The Banyan--Dean Harvey

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	Death with Dignity: Right to Die by Dean Harvey
1	The basic dilemma surrounding the subject of assisted suicide is who has the right to choose when someone dies? There are many layers of questions and varying opinions surrounding this right. How can our own self-determination be considered morally wrong when taken in the context of the opinion of others? In a society that stresses individual freedoms why is it that Congress continues to hinder doctor-assisted suicide (Keminer, 2000, p. 8)?
2	First some terms require clarification. Suicide is considered the intentional killing of one's self. Homicide is determined to be the intentional killing of one person by another (Savulescu, 1978, p. 31). Euthanasia (Greek: good death) is the intentional killing of one person (or animal) by another for the former's benefit. Assisted suicide is when an individual aids another person in killing him/herself. Poison is a substance (as a drug) that in suitable quantities has properties harmful or fatal to an organism when it is brought into contact with or absorbed by that organism (Webster's Third New International Dictionary, 1994).
3	The pertinent question is, where does one's individual rights cease when a matter reaches the point of a life or death decision? Proponents of assisted suicide say that individuals have free choice, individual rights and moral autonomy. They have the right to act and govern themselves in accordance with their own private beliefs, values and choices, without interference, as long as their behavior does not harm others. Physician-assisted suicide is a natural extension of the constitutionally protected right to privacy and the moral right of self-determination. Opponents of this argument claim that the sanctity of life, protection of those vulnerable to medical or family abuses, the common good and the Hippocratic oath are values that, in fact, outweigh the individual's rights. The question then becomes, how far do individual rights go in view of society as a whole?
4	One of the primary arguments in opposition to legalizing physician-assisted suicide is that there is no effective way of constraining the practice so as to provide adequate protections for the poor and the weak. There have been no hard facts to support whether this problem exists or persists. Until more data is accumulated this argument is moot.
5	The practice of physician assisted suicide is not really suicide at all. There seems to be four distinct types of cases that deal with doctor-assisted suicide. The first is when life-saving treatment is discontinued. This includes shutting off or removing a patient from equipment used in keeping the individual alive—including both feeding and other equipment to prolong an individual's life. The second case involves not being placed on life saving equipment initially. The third type is that the patient requests a lethal drug or drug dosage, which he can take at a time of his choosing. The fourth case type is when a patient is incapable of taking the drug himself and asks the physician to administer it.
6	The first two cases are legally permitted in the United States. They are also, by societal consensus, considered morally acceptable. The doctor must ensure the lucid mental state of the patient and that the patient is not being seduced or coerced into this choice. The patient gets to choose.
7	The third type is the type which could truly be called doctor-assisted suicide. These are the cases with which proponents of assisted suicide are primarily concerned. This and case type four are considered illegal in most states.
8	The fourth case must be examined for one key reason: The doctor does not only provide the means to end the patient's life, but also administers the drug himself. This is not suicide, for the patient does not kill himself, but has the doctor do it (Thomson, 1999, p. 497). This is more likely euthanasia. This should not be classified as doctor-assisted suicide because suicide by definition is the act of self-inflected death.
9	All these cases are concerned with the death of a patient and the physician's role in it. In the first two cases a physician permits a patient to die, in other words he allows a natural progression of events. He is merely allowing his patient to die from a medical condition that is terminal. In this instance, ultimately the disease causes the patients death. In the last two cases death is caused by the drug provided or administered by the physician. The physician plays an active part in the death of the patient if he disconnects the equipment that is keeping his patient alive. The physician has killed the patient. Kill in this context means to shorten one's life.
10	In the third case, assisted suicide, the physician provides the drugs but does not administer them to the patient. The patient takes the drugs to die, thus committing suicide. How does this differ from the first two cases? The patient does not request connection to equipment intended to extend his life, nor does he ask to be taken off of equipment for the sole purpose of dying. He has asked the physician to take an active role in his death. The same can be said about assisted suicides.
11	Legal issues around suicide and attempted suicide have changed. Since suicide was a crime, so was attempted suicide. Suicide is no longer a crime, nor is attempted suicide. Which brings up a critical point; if suicide is not a crime, how then can assisted suicide be considered a crime? If active participation in something is not a crime, how can contributory participation be classified as a crime? In her concurring opinion in Vacco v. Quill (an assisted suicide case), Justice O'Conner wrote: "The parties and amici agree that in those states [New York and Washington] a patient who is suffering from a terminal illness and who is experiencing great pain has no legal barriers to obtaining medication, from qualified physicians, to alleviate that suffering, even to the point of causing unconsciousness and hastening death." Does this not open the door for the grounds of assisting someone to alleviate pain at the cost of his life if he so chooses?
12	The role of the physician in all cases dealing with what I will call medical assisted dying, either active or passive, is one of the major components of the question. Both sides of the argument on assisted suicide use the Hippocratic oath to bolster their position. Opponents of physician-assisted suicide state that the physician should do no harm to the patient. "I will neither give a deadly drug to anyone if asked for it, nor will I make a suggestion to this effect…. In purity and holiness I will guard my life and my art." This is a pledge to refrain from practicing assisted suicide. Proponents of physician-assisted suicide use the more current version of the oath that was issued by the World Medical Association (WMA) in 1948. They issued the current version because they felt that the older version had little relevance today. It should also be noted that nether versions of the Oath are required to be taken by a physician. Few medical schools require its readings. Many physicians have never even read it (Humphry & Clements, 1998).
