Over the years, ethics in medicine have changed tremendously. There are arguments that have carried out through these years that are still relevant to today. One of these deals with the legalization of physician-assisted suicide and euthanasia in the United States. While these two treatments are usually considered to be quite similar, there is one large difference that causes them to be variably accepted or denied. The legal definition of physician-assisted death is as follows: “suicide by a patient facilitated by means (as a drug prescription) or by information (as an indication of a lethal dosage) provided by a physician aware of the patient’s intent” (Physician-Assisted Suicide, Merriam-Webster). On the other hand, the medical definition of euthanasia is “the act or practice of causing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy (also called mercy killing)” (Euthanasia, Merriam-Webster). Even though it may not be completely clear by these two definitions, the biggest difference in these acts is that one is administered by the patient while the other is done by the physician. Most of the debate is over physician-assisted death as the United States does not seem quite ready for euthanasia. There have already been a total of six states and the District of Columbia to legalize physician-assisted suicide, Oregon being the first of these back in 1994. The other states have laws either prohibiting physician-assisted suicide or they consider it to be a felony or form of manslaughter.  

Arguments that are against the legalization of these treatments range anywhere from statistics to religious beliefs. Those arguments that support the idea usually revolve around statistics of nationwide approval as well as compassion for those requesting the treatments. The determination of whether these actions should be legalized does not need to be based on emotional preferences but rather the ethics behind the treatments. The reason for this is that laws are not based on emotions but rather facts and research and solid reasoning that does not waver. The supporting side provides compelling arguments by using examples of patients, such as Brittany Maynard, who express their feelings when given the choice of physician-assisted suicide; however, the ethics and research behind the treatments as well as opinions of other physicians worldwide who have legalized either treatment provide strong evidence that neither of these treatments should be made legal in the United States. 

This debate was reignited a few years ago with the rise of the Brittany Maynard case. Mrs.Maynard was diagnosed with terminal brain cancer at the age of twenty-nine (Brittany’s Choice CBS). She had to undergo a few surgeries in an effort to remove the tumors, but they only came back in a more aggressive form. In addition to taking the normal end-of-life care steps to make dying more comfortable, Mrs.Maynard and her husband moved from the state of California, which did not have physician-assisted death legalized at the time, all the way up north to Oregon. She stated that her biggest fear was the pain and suffering she would endure as well as what her family would have to go through while watching her suffer. Mrs.Maynard proves as a strong advocate for the support of legalizing physician-assisted suicide. She claimed that having the prescription made her feel more in control and the fact that she had it did not make her suicidal. She stated that having that control and being able to decide on her own terms when it was time is what allowed her to enjoy every minute she spent on the Earth and with her family, and she knew there was a “safety net” for when things got bad. Her wish to those who may possibly walk in her shoes is that physician-assisted suicide is offered to them as well, because they should have the right to say when it is time to end their suffering and to have those closest to them by their side to say goodbye (Maynard, “My Right”). Although this seems to be a good argument supporting the nationwide legalization of the treatment, there were many different opinions on her choice. That seems to be the problem: everything is an opinion. Opinions do not need to be the main support on something that could potentially be legalized. Even though opinions are what people depend on to make many decisions in their life, when dealing with legal issues evidence and proven facts should be the basis of people’s choice. Mrs.Maynard pulled on the heartstrings of many people, especially those experiencing what she did, but her case is not evidence. Her case is her own personal feelings, which were actually quite selfish. Rather than spending the little amount of time she had with her friends and family, she decided to take matters into her own hands and end her life despite her loved ones’ feelings about her situation. In the interview with CBS, her choice seems brave as she was standing up for her own right to die, however when put into perspective it was more self-centered than valiant.  

