Suicide Literature Review

Perspectives of Physician Assisted Suicide 1
Perspectives of Physician Assisted Suicide

By: Joanna O’Keefe
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The right to assisted suicide is a topic that concerns everyone all over the United States. A
legal prescription for life-ending medications is only available in states that have Death with
Dignity laws. There are only a few states in the United States that have Death with Dignity laws.
These states include Oregon and Washington State. In 2009 the Supreme Court in Montana
decided that aid in dying wasn’t “assisting suicide” but it was a legal medical protocol. (Wolff
2016). If an individual is looking into assisted suicide he or she has to seek a physician who is
willing to “assess their suitability for a lethal script” (Wolff, page 9). At any moment in a
person’s lifetime an individual can be diagnosed with a terminal illness. This illness can cause
pain and suffering so horrid that he or she may want to end their life in a humane way, rather
than suffering. The purpose of this literature review is not to argue in favor of or against assisted
suicide, but rather to give an analysis of the subject to inform the reader of different perspectives
people have when it comes to physician-assisted suicide. The research question that was
considered when writing this essay was “Should physician-assisted suicide be legalized in all
states?”. This literature review will be categorized into four parts: recent cases, the arguments of
people for it, the arguments of people against it, and the perspectives of medical professionals.
Recent Cases
In 2014 Brittany Maynard, a 29-year-old teacher with stage 4 glioblastoma, decided to
end her life using physician-assisted suicide. This particular case went viral on social media
because of the circumstances surrounding it. Brittany was very young and although she was only
suffering from seizures and minor pain at the time, she decided she wanted to live the remainder
of her life happy. She did not want to wait until the cancer progressed and left her feeling
dysfunctional. What made this case so different was the fact that Brittany was very young, and
she had a close and loving family. Since 1997, only seven people under the age of 34 have used
Oregon’s Death with Dignity Act. Maynard’s case is widely known and spread by advocates of
physician-assisted suicide. She was known as “the poster child for assisted death” (Kotva 2016).
Ruth Duffin was diagnosed with Parkinson’s disease in 2008. She was able to live life
around the disease for many years but as each year passed her condition progressively worsened.
Ruth lived in Canada and felt as if she could no longer deal with this disease and she did not
want her family to have to keep taking care of her for more years to come. Ruth and her family
contacted End of Life Planning Canada and after a long conversation with them it was clear that
Ruth did not have many options. Voluntary stopping of eating and drinking (known as VSED)
was the only realistic legal option until the laws in Canada changed. However, the family
decided that this would be a horrible and drawn out way to die. Ruth was denied the right to
physician-assisted suicide because she had more than a few months to live. The government only
allowed this to be an option to people if they were going to die very shortly. In 2015, Ruth and
her family traveled to Switzerland where Ruth could legally end her life. The estimated trip cost
was about $28,000 total, including the fees from the Swiss organizations for assisted death
(Proudfoot 2016). The anesthesiologist connected sodium pentobarbital to Ruth’s IV line and
with her family holding her she died peacefully and within minutes.
The Pro-Assisted Suicide Arguement
Assisted suicide activists argue that physician-assisted suicide provides a way for a
patient suffering to end his or her life, on his or her terms, in a humane way, without having to
worry about leaving their family and loved ones in financial debt. They argue that it should be a
personal choice and individuals should not feel any pressure from family members or physicians
to go through with this decision. Anyone who is considering this option should be able to have
access to a psychologist to be able to communicate their feelings openly. Stephanie Antill
explains that “the top three motives of patients requesting physician-assisted death are loss of
dignity, diminished ability to engage in enjoyable activities, and lost autonomy (2016)”. Death
with Dignity laws are important because they give people options at the end of their life. Werth
and Wineberg (2005), the individuals who drafted the Death with Dignity Act in Oregon, argued
that
“This act was necessary because the dying process in the United States had become impersonal,
with little communication between physicians and their patients, with little compassion for the
dying person, and the autonomy of the dying individual had been taken away. (p. 2)”
Karen Sanders argues that if physician-assisted suicide is legalized then this will provide legal
clarity for protection of nurses and patients. As of right now there is no protection is certain
states for physicians and even individuals who are constantly seeing their family members or
loved ones in pain and want to help. There is only punishment for those who assist with suicide.
Sanders argues that
“The current legal situation also causes difficulty for nurses and other healthcare professionals.
The director of public prosecutions’ guidance on assisted suicide states that prosecution is more
likely if the person assisting was a healthcare professional acting in that capacity. However, it is
not clear what constitutes assistance by healthcare professionals. While the RCN tells us that we
should discuss a patient’s desire for an assisted death with them, the medical Defence Union
recommends its members do no such thing. What is a nurse to do? (pg 1)”
The Anti-Assisted Suicide Argument
Many people argue that Death with Dignity laws bring physicians too much power.
Physicians are supposed to save lives, not end them. Gregor Wolbring, a German biochemist
living in Canada, and a leader in the international anti-euthanasia movement expresses his
concerns about assisted-suicide. He states, "Now you can also get euthanasia if you are
emotionally having a problem, or if you are incurable. The safeguards they had ten or fifteen
years ago, don't exist anymore."(Garton 2012). Anti-activists argue that legalizing assisted
suicide could send the nation on a “slippery slope”. The slippery slope argument is that if
assisted dying becomes legalized for terminally ill people then there is a risk that vulnerable
groups, such as older people with learning disabilities and mental illnesses, will be encouraged
by their loved ones to take this course (Haigh 2012). Anti-euthanasia movement individuals
believe that people will take this easy way out instead of learning to cope with his or her mental
illnesses. Moira Garton argues that assisted suicide should not be legalized because people may
feel as if suicide is the only option. “Assisted suicide purports to be about free choice. But there
are significant dangers that many people would take this “out” due to pressure, such as elderly
individuals who don’t want to be a financial or caretaking burden on their families” (2012).
There are many anti-activists groups and one of them is called The Coalition Against Assisted
Suicide. The CAAS, is a group based in Washington State and many of their member’s post
testimonials on the website. One member, Camille Pauley stated on the CAAS site
“The tragedy of allowing doctors to help people kill themselves is that it completely abandons
the patient, and ignores our responsibility as a civilized society to create systems that enable
everyone to die with the true dignity, love, and care that my mother received," (Pauley, 2008).
Buchanan states that as medical professionals they should be demanding better education and
resources for end of life care instead of helping their patients commit suicide. By supporting PAS
she is fearful that people will lose trust in their physician. Buchanan argues that medical
professionals are supposed to be “healers” and if they choose to help end a life then it may
“demean the value of a human life” (Sanders et al, 2012).
The perspectives of medical professionals regarding PAS.
Karen Sanders, an active supporter of PAS, and a nurse with 25 years of experience, argues that
safeguards should be put in place to support and protect any vulnerable people (2012).
Research shows that geographical location, religion, and a medical professionals workplace all
can effect whether or not the person agrees with physician assisted suicide. In the US and in the
Netherlands, there is still a great portion of nurses who are against assisted suicide despite it
being legalized. For example, in Israel, 33% of nurses would not administer life-ending drugs
because of religious reasons. Tepehan et al (2009) found that out of all the nurses who opposed
legislation of assisted suicide, 42% claimed it was because of religious reasons. A poll was
conducted at Royal College of Nursing that showed 49% of the nursing students supported
assisted suicide while 40% opposed it (Evans 2015). These nurses also worked in different
areas of hospitals and it was found that nurses who worked in the oncology department were
more open to the idea of assisted suicide than nurses who work in the ICU or the pediatric unit.
This poll also found that the majority of the nurses supported their patient’s choice to end their
life they did not completely agree with the choice for ethical reasons (Evans 2015).
Conclusion
Physician-assisted suicide is going to be an ongoing controversy for many years to come. It is
clear that many people have different influences and ideas of what is morally and ethically right
and wrong. Assisted suicide is a controversial topic because it effects so many people in the
world. It effects the elderly, the disabled, the terminally ill, their families, and all medical
professionals involved. The anti-activists and pro-activists both provide logical and valid points
on the legalization of assisted suicide. However, it is hard to say for sure the negative and
positive effects PAS will bring to the world because there are still so little places that have
actually legalized it.
References
Antill, S. (2016). Death With Dignity Provides Options for Patients at the End of Life.
ONS Connect, 31(2), 36-37.
Evans, L. (2015). Nurses' attitudes to assisted suicide: sociodemographic factors. British
Journal Of Nursing, 24(12), 629-632.
Garton, M. B. (2012). Euthanasing the disabled. Eureka Street, 22(12), 5-6.
Haigh, C. (2012). Exploring the case for assisted dying in the UK. Nursing Standard,
26(18), 33-39.
Kotva Jr., J. J. (2016). Dying in Oregon. Christian Century, 133(8), 28.
Pauley, C. (2008). Coalition against assisted suicide. Retrieved from

