The Legalization of Physician-Assisted Suicide: Critical Thinking Paper

Shifra Dayak

CAP 9

Green Group

5/15/2017
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Physician-assisted suicide, often called euthanasia and loosely termed mercy-killing and

death with dignity, is the practice of providing a competent patient with a prescription for

medication for the patient to use with the primary intention of ending his or her own life

(Medical Definition) in cases of terminal illness. Those in favor of physician assisted suicide

argue that individuals have the right to choose to die if the conditions are appropriate. People

who are against the procedure claim that it is extremely common for medical predictions of a

short life expectancy to be wrong (Golden) and that physician-assisted suicide contradicts the

Hippocratic Oath, in which doctors swear to do no harm. In recent years, only a few measures

regarding the nationwide legalization of physician-assisted suicide have been taken, but more

action needs to occur in the near future. Legalizing physician-assisted suicide has several

benefits which are much greater than the drawbacks. In order to uphold the constitutional rights

of terminally ill patients to make decisions regarding their bodies and well-being, reduce anxiety

for families of terminally ill individuals about future circumstances and medical expenses, and

ensure that all actions carried out by terminally ill patients are safe and legal, the United States

Congress must pass a bill legalizing physician-assisted suicide in all 50 states.

The battle to legalize physician-assisted suicide came about in England in 1935 with the

founding of the Voluntary Euthanasia Society, or VES. The organization, which was created and

led by George Bernard Shaw, H.G. Wells, and Bertrand Russell, lobbied for the passage of laws

that would permit physician-assisted suicide. Despite persistence by the VES, in 1936, the House

of Lords in Parliament struck down a bill that would have legalized euthanasia in cases of

terminal illness. In 1938, the prospect of physician-assisted suicide traveled to the United States.

The Euthanasia Society of America was established in the same year by Reverend Charles
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Francis Potter, and several Americans began to lobby for the procedures legalization (Assisted

Dying). Soon, the Euthanasia Society of America was renamed the Society for the Right to Die;

it then merged with a series of pro-euthanasia organizations and became the National Hospice

and Palliative Care Organization, which is still in operation today (Alters). Throughout the 20th

and 21st centuries, many individuals and smaller organizations have also come together to fight

for the nationwide legalization of physician-assisted suicide.

After a long fight, Oregon was the first state in the United States to officially legalize the

procedure, enacting the Oregon Death with Dignity Act in 1994; the act was updated with

additional information in 1997. Then, in 2008, a second Death with Dignity Act was passed,

legalizing euthanasia in Washington state. The passing of the Patient Choice and Control at the

End of Life Act in 2013 legalized the procedure in Vermont. Finally, two End of Life Options

Acts passed in 2013 made physician-assisted suicide legal in California and Colorado. The status

of euthanasia is disputed in Montana in 2009, it was deemed legal only through Supreme

Court decision, but there are no laws permitting or prohibiting the procedure in the state (Death

with Dignity). Although the above laws have alleviated the suffering of terminally ill patients in

certain states, they are not enough in the 44 remaining states, resources for safe assisted

suicide are not available, and therefore, individuals are being deprived of their rights, causing

conflicts and unnecessary worry about medical expenses and coverage, and taking their lives

unsafely.

Currently, terminally ill patients do not hold the right to make free decisions concerning

their health. If the United States Congress were to legalize euthanasia nationwide, terminally ill

individuals would gain this right and justly be able to make personal and medical choices. The
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Equal Protection Clause, found in Article 1 of Amendment XIV, rules that No state shall

deny to any person within its jurisdiction the equal protection of the laws (US Const.

amendment XIV, sec. 1). The clause, therefore, ensures that terminally ill persons deserve the

same rights as others who do not have chronic illnesses. However, in the mid 1990s, the

landmark Supreme Court case Vacco v. Quill made it evident that the prohibition of

physician-assisted suicide is unconstitutional and deprives terminally ill patients of their rights to

make decisions about their bodies and well-being. Physicians Timothy E. Quill, Samuel C.

Klagsbrun, and Howard A. Grossman of New York, along with three terminally ill patients who

have since died, sued New York Attorney General Dennis C. Vacco on the account that New

Yorks euthanasia ban violated the Equal Protection Clause (Legal Precedents).