Confusion plays a large role in the physician-assisted suicide/euthanasia debate. One of the largest candidates for this confusion is the format of the question being asked during the surveys. Most people respond negatively to the term “suicide” so they are more likely to oppose any idea using this term (Emanuel, Attitudes). TIME Magazine conducted a survey where they asked people how they felt about “euthanasia” versus “physician-assisted suicide.” Even though there is a significant difference in the way these two treatments are carried out, the difference in names causes euthanasia to have a higher support rate than the assisted suicide. For those who were surveyed and showed opposition to either or both treatments, TIME labeled them as “religious” or “church-goers” which shows the one-sidedness of this survey. This bias causes the source to be less reliable than others, however it goes to show how people can be swayed one way or the other just through the use of certain terms (TIME). 

Euthanasia is the other part of this debate, but not as strongly in the United States. The reason for this is because other countries that have this treatment legalized have come across the issue of physicians interpreting patients’ requests for pain relief as requests for euthanasia. This causes patients to fear requesting the pain relief necessary to reduce their suffering and make dying more comfortable. Opiates and other pain relief medications should not be the source used for carrying out euthanasia because it consequently places this fear in patients that by requesting these prescriptions, their physician could interpret it as requesting their death. This issue deals mainly with those who are terminally ill and require prescriptions such as strong opiates to relieve their pain. Along with this is the removal or addition of pain relief with any intent of shortening the patient’s life. This still constitutes as “intention of killing” which falls under the definition of euthanasia (Emanuel, Attitudes). 

According to Somerville in chapter seven of her book Death Talk, Second Edition: The Case Against Euthanasia and Physician-Assisted Suicide, there are three parts to the confusion of this debate. The first is the definition of either physician-assisted suicide or euthanasia. The definition of euthanasia given in this text is different from that of Merriam-Webster, but it is given as: “a deliberate act or omission that causes death, undertaken by one person with the primary intention of ending the life of another person, in order to relieve that person’s suffering” (page 119). Somerville goes on to make the point that most people associate euthanasia with a lethal injection given to a terminally ill patient with informed consent of the patient, however, nowhere in that definition does it state they must be terminal or have informed consent. By using such a broad definition, euthanasia could count as anything such as refusing pain relief or any other treatment where doing so would then shorten the life span of the patient and allow them to experience a “good death.” Based on this definition, when doctors and nurses are surveyed and asked if they have taken part in any acts of euthanasia and they respond by saying they have, it is then assumed that there are secret performances of euthanasia being done and in order to ensure the safety of patients, they should just go ahead and legalize it. By twisting these answers around, it places fear in those being told the statistics because they automatically assume euthanasia is lethal injections. They would then support the legalization of this treatment in order to stop the “secret performances” and abuses of what they assumed was happening (pages 119-120). 

The second part of the confusion factor is the language used when talking about euthanasia or physician-assisted suicide. There are completely different reactions drawn between the phrases “merciful act of clinical care” and “killing.” Because the word “kill” can entail anything from murder to manslaughter, doctors prefer terms such as “voluntary or involuntary euthanasia” so as to narrow it down to the medical degree. Another part of the language aspect is how patients communicate to their physicians what they would like to do. At some point along the process, most terminally ill patients may express their wish of dying, however, does this constitute their consent to euthanasia? Clear communication between physician and patient is the only way to figure out exactly what the patients wants or means by their “death wish” and if they are actually saying they want physician-assisted suicide or euthanasia (pages 121-123). 

The final point Somerville makes regarding the confusion of this debate is the association euthanasia has within the medical care. Some people would refer to it as “the final stage of good palliative care,” while others would consider this statement to be a sugarcoating of what euthanasia really is: killing someone. If people are considering euthanasia to be one part of the end of life care, which usually includes the relief of pain and suffering for the patient as well as providing compassion for them, then why would anyone want to oppose such a “good” thing? This proposition also puts what is called a “medical cloak” around euthanasia which makes it primarily a medical issue without the inclusion of it being a philosophical and societal issue as well. Since the primary goal of physicians is to cause no harm, researchers have asked if there should be a certain group of lawyers who should be trained to perform the act of euthanasia. Even pro-euthanasia individuals oppose the idea of lawyers “killing” people, however they see no problem with it when a physician is involved in the act. People assume it is safer with a doctor and more acceptable, but if it is considered killing when someone other than a doctor initiates the act, then why is it not considered killing altogether? These feelings do not align with one another, because it is the same action just being performed by different individuals. This final point made by Somerville is what tears down the weakest part of the supporting side’s argument (pages 124-126).

