Question

explain the case for and against the legalization of physician assisted suicide

Answer 1

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.

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 were 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 against physician-assisted suicide is that it threatens society by cheapening the value of human life.

Society has a responsibility to preserve the sanctity of life, so an individual’s wish to end their life 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.