Faculty Editor: Dr. Heather Olins
The intrinsically ubiquitous nature of death has made it the subject of countless works of philosophy, medical research, and international adjudication. Though we often consider death in terms of its inevitability, there is a more perilous side to death, perhaps even more perilous than death itself, that has ravaged the United States since the last quarter of the twentieth century: the debate over physician assisted suicide (PAS). While PAS is not uniquely American, this article will focus on its multifaceted implications in the United States exclusively to help create a more comprehensive understanding of its evolution and current status.
Before analyzing how the concept of “dying with dignity” (a more euphemistic description of PAS) has evolved in the U.S., it is important to contextualize the philosophical side of the debate by remembering Hippocrates, the “father of medicine” (Tyson, 2001). Although recent developments in the medical field have placed many of his words out of step with contemporary practice, the fact that derivations of the Hippocratic Oath continue to be read in nearly every institution of medical instruction across the U.S. is telling of the impact he has had on modern medicine.
Of the more than three-hundred words that comprise his original contract between the physician and the Greek gods, none are of more importance to this discussion than: “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect” (Tyson, 2001). While a 1993 survey of medical schools in the U.S. and Canada showed that only 14% of oaths prohibit euthanasia (as is implied in Hippocrates’s original piece), there is little empirical data to aid in understanding how medical schools are confronting the issues of physican assisted suicide today.
When Derek Humphry assisted in his terminally-ill wife’s death in 1975, he likely did not know that he could lead a movement that would put this Hippocratic assertion out of the public’s favor (Wood & McCarthy, 2017). Nonetheless, Humphry would find himself beginning a life long journey to support the “right to die” only five years later with the founding of the Hemlock Society, the first American “right to die” organization (Childress, 2001). Despite his tireless efforts to create legislative and judicial support for the terminally ill, Humphry’s movement was overtaken on the national level as Dr. Jack Kevorkian, more commonly known as “Dr. Death,” began to provide human euthanasia out of his Volkwagen using a homemade death machine (Public Broadcasting Service, 2014). In the years that followed, states as geographically proximous as California and Oregon took radically different approaches to the issue of human euthanasia: California voters overhwlemingly defeated a 1992 “aid in dying” measure, while only two years later, Orgeon became the first state to leagalize doctor-assisted suicide (Childress, 2001).
Although these proposals dealt with the philosophical and moral issues regarding physician-assisted suicide, the legal side of ‘death with diginity’ has also made national headlines, especially after ‘Dr. Death’ was convicted of murder in 1999. In fact, during Kevorkian’s trial, Judge Jessica Cooper noted that the law under which he was found guilty did not require a test of ethics: ”This trial was not about the political or moral correctness of euthanasia … It was about you, sir. It was about lawlessness” (Johnson, 1999). While Gonzales v. Oregon would later reaffirm the ability of the States to decide appropriate legislation relating to the public health and safety of its residents, contention over the ethical implications of the complicity of medical professionals in the premature death of their patients remain, pitting religious and sociopolitical liberty groups at odds (Gonzales v. Oregon, n.d.)
As we examine positions on both sides of this debate from a less defined, legal perspective, two primary questions arise: Is the role of a doctor to fulfill the requests of a patient without question (assuming the patient has the requisite information available to make an informed decision)? Is physician assisted suicide antithetical to the very idea of “healthcare”?
When determining the general role of the doctor in a patient’s care , it is imperative to remember that, ultimately, the decision to seek care from a medical professional is done willfully: with the rare exception of incapacitation due to significant trauma, individuals are able to choose whether or not they would like to seek medical assistance. As such, the recommendations that arise as a result of this relationship are largely informational—the patient is left the final decision of how his/her care should be handled.
This creates a complex dynamic as we are forced to weigh the advice of a knowledgeable professional against the desires of an individual subject to emotional distress. Especially in cases where PAS might be appropriate, patients are under immense emotional (and sometimes financial) strain as a result of severe, terminal illness. With this in mind, some believe that a medical professional’s recommendation should be taken above the patient’s requests.
In spite of this argument, it is overtly clear that the requests of the patient should be adhered to in all circumstances relating to end-of-life care: as long as the patient has sufficient information to make an informed decision, the role of the doctor is to do as the patient asks—after all, they provide a service to another individual, an individual to whom they have the responsibility to serve to the best of their ability. In a similar fashion, it is not the role of any democratic government to prohibit an individual from making end-of-life care decisions that emanate expressly from the individual and do not have tangible consequences for the community at large. Though the rebuttal to this argument would be that other members of the patient’s family could be emotionally impacted from PAS, it is ultimately the decision of the individual who is coping with illness to choose how to handle end-of-life care. Unlike mandatory vaccination, which, if not systematically instituted, can have serious health implications for the community at large, end-of-life care decisions are uniquely private (U.S. Department of Health, 2018).
The second question that arises in this debate over death with diginity is if physician assisted suicide is antithetical to the very idea of “healthcare.” In considering this question, one need look no further than the purpose of healthcare as evident in the term’s grammatical construction. Healthcare should promote the health of the patient, both emotionally and physically. Healthcare should also focus on the care of and for the patient. In the case of PAS, is is clear that the employment of a doctor for the premature termination of one’s life due to chronic illness does not constitute an affront to the meaning of healthcare. This is primarily rooted in the serious emotional distress that arises from chronic illness and the nature of the doctor-patient relationship as one that is of and for the patient.
Despite our predispositions to be opposed to PAS as a consequence of theological or philosophical values, it is neither the role of a democratic government nor of a healthcare practitioner to disallow death with dignity (though refusal at the individual provider level may be acceptable). While it is within the bounds of their respective contractual responsibilities to ensure that the patients making these decisions are informed by the most recent, comprehensive data, the ultimate will of the patient should be respected.
By virtue of the constant national debate we seem to have over end-of-life care, we threaten to make death even more perilous than it already is as we chastise those who suffer from chronic illness for attempting to find reprieve for themselves and their families from the physical and financial hardships of terminal illness. It is time for action on the state level to protect the individual right to die.
- Childress, S. (2012, November 13). The Evolution of America’s Right-to-Die Movement. Retrieved from https://www.pbs.org/wgbh/frontline/article/the-evolution-of-americas-right-to-die-movement/.
- Public Broadcasting Service. (2014). The Kevorkian Verdict. Retrieved from https://www.pbs.org/wgbh/pages/frontline/kevorkian/aboutk/thanatronblurb.html
- Gonzales v. Oregon. (n.d.). Oyez. Retrieved from https://www.oyez.org/cases/2005/04-623
- Johnson, D. (1999, April 14). Kevorkian Sentenced to 10 to 25 Years in Prison. Retrieved from https://www.nytimes.com/1999/04/14/us/kevorkian-sentenced-to-10-to-25-years-in-prison.html.
- Tyston, P. (2001, March 27). The Hippocratic Oath Today. Retrieved from https://www.pbs.org/wgbh/nova/article/hippocratic-oath-today/.
- U.S. Department of Health & Human Services. (2018, January). Five Important Reasons to Vaccinate Your Child. Retrieved from https://www.vaccines.gov/getting/for_parents/five_reasons
- Wood, J. & McCarthy, J. (2017, June 12). Majority of Americans Remain Supportive of Euthanasia. Retrieved from https://news.gallup.com/poll/211928/majority-americans-remain-supportive-euthanasia.aspx