the serious pain and suffering a person must go through. In a T.E.D. talk with Dr. Allan Saxe, he talks about the reasons why physician assisted suicide should be legal for all. Dr. Saxe also mentions a personal story about his friend who was suffering from kidney failure. She was unable to receive any pain pills from the doctors and suffered a long painful death. In the video he states, “If someone wants to go, if they want to leave the party so to speak, let them leave…  This does not denigrate life, it enhances it. There is nothing noble in my mind about suffering” (Saxe 7:09- 7:29). Death should not be as complicated as it is, and in order to grow as a more prosperous society with access to helpful alternatives, we need to start educating ourselves on helpful alternatives like physician assisted suicide. 

With education on alternative medicine, ethics will always be a key factor. The ethics involved in physician assisted death has a broad range of opinions with physician assisted suicide. On the one side, doctors are not allowed to comply with a patient’s request in dying, however, is not it just as bad to look upon a dying person and not give them the means to end their pain? Vicki Lachman’s "Physician-Assisted Suicide: Compassionate Liberation Or Murder?” discusses the many ethics involved in a Physician assisted death. In the article, the charts show a rapid growth in popularity of this procedure each year. One section titled “What is the Best Response for Nurses to a Request for Aid in Dying?”, is a very detailed procedure most health care workers must follow in order to insure patient safety. In the article, Lachman also discusses an alternative method that nurses and other healthcare professionals can offer patients where the patient stops eating and drinking. The act of dehydration and starvation  is a legal alternative to physician assisted suicide but death takes approximately one to three weeks. As long as the patient is competent and physically, physiologically, and spiritually prepared, he or she has the right to exercise this choice. Even though this method is legal, I don’t believe the patient is as comfortable or would be content with death through starvation and dehydration. In another article by Nicole Smith, “The Positive Aspects of Physician Assisted Suicide”, Smith states that “Patients seeking a suicide that is safely monitored and administered by a physician often have terminal illnesses from which know they will never recover. According to one report by Exit, which is a Swiss organization that helps in about 100 suicides per year, ‘about 70 percent have cancer. Other common conditions are heart disease, AIDS, and neurological disorders such as motor neuron disease.”(Smith). From this article, it is understood that patients who request this procedure are not going to recovery and with physician assisted suicide, will be able to end their severe suffering. 

However, not all agree with this point of view on ethics within physician assisted suicide. Ira Byrock of the New York Times, claims that physician assisted suicide is an unethical act that violates doctor-patient relationships and can be abused or used inappropriately. In the article, he states, “In April, a 47-year-old Dutch mother of two was granted her wish to die because of long-standing tinnitus (ringing of the ears)” (Byrock). This disorder case in the Netherlands is a clear, inappropriate use of physician assisted suicide. Tinnitus is a treatable and manageable disease, making this disease unsuitable for PAS.  As Byock states in his article, the ethics of the patient doctor relationship must not be ignored when discussing physician assisted suicide. He claims this “excess” is what is hurting patients; that doctors may see some lives as not worth living and end their supposed misery. While the cases that are extreme did happen in foreign countries, Byock claims they could eventually happen in the United States where physician assisted suicide is legal or in the future where more legislation is in the process of legalizing physician assisted suicide. With a standardized healthcare system like America, this is extremely unlikely due to the already set regulations. Byock also fails to illustrate the many other conditions that are being ignored in the United States. Patients with severe pain are forced to continue out the remainder of their lives in a hospital with a barely functioning mind. While there are extreme cases of abuse of physician assisted suicide, it is very unlikely. The Journal of Medical Ethics states “At least in theory, the answer to the question of how many abuses can be tolerated could go like this: we should tolerate the same level of abuse in PAS that we tolerate in forgoing life sustaining medical treatment (FLSMT)”  (Dahl, Levy). This quote is stating that while in some cases a patient could be potentially influenced into a physician assisted death, a patient could also be pressured into forgoing life sustaining medical treatment. This could be equally as damaging and as a society we must tolerate both sides. Another common argument is that some patients requesting physician assisted suicide are not educated or do not have the funds for hospice care. However, this is not the case, “according to the Oregon Department of Human Services, however, which monitors compliance with the DWDA (Death With Dignity Act), the overwhelming majority of patients seeking physician assisted suicide are financially well off, highly educated, and have health insurance. On average, 86 percent of patients using the act are enrolled in hospice care.” (Dahl, Levy). With these statistics, none of the patients are purposely being taken advantage of. Hospice is also used to make patients as comfortable as possible with their illness, so shouldn’t these patients have all possible options?

