One of the recent trends among younger generations is to create a bucket list. A list full of goals that one wants to achieve before they die, bucket lists are ideal examples of how death is regarded in the modern world. Death is often portrayed as an unavoidable misfortune, feared by many and dreaded by most, and bucket lists illustrate how people frequently attempt to pack their youth with as many accomplishments as possible, before they become too old. Typically death comes at an elderly age, and today the average life expectancy in the United States is around 77 years old for men and 82 years old for women (Weir, 24). Unfortunately, despite these long life spans, it is not uncommon for people to fall sick with illnesses that can end their lives earlier than expected. When people contract terminal diseases, they are eventually forced to accept the nature of their condition, and realize that they only have a limited amount of time left to live, and usually this time is spent in hospitals with medical professionals. Some patients dislike this fate so much that they will do anything they can do to spend as little time confined in an institution, including end their life early. Already certain that they have little time left due to whatever illness becoming lethal, patients sometimes see no reason to continue living this new life of theirs as it would be extremely limited because of their fragile state of health, and even turn to their doctor for assistance in this specific area of palliative care. A physician may receive a request by the patient for assistance in a suicide due to their suffering of illnesses. Choosing this method, rather than dying naturally, is a highly controversial subject, as there are parties in the United States that believe that placing someone’s fate in the hands of another, even a trusted medical professional, should not be permitted. However, should a terminally ill patient wish to end their life with the assistance of a medical specialist, provided sufficient evidence of a patient’s consent, there is no reason to not allow physician assisted suicide.

There are many people that view this altercation in opposing ways. The book Euthanasia and Physician-assisted Suicide by Dworkin, Frey and Bok opened my eyes to different points regarding this topic that went below the surface of just basic reasons why it is wrong or right. All three of the authors discuss the principles concerning the distinctions between what is right and what is wrong regarding the lethal drugs that can be taken by terminally ill patients. The authors Dworkin and Frey put forth the argument that it is important for it to be legal for physicians to have the knowledge on physician assisted suicide and are able to perform it under certain circumstances. Dworkin who is in favor of physician-assisted suicide argues, “The reasons for favoring physician-assisted suicide are not difficult to determine. They consist mainly of the interests that dying patients have in the process of dying being as painless and dignified as possible. They also rely on the interest of patients in determining the time and manner of their death. Autonomy and relief of suffering are values that we all can agree to be important”(Dworkin). On the other side of the argument, the other author Bok believes that it should not be legal and says, “…the legalization of euthanasia and physician-assisted suicide would entail grave risks and would in no way deal adequately with the needs of those at the end of their lives, least of all in societies without health insurance available to all”(Bok). Dworkin and Frey focus on what they call the “quintessential” case of physician-assisted death, which means that the patient is terminally ill, competent, and has voluntarily requested the assistance from the doctor. One of the arguments that Dworkin and Frey bring up that I found to be very interesting is the comparison of switching off a ventilator, prescribing morphine to patient and giving a patient a pill that will kill them. The authors Dworkin and Frey argue that essentially all of these acts are morally equivalent and that there is not really a difference between a patient dying due to refusing treatment from morphine or a ventilator and being given a pill. Bok takes a different approach with her assessments about physician-assisted suicide. She believes that there has been an unacceptable use of physician assisted suicide and talks about the issue in the Netherlands and hard it is to put a stop to the unnecessary use of legal euthanasia once it is allowed. Overall out of the 9700 cases that were recorded for physician-assisted suicide 3,700 of them were accepted and about 1,000 of those patients were unable to make the decision and were put to death in violation of the guidelines. There are so many cases of euthanasia and physician-assisted suicide and with that being said there are a lot of patients who were comatose or demented that did not request physician assisted suicide and they were still terminated.

For many centuries, medical professional codes of conduct have strictly prohibited any physician involvement in a patient’s suicide (Hulkower). Despite the controversy behind its ethical and legal prohibitions, calls for legalizing the act of assisted suicide have increased, though it is unclear whether this increase was triggered by a growing number of patients falling terminally ill, or simply from more and more people viewing assisted suicide as a legitimate option in their future. However, there are many obstacles standing in the way of any patient pursuing this option, one of them being the Hippocratic Oath. The Hippocratic Oath is an oath taken by healthcare professionals swearing to practice medicine honestly and with integrity. A frequently quoted portion of the Hippocratic Oath against legalizing assisted death states “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan” (Hulkower, 12). Even though the Hippocratic Oath is the most popular of the professional medical oaths that medical schools incorporate, it is also the oldest, originally written over 2,400 years ago, making it outdated. Believed to have been composed in Greece in the fourth century B.C.E., the Oath does not have the same relevance to medicine today as it did when first put to use, and it is now unreasonable to keep following precedents from centuries ago (Hulkower, 21). The role of physicians is not to simply preserve life, their role is also to apply expertise and skill to help improve patients’ health or alleviate suffering. This includes providing comfort and support to dying patients, occasionally including death as a means to end such misery (NE Journal of Medicine). Palliative care (medical care that specializes in the relief of pain and suffering caused by serious illnesses), attempts to help patients live as normal a life as possible until death, which is an impractical request to uphold if the last months of life are spent relying on machinery (Materstvedt). Though