Most people assume that those who are against physician-assisted suicide and euthanasia are religiously affiliated. This affiliation usually surrounds the beliefs and teachings of Christianity and Catholicism which seem to be more prominent in the United States (Masci). From the religious aspect, both physician-assisted suicide and euthanasia are morally unacceptable. Not only do they encompass the act of killing, but they also take away the life that God blessed us with. One of the Ten Commandments found in the Bible in Exodus 20:13 clearly states, “You shall not murder.” Even though neither of these treatments involve holding a gun to somebody’s head to end their life, withdrawing or injecting medications still falls within the category of “killing” because it intentionally shortens the patient’s life. While this reasoning is not necessarily the basis of all religious people’s beliefs, it is still good to understand the explanation as to why it may be for some.

Within the states where physician-assisted death is legalized, most of the patients requesting the treatment are those in hospice care, more specifically those with some type of terminal illness such as cancer. The “Death With Dignity” Acts found in these states, specifically Oregon and Washington, allow these patients to request a lethal drug in order to end their life on their own terms. The problem found here is the admission of terminally ill patients into hospice makes people question the true purpose of hospice. This “end-of-life” care does not necessarily mean ending the patients’ lives. The purpose of hospice is supposed to be making dying more comfortable for the patient and their family as their life finishes its course, not speeding up the process through medication. This concerns some people because they are worried that by placing a patient in hospice, assisted suicide will then become the first resort of this palliative care (Campbell, Dignity). 

Another issue arises when those suffering from a terminal illness request this assisted suicide because they are depressed. Research was conducted to determine the different reasons behind patients requesting assisted death, and those related to pain seemed to be less of a problem compared to the psychological, existential, and social issues these patients faced. Professional and familial interpretations of the patients’ mental state were given as evidence to support their possible reasons for requesting the assisted. Most of these requests proved to be persuaded by the depressed and emotional state that the patient was in. The conclusions met from this research discussed how further investigation of this issue should focus on studies surrounding patients who have requested death assistance and the reasons behind their desire to do so. If the assisted suicide were legalized, the protocol would be to highly recommend them to a psychiatric treatment before deciding on their death when depression is something that can be helped (Hudson, Desire). The issues regarding depression of patients also raise concerns about people requesting death even though their illness could potentially be cured. There are more factors causing people to choose voluntary death in the states where it is legal besides just untreated pain, even though that seems to be the common reason, mental state proves to be prominent behind the scenes (King, More).

My overall belief is that euthanasia and physician-assisted suicide should be made illegal in all states of the United States, even in those where it has already been legalized. Unnecessarily removing or adding pain relief treatment as well as giving lethal injections counts as intent of killing. Having the intent to kill a patient as a physician clearly goes against the law as “murder.” Even though pro-choice individuals in this debate disagree with the use of the words “killing” and “murder” saying they suggest a harsh treatment that is exactly what these two treatments encompass. By purposefully causing the life of the patient to be shortened to some extent, with or without consent of the patient, they are potentially killing the patient. Even though the argument against this is that those with terminal illnesses will reach death anyway, the speeding up of the process by any means is unethical. Most people may ask why anyone truly cares about this debate. The reason is because we all die at some point. Some people are diagnosed with cancer and only given a few months to live, others live a full healthy life of ninety or more years. By legalizing physician-assisted suicide or euthanasia we are only speeding up the process and offering an easy out for those who may or may not be on their death bed. On the other hand, if we as a country keep these treatments illegal, the reputation of doctors and physicians will remain as professionals whose number one priority is to keep their patients alive. Patients in the states where physician-assisted suicide is not allowed will then not have to worry about feeling pressured to end their lives and will be able to further trust those taking care of them. 