\http://noassistedsuicide.com/qanda.html
Proudfoot, S. (2016). ‘THIS IS NO WAY TO LIVE’. Maclean's, 129(47), 14.
Sanders, K., & Buchanan, M. (2012). Pros and cons of assisted dying. Nursing Older
People, 24(2), 8-9.
Tepehan S, Ozkara E,Yavuz M (2009) Attitudes to euthanasia in ICUs and
other hospital departments. Nurs Ethics 16(3): 319–27
Wolff, B. (2016). Death with Dignity: The Debate Broadens. New Mexico Nurse61(1),
8-11.
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Perspectives of Physician Assisted Suicide 1

Perspectives of Physician Assisted Suicide

In 2014 Brittany Maynard, a 29-year-old teacher with stage 4 glioblastoma, decided to

The Pro-Assisted Suicide Arguement

access to a psychologist to be able to communicate their feelings openly. Stephanie Antill

Sanders argues that

The Anti-Assisted Suicide Argument

“demean the value of a human life” (Sanders et al, 2012).

The perspectives of medical professionals regarding PAS.

Physician-assisted suicide is going to be an ongoing controversy for many years to come. It is

actually legalized it.

ONS Connect, 31(2), 36-37.

Evans, L. (2015). Nurses' attitudes to assisted suicide: sociodemographic factors. British

Journal Of Nursing, 24(12), 629-632.

Garton, M. B. (2012). Euthanasing the disabled. Eureka Street, 22(12), 5-6.

Kotva Jr., J. J. (2016). Dying in Oregon. Christian Century, 133(8), 28.

Pauley, C. (2008). Coalition against assisted suicide. Retrieved from

Proudfoot, S. (2016). ‘THIS IS NO WAY TO LIVE’. Maclean's, 129(47), 14.

People, 24(2), 8-9.

Tepehan S, Ozkara E,Yavuz M (2009) Attitudes to euthanasia in ICUs and

other hospital departments. Nurs Ethics 16(3): 319–27

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