Should Physician-assisted Suicide Be Legal?

Physician assisted suicide was brought to mainstream attention in the 1990’s due to Dr. Kevorkian’s “suicide machine," who claims to have assisted over 100 suicide deaths of terminally ill patients with Alzheimer’s disease (Dickinson, p. 8). In the early 1990’s, for the first time in United States history the issue was brought to the voting polls in California, Washington, and Oregon (Dickinson, p. 9). The bill was passed in Oregon; legally allowing physicians to facilitate death of the terminally ill, but voters fails to pass the bill in Washington and California (Dickinson, p. 9). In 2008 voters in Washington State passed the Washington Death with Dignity Act (Dickinson, p. 277). Today

The court case of Washington vs Glucksberg decided assisted suicide was unconstitutional, in 1997. Basically, Dr. Harold Glucksberg along with four other physicians and a few terminally ill patients went to court to argue with the ban on assisted suicide. Court decision was 9-0,

Oregon is one of only five states along with Vermont, Washington, Montana and New Mexico that allow medically assisted suicide. In the rest of the country, assisting people with suicide even if they are terminally ill will be accused as a crime. According to the KQED news, ”Advocates of assisted-suicide laws believe that mentally competent people who are suffering and have no chance of long-term

Oregon’s physicians are required by law to recommend hospice and palliative care, but are often not qualified, therefore only thirteen percent of dying patients get to hear their alternatives. (Hendin) Oregon also does not require a psychiatric evaluation when a patient makes a request for suicide. (Hendin) Studies have shown that 13-77% of patients who request assisted suicide are suffering from depression; however, psychiatrists believe that depression is a normal response to a severe illness. (Boyd) Also, patients who are aware they are going to receive a psychological evaluation which may allow them to commit suicide may lie during the evaluation so that they seem fine.

One of the most controversial end-of-life decisions is “physician-assisted suicide” (PAS). This method of suicide involves a physician providing a patient, at his or her own request, with a lethal dose of medication, which the patient self-administers. The ethical acceptability and the desirability of legalization of this practice both continue to cause controversy (Raus, Sterckx, Mortier 1). Vaco v. Quill and Washington v. Glucksberg were landmark decisions on the issue of physician-assisted suicide and a supposed Constitutional right to commit suicide with another's assistance. In Washingotn v. Glucksberg, the Supreme Court unanimously ruled that the state of Washington's ban on physician-assisted suicide was not unconstitutional.

The case was appealed to the 9th Circuit Court of Appeals and a panel of judges from that court heard the case and overturned the lower court’s ruling on the basis that there has never been asserted that there is a constitutional right to aid in killing yourself which was upheld by a court of final jurisdiction such as the Supreme Court. When the case was head by the entire 9th Circuit Court of Appeals they reversed the panel decision and agreed with the district court. They based their decision on the same cases as the lower court as well as the historical and societal views towards the right to die. After considering all this they concluded that through the Constitution there is a liberty interest in determining the time and manner of one’s death. They determined that there was a constitutional right to die and the state law was unconstitutional since it applied to terminally ill patients who were competent to make their own decisions and wished to end their lives. The case was appealed to the Supreme Court which after hearing arguments decided that the Constitution was not violated by the state law and found that the state had the legal right to pass such a law.

Dr. Jack Kevorkian may have been onto something though. Today, physician-assisted suicide is legal in one state: Oregon. Medical Doctor Suzan Okie stated that Oregon has a set of laws for assisted suicide. The patient must be 17 or older, be able to communicate and make decisions, be terminally ill with less than six months to live, and the request must be written and spoken orally. If the doctor is suspicious of the decision, a psychiatrist can evaluate the patient’s mental condition (1627).

'Choosing death before dishonor is seen by some philosophers and ethicists as a rational reason to commit suicide.' In the 1994 case of Glucksberg v. Washington (Otherwise acknowledged as Compassion In Dying v. The State Of Washington), Harold Glucksberg, alongside the right-to-die organization Compassion In Dying, filed a suit in opposition to the state of Washington for three fatally ill patients he treated.

In 1975 the State of Washington enacted a law that stated that no person was to aid or encourage a person to commit suicide in any given circumstance. This law had some insight pertaining to teenagers because the state didn’t want teenagers to be encouraged in committing suicide. After all, all life is valued and precious. However Dr. Harold Glucksberg in 1976 got together with four other physicians, three terminally ill patients, and a non-profit organization that counsels clients in end of life circumstances.

The en banc decision held that the Constitution in fact encompasses a due process liberty interest in controlling the time and manner of one’s death”, therefore the state’s assisted suicide ban was unconstitutional. The case went before the United States Supreme Court in 1997. After thorough review, the United States Supreme Court held that the Fourteenth Amendments forbids the government’s control on fundamental liberty interests unless the infringement was tailored to serve a compelling interest to the state.

The Superior Court of Los Angeles County became a pivotal case in a patient’s right to refuse treatment. In the initial case Ms. Bouvia and her legal team sought a court order to have the NGT removed and to stop all medical treatments she did not consent to. She argued that this treatment would not be a cure for her condition and would not improve her quality of life. The hospital staff argued the interest of the state prevailed over a patient’s right to refuse treatment. They noted that the state and healthcare teams viable interests include: “(1) preserving life, (2) preventing suicide, (3) protecting innocent third parties, and (4) maintaining the ethical standards of the medical profession, including supporting the right of physicians to effectively render necessary and appropriate medical services” (Liang & Lin, 2005). Additionally they sighted Ms. Bouvia’s failed previous attempt to “starve herself to death” in 1983 with the assistance of her medical team. The court denied her request citing these key interests and the fact that medical professionals felt that Ms. Bouvia could live 15-20 additional years with supplemental nutrition justified the state’s interest in preserving her life. The court also stated that any other decision would be condoning a medical team to aid and abet suicide.

Physician-assisted suicide has been brought to the attention of the Supreme Court on several occasions, in order to test the constitutional backing. The result is always quite similar: the Supreme Court rules against physician-assisted suicide. There was one particular supreme court case, Washington v. Glucksberg. The state of

The U.S. Supreme Court upheld court decisions in Washington and New York states that criminalized physician-assisted suicide on July 26, 1997.12 They found that the Constitution did not provide any “right to die,” however, they allowed individual states to govern whether or not they would prohibit or permit physician-assisted suicide. Without much intervention from the states individuals have used their right to refuse medical treatment resulting in controversial passive forms of euthanasia being used by patients to die with dignity such as choosing not to be resuscitated, stopping medication, drinking, or eating, or turning off respirators.9

A retired social worker, Smith, was diagnosed with cancer at the age of 86. He said that he has no regrets but worries about the pain. "Death itself is not a fearful consideration for me," he said. "But the process of dying could be if it were extremely uncomfortable." He is in no haste to die but expects that he will feel severe pain when the cancer reaches its final phases and when it happens; he would want his doctor to be able to prescribe him with a toxic dose of medication that he can use to end his life

In 1994, Oregon voters passed the Oregon Death with Dignity Act, which exempted, “from civil or criminal liability physicians who, in compliance with specific safeguards, dispense or prescribe (but not administer) a lethal dose of drugs upon the request of the terminally ill patient.” Oregon, to this day, remains the only state within the Union to allow physician-assisted suicide. In 1997, the United States Supreme Court ruled in a landmark case that, although there was no constitutionally protected right to physician-assisted suicide, states have permitted to pass laws allowing it. Thus, the issue of euthanasia remains widely open to philosophical, political, legal, and ethical challenges.