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1. What is Physician-Assisted Suicide?

 

Assisted Suicide has been prohibited in medicine for over 2000 years. In years past, doctors took the Hippocractic Oath and pledged that, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. ”First do no harm.” This “silver rule” is the foundational moral principle of medicine. It reminds doctors that as they attempt to cure and relieve suffering, they should never do anything that injures the patient.

 

 

 

 

 

End-of-Life Definitions

 

Term	Definition	Example
Physician-Assisted Suicide	Helping a person to kill himself. In physician-assisted suicide (PAS), the doctor prescribes a lethal dose of one or more medications. The doctor may also give verbal advice about how the patient can take his own life or instruction for use of suicide machinery.	A doctor prescribing a lethal dose of barbituates, which the patient takes himself.
Euthanasia (Active Euthanasia)	From Greek meaning "good death" - The act or practice of ending the life of a patient out of mercy.	Can be passive or active. If active, it can be voluntary, non-voluntary or involuntary. Physician-assisted suicide is a form of euthanasia.
Passive Euthanasia	Withholding or withdrawing medical interventions; the intent is to cause death. The patient is not dying, but the withdrawal or withholding of medical interventions will cause death.	Not giving insulin to a Type I diabetic; deciding to not operate on a baby with bowel obstruction because they have Down’s Syndrome.
Voluntary Euthanasia	Patient consents to doctor’s lethal injection.	Patient asks doctor for lethal injection; doctor complies.
Non-voluntary Euthanasia	Patient’s consent not possible due to unconsciousness, mental incompetence or other medical reason.	Patient is comatose or demented and it is assumed they would want euthanasia.
Involuntary Euthanasia	Patient’s consent possible but not sought.	A competent patient is killed without his or her consent.
Medical Futility	When treatment will have no benefit or is outside accepted medical practice, the clinician may be justified in withholding or withdrawing treatment.	“Pulling the Plug”; Discontinuing life support when it is just prolonging the dying process.
Advance Directives	Discussions or written statements which convey a person's wishes to his or her family and physician in the event that he or she becomes unable to discuss such matters.	Durable Power of Attorney for Health Care, Health Care Proxy, Medical Proxy, Five Wishes, “Living Will”.

 

 

 

"... When I started losing my hearing about three years ago, it irritated my daughter. She began to question me about financial matters and apparently feels I won’t leave much of an estate to her... She became very rude.... Then one evening (she said) she thought it was okay for older people to commit suicide... So I sit, day after day, knowing what I am expected to do." Santa Rosa Press Democrat, September 14, 1993, interview with 84-year-old woman

 

 

2. What You Should Know

 

There are many factors driving the physician-assisted suicide movement in the 21st century. Seventy-seven million "baby boomers"—Americans born between 1946 and 1964—will begin entering the Medicare system in the year 2011¹. Americans aged 65 and older account for almost a fifth of all suicides². And proponents of "hastened death" speak of compassionate solutions to painful illnesses through "death with dignity." Combine these powerful forces with an impersonal and technological health care system, and the result has proven lethal. But what you should know is that assisted suicide is an immoral slippery slope that corrupts the doctor-patient trust, a trust based on the physician’s commitment to heal, not to kill. It is dangerous public policy.

 

 

Studies Show...

 

An article by Ezekiel J. Emanuel, MD, PhD, in the Archives of Internal Medicine, January of 2002, evaluated several recent studies conducted on physician-assisted suicide and euthanasia. His conclusions^3,4:

 

• More than 90 percent of the public deem withdrawing life support as ethical when the patient is dying, while at best 65 percent support euthanasia or PAS.
• Among oncologists, as many as 50 percent have received requests for euthanasia or PAS.
• Although most patients initiated the request for PAS, almost half of them did not repeat the request.
• Among the first 43 cases of PAS in Oregon (the only state where it is legal), 72 percent of the patients had cancer.
• Among the patients receiving PAS in Oregon, only seven percent had uncontrolled pain. Depression, hopelessness, and wanting to stay in control are consistently associated with interest in PAS and euthanasia.
• Among terminally ill patients, the extent of care giving needs was associated with interest in euthanasia or PAS.

 

Other study findings:

 

• "Factors associated with being less likely to consider euthanasia or PAS were feeling appreciated, being aged 65 years or older, and being African American. Factors associated with being more likely to consider euthanasia or PAS were depressive symptoms, substantial caregiving needs, and pain."⁵
• "In cases of completed suicides [in Oregon] in 2001, concern over losing autonomy was given as a reason 94% of the time and fear of losing control of body functions was mentioned by more than half the patients."⁶
• "The basic tenets of palliative care, including symptom control, psychological and spiritual well-being, and care of the family, may all be summarized under the goal of helping patients to die with dignity… What defines dignity for each patient and his or her family is unique and should be considered by clinicians to provide the most comprehensive, empathic end-of-life care possible."⁷
• "Frequently, the request for PAS reflects a patient's misunderstanding about his or her options for end-of-life care. Patients who ask for PAS may actually be requesting aggressive symptom control should their suffering become intolerable. They may not understand that medications can be increased to whatever levels are required to relieve physical symptoms…or other physical and emotional suffering. Even if death is hastened in the process which is extremely rare…such actions are morally permissible and legal when the intent of the treatment is to relieve symptoms and not to cause the patient's death."⁸

 

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