Be it due to a life-threatening disease, age, or a terminal condition, end of life is a difficult time, not just for the patient but also for their friends and families. Such issues include, but not limited to, fear, pain, depression, coping, and uncertainty about what happens after death (Renz et al., 2018). Some people might, therefore, contemplate ending their life through euthanasia or physician-assisted suicide. According to Evenblij et al. (2019), euthanasia is the practice of ending a life to relieve pain and suffering. On the other hand, physician-assisted suicide, as defined by the American Medical Association (AMA), is when a physician facilitates a patient's death by either providing the means or the information that allows the patient to perform the act (Hetzler et al., 2019). These practices, however, have long been debated on moral, spiritual, and ethical grounds. I hold that these practices are unethical, immoral, sinful, and illegal, regardless of whether the local, state or federal laws allow them. I feel that before contemplating and deciding to end your life, there are different alternatives and possibilities. Besides, historical evidence, which I will elaborate on in the paper, fails to provide the necessary level of detail on the subject matter.
Technical Aspects
To fully understand what patient’s go through when dealing with end of life, however, we must first establish context using the technical aspects of the subject matter. According to Hedberg & New (2017), the practice was first legalized in Oregon in 1997 with the Death with Dignity Act. Since then, eight other jurisdictions have joined in. Montana, on the other hand, has gone ahead and decriminalized the practices (Emanuel et al., 2016). Therefore, if a patient is living or being treated in a jurisdiction where the practice is legalized, they still have to meet minimum qualifications for the Death with Dignity Act to be in effect.
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Even then, the process is not as cut and dry. Patients who meet the qualifications to consider death with dignity have to go through an evaluation with a physician. The process takes about two weeks before getting approval and has the following eligibility criteria that must be met without exception. First, the patient must be a resident of a jurisdiction that has dying laws. This includes DC, Maine, Oregon, California, Vermont, Colorado, Hawaii, New Jersey, and Washington ( Hausdorff, 2019). Proving residency is necessarily not a matter of minimum length of stay within said jurisdiction. Instead, the patient must prove they are current bona fide residents of the jurisdictions. The specific vary from one jurisdiction to another, however.
Secondly, the patient must be over 18 years old and mentally competent. In other words, they must be of legal age and capable of independently making their health care decisions as well as communicate them with their physicians (Peters et al., 2020). Lastly, the eligibility criteria specify that the patient must be suffering from a terminal condition that will result in death in half a year, as diagnosed and judged by a legal, medical practitioner (Peters et al., 2020). After the evaluation, the patient must demonstrate the ability to self-administer the medication. Finally, the evaluation should be verified by another physician, especially the eligibility criteria. It is also critical that friends, family, and other close relatives be involved in the decision-making process so that they do not feel that they are forced into untenable positions.
Contemporary Views with End of Life
After gaining a deeper understanding of the technical aspects of end of life practices and associated issues, it would be negligent in ignoring the views of other stakeholders. For instance, prior to 1977, people with terminal illnesses or those in a "vegetable" state did not have the freedom and right to end their lives or have the decision made by a family member. According to McCarthy (2020), however, as much as 73% of the Americans support the Death with Dignity Act because they believe that people have the right to control their lives and decide if they should end them, provided they meet the eligibility criteria. Another stakeholder that is often overlooked is the physicians who are integral to the practice. To this effect, Hetzler et al. (2019) sent a survey to 1000 physicians in the US. The results of the survey indicated that 60% of the respondents supported the legalization of the practices.
Regardless, there still are some objections. For instance, Hetzler et al. (2019) discovered that 30% of the physicians were of the opinion that the legalization of physician-assisted death would result in the legalization of euthanasia. This view is closely related to the concern that the Death with Dignity Act could be a slippery slope for the legalized offering of physician-assisted suicide and euthanasia on a mass scale, especially since the line between voluntary and involuntary euthanasia. Other objections against the practice raise concerns about changing attitudes, especially towards the elderly and terminally ill as these practices would be easier, and cheaper than treating them till their natural deaths. The physicians surveyed by Hetzler et al. (2019) echo this concern through a 46% consensus that insurance companies could preferentially cover physician-assisted suicide and euthanasia instead of treatments that could potentially save lives if the practices are widely legalized. Therefore, conflicts of interest, especially among the involved stakeholders, could lead to more unnecessary deaths if the patient could have been treated for a long period of time.
