Life is temporary, and so is pain. Any single person could be here one day, and gone the next. It is up to each and every one of us to cherish the time we have with loved ones. I once had a little dog named Emmitt, and I was faced with the hardest choice I've ever had to make in my life. Emmitt was only five when he was taken from me due to liver failure. My best friend was suffering for years before I figured out that he was ill. He had an incurable disease, and I had to face reality. I had to choose whether to let him live out the rest of his life in pain, or to relieve him of his suffering and let him run around in Heaven. To do this day, I am glad that I had the opportunity to help a dog who I loved more than the whole world, end his suffering. I could not bare to see him lay in pain all day, for endless days and nights. I knew he was not himself. As much as I wanted to be with him, I knew in the back of my mind how selfish I would be to let him suffer on. Human beings should be given the same opportunities when they have terminally-ill diseases, because it is morally right. 

The legalization of euthanasia and physician-assisted suicide has long been disputed on the grounds of cultural, spiritual and moral responsibility. Originally, the responsibility of making end-of-life decisions fell to the patient’s next of kin, not allowing able-minded patients to decide their own fate. In the past decade, there has been a lot of advocation towards the legalization of euthanasia and assisted suicide on the basis that these individuals should have the right to determine what happens to their own bodies. A few countries have taken the initiative of legalizing either physician-assisted suicide or euthanasia, and in some cases both. These countries include the Netherlands, Belgium, and Luxembourg. Certain states in the US have also legalized the practice, such as Oregon, Washington, Colorado and California (Death with Dignity). Physician-assisted suicide is also tolerated in Switzerland due to a pre-existing law that decriminalized the act of suicide, creating an effective loophole for patients considering the option (Pereira). Because of this decriminalization, suicides can be assisted by someone who is not a practicing physician. Both euthanasia and physician-assisted suicide should be legal in modern day society; all individuals deserve to exercise their right to choose in both life and death.

The act of euthanasia is undertaken by the physician when they administer a lethal substance to their patient with the intention of ending the patient’s life (Pereira). Physician-assisted suicide differs in practice as the patient self administers the lethal substance that is prescribed to them by their physician (Pereira). While patients have plenty of support when it comes to campaigning their right to choose, there is a discrepancy as to whether the act should be carried out through euthanasia or assisted suicide. The support of either practice usually involves disparities between different cultural conventions. In the US, only physician-assisted suicide has been legalized, while euthanasia remains illegal. The opposite of this is true in Belgium, where only euthanasia is permitted (Pereira).

A study was carried out interviewing 70 terminally ill patients who were all surveyed through semistructured interviews (Wilson). This study found that 67% of them believed euthanasia was more acceptable than physician-assisted suicide due to their belief that the termination of life requires clear medical knowledge (Wilson). These patients also expressed that they considered physicians to be the most qualified when it came to determining the appropriate timing of the administration of the drug, as well as being able to determine the stability and rationality of the patient and their request (Wilson). For those who considered physician-assisted suicide to be the better option, they put more value into the comfort of the patient. They believed that the ability to self-administer the lethal substance maximized the control of the patient, giving them choice of where and when they want their death to occur (Wilson). These patients also expressed that the termination of life is not a role a physician should take on, and that the active participation in the deed would be inappropriate (Wilson). Overall, 73% of the 70 patients interviewed believed that either euthanization or physician-assisted suicide should be legal, their reasons mainly focused on the individual’s right to choose and their pain level. The study also discovered that if given the option, 58% of the patients would consider a hastened death as an option if their physical symptoms became intolerable (Wilson). Although, a separate study found that patients were more likely to request euthanasia out of their desire to remain autonomous, with their physical pain having less influence on their decision over all (Aviv).

When terminally ill patients were asked what reasons would cause them or another person to potentially seek an option such as assisted suicide, they provided a list of points which could attribute to making such a decision. Besides the commonly thought of reasons such as pain level and an individual’s right to choose, they also acknowledged how the interpretation of others could influence them. Patients said that they would be more inclined to go through with the process if they felt that their life had become a burden to others (Wilson). Not wanting to force their loved ones to continue to take care of them and their sickness when they are reaching their inevitable death. They also cited mental illness as a factor that could cause them to hasten their death. In Belgium, 13% of the patients who were euthanized in one year were not terminally ill, instead they were suffering from prolonged and intense psychological issues (Aviv). Wim Distelmans, an oncologist as well as a professor of palliative medicine at the Free University of Brussels, participated in the physician-assisted suicide of a patient who was not terminally ill but had suffered from depression for 40 years (Aviv). Distelmans justified his decision to prescribe his patient with the lethal substance saying that she “wanted to do one decent thing in her life, and that was to die in a decent way” (Aviv). This supports the ideology that all individuals have the right to determine how they want to die. A competent, able-minded patient should not be denied the opportunity to escape their suffering and choose a dignified death. In general, people often tend to overlook the impact a psychological disorder can have on an individual’s quality of life. One psychiatrist, Lieve Thienpont, tried to urge other professionals in her field to understand the limits of psychiatry, understanding that it is possible for a patient to reach such an extensive level of pain that their mental illness should be considered as terminal. Thienpont acknowledged that true psychic suffering could be just as unbearable as physical pain (Aviv).

