There is a lot of disagreement about the ethics of physician-assisted death. Some people believe that someone with a terminal illness should have the choice to end their suffering with dignity. Other people maintain that physicians can't help people end their lives because it's at odds with their role as a healer.
What Is Physician-Assisted Dying?
Physician-assisted dying is when a physician provides a patient with a prescription for a lethal dose of medication that they can use to end their life when they're ready.
Physician-assisted dying is not the same as physician-assisted suicide or euthanasia, although you may find the terms are often interchangeable.
Euthanasia
Euthanasia and physician-assisted dying are both designed to peacefully end someone's suffering by ending their life. However, with euthanasia, someone else administers the medication. With physician-assisted death, the individual ingests the medicine when they decide to, maintaining control over the process. Euthanasia is illegal in every state in the U.S.
Physician-assisted suicide
The American Association of Suicidology (AAS), which aims to prevent suicide through education, research, public awareness, and training, states that physician-assisted dying is not the same as suicide. All of the primary medical professional associations oppose the use of the term "physician-assisted suicide".
Is Physician-Assisted Suicide Legal?
Physician-assisted dying is legal in the following states under different laws:
- California
- Colorado
- Hawaii
- Maine
- Montana
- New Jersey
- New Mexico
- Oregon
- Vermont
- Washington, DC
- Washington
To be eligible for medical aid in dying, a person has to meet all of the following requirements:
- Age 18 or older
- Have a terminal illness with a prognosis of fewer than six months to live
- Be mentally able to make their own medical decisions
- Be able to ingest the medicine themselves
Additional safeguards are in place to help ensure that medical aid in dying honors the patient's preferences, values, and needs. These include:
Informing patients about their other options
The physician prescribing the end-of-life medication must inform the patient about their other options, including comfort care, hospice care, palliative care, and pain control.
Right to change their mind
Physicians must tell patients they have the right to change their minds about ingesting the medicine at any time, even after they filled the prescription.
Take back their request
Physicians have to offer their patients the opportunity to take back their request for medical aid in dying.
Physician-Assisted Death Ethics
Physicians disagree about the ethics of providing medical aid in dying. Some support the option, while others think it shouldn't be a choice.
Arguments against medical aid for dying
Physicians opposed to providing medical aid in dying feel that doing so causes more harm than good. While they understand why some people may have valid reasons for preferring death, physicians shouldn't help them end their lives. Their argument is that physician-assisted dying is:
- Not compatible with a physician's role as a healer
- Difficult or impossible to control
- A risk to society
Instead of assisting with dying, doctors who opposed medical aid in dying believe that physicians should:
- Continue providing care, even after determining there's no cure
- Respect their patient's autonomy
- Communicate effectively and provide emotional support
- Provide comfort care
- Provide pain control
Arguments for medical aid in dying
Some people believe medical aid in dying should be legal because it doesn't cause any harm and benefits people who are suffering. The arguments in favor of medical aid in dying include the following:
It's proven to be safe
Medical aid for dying has been legal in Oregon for 20 years. There have not been any bad outcomes in Oregon or any other states where it's legal.
It's a choice the patient makes
Even in states where it's legal, it is rare for terminally ill patients to choose medical aid in dying. Only about one in three hundred deaths occur with medical aid in dying in states where it's legal. Among patients who receive the medication, about one-third don't choose to take it. However, proponents say it comforts people to have the option.
It's the best option for some chronically ill people
Most people with terminal illnesses can receive adequate care from palliative care or hospice. However, not all suffering can improve with these options. People in severe pain and suffering should have options for a merciful, peaceful death.
Evaluating Requests for Medical Aid in Dying
Even in states where medical aid in dying is possible for patients who meet the legal requirements, physicians must carefully evaluate requests to determine if they can assist with dying in good conscience. The American Academy of Hospice and Palliative Medicine has issued guidance to help physicians assess requests for medical aid in dying.
When physicians receive a request for a physician-assisted death, they should consider the following:
- The nature of the request — is the patient serious or just frustrated with their present circumstances?
- The cause of the suffering — is there severe pain, emotional distress, or concerns over being a burden?
- The patient's decision-making capacity.
- Emotional factors — is depression or feelings of guilt, worthlessness, or fear driving the request?
- Situational factors such as coercive factors, abuse, or exploitation.
These considerations begin the evaluation process of a patient's request for medical aid in dying. Physicians will carefully consider all of the circumstances, including other options for comfort care, before agreeing to a patient's request.