Physician Assisted Suicide

Contemplating suicide as an alternative to the suffering and constant pain in his life, Hamlet, a Shakespearean character in one of the most widely-known, tragic plays in history, begs the question: "To be or not to be?" Four hundred years later, the same tragic question echoes in the lives of many human beings who, like Hamlet, are also suffering greatly. Terminally-ill people who are enduring tremendous physical pain, suffering the loss of their autonomy and witnessing the destruction of their family's financial security are fighting for the legal right to choose the timing and manner of their death through physician assisted suicide. Physician assisted suicide (PAS) refers to a practice in which a physician provides a competent, voluntary, terminally-ill patient with a prescription for a lethal dose of medication for which the patient intends to use to end his or her life (CEJA 8 1). The rationale behind the promotion and legalization of PAS is the moral right of autonomy -- independence and the right to self-determination -- and the elimination of suffering (Marker 1). Almost everyone can empathize with the plight of those who suffer greatly, however, current PAS legislation is a danger to all humanity because it is ideological and thus impossible to regulate, conflicts with the sworn duties of physicians in society, and creates an environment for the promotion of euthanasia.

PAS legislation is ideological because its practical ideas and applications are as prominent as its conceptual ones. Ideologies are impossible to regulate because their values are based on human interpretation and judgment. The main principles of PAS legislation imply that only competent, voluntary, and terminally ill people who suffer great pain and loss of dignity will qualify to receive a physician's assistance with their death. The very nature of these criteria begs for interpretation. The exact definitions of unbearable pain, suffering, and autonomy are subject to interpretation: What is an acceptable level of suffering to qualify for suicide and how will it be measured? How far does the necessity for autonomy extend and what amount is measurable to qualify for suicide? Can voluntarism be coerced by family members who don't have the money or time to take care of another? What level of competency exists if a patient is on strong-prescription-pain medication and suffering with depression and anxiety from dealing with the emotions surrounding his or her mortality? These are but a few of the ethical and conceptual questions that could be endlessly debated when making the decision on whether or not PAS should be legalized. Proponents for PAS legislation present the ideology as practical and humane - the alleviation of suffering and protection of autonomy - and it could be in a world without greed, apathy, and ill motive; but that is not the world of the 21st century. In truth, PAS is an altruistic ideology that by its own principles will be impossible to determine and regulate. But who, according to PAS legislation, must make the final determination of competence, voluntarism and suffering? On whose final decision will the patient's request for death rest? The answer, of course, is the treating physician.

To place the ethical judgment and moral responsibility for determining the necessity and value of a patient's life on the treating physician conflicts with the physician's sworn Hippocratic Oath and their role in society - that of "healer of disease and injury, preserver of life and reliever of suffering (CEJA B 3)". If physicians begin take action to quicken the death of a patient, conflicts will arise between the sworn duty to relieve suffering and the sworn duty to preserve life. According to the American Medical Association (AMA), a physician currently cannot offer a medical treatment which is considered "unsound" - or contrary to Hippocratic Oath - and his or her failure to save a person's life is considered "negligent" (CEJA B 3). The AMA also reports that "the fear of pain is the most pervasive cause of anxiety among patients, their families and the public", and that there is evidence to suggest that "requests for PAS would be eliminated or greatly reduced if patients were guaranteed that their pain and suffering would be minimal, and their dignity and