Should Assisted Suicide be Legalized?

Should assisted suicide be considered a fundamental right? Are there too many possible dangers in fully legalizing this practice? Kai O'Neill and Max Fisher debate the merits and cons of legalizing such a controversial medical practice.
Aaryaman SheoranManaging Editor

FOR

Pursuit of self-determination formed one of the key motivators for which the American Colonies were settled, and later constituted one of the fundamental values on which the United States was founded. Today, the right to self-determination remains one of the core aspects of the American socio-political identity, with concerns over how best to preserve it motivating the ideologies of people across the political spectrum.

A terminally-ill patient’s conscious wish to have their life ended seems just such a matter of personal choice, harming nobody else, that the right to self-determination exists to protect. Governmental restrictions on a person’s ability to act on this choice thus appear to violate this right. In rectification of this injustice, assisted suicide should be made legal.

Numerous statistics reinforce the idea of legalization. A large majority of Americans support the policy, and the number remains above fifty percent no matter how the issue is presented and even when asked about the policy’s morality [1]. That Americans view the policy as not only just but moral, and support holds across various demographics, illustrates the depth of the broad support behind the policy [2]. Furthermore, in U.S. jurisdictions that have already legalized assisted-suicide, very few people take advantage of the policy. 0.32% of deaths in Washington, and 0.39% of deaths in Oregon in 2015 were attributed to assisted-suicide, and the numbers proved only slightly higher in foreign countries (all with a higher median age than the U.S.) that have legalized the practice [3]. Such empirical evidence, especially the likely more instructive examples of the U.S. states, proves that there has not been a sudden surge of mass-death following legalization, and should help to allay concerns about the policy’s potential for abuse. Additionally, assisted suicide would enable a more efficient distribution of healthcare resources, saving money by no longer sustaining the last few months of life a patient does not want [4], and freeing up healthcare workers to treat those patients actually desiring aid. Lastly, one should not overlook the crucial fact that those who would die following the policy’s implementation actually, often fervently, want to do so [5]. What right does the government, or any one of us, have to say that a person cannot kill themselves, but must instead endure another few months of agonizing pain before reaching the same inevitable end?

"Why should a person not get to say goodbye on their own terms, and choose how they want to be remembered, rather than fade into a hollow husk of a human being, living a wretched existence that brings despair to, and generally encumbers, both themselves and their loved ones? Though this forms the crux of the argument in favor."

Though this forms the crux of the argument in favor of assisted suicide, and should stand on its own in bringing people to support the program, examining opponents’ justifiable concerns with the idea might provide even greater clarity as to the concept’s benefits and beneficence.

Perhaps the foremost concern with assisted suicide is that it would serve as only the first step in a slippery slope towards allowing broader forms of state-sanctioned euthanasia. This view is certainly understandable, especially given history’s historic examples showing such a future’s concrete possibility. When it comes to assisted-suicide, these critics are, however, misplaced. To begin with, the key requirement for the policy getting carried out is the patient’s consent. A person asking for death remains very different than groups getting targeted for euthanization. Secondly, as currently envisioned and implemented in the U.S., the policy only applies to those who will soon die anyways. Thus, rather than foisting death upon someone, assisted-suicide only hastens an unpleasant end. Any drive to implement assisted-suicide should certainly ensure that the legislation provides for a high standard of proof for patient consent, and limitation to only those conformationally and irreversibly near death.

Opponents also contend that assisted suicide would violate the hippocratic oath. Herein lies only an issue of perception however. If the hippocratic oath is to do no harm, then complying with a patient’s desire for a relatively painless death surely better complies with the oath than condemning them to prolonged agony? Another very large source of objection to assisted suicide comes from a religious opposition to both suicide and any form of killing. While people’s religious beliefs should absolutely be respected, and those religiously opposing assisted suicide should in no way have to involve themselves with the practice in any way, this country has long since established a separation of church and state, and individual views of morality should not be allowed to abrogate others’ personal freedoms.

While a host of other objections remain, assisted suicide thus ultimately rests on one key point: dying people are suffering, and desire an escape from that pain. To deny them that escape would be to deny them one last act of individuality, one last rejection of inevitability, one last moment of control. In confronting imminent death, and having the courage to chart their own path to its depths, their final action is one of undeniable self-determination.

Kai O'NeillStaff Writer

AGAINST

In its ideal form, assisted suicide sounds like it may be a peaceful way to confront the harrowing reality of death. Families and friends are able to see their loved one pass away peacefully, knowing that their passing was controlled and moderately free from suffering. While passing away in this manner may seem like the most beneficial way to meet this painful reality, the complexities that result around assisted suicide are troubling. Improper regulation of patients is common, especially for those with mental illnesses. Large healthcare companies often have financial benefits in coercing patients to take their own lives. Assisted suicide may have promise to become beneficial, but the large amount of complications seen in states where euthanasia is legal deters it from becoming a universal medical practice.