it has recently become more popular in modern medicine, physician assisted suicide is not a new phenomenon. Suffering is, and always has been a part of life, and the search to end suffering through means of death has been present since the beginning of medicine, however legalizing this practice is a process that began within the last century in the United States. In 1967, the first action in the United States in what has been referred to as the “End of Life Movement”, was proposed. A right-to-die bill was introduced in the Florida legislature, and aroused extensive debate, but was unsuccessful when put to vote (Compassion and Choices). Because it is such a recent popular debate, few American citizens can say that they truly understand the debate thoroughly, and fewer would be able to differentiate between doctor assisted suicide and euthanasia. Though they have similar goals, the two practices differ in whether or not the physician participates in the action that finally ends life. In doctor assisted death, the medic will provide the necessary information, and the patient performs the final act on their own. But in euthanasia, the medic performs the intervention on his or her own, with only the consent of the subject. Euthanasia qualifies as “The act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy”, as the person who is doing the acts that bring about the death is not the hopelessly ill and suffering person (Weir, 44). Because of it’s relatively new status as a subject in today’s politics, many taking a position in these debates don’t always have the basic background information needed to give them a reason to argue.

Physician assisted suicide provides benefits to patients that can’t be given by any other means. As stated with the bucket lists, death appears as a menace, something that is wished to be avoided at all costs, however it’s not hard to visualize how death can be seen as a relief, or as an escape from suffering. Mentally adequate, yet terminally ill patients have the legal right to refuse treatment that will prolong their deaths. For patients who are suffering but not dependent on life support, refusing treatment will only keep them in pain longer. To treat these patients to the best of any abilities, allowing assisted death would be moral, as it is their only option to end their agony earlier. However, what many who oppose assisted death overlook, is that suffering is more than just pain. Other physical, existential, social and psychological burdens such as the loss of independence, loss of sense of self, and loss of functional capabilities that some patients experience can jeopardize a patient’s dignity. While it may be possible to relieve the physical pain, it is not always possible to relieve suffering, and allowing death with the aid of a doctor can be a compassionate response to this unremitted suffering. (U of Washington). These patients frequently are reduced to shells of their former selves in their conditions, and allowing them to die with dignity would often be preferred to dying feeling incapable and weak. The highest possible quality care should be the standard for treatment of suffering, and physician assisted suicide, if considered, should only be a last resort when treatment has failed (Quill and Greenlaw). However, should the unfortunate incident occur that there is no possible way to save the patient, doctors should not feel restricted by a law that says they can’t relieve one’s suffering.

Not only does physician assisted death benefit the patient, but legalizing aided suicide would provide unquestioned advantages to others as well, including doctors and family members. By the administration of specific drugs from certified medical professionals, patients can die by taking lethal narcotics, and these medications could be specially designed to not damage any vital organs (BalancedPolitics). Saving these organs, doctors can be permitted to use them to save the lives of others through organ donation (BalancedPolitics). The more hospital space that is being taken up by patients with no chance of survival becomes less space for people who need immediate attention. By allowing patients to die earlier, nurse and doctor time can be freed and spent on savable patients. Hospitals, especially those in thickly settled urban areas with high populations do not always have enough rooms or staff to treat every patient to their best ability (Pickert). If rooms and staff members are occupied by patients’ deemed terminal that wish to no longer keep living, then the rooms and staff members that they are occupying could be used to help treat new patients with better chances of treatment. Another advantage that legalizing death could present is lowering finances. Healthcare costs would reduce saving estates and lower insurance premiums, leaving more to be left in last wills and testaments (Reichel). In the face of an inevitable and approaching death, people deserve the right to end their lives on their own terms, just as humans would not allow a pet dog or cat of theirs to continue the remainder of their lives in pain. “Faced with terminal illness and significant suffering, we don’t even have the legal right to end our pain in most parts of the [United States]. For animals it’s humane; for humans it’s a capital offense. We refuse to allow animals to suffer yet we are committed to making sure people die naturally no matter how much misery they must endure” (Siebold). In most situations where a pet is put to sleep, owners frequently say that they made the decision because they could not stand to see their beloved pet suffering, and the pet had no chance of survival. Using this logic raises the question: wouldn’t the emotions be the same, if not worse, for a loved relative? The emotional pain and anguish of the patient’s family and friends can be lessened and final goodbyes can be made if the death is predictable (Compassion and Choices). Although the issue of aided death is obviously most beneficial to the terminal patient, there is no denying that it would provide advantages to others as well.