Legislators are working to show that patients are not being taken advantage of. In her editorial, "Physician Aid in Dying Gains Acceptance in the U.S.", Paula Span, starts off interviewing Judith Dunning, who is working with legislators to end her life due to her terminal cancer. Span also describes in the article that many laws passed that have allowed for states such as Vermont, Montana, Washington, and Oregon to keep physician assisted suicide legal. Some states have also begun legislation such as California, Colorado, and the District of Columbia. The Death With Dignity Act also allows physicians to write prescriptions for lethal drugs when patients qualify, those with a terminal illness/cancer, for physician assisted suicide. Patients must have the mental capacity to make medical decisions (Span). Many hospitals and hospices are allowed to forbid their doctors to prescribe the necessary medication, and some patients who qualify for physician assisted suicide often die before they are considered eligible and some become too incapacitated from their illness that they are no longer able to take the drugs themselves which is a requirement. An article recently written by Kevin Drum, “My Right to Die” states

Ever since Oregon's Death With Dignity Act took effect in 1997, the state health authority has published annual reports about the numbers and types of patients who have gotten a prescription for DWDA drugs. Probably the main takeaway is the simplest one: If Oregon is any indication, assisted suicide will never be a popular option. In 1998, only 24 people received DWDA prescriptions, and 16 used them. By 2014, after 16 years in which Oregonians could get used to the idea, 155 people requested prescriptions, and 105 used them. That's 105 out of about 34,000 total deaths statewide, or roughly one-third of 1 percent. (Drum)

This lack of popularity can be explained by Oregon’s many restrictions of who can obtain a physician assisted suicide. These restrictions include, “Requests for DWDA drugs must be confirmed by two witnesses and approved by two doctors. The patient must not be mentally ill. And most important of all, both doctors have to agree that the patient has no more than six months to live.” (Drum). Since two-thirds of patients who requested the drugs have cancer, they were denied due to the fact cancer often has a definite timeline. While these restrictions were set in place to help and protect patients, they will only cause pain to those who need this procedure most.

Although physician assisted suicide revolves around the patient and their health, their relatives and loved ones are also impacted with this experience. Jean-Jacques Georges, an author based in the Netherlands, scholarly article discusses the views of relatives that have experienced close family members who have gone through physician assisted suicide. These cases were from the Netherlands, where physician assisted suicide is legal. It was found that around 92% of relatives interviewed agreed that physician assisted suicide contributed to the quality of end of life for the patient and an astounding 100% of relatives interviewed stated that all patients were ready to die (Georges). Reading the statistics in the article was very helpful in understanding the after effects on the close relatives after losing a loved one. It’s clear to see that not only do patients suffering prefer physician assisted suicide, but their loved ones and family members also prefer having patients die on their own terms. Many of us will never have to face the choice in ending our own suffering, but with physician assisted suicide we at least have a choice in the matter. The majority of the people interviewed agreed that by not prolonging the suffering on their family member, this then helped the dignity of the patient. Legality is very complicated, but through the analyzing other states and countries who have some form of legal physician assisted suicide, legislators have a better understanding of how successful and helpful this procedure is for people not only in the United States, but the world. 

With legality, comes cost. In a capitalist society like the United States, cost is a major issue when discussing any change in law or healthcare. In the scholarly article,  "The Value Of Planned Death." written by Leo Chan and Donald Lien,  a group of mathematicians configure the economics and costs that go into to physician assisted suicide. In the article, they discuss that there is an economic benefit to legalizing physician assisted suicide. With prolonged illness, the medical cost to keep the patient alive can be very expensive and can also end up falling onto the patient's family or a “society to prolong life” (Chan, Lien) causing there to be more stress on the patient’s family. Thus, legalizing physician assisted suicide could be less expensive to the patient and taxpayer and relieve some of the burden put on the family. The discussion concludes that as the opinion of physician assisted death grows in popularity, the cost of physician assisted suicide will go down. With the longer life lived in America, it is more practical to accommodate to all those with terminal illness and what that entails for the common American taxpayer. Not only is it less expensive for the everyday American, it is also less expensive for hospitals, “But once a decision is made not to pursue cure or treatment, and assisted suicide and euthanasia are available, the economic logic will be inescapable. The care provided to dying or very ill patients, not just their treatment, is expensive and demanding for healthcare professionals. The extra weeks or months of caring for patients who do not opt for assisted suicide or euthanasia will seem all the more 'futile' and costly." (New York State Department of Health). With health care costs constantly on the rise, a way to cut costs in the medical field is to start to allow patients access to physician assisted suicide.

With new information on physician assisted suicide, and it’s many benefits to terminally ill patients, the road towards legality is not as far out of sight as it once was in America. In the cases of ethical dilemma, physician assisted suicide in no way heeds or lessens the code of ethics placed upon health care workers. Legality has also had many ups and downs throughout the twenty first century with unnecessary restrictions on cancer patients. While it is not ideal, progress is being made, with more Americans and healthcare workers favoring legislature to legalize physician assisted suicide throughout the years. Lastly, looking at the cost of physician assisted suicide shows us that this procedure is more beneficial economically speaking for the tax payer and hospital funding compared to continuing the patient’s treatments. Physician assisted suicide can be beneficial to many people coping with a terminal, painful illness. Legislators and critics may understand the concept of suicide but until they have gone through a personal experience of dealing with the pain everyday, that was a result from a terminal illness, or having a family member go through this experience and grasping for lost hope, I don’t think they will ever comprehend the blessing of getting to die on one’s own terms. 