J.J. Hanson, a political contributor for the Hill, was diagnosed with grade 4 glioblastoma multiforme (GBM), and was expected to live for only four months. His doctor claimed his surgery was “inoperable,” while three other doctors claimed there was “nothing they could do [6].” Along with many other patients with seemingly terminal prognoses, Hill opted in to experimental treatment, which worked and has allowed him to return to a normal life (he is in remission and even has two kids). Instead of selecting the assisted suicide route, of which he was more than qualified–one is able to obtain permission if their prognosis calls for death within six months [7]–Hill decided to fight for his life, and his treatment has afforded him a second chance. When one considers diseases or illnesses that affect mental cognitions, a temporary state filled with suicidal thoughts can be deemed legally sufficient in ending one’s life. Psychological distress is unidentified and under-diagnosed in many patients, and an arbitrary threshold of “six months” is simply not an allowable measure when deciding for physician-assisted suicide.

Similarly, permitting assisted suicide creates a stigma for disabled, sick and elderly people to see themselves as a financial and emotional burden. According to the Oregon Health Authority Public Health Division, “the ‘right to die’ could become a ‘duty to die.’” In Oregon, 49% of those receiving legal assisted suicide in 2016 cited “concern about being a burden” as a reason [8].

"Rather than seeking treatment to better themselves of their illness, patients act sacrificially to help their families, thinking their terminal diagnosis only serves to exacerbate medical bills and their families’ well-being."

Paul Dunne, a palliative care specialist, states that “persistent requests for euthanasia are not based on pain, but on non-physical reasons such as a desire to be in control, a fear of being a burden or feeling socially isolated.” [9]. These mental preoccupations show that assisted suicide would not address what it is meant to–a severe and chronic pain condition without sufficient treatment–but rather harms patients who are pressured by their families and physicians. Prohibiting any form of assisted suicide removes this internal dilemma of suffering patients and allows them to focus on their own well-being.

To play devil’s advocate, let us assume that assisted suicide has become legal throughout the United States. A patient now has the jurisdiction in deciding whether or not they want to end their suffering, and if they meet the ample requirements, the process begins. In Belgium and Oregon, two locations where assisted suicide is legal, problems surrounding consent begin to occur. According to a 2010 Canadian Medical Association report (CMAJ) study, 66 of 208 (32%) cases of euthanasia occurred in the “absence of request or consent.”[10]. Adding to this dark, legal foundation is the lack of regulation in legal euthanasia and the improper administration of medication doses. In 2016, four out of five cases in Oregon (79.4%) did not have a physician or other healthcare provider known to be present at the time of ingestion [11]. Without a doctor or therapist to ensure the death was consensual, there is no possible way to know that the person who took the lethal dose did so consensually. Family members may have given them the medication with surreptitious or malicious intent, perhaps because they did not want to see their loved one suffering or because of possible financial incentives. The RAND Corporation writes that the elderly are often vulnerable or chronically ill, and these factors may account for incorrect usage of lethal medication [12]. There are plenty more of these instances that can lead to an erroneous death and allowing assisted suicide risks creating these hypotheticals into a reality.

A deeper dive into this issue yields even more problems within the realm of assisted suicide. Hanson writes that “assisted suicide policy also injects government insurers and private insurance companies with financial incentives into every single person’s end of life decisions.” His claims are backed up, as MetLife writes that elder financial abuse through these corporations cost victims an estimated $2.9 billion [13] . Dying a peaceful or simple death may be seen as an ideal way to go out, as one gets to pass away while surrounded by family and friends. However, the plethora of pitfalls that meets assisted suicide and its inability to be successfully regulated are too overwhelming. Until change is seen in this issue, assisted suicide should not be a legal measure.

Max FisherStaff Writer

Sources and Notes

[1] https://news.gallup.com/poll/235145/americans-strong-support-euthanasia-persists.aspx
[2] https://news.gallup.com/poll/235145/americans-strong-support-euthanasia-persists.aspx
[3] http://theconversation.com/in-places-where-its-legal-how-many-people-are-ending-their-lives-using-euthanasia-73755
[4] https://www.cbc.ca/news/canada/manitoba/medically-assisted-death-could-save-millions-1.3947481
[5] https://www.deathwithdignity.org/stories/
[6] https://thehill.com/opinion/civil-rights/352757-assisted-suicide-laws-will-pressure-poor-elderly-depressed-to-die
[7] https://www.nytimes.com/2018/08/31/health/suicide-elderly.html?rref=collection%2Ftimestopic%2FAssisted%20Suicide
[8] http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year19.pdf
[9] Dunne, P. (2012, May 12). Euthanasia and the issue of pain. Link: https://www.youtube.com/watch?time_continue=4&v=MzcHt2QLnuA
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/ (referenced from http://www.cmaj.ca/content/182/9/895)
[11] Oregon Public Health Division, Oregon Death With Dignity Act: Data Summary 2016, p.7, http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year19.pdf
[12] https://www.rand.org/capabilities/solutions/improving-health-care-quality-for-vulnerable-elders.html
[13] http://ltcombudsman.org/uploads/files/issues/mmi-elder-financial-abuse.pdf

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