Bioethical Controversies Surrounding Physician-Assisted Suicide

Physician-assisted suicide, or voluntary euthanasia, has sparked highly controversial opinions surrounding the right to control one’s own death. Physicians incessantly weigh benefits of a procedure against risks of harm and face ethical dilemmas when balancing beneficence and the duty to do no harm, non-maleficence.

Some physicians believe that by assisting in death, they are abandoning their medical and ethical duties. Typically, patients seeking assisted suicide experience inability to engage in pleasurable activities, a loss of dignity, and a loss of autonomy. For terminally ill patients, if all curative medical interventions have been exhausted, some physicians begin the next step of administering relief in depression or other mental illnesses even when it only provides a short period of improved life quality.

However, other physicians believe that they are helping patients by providing them the choice to die on their own terms. The honor in having the right to a dignified death is strongly supported by secular humanism, an officially recognized belief by the Belgian government, which has the most liberal laws surrounding euthanasia.

The Netherlands, Belgium, and Switzerland allow physician-assisted suicide to be administered to not only terminally ill patients, but also patients suffering from mental illnesses. The National Institute of Health looked into physician-assisted suicide records in the Netherlands and found that 37 of 66 assisted deaths were cases that mentally ill patients refused recommended treatment options.

In countries like Belgium where psychiatric care is minimally funded, physicians have been pushed to accept the limits of psychiatry. There, when patients request euthanasia, physicians may classify patients mental illnesses as terminal and comply with requests to die.

When a patient requests euthanasia, Belgian doctors have the right to conscientious objection. However, lawmakers are attempting to change the current law by requiring all doctors to respond to the patient’s request in a very short amount of time and to refer the patient to another doctor that will fulfill their death request.

Not only is this controversy difficult for physicians, but also it is a huge problem for religious institutions that do not support self-inflicted death. The Catholic Health Association believes that suicide and euthanasia will never be morally acceptable opinions and therefore, “Catholic health care institutions may never condone or participate in euthanasia or assisted suicide in any way.”

In the United States, the most fundamentally protected rights are those embodied in the Constitution, including an individual’s right to preserve autonomy and retain bodily integrity by refusing life-sustaining medical treatment. Cruzan. However, in Vacco v Quill, the Supreme Court decided that although a competent individual can refuse unwanted medical treatment, there is not a constitutionally protected right for individuals to choose to die. The right to die is left for the states to determine.

Currently, only four states including Oregon, Washington, Vermont, and most recently, California, have implemented statutes allowing physician-assisted end of life options for terminally ill patients. In Montana, the Supreme Court decriminalized physician-assisted suicide upon the request of a terminally ill and competent patient. The court determined that the right to die with dignity is not contrary to public policy and physicians are not committing a crime by prescribing a lethal dose of medication as long as the terminally ill patient makes the final decision to take the lethal dose on his own, without any assistance.

This year, Canada and Columbia have also decriminalized physician-assisted suicide. The debate continues in England as well as here in the United States, where an additional 23 states anticipate hearing proposals regarding the right to die.

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