MMI Medical Ethics Topic 1: Physician Assisted Suicide

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MMI Medical Ethics Topic 1: Assisted suicide is suicide committed with the aid of another person, sometimes a physician. The term is often used interchangeably with physician-assisted suicide (PAS), which involves a doctor knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide, including counseling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs.

Physician-assisted suicide is often confused with euthanasia. In cases of euthanasia, the physician administers the means of death, usually a lethal drug. In physician-assisted suicide, it is required that a person of sound mind voluntarily expresses his or her wish to die and requests a dose of medication that will end his or her life. The distinguishing aspect is that physician-assisted suicide requires the patient to self-administer the medication.

Physician-assisted suicide has its proponents and its opponents. Among the opponents are some physicians who believe it violates the fundamental tenet of medicine and believe that doctors should not assist in suicides because to do so is incompatible with the doctor’s role as a healer. Physician-assisted suicide is often abbreviated PAS. It is called doctor-assisted suicide in the UK.

One argument for medical aid in dying is that it reduces prolonged suffering in those with terminal illnesses. When death is imminent (half a year or less) patients can choose to have aid in dying as a medical option to shorten an unbearable dying process. Pain is mostly not reported as the primary motivation for seeking physician aid in dying in the United States; the three most frequently mentioned end‐of‐life concerns reported by Oregon residents who took advantage of the Death With Dignity Act in 2015 were: decreasing ability to participate in activities that made life enjoyable (96.2%), loss of autonomy (92.4%), and loss of dignity (75.4%).

The American Medical Association is steadfast in its opposition to PAS and euthanasia. In its latest Code of Ethics, the AMA reaffirmed its long-held position that allowing physicians to engage in assisted suicide would cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.

The specific method in each state varies, but mainly involves a prescription from a licensed physician approved by the state in which the patient is a resident. Canada, Belgium, the Netherlands, Luxembourg, and Switzerland allow physicians to physically assist in the death of patients. In the United States, six states allow medical aid in dying; a legal practice in which a person who has been diagnosed as terminally ill with 6 months or less to live can request a lethal dose of a medication to self-administer in order to end their life. This option is designated a legal form of assisted suicide by distinct state laws. Non-medical assisted suicide is unlawful by common law or criminal statute in the vast majority of the United States (with some states having no definitive law or statute).