Distelmans also helped found the Life End Information Forum in Belgium. This forum was formed in order to educate and train physicians to give proper consultations to patients considering euthanasia. These forums ensure that all the physicians are well educated about all the options, included palliative care, and that they are able to efficiently relay that information to patients (Pereira). Other forums, such as the Support and Consultation on Euthanasia in the Netherlands were created with the same purpose of ensuring that both the physicians and the patients had the necessary information to make an informed decision. Joris Vandenberghe, a professor of psychiatry at the University of Leuven and member of the Belgian Advisory Committee of Bioethics, said that “we, as humans, have the possibility to weigh our own life and decide to end it” (Aviv). 

The Death with Dignity laws are based off of the ideology that all individuals have the right to determine their own fate, as well as how much pain and suffering they should be forced  to endure (Death with Dignity). These laws make it possible for patients, the majority of whom are waiting for their illness to finally led to their death, to have a dignified, peaceful passing. By choosing the time and place of their death, patients are able to take control of the limited time they have left. Euthanasia also provides patients with an easier form of dying than the pain they are already experiencing (Pereira). In the Netherlands, 80% of patients who died from either physician-assisted suicide or euthanasia had some form of cancer (Wilson). With the exception of Belgium, all patients must be terminally ill in order to qualify for assisted suicide or euthanasia. Because of this requirement in which all patients are given a maximum of six months to live, the moral argument changes significantly (Chin). It was found that 30% of the patients who started the process died before they were administered the final medication (BBC News). Regardless of what measures are taken regarding the patient’s comfort, they are going to die, it then comes down to a matter of how. By utilizing euthanasia, patients are able to be granted a peaceful death in which they can set the parameters. In Oregon, 65% of patients who participated in physician-assisted suicide were unconscious after five minutes of ingesting the lethal medication and had passed away after an hour of ingestion (Chin). Those patients were able to die peacefully in their sleep in the comfort of their own homes and on their own terms. Not a single complication, such as seizures or vomiting were reported after the medication was administered. Even though the practice requires the extermination of a live, it gives the individual the choice of a painless death. This also allows patients to choose the time of their own death, thus ensuring that all their affairs are in order and they have time to say their goodbyes. The families of the individual undergoing the assisted death are also giving the opportunity to come to terms with the loss of a loved one, and prepare for the inevitable in a peaceful way. 

The Oregon Death with Dignity Act allows state residents who are terminally ill to self-administer a lethal substance given to them by their doctor (Chin). The act requires that the patient receiving the lethal drug be able to make clear, well informed decisions about their health. It also requires that a consultant, along with the primary physician, confirm the diagnosis and prognosis of the patient. If either physician suspects that the patient’s judgment is impaired by a psychological disorder, such as depression, they are required to refer that patient to psychiatric counseling instead (Chin). Patients must also be informed of all other viable options, such as pain treatment or hospice care, so that it can be ensured that the patient is making an educated decision. Doctors must report all prescriptions of lethal medications to the Oregon Health Division in order to ensure that all the protocol was followed leading up to the patient’s death and that any malpractice can be avoided (Chin). The patients are also given protocol that they must follow in order to guarantee that the individual has the proper amount of time to think through their decision and change their mind if necessary. The patient must make one written and two oral requests from their physician to go through with the plan. There must be made with a minimum of 15 days separating the times of each oral request. The patient also has to wait a specific amount of time between receiving their prescription for the medication and getting it filled (Death with Dignity). This verifies that the patient has had a sufficient amount of time to come to a decision (Chin). One study showed that 45% of the patients changed their mind and decided not to go through with the assisted suicide (BBC News). This proves that not only are the patients able to make clear decisions but they are also given an appropriate amount of time to come to a fine decision about their health. 

Many regulations are put in place to guarantee that the patient is being treated fairly and is making an informed choice. The most important requirement is the explicit consent by the person requesting euthanasia. In regions in which euthanasia is legalized, it is required that only physicians administer the medication to the patients, with the exception of Switzerland (Pereira). All cases must be reported regardless of if it is euthanasia or physician-assisted suicide. These criteria and procedures were established in order to prevent euthanasia and assisted suicide to be misused or abused (Pereira).The request for euthanasia has to be voluntary, well considered, informed and persistent over time, in places like Oregon, there are specific time minimums that need to be met (Pereira) The patient requesting the euthanasia must be competent and coherent at every point where a request is made (Chin). Two thirds of requests for euthanasia are denied by physicians, this proves that not only are the patients making sure this is the best option, but the doctors are careful to ensure that they are well informed and able to make this decision (BBC News). If a patient is unable to give consent, due to a coma or dementia, it is within the rights of the physician to make the decision regarding what the best action would be for that individual (Pereira). This decision must be agreed upon by at least two physicians and appeals to their social responsibility as a citizen. In Belgium, a third consultant is required if the patient is nonterminal, this often occurs in cases in which the patient has suffered from a long term psychological disorder (Aviv). Even in patients that are diagnosed with a terminal illness, psychological considerations are just as salient as physical ones, acknowledging that a diminished quality of life is a major factor (Wilson). 