Those opposing legalization of professionally assisted suicide often say that it cannot be trusted because it is so hard to predict its use in the future, however it is possible to look to other governmental bodies to observe potential precedent. In the United States, physician assisted suicide is legal in Washington State, Vermont, and Oregon, all three which can serve to predict actions after potential legalization. In 1994, Oregon established the Death with Dignity Act, legalizing physician assisted suicide with certain restrictions, and in 2008, Washington State followed. Not long after, Vermont followed in 2013, making these states the first in the U.S., and some of the first jurisdictions in the world to do so. Outside of the United States, Switzerland and the Netherlands are also of the few bodies of government that allow aided dying. The data from these two countries show that out of all the patients who seriously consider physician assisted suicide, only a minority of these patients actually follow through with their decision. Most change their minds and decide to die naturally, which shows that this practice can easily be abandoned. In Holland and Belgium there are specific guidelines for the medic who aids the patients, as stated in the Moniteur Belge, the Belgian Official Journal which records every new law or changes to the law made by the government (Moniteur Belge). According to the journal, the doctor who performs the euthanasia suffers no consequences and “commits no offense if he is absolutely sure that: the patient is an adult or emancipated minor who is conscious at the time of the request; the request is voluntary, considered and repeated, and has not come about as a result of external pressure; the patient is in a medically hopeless condition of constant and unbearable physical or psychological suffering that cannot be alleviated, and that is the result of a serious and incurable illness; and that the doctor has complied with the conditions prescribed in the nation’s law and standard of procedure” (Moniteur Belge). Belgium’s careful guidelines provide a good example that the U.S. can look to if needed. Those who oppose the legalization say that the future implications would be unpredictable, but policy makers can look to nations and other bodies who have already legalized assisted death for precedent to take into consideration.

Scientific studies and professionally published opinions show that those with extensive knowledge, and in some cases even personal experience, believe that legal physician assisted suicide could have helped their situations. Most recently, on January 13th, 2014, the New Mexico state court decided “terminally ill residents have a constitutional right to obtain ‘aid in dying’” (New York Times). After a 49 year old woman requested the assistance of two doctors in her own suicide, the doctors sought legal protection should they provide the fatal drug prescription, and when the patient provided her testimony, she told the court during trial in December that she doesn’t “want to suffer needlessly at the end” (Eckholm). Doctor Katherine T. Morris, an oncologist in Albuquerque, and one of the two plaintiffs seeking legal protection in this case, said that after years of experience, she and her colleague hadn’t seen the slippery slope that so many people are worried could come about should assisted suicide be legal. For patients with terminal pain, a majority of oncologists found aided death acceptable, but only about 1 in 7 of the questioned medical professionals had carried out physician assisted suicide (ScienceDirect). In fact, patients actually experiencing pain more frequently also found aided death unacceptable (ScienceDirect). The Journal of the American Medical Association mailed an anonymous two part questionnaire to estimate how often the physicians receive requests for assisted suicide or euthanasia. Out of the total of 1,453 potential respondents who were mailed the questionnaire, 828 physicians completed and returned the survey, providing a response rate of fifty seven percent. The polls were sent to a random sample of primary care physicians in Washington State, one of the few states in the U.S. where aided death is legalized. The surveys measured the frequency of explicit patient requests for death, and the results show that twelve percent of respondents received on or more explicit requests for physician assisted suicide and four percent received one or more explicit requests for euthanasia. Diagnoses of conditions that

were most often associated with requests were cancer, neurological disease and AIDS. The patients who made these explicit requests were perceived by the physicians to be most concerned with loss of control, being a burden, becoming dependent on others for personal care and loss of dignity. Of the 156 patients who requested physician assisted suicide 38 of these patients were written prescriptions and 21 of them died as a result of the prescriptions. 58 patients requested euthanasia as opposed to physician assisted suicide, however none of these 58 were granted euthanasia, and 14 of these patients received parenteral medication, which was intended to be beneficial to their health, but still died (JAMA Network). All subjects of the JAMA test were cases with specific knowledge of aided death, or patients who had seriously considered it, but even average citizens have some opinion on the matter. In the United States, 18 states voted with a majority in favor of legalizing physician-assisted suicide, as of 2013 (JAMA Network). These data points and surveys illustrate not only that this is a pressing issue for many Americans, but also that the concern that doctors will be lead down a slippery slope and begin to abuse this practice is not a reasonable fear.

Though the reasons to support the legalization of physician-assisted suicide are morally compelling, it is not difficult to see where and how those opposing it have concerns. There are other options to death aside from administering lethal doses of drugs. One alternative would be allowing patients to stop eating and drinking, becoming so malnourished that they die of inanition. Another form could be sedating the patients to the point of unconsciousness and maintain this state until they die from lack of nutrients (Quill and Greenlaw). Allowing doctors and medical professionals to have so much power over another human’s life can lead to abuse, and this slippery slope may quickly become something that the government will regret allowing. However, as these are valid reasons to be apprehensive, looking at the opinions that doctors have stated as part of surveys, and the published opinions of the doctors in the New Mexico court case, professionals believe that there is no danger of abuse in this practice.

Many things over the course of life can have drastic changes on one’s outlook on life, however none as much as the threat of immediate death. When learning that they have few months to live, patients deserve to have the option to end their life with the assistance of doctors, assistance that cannot be given if the aid is illegal. By legalizing the practice, medical professionals have the freedom to help who asks for it, and should a terminally ill patient wish to die with the assistance of doctor, there is no reason that they should be denied this final wish.