First plaintiff Quill argued that because New York permits a competent person to refuse

life sustaining medical treatment, and because the refusal of such treatment is essentially the

same thing as physician assisted suicide, New York's assisted suicide ban violates [Amendment

XIV] (Vacco v. Quill). Although doctors Quill, Klagsbrun, and Grossman ultimately lost the

case with a 9-0 vote, their statements had a lasting effect on many people and created a new

outlook on the euthanasia ban (Legal Precedents). Despite the final ruling, Vacco v. Quill

proved that the prohibition of physician-assisted suicide in 44 states does not fully comply with

the U.S. Constitution, as it does not offer terminally ill patients equal protection or equal

opportunity. It is important that this unconstitutionality is reversed and that terminally ill patients

are given the same rights as others; this is only possible if physician-assisted suicide is legalized

in all 50 states.
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The prohibition of physician-assisted suicide in 44 states causes distress for many

families of terminally ill patients around the nation medical expenses, the prospect of death,

the lack of rights, and limited medical options are all huge factors in the lives of those who have

a terminally ill acquaintance. If the United States Congress were to legalize physician-assisted

suicide, these negative factors would be greatly reduced and families of terminally ill patients

would have access to a more stable lifestyle. A recent study conducted by the New England

Journal of Medicine revealed that most terminally ill patients rely completely on family and

friends... [rather than on] paid care (Emanuel et al.) because of accessibility issues. In these

cases, family members lives are consumed by caring for terminally ill patients. Often, family

members support patients decisions to seek euthanasia in order to end stress, suffering, and

other negative emotions, but are restricted because of its prohibition. In fact, it was found that in

an average year, about 54 percent of requests for lethal injections or physician-assisted suicide

a large part of which are not granted around the country are made by family members on

behalf of terminally ill patients (Meier et al.).

It is evident that Dying patients frequently have important and wide-ranging needs for

assistance in addition to the medical care received from physicians and hospitals. Previous

studies have documented that the families of dying patients take on substantial burdens in

caring for them (Emanuel et al.). Individuals with terminal illnesses will inevitably die, but in

many places in the United States, their families are forced into taking care of them despite a

desire to turn to assisted suicide. Not only does this situation induce stress and other numerous

negative emotions, it costs an incredible amount of money. The phenobarbital/chloral

hydrate/morphine sulfate mix, the cheapest euthanasia drug mixture, is approximately $450 to
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$500 (Death with Dignity), while end-of-life care can amount to an average cost of

approximately $10,700 per patient (Hospice). Clearly, the cost of euthanasia is easier to

afford for many families, and causes less of a financial burden than full-time care for a terminal

illness does. However, while euthanasia is a cheaper and more efficient alternative to

all-inclusive chronic disease care, it is prohibited in the majority of the United States. In many

cases, Family members may resent precious time and [money] being spent on work that will not

give a chance of a cure (Chapple et al.). Through numerous studies and experiences, it is clear

that family members and caretakers of terminally ill patients face negative emotions and

unnecessary burdens, and are weighed down by cost considerations (Lee and Stingl). It is

crucial that suffering for families is reduced; this can most effectively be done by legalizing

assisted suicide nationwide.

For chronically ill persons, the absence of the opportunity to turn to physician-assisted

suicide can often lead to unsafe, illegal, or irresponsible actions. If the United States Congress

were to legalize euthanasia in all states, the amount of illegal and unsafe actions carried out by

terminally ill patients would considerably reduce. It was recently discovered that Up to 8.5% of

terminally ill patients express a sustained and pervasive wish for an early death, and in one

survey 10% of terminally ill patients reported seriously pursuing suicide (Marks and

Rosielle). Without the option to safely end their lives through euthanasia, many desperate

individuals who face terminal illnesses will resort to other methods of suicide, many of which are

dangerous or involve illegal processes. In a study conducted with a series of chronically ill

patients in palliative care institutes in Winnipeg, Manitoba, Canada, a dangerously high range

of putative risk factors for suicide [were] discussed in relation to patients with advanced dis-
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ease, including physical problems social factors and various dimensions of psychopathology

and psychiatric history (Chochinov et al. 369). Evidently, those with terminal illnesses can

resort to dangerous methods of coping if not given the necessary resources.