13	The original Oath says that the physician will not give a deadly drug to anyone. This is not true. Physician prescribes drugs everyday to patients. They are used within certain levels to control diseases and infections. Physicians also prescribe painkillers to ease pain. This is a drug, as with many, that if used in the wrong dosage has the potential to cause death. There are even warnings on medications to emphasize this fact.
14	The new version of the Oath states that the "physician will practice medicine with conscience and dignity, and not allow consideration of race, religion, nationality, or social standing to intervene between my duty and my patient" (Humphry & Clements, 1998). It should be noted that this version of the Oath does not state what a physician will do, but how he should do it.
15	Another key factor that has arisen is that of prolonged life as the result of advances in medical technology. This ability has kept patients alive, even against their will and has led to several court cases on behalf of patients who are in a persistent vegetative state. In addition, in regards to hospital policies, do-not-resuscitate (DNR) orders are becoming more commonplace with physicians. If a patient is in a vegetative state, who should determine if life-sustaining equipment should be turned off or removed? At this point, the choice is taken from the patient in a persistent vegetative state and given to someone else. Use of medical technology has increased life span but has it increased quality of life? You may be able to extend life but is the cost pain and loss of dignity?
16	Another point of contention is that of abuse. Supporters say assisted suicide would respect the rights of individuals provided safeguards are devised to ensure that no one would be coerced into an assisted suicide. Bishop John Shelby Spong in speaking before a House subcommittee asserted, "Assisted suicide must never be a requirement, but it should always be a legal and moral option." Opponents say that assisted suicide could become not a choice but an obligation thrust upon the patient by their families, friends, and society. "If suicide were culturally validated, an ill person would have to justify his or her decision to keep on living," writes Catholic ethicist Sidney Callahan. They are also worried that if this law was enacted there would be an increase in deaths by assisted suicide. "While there was a numbers increase from the first year to the second, the third year's findings indicated that this increase was not part of a trend (Death with Dignity Act Report, 2000).
17	One of the strongest points of contention is whether or not suicide is ethical? Pope John Paul II declared assisted suicide unethical. "Suicide is always as morally objectionable as murder." Many religious leaders, ethicists, and others who believe that is God's right to determine a person's life span share this view. They also contend that it devalues life and condones killing. Others argue however, that assisted suicide is ethical because it respects a person's choice to end life that lacks some important factors, physical, emotional, or spiritual meanings. The Hemlock Society, an organization which seeks to legalize physician-assisted suicide wrote "[the pope] might recall that the U.S. was formed in the name of democratic religious freedom, where people are free to worship as they want (or not at all), to base their lives on whatever ethic they choose, and to have a say in governmental issues." This disagreement reflects this debate. Does the belief that it is immoral to intentionally end a life take precedence over the belief that terminally ill individuals should have the freedom of choice with regards to how they will die?
18	As with all controversies, opinions vary between people. Some are steadfast in their beliefs and some waver from time to time. The controversy has been going on for many years. Recently it has taken the forefront due to Oregon's Death with Dignity Act and the congressional passage of a bill that effectively criminalized physician-assisted suicide.
19	One last point that needs to be taken into consideration—would society as a whole be better served with an assisted suicide law than without one? Consider the following; without the law someone who wishes to commit suicide will commit suicide. They will do this without consideration of mental well being. They will not be given proper examination for depression. If on the other hand, there were an assisted suicide law, the patient would have to be screened and cleared before the act can be carried out. Also no one will be obligated to use assisted suicide against his beliefs or wishes. If there is a law then the patient's wishes will be honored within the framework of the law.
20	So the case of physician-assisted suicide and the right to die is complex and very emotionally charged. The question of individual rights seems to play a major part in this controversy. How can Congress pass laws that interfere with individual choice? We live in a country that prides itself on individuality of its citizens, yet balks at the idea of giving them the choice to live in pain or die with dignity. Also, why is it legal to refuse treatment for a life ending situation but see hastening a death, as a compassionate response to overbearing pain and loss of dignity, as a crime? The patient will die in either case. Why must the patient be made to suffer simply because his situation will not kill him immediately? Why is it condoned for a mentally competent patient who has a terminal illness be denied the same rights and privileges as everyone else?
21	This whole controversy should really be about only one thing; "What is best for the patient"? The patient should have all information needed to make well-informed decisions and the patient needs to be comfortable with this decision. The physician needs to be able to provide information that is pertinent to the patient making this decision. Any patient would feel more at peace if provided with all the necessary information to make the final decision themselves. This decision should be the patients', because in the end they will be the ones judged.
	References Humphry, D. & Clement, M. (1998). Freedom to Die: People, Politics, and the Right-to-Die Movement. St. Martin's Press. Kaminer, W. (2000). When Congress Plays Doctor. The American Prospect, 11(4), 8. Oregon's Death with Dignity Act Report for 2000. http://www.ohd.hr.state.or.us/chs/pas/ar-index.htm Savulescu, J. (1997). The Trouble with Do-Gooders: The Example of Suicide. Journal of Medical Ethics, 23,108-113. Thomson, J. J. (1999). Physician-Assisted Suicide: Two Moral Arguments. Ethics, 109(3), 497(1). Nominated by Yvonne Wilebski, Psychology Instructor