In many medical fields, there comes a time where they have done all that they can for a patient. Today’s culture is full of continuously advancing medical technology that allows humans to defer death for an extended period of time. Eventually, patients with terminally ill diseases come to terms with the fact that their death is inevitable in the near future. For many of them, it is more important to have a happy, peaceful death than it is to spent those last couple months prolonging the inevitable. The same way a patient has the right to choose what type of care they receive, they deserve the right to determine that they have had enough medical help. Some religions, such as Buddhism and Jainism, believe that death is the next step in one’s journey and that it should not be feared, but embraced. For patients practicing this religion or that have similar ideologies, it is a choice that they are content with making. Unlike with animals, humans have the ability to advocate for themselves when their pain and suffering has become too much for them to endure. As a culture, individuals consistently choose to euthanize their pets in order to end the pain of a loved one but do not have the same reaction when it comes to other people. By letting these patients die a natural death, both doctors and family members are subjecting the person they are trying to protect to a painful end. Humans often acted out of their own self interest and are not always conscious of how their action impact others. By choosing to deny patients the right to decide their own fate, they are prolonging their suffering (ProConorg Headlines). 

Although, like any other law, the regulations put in place to ensure that all parties are acting in the best interest of the patient are not always followed properly. Around the world 900 people annually are administered lethal substances without having given explicit consent. This however, is usually non-voluntary euthanasia, meaning that the person is unable to provide consent generally due to a coma or severe dementia (Pereira). Non-voluntary euthanasia occurs almost explicitly in patients of 80 years of age or older, who also suffer from dementia or have fallen into a coma. In the Netherlands, 0.4% of all deaths are caused by patients being giving lethal substances without giving explicit consent to the euthanasia (Pereira). In the Flemish region of Belgium, 32% of euthanasia occurred without any request or consent. Out of that same 32%, 17% of those cases involved a physician proceeding because they believed that it was “clearly in the patient’s best interest” (Pereira). Even though all physicians are required to document all the lethal prescriptions they administer, 50% of euthanasia went unreported in one jurisdiction in Belgium (Pereira). In those cases not reported to the Federal Control and Evaluation Committee, 41% of the lethal drug was administered by a nurse instead of a doctor. In the Netherlands, 20% of the cases go unreported (Pereira). If the physicians are not documenting these cases then there is no way to regulate them to ensure that they are properly carrying out the protocol.

Another major concern is that the desire to hasten one’s death is not consistent over time. In one study, 3 out of 70 patients reported that they would have considered euthanasia at an earlier point in their life but now have no desire to go through with it (Wilson). The fact that some patients may change their mind brings up an alarming moral argument that some of the patients who chose to go through with the euthanasia or assisted suicide could have lived happy lives if they remained alive. Concerns also arose around the reliability of the patient’s mental stability, since there was a higher prevalence of depression amongst patients who requested the euthanasia (Wilson). Since depression is often treatable, this could case a patient to have a negative bias and decide to end their life while they could have potentially recovered. The UN also conveyed their concerns that some patients may feel influenced or pressured into euthanasia if they are already in a fragile state of mind. They were also worried that the system would fail to detect situations in which the physicians felt the pressure to administer patients the lethal medicines (Pereira). There are also many issues regarding the morality and religious sensitivity of euthanasia and assisted suicide. One study found that they 27% of patients surveyed who did not support such practices, all cited religious and moral objections are their reason (Wilson). Many of them felt that it is inappropriate for a physician to participate in an act that terminates a life and that such participation calls into questions the integrity and judgment of that doctor. Many religions also forbid such an act that hastens one’s death such as Episcopalianism, Islam, and Hinduism (Death with Dignity). For anyone who practices these religions, or ones with similar perspectives, consider it to be a sin for those who partake in shortening an individual’s life. Although all of the religions are different, they all regard human life as a gift that should be cherished above all else. It is understandable how individuals could unintentionally project their own personal values onto other people, believing that the morals that are in accordance with their own spirituality are the ones that need to be followed.

Overall, it is the individual living in the experience that is able to gage the severity of a situation and make the most educated decision that it is time to move on. Regardless of religious, spiritual or moral differences, all people should be given the legal right to make their own choice on their end-of-life affairs. In one study, 12% of patients claimed that they would have pursued euthanasia or physician-assisted suicide if it was available to them (Wilson). De Wachter, a professor of psychiatry at the University of Leuven, was told by patients that “I am an autonomous decision-maker. I can decide how long I live. When i think my life in not worth living anymore, I must decide” (Aviv). The physicians that were prescribing their patients with the lethal doses tended to be older in age and had more experience within the field (Chin). This suggests that not only could these physicians give their patients extensive information about their other options, they also had more of an understanding of the impact and importance that physician-assisted suicide can have on them and their families. As a society that allows individuals the privilege of practicing their own beliefs in all aspects of life, it is essential that they are given the same opportunity to do so in death. 