In January 2008, political columnist Kevin Drums father-in-law, who suffered from a

dangerous terminal cancer called multiple myeloma, took his life through suffocation in order to

end his pain. Drums father-in-law, Harry, lived in California, where physician-assisted suicide

was prohibited. His first choice to cope with his illness was professionally-administered

euthanasia, but since it was not accessible to him, He walked into his bedroom, put a plastic bag

over his head, and opened up a tank of helium. A few minutes later he was dead (Drum). This

method of suicide, which is common among individuals who are denied euthanasia, is extremely

dangerous and can harm those around the victim in certain situations. If a pressurized tank of

non-oxygenated gas is left open and unintentionally inhaled by individuals, lung damage and

hemorrhages can result, among other extreme consequences (Engber). Harrys situation is

similar to that of many others while the exact suicide rate of terminally ill patients is

unknown, one can presume that a fair amount attempt to take their lives through unsafe methods

because of the prohibition of a safer alternative (Marks and Rosielle). Assisted suicide involves

lethal doses of physician-administered drugs or liquids, lethal injections, or other authorized

methods; these methods are professionally monitored and therefore are not dangerous or

unlawful (Humphry). When these methods are unavailable and individuals are desperate for a

solution to a chronic illness, however, reckless behaviors can result. It is necessary to halt the

spread of unsafe and unlawful behaviors among individuals with terminal illnesses by providing
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a safe, legal alternative to all ill persons; this can only be done by legalizing physician-assisted

suicide around the United States.

Presently, physician-assisted suicide is governed by state legislation, meaning progress

and advances in the field are slow. Currently, euthanasia is only legal in six states: Oregon,

Washington, Vermont, California, Colorado, and Montana (Death with Dignity). Through

evidence gathered from many studies, personal experiences, and articles expressing both fact and

opinion, it is clear that if the status of physician-assisted suicide remains the same in the future,

life will be difficult for those with chronic illnesses in the remaining 44 states. Terminally ill

individuals will continue to be deprived of their constitutional rights and freedom to make

medical decisions, family members of those with chronic illnesses will continue to be weighed

down with negative emotions and monetary concerns, and terminally ill individuals will continue

to resort to unsafe and unlawful behaviors. In order to uphold the rights of terminally ill

individuals, reduce burdens in the lives of family members, and ensure that all actions carried out

by those with terminal illnesses are safe and lawful, Congress must author and pass a bill

legalizing physician assisted suicide in all 50 states and in turn removing the state-by-state basis

of euthanasia legislation. The benefits of legalizing assisted suicide nationwide, discussed above,

far outweigh the drawbacks, and it is important that action is taken on the matter in the near

future.
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Works Cited

Alters, Sandra M. "Suicide, Euthanasia, and Physician-Assisted Suicide." Death and Dying:

End-of-Life Controversies, 2010 ed., Detroit, Gale, 2010. Information plus Reference Series.

Student Resources in Context. Accessed 6 Feb. 2017.

"Assisted Dying and the USA." The World Federation of Right to Die Societies, RTD Europe.

Accessed 31 Mar. 2017.

Chapple, A., et al. "What People Close to Death Say about Euthanasia and Assisted Suicide: A

Qualitative Study." Journal of Medical Ethics, National Center for Biotechnology

Information, Dec. 2006. Accessed 2 Apr. 2017.

Chochinov, Harvey Max, et al. "Depression, Hopelessness, and Suicidal Ideation in the

Terminally Ill." July 1998. ResearchGate. Accessed 2 Apr. 2017. Working paper.

"Death with Dignity Acts." Death with Dignity, Death with Dignity National Center. Accessed 7

Feb. 2017.

Drum, Kevin. "My Right to Die." Mother Jones, Jan.-Feb. 2016. Accessed 7 Feb. 2017.

Emanuel, Ezekiel J., et al. "Assistance from Family Members, Friends, Paid Care Givers, and

Volunteers in the Care of Terminally Ill Patients." The New England Journal of Medicine,

Massachusetts Medical Society, 23 Sept. 1999. Accessed 2 Apr. 2017.

Engber, Daniel. "Stay Out of That Balloon!" Slate, The Slate Group, 13 June 2006. Accessed 13

May 2017.

Golden, Marilyn. "Why Assisted Suicide Must Not Be Legalized." Vermont Alliance for Ethical

Healthcare, 7 Dec. 2015. Accessed 6 Feb. 2017.