Personal Reflection and my Beliefs
Considering everything that this paper has discusses so far, and after further reflection with my personal beliefs, I make the claim that the Death with Dignity Act that facilitates euthanasia or any other form of assisted suicide is immoral, unethical and should be illegal instead. First, I believe that regulating the process by which patients would have legal access to it and the way they will be treated can be misguided. Physicians who participated in the survey conducted by Hetzler et al. (2019) echo my concern with their uncertainty that the safeguards put in place by the law and other regulations might not be enough. Additionally, they point out that the nationwide, or even international spread and legalization of the practice would still be a slippery slope. Therefore, until these concerns are resolved, I believe and recommend that the precedents created by the Death with Dignity Act should be overturned.
Secondly, it is part of my duty, as a physician, to do my best to keep my patient alive and healthy and not focus on how to get them closer to death. It is undeniable that death is the inevitable end of life. However, my oath and the ethical standards I uphold treat bringing a patient closer to death a gross betrayal and dereliction of duty (Health Service Executive, 2020). Lastly, and most importantly, I do not have the right to decide whether I or someone else gets to live or die. That is a decision made by God. Besides, science has yet to figure out the mystery of how life emerges and dies. Given that the debate on the exact definition of life, or its beginning (conception or birth), is still going on, arbitrarily deciding something to which we have no right to is sinful.
Historical Context
My personal views of euthanasia and physician-assisted suicide were not formed purely out of my religious beliefs. Instead, I grew up listening to the horror stories about euthanasia back in Armenia. Though it is illegal, my family has told me many stories about how physicians offer a form of death with dignity without regard for the law or ethical standards. My parents, for instance, told me about patients who were misdiagnosed with terminal illnesses and ended up euthanizing themselves. However, the most horrific story was of a middle-aged man who has tested positive for AIDS. His physician took advantage of his vulnerability and assisted him in euthanizing himself instead of offering counseling and treatment because he would make more money administering the lethal injection rather than doing the treatment.
In an academic or research paper, these stories would have no bearing nor relevance. However, they are part of my history and cultural heritage. They are part of my belief system and why I am against physician-assisted suicide and euthanasia. Similar to how in the paper, I expressed the views from different perspectives and stakeholders, I am providing context to how my beliefs form and their significance to my practice as a physician. The point, however, is not just about my position on the subject matter but also the precedent it sets and the long-term repercussions.
Opinion and Conclusion
I, therefore, conclude that after extensive research and reflection, that death with dignity should not be an option for patients on moral and ethical grounds as well as its potential for misuse. Based on my beliefs and the state of health care today, I believe that the public, as well as physicians should avoid a defeatist attitude and focus on treatment than death. Death is not a treatment but a permanent resolution that warrants deeper contemplation that it is currently viewed as. Besides, the legal and regulatory standards, such as the eligibility criteria and evaluation process, do not foolproof. I hope that the government, public, physicians, and other health care stakeholders start pushing for a law that would make physician-assisted suicide and euthanasia illegal.
References
Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Jama , 316 (1), 79-90.
Evenblij, K., Pasman, H. R. W., Pronk, R., & Onwuteaka-Philipsen, B. D. (2019). Euthanasia and physician-assisted suicide in patients suffering from psychiatric disorders: a cross-sectional study exploring the experiences of Dutch psychiatrists. BMC psychiatry , 19 (1), 74.
Hausdorff, M. (2019). Understanding Assistance in Dying: Arguments in Favor of the End of Life Option Act. Culture, Society, and Praxis , 11 (2), 4.
Hedberg, K., & New, C. (2017). Oregon's Death With Dignity Act: 20 years of experience to inform the debate. Annals of Internal Medicine , 167 (8), 579-583.
Health Service Executive. (2020). Arguments for and against euthanasia. Retrieved July 12, 2020, from https://www.hse.ie/eng/health/az/e/euthanasia-and-assisted-suicide/arguments-for-and-against-euthanasia.html
Hetzler, P. T., 3rd, Nie, J., Zhou, A., & Dugdale, L. S. (2019). A Report of Physicians' Beliefs about Physician-Assisted Suicide: A National Study. The Yale journal of biology and medicine , 92 (4), 575–585.
McCarthy, J. (2020, March 30). Majority of Americans Remain Supportive of Euthanasia. Retrieved July 12, 2020, from https://news.gallup.com/poll/211928/majority-americans-remain-supportive-euthanasia.aspx
Peters, K. A., Lee, D. S., & Irwin, A. N. (2020). Pharmacist experiences and perspectives with Oregon's Death with Dignity Act. Journal of the American Pharmacists Association .
Renz, M., Reichmuth, O., Bueche, D., Traichel, B., Mao, M. S., Cerny, T., & Strasser, F. (2018). Fear, pain, denial, and spiritual experiences in dying processes. American Journal of Hospice and Palliative Medicine® , 35 (3), 478-491.
