Anyone who has watched a loved one suffer through a serious illness with no hope of recovery understands the anguish of the patient and the loss of the will to live, if it means continued suffering and diminished capacity.
But, regardless of the circumstances, should a patient have the right to choose when to end their life?
Some advocate for physician-assisted death, also referred to as medical aid in dying, the practice of receiving aid from a medical professional in ending the life of a terminally ill adult with less than six months to live.
Physician-assisted death should not be confused with euthanasia, which involves a person bringing about the death of another in order to end their suffering, but not necessarily with medical assistance or consent of the patient. In a physician-assisted death, a physician provides the means for a severely ill person who has chosen, voluntarily, to end his or her own life.
The practice has been deeply controversial, although a 2017 Gallup poll showed 73% of Americans in favor of allowing a patient with terminal illness to have the legal right to choose physician-assisted death.
The U.S. Constitution does not provide the right to physician-assisted death. While the Supreme Court did rule in 1990 that a patient has the right to refuse life-saving medical treatment, the court, in two 1997 decisions, declined to rule that choosing when to die is a protected right. Because the 1997 rulings stopped short of declaring physician-assisted death illegal, the issue was left open for states to decide individually.
As of April 2019, physician-assisted death has become legal in eight states and Washington, D.C.: California, Colorado, Hawaii, New Jersey, Oregon, Vermont, Washington, and Montana (which gives the option to individuals via court decision). A so-called “death with dignity” law was under consideration in Nevada in April 2019.
Even in states where the practice is legal, a physician may decline to participate on ethical grounds.
“There are many services physicians can provide a patient who asks for assistance in dying without violating professional ethics or personal beliefs,” wrote Faith Lagay, director of the American Medical Association ethics resource center, in the AMA Journal of Ethics. “First, they must confront the task of presenting the most accurate prognosis. Next, physicians must carefully describe all possible treatment and palliative care options to the patient and discuss what he or she can expect as consequences of each of those care options, as well as the consequences of accepting no treatment or care. Physicians can also play a role in referring terminally ill patients to others – psychiatrists, hospice workers, clergy – who can evaluate their mental status and help them consider end-of-life decisions.”
Many medical and legal ethicists, as well as patients, object to the frequently used description “physician-assisted suicide,” calling it derogatory and inaccurate, and prefer the more neutral “aid in dying.”
“Portraying me as suicidal is disrespectful and hurtful to me and my loved ones,” wrote terminally ill patient Louise Schafer. “It adds insult to injury by dismissing all that I have already endured; the failed attempts for a cure, the progressive decline of my physical state and the anguish which has involved exhaustive reflection and contemplation leading me to this very personal and intimate decision about my own life and how I would like it to end.”
An academic article from the University of Washington School of Medicine outlines the arguments of those who consider physician-assisted death ethically permissible and those who don’t.
Arguments in favor of physician-assisted death include:
- Respect for autonomy: Competent people should have right to choose the timing and manner of their own death.
- Compassion: Suffering includes pain, but also the loss of independence, sense of self, and functions that lead to loss of dignity.
- Individual liberty vs. state interest: Though society has strong interest in preserving life, that interest lessens when a person is terminally ill and wishes to end his or her life. Prohibition limits personal liberty.
- Honesty and transparency: Some acknowledge that assisted death already occurs in secret. Illegality prevents open discussion between patients and physicians; legalization would promote open discussion and better end-of-life care.
Arguments in opposition of physician-assisted death include:
- Sanctity of life: Many traditions, both religious and secular, have historically prohibited suicide or assistance in dying; they view it as diminishing the sanctity of life.
- Passive vs. active distinction: There is a difference between “letting die” and actively “killing.” Withholding treatment is viewed as justifiable, while physician-assisted death is equated with actively causing death, so is not justifiable.
- Potential for abuse: Vulnerable populations, lacking access to quality care and support, may be coerced into assisted death. As costs mount, burdened family members and health care providers may encourage assisted death.
- Professional integrity: Historical ethical traditions in medicine are strongly opposed to taking life. The American Medical Association and American Geriatrics Society oppose assisted death, and express concern that linking physician-assisted death to the practice of medicine could harm the integrity and the public’s image of the profession.
- Fallibility: Doctors may make mistakes; there may be uncertainty or errors in diagnosis and prognosis, or inadequate treatment of pain. The state has an obligation to protect lives from mistakes.
“Physicians should support regulations that ensure humane care for the terminally ill [to] reduce patients’ concerns that their end-of-life care is overwhelmingly burdensome to others,” Lagay wrote. “It is desirable to have guidelines and practices in place that allow health care professionals to respond legally and ethically.”
To avoid any confusion or miscommunication, it’s strongly advised that you clarify your wishes regarding end-of-life medical care through an advance directive or living will, a legally binding document to guide loved ones and medical staff in the event you are not able to speak for yourself. It’s also advisable to appoint someone you trust to make decisions on your behalf via power of attorney.
Every state that allows physician-assisted death for the terminally ill requires specific procedures. Neptune Society is in no way an expert on this subject, nor does this article convey an opinion for or against physician-assisted death. If you have additional questions about the issue, consult a health care attorney in your state.
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