"Hospice and End-of-Life Options and Costs." Debt. Accessed 2 Apr. 2017.
 Dayak 9

Humphry, Derek. "Definitions of Euthanasia." Assisted Suicide, Euthanasia Research &

Guidance Organization, 19 Jan. 2006. Accessed 2 Apr. 2017.

Lee, M., and Alexander Stingl. "Assisted Suicide: An Overview." Points Of View: Assisted

Suicide (2016): 1. Points of View Reference Center. Web. 7 Feb. 2017.

"Legal Precedents: Landmark Euthanasia and Physician-Assisted Suicide Legal Cases."

ProCon.org, 13 Apr. 2009. Accessed 30 Mar. 2017.

Marks, Sean, and Drew A. Rosielle. Fast Facts and Concepts #210: Suicide Attempts in the

Terminally Ill. Palliative Care Network of Wisconsin, Nov. 2008. Accessed 12 Feb. 2017.

"Medical Definition of Physician Assisted Suicide." Medicine Net, MedicineNet, 24 Jan. 2017.

Accessed 8 Feb. 2017.

Meier, Diane E., et al. "A National Survey of Physician-Assisted Suicide and Euthanasia in the

United States." The New England Journal of Medicine, Massachusetts Medical Society.

Accessed 23 Apr. 1998.

United States, Supreme Court. Vacco v. Quill. 26 June 1997. ProCon.org. Accessed 31 Mar.

2017. No. 95-1858.

US Constitution. Amendment XIV, sec. 1. Legal Information Institute, Cornell University Law

School. Accessed 2 Apr. 2017.

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Annotated Bibliography

Alters, Sandra M. "Suicide, Euthanasia, and Physician-Assisted Suicide." Death and Dying:

End-of-Life Controversies, 2010 ed., Detroit, Gale, 2010. Information plus Reference Series.

Student Resources in Context. Accessed 6 Feb. 2017.

This article gave me a good first overview of physician-assisted suicide. It allowed me to

learn about several basic sub-topics and was a helpful source with which to start my

research. The definitions, history, and viewpoints included in this source also provided me

with concise, persuasive quotes to incorporate in my paper.

"Assisted Dying and the USA." The World Federation of Right to Die Societies, RTD Europe.

Accessed 31 Mar. 2017.

This webpage gave me deeper insight into the history of physician-assisted suicide. It helped

me understand where and when the movement to legalize euthanasia started, and gave me

much helpful information about the progression of the issue through the past years. This

source helped me compare the condition of the movement in its early days to its condition

now, which was helpful in developing my arguments.

Chapple, A., et al. "What People Close to Death Say about Euthanasia and Assisted Suicide: A

Qualitative Study." Journal of Medical Ethics, National Center for Biotechnology

Information, Dec. 2006. Accessed 2 Apr. 2017.

This study gave me specific statistics on euthanasia and was especially helpful in

developing my second argument. The quotes in this source regarding physician-assisted

suicide, family members views, and monetary concerns were concise and persuasive, and
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made my overall paper stronger. This source also provided some basic definitions and

history, which I employed throughout my paper.

Chochinov, Harvey Max, et al. "Depression, Hopelessness, and Suicidal Ideation in the

Terminally Ill." July 1998. ResearchGate. Accessed 2 Apr. 2017. Working paper.

This source helped me strengthen my final argument greatly. The mixture of quotes and

statistics provided me with a strong base for my research, and I was able to use the

information in this paper to support my writing.

"Death with Dignity Acts." Death with Dignity, Death with Dignity National Center. Accessed 7

Feb. 2017.

This source provided me with a basic history of the Death with Dignity acts enacted in the

United States, which was a great base for my paper. The concise, simple facts and timeline

included on this webpage allowed me to expand my knowledge, and also gave me a good

starting point for research.

Drum, Kevin. "My Right to Die." Mother Jones, Jan.-Feb. 2016. Accessed 7 Feb. 2017.

This article was extremely personal, and allowed me to imcorporate pathos into my paper.

The anecdotes told in this source, as well as the facts and history mentioned, helped me

make my paper more persuasive and appealing to readers.

Emanuel, Ezekiel J., et al. "Assistance from Family Members, Friends, Paid Care Givers, and

Volunteers in the Care of Terminally Ill Patients." The New England Journal of Medicine,

Massachusetts Medical Society, 23 Sept. 1999. Accessed 2 Apr. 2017.

