Reasons for Opposing or Supporting Physician Assisted Suicide

There are arguments for and against physician assisted suicide

Do not resuscitate form
Writing do not resuscitate form. Credit: Peter Dazeley / Getty Images

The debate over the morality and legality of physician-assisted suicide (PAS) isn’t new. It’s been a topic of heated discussions for hundreds of years and doesn't show any signs of cooling down.

Physician-assisted suicide is currently legal (2017) in Oregon, Washington, Vermont, Colorado, and Montana. Around the world (though restrictions vary considerably) it is legal in the Netherlands, Belgium, the U.K., Columbia, and Japan.

It is also legal in the province of Quebec in Canada. It's important to note that physician-assisted suicide is a separate issue from the right to withhold or withdraw life-sustaining measures or palliative sedation, over which there is much less controversy and which are usually personal decisions rather than legal issues.​

What are the reasons to support or oppose physician-assisted suicide?

Arguments Which Support or Oppose Physician-Assisted Suicide

There are clearly strong proponents on both sides of the issue of physician-assisted suicide, but before going into these, it's important to quickly define what we are debating. What is physician-assisted suicide and how does this differ from, say, euthanasia? Physician-assisted suicide or PAS is defined as the voluntary termination of one's own life by administration of a lethal substance with the direct or indirect assistance of a physician.

In contrast to euthanasia, in which the physician performs the intervention, in PAS the physician provides the necessary means and the patient performs the act.

Four Primary Points in Opposition of PAS (and the Counterarguments In Support)

While there are many fine points and details to the emotionally-laden issue of physician-assisted suicide, these can be broken down into four main points which often arise against its acceptance or legalization.

And to every argument, there is a counter-argument.

1. Improved Access to Hospice and Palliative Care

One argument in opposition to PAS is that—because a model for quality end-of-life care is available through hospice and palliative care programs—there should be no reason anyone would need to seek PAS. In this view, the focus should not be on legalizing PAS, but on improving access to hospice care.

There are over 4,000 hospice agencies in the United States, but because of funding restrictions and the rigidity of the Medicare Hospice Benefit requiring patients to have a life expectancy of six months or less, millions of people in the United States don’t have access to them.

Counter-argument: Even with improved access to quality end-of-life care, there will still be rare cases of persistent and untreatable suffering. The most recent statistics we have from Oregon (2014), where PAS is legal, show that 93 percent of patients who opted for PAS was on hospice. This suggests that hospice and palliative care aren’t always sufficient to treat severe suffering.

2. Limits on Patient Autonomy

It was determined in the opinion of Bouvia v. Superior Court (CA) that “the right to die is an integral part of our right to control our own destinies so long as the rights of others are not affected.” This was a matter of patient autonomy.

PAS is not a completely autonomous act; it requires the assistance of another person.

The argument in opposition of PAS is that PAS threatens our society by cheapening the value of human life. Society has a responsibility to preserve the sanctity of life, so an individual’s choice of PAS should be overruled for the overall good.

Counter-argument: Physicians who are approached with the request to assist in ending a patient's life have the right to decline on the basis of conscientious objection. Their rights, therefore, are not affected according to the Bouvia decision.

3. The “Slippery Slope” to Social Depravity

Those in opposition to PAS are concerned that if assisted suicide is allowed, euthanasia won't be far behind.

This view holds that it is a slippery slope towards the "mercy killing," without consent, of individuals with mental illness, physical handicap, elderly, demented, homeless, and anyone else society deems “useless.”

Counter-argument: Our highly cultured societies are unlikely to allow this “slippery slope” to happen. Cited examples include Adolf Hitler, Joseph Goebbels, and Joseph Mengele, who were defeated in their mission to “cleanse” Germany’s gene pool.

4. Violation of the Hippocratic Oath

The Hippocratic Oath states that a physician’s obligation is primum non nocere, “first, do no harm.” PAS directly contradicts that oath, as deliberately killing a patient is regarded as harm.

Counter-argument: The Hippocratic Oath should be interpreted and modified as necessary according to an individual patient’s need.

5. Alternatives to PAS

Those in opposition of PAS argue that there are legal and morally ethical alternatives to assisted death. Patients may refuse further medical treatments that may prolong their death, including medications.

Counter-argument: Some patients do not rely on life-sustaining measures to live and still suffer. Withholding life-sustaining treatments would only prolong suffering for these patients.

Another argument is that patients can, and often do, decide to stop eating and drinking to hasten their death. Death will usually occur within one to three weeks, and it is usually reported as a "good death."

Counter-argument: One to three weeks of intense suffering is too much for anyone to have to tolerate. (Learn more about the reasons why people seek physician-assisted suicide.)

Summary of The Major Arguments in Support and Opposition to PAS

The final resolution of this physician-assisted suicide debate has yet to be seen. Because of the undercurrent of public support on the subject, we may see it become more of a reality in our society. It is already legal in the United States in Oregon and bills to legalize it have been presented multiple times in many other states. PAS is also legal in several other countries, such as the Netherlands.

There are many resources available if you are in the fence in your own beliefs, wish to learn more about the Death with Dignity movement, or want to explore some of the further issues which either support or oppose physician-assisted suicide and the right to die.

Sources:

Braverman, D., Marcus, B., Wakim, P., Mercurio, M., and G. Kopf. Healthcare Professionals’Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency. Journal of Pain and Symptom Management. 2017 Jul 14. (Epub ahead of print).

Centers for Disease Control and Prevention. Hospice Care. Updated 07/06/16. 

Emanuel, E., Onwuteaka-Philipsen, B., Urwin, J., and J. Cohen. Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. JAMA. 2016. 316(1):79-90.

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