 Dayak 12

This study gave me specific statistics and quotes which allowed me to build up my second

argument. The charts and numbers were especially helpful, as they made my statements

more credible. This source allowed me to incorporate logos in my paper.

Engber, Daniel. "Stay Out of That Balloon!" Slate, The Slate Group, 13 June 2006. Accessed 13

May 2017.

This source helped me strengthen my third argument. It gave me accurate, scientific facts on

the danger of certain suicide methods and therefore, made my paper more effective and

persuasive. This source gave me credible information and added to the overall logos of my

paper.

Golden, Marilyn. "Why Assisted Suicide Must Not Be Legalized." Vermont Alliance for Ethical

Healthcare, 7 Dec. 2015. Accessed 6 Feb. 2017.

This source allowed me to develop my opening paragraph and come up with convincing

counterarguments. The article gave me insight on the other side of the euthanasia issue, and

allowed me to make my offense arguments even stronger.

"Hospice and End-of-Life Options and Costs." Debt. Accessed 2 Apr. 2017.

This webpage gave me plenty of information about the monetary aspect of euthanasia.

Being able to view specific costs and percentages allowed me to include logos and

strengthen my arguments with credibility.

Humphry, Derek. "Definitions of Euthanasia." Assisted Suicide, Euthanasia Research &

Guidance Organization, 19 Jan. 2006. Accessed 2 Apr. 2017.

This webpage gave me basic definitions of words such as assisted suicide, euthanasia,

and death with dignity. The simple, concise quotes included in this source were easy to
 Dayak 13

incorporate into my paper, and helped me to verify that I was including factual information

in my writing.

Lee, M., and Alexander Stingl. "Assisted Suicide: An Overview." Points Of View: Assisted

Suicide (2016): 1. Points of View Reference Center. Web. 7 Feb. 2017.

This source was another good starting point, since it gave me a basic history, basic

definitions, and basic viewpoints. It sparked my interest in the topic and allowed me to

expand my research and form new ideas and opinions.

"Legal Precedents: Landmark Euthanasia and Physician-Assisted Suicide Legal Cases."

ProCon.org, 13 Apr. 2009. Accessed 30 Mar. 2017.

This source helped me greatly in developing my first argument. The brief but informative

summaries of euthanasia-related court cases gave me several quotes and paraphrases for my

paper, and allowed me to create a concise but factual base for the beginning of my writing.

Marks, Sean, and Drew A. Rosielle. Fast Facts and Concepts #210: Suicide Attempts in the

Terminally Ill. Palliative Care Network of Wisconsin, Nov. 2008. Accessed 12 Feb. 2017.

The statistics included in this webpage helped me strengthen my third argument. I

appreciated having a source with a concise list of information, since it provided me with a

manageable but informative database of facts.

"Medical Definition of Physician Assisted Suicide." Medicine Net, MedicineNet, 24 Jan. 2017.

Accessed 8 Feb. 2017.

This dictionary entry was essentially the base of my paper, since it defined the key concept.

The quotes included in this source helped me build a factual skeleton for my paper and gave

me a way to draw readers into the material right away.

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Meier, Diane E., et al. "A National Survey of Physician-Assisted Suicide and Euthanasia in the

United States." The New England Journal of Medicine, Massachusetts Medical Society.

Accessed 23 Apr. 1998.

This study gave me insight on terminally ill patients feelings about physician-assisted

suicide, and therefore provided me with memorable anecdotes and statistics for my paper.

The balance of pathos and logos in this source allowed me to build a paper that was both

emotionally appealing and factually verified.

United States, Supreme Court. Vacco v. Quill. 26 June 1997. ProCon.org. Accessed 31 Mar.

2017. No. 95-1858.

This court case transcript greatly helped me build by first argument. Seeing the quotes and

happenings of this case firsthand was helpful in developing arguments and paraphrasing

information. This primary source made my paper much stronger overall as well.

US Constitution. Amendment XIV, sec. 1. Legal Information Institute, Cornell University Law

School. Accessed 2 Apr. 2017.

This transcript of the U.S. Constitution was also helpful in strengthening my first argument.

The easily accessible quotes in this source allowed me to add ethos to my paper and build

my writings credibility greatly.