In recent years, a great deal of publicity has been generated regarding “assisted suicide.” Assisted suicide or Physician- assisted suicide is often used interchangeably, and it involves the hastening of death through the administration of lethal drugs in which the patient administers themselves (Gamondi, et al. 2019).
In the United States, Physician assisted suicide has been traced back to the early 1990s, when Dr. Jack Kevorkian of Michigan assisted over 40 people into committing suicide with the use of lethal drugs. Some of his patients were not terminally ill and could have committed suicide without assistance if they wanted to (Shan & Mushtaq, 2014).
Dr. Kevorkian believed that people have the right to avoid a miserable lingering death. He was a vigilant proponent in the assistance of implementing life ending measures, therein ensuring a death that was quick and painless.
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In ethical debates about assisted suicide, the focus is usually on the involvement of health care providers; nurses are seldom given much thought on the matter, but a study done by Stokes (2017), found that approximately 17-40 percent of intensive care and hospice nurses have received request to hasten a patient’s death as a mean to end suffering.
However, it is unethical for nurses to take part or assist in administering any lethal drugs to patients. Instead, nurses must be advocates for the patients and their families, addressing their spiritual needs, anxieties, and be supportive while educating them in ways to lessen suffering.
Proponents argue from a standpoint which embraces respect for individual’s self-determination, autonomy and quality of life. While opponents argue that society has a moral duty to protect and preserve all human life. Assisted suicide should not be legalized because it undermines the value of and respect for all human life, desensitizes society to the taking of human life, and erodes patient trust in the health care system.
View 1: Assisted suicide should not be legalized because it undermines the value of and respect for all human life, desensitizes society to the taking of human life, and erodes patient trust in the health care system.
Human life demands care, nurture, and preservation. And the taking of human life on any level equates to murder, which violates the core values that has been established to govern our modern society. The presence of life altering illness, pain, or suffering should not be accepted as justification for ending of human life.
Physician -assisted suicide is legal in the Netherlands, Belgium, Luxembourg, Columbia, and Canada. Additionally, the practice is legal in five US states, including Oregon, Washington (state), Montana, Vermont, and California, and the District of Columbia (Stratton, 2016).
There are specific requirements for this process which include: A patient must be a legal resident of the state, must be at least voting age, must have six months to live and verified by two independent doctors, must submit a written request and two verbal requests, and must have a psychiatric evaluation and found to be competent (Hanson, et al., 2018).
A study done by Gamondi, Borasio, Limoni, Preston, Payne (2014) found that in 2012, more than 5000 patients die after assisted suicide in the United States where these practices are permitted.
The Hippocratic Oath which all physicians were historically required to take, which was written over two thousand years ago, includes the unambiguous statement, “I will not give a lethal drug to anyone if I am asked, nor will I advise such plan”(Bradley, 2015), is dishonored each time health care providers like Dr Kevorkian elect to do otherwise. Life is a value, and even if life is full of pain and suffering, these do not remove life’s value and are not a reason for ending life.
The aid of assisted suicide is not a healing act. The right to die could empower health care providers to transform the right to die into a duty to die especially the elderly and very fragile and vulnerable patient. The central task of medicine is to heal, not kill.
The essence of healing is a much broader concept than curing, therefore, it makes no sense to claim that patients have been healed by assisting in the ending of their lives. The relief of suffering is an essential part of the health care provider’s role as healer, and nurses as comforters and advocates.
The nurses are the ones at the bedside witnessing these patients suffering. Stokes mentioned previously that 17-40 percent of nurses have been asked to administer a lethal drug to end their patients suffering, however, it is a violation of the Code of Ethics for nurses to participate in any action that contributes to the means to end any patient’s life such as providing or administering medication with knowledge of the patient’s intent (Stokes, 2017).
Instead, the nurse should provide interventions to relieve pain and other symptoms and educate the patients and their families on care such as palliative care. Physicians took the Hippocratic Oath to do no harm and assisting in assisted suicide is murder.
Trust has traditionally been considered a cornerstone of effective patient-physician relationship. The need for interpersonal trust relates to the vulnerability associated with being ill, as well as trust in the medical competence of the health care provider.
Patients trust the opinions of his/her health care providers, and if their health care provider fail them by misdiagnosing, then the patient and their families are likely to accept this as fact. This could be problematic as health care providers do sometimes commit errors; possibly resulting in physician assisted suicide for someone who is not terminally ill.
Patients want to be reassured that the health care providers want to help them, not hurt them. Therefore, it is important that patients can rely on their health care provider to follow the Hippocratic Oath, and do the right thing and provides the care they need, even if they have one month to live.
View 2: Assisted suicide should be legalized because it promotes respect for patient autonomy, a right to die, and dying with dignity.
Autonomy enables a person to make decisions based on his/her own abilities. Some patients desire the opportunity to have influence over how and when they die. There are currently five states within the U.S., as well as the District of Columbia, that have adopted and enacted laws recognizing Physician Assisted Suicide as a legal process. This allows terminally ill individuals to choose a quick death, often through the administration of lethal drugs, instead of enduring a prolonged painful death.
The laws are restricted to individuals with uncompromised competency and capacity. The American Public Heath Association exemplified this approach in expressing support for patients’ rights of self- determination in end-of-life decision making (Buchbinder, 2018).
It is widely accepted that the emotional and psychological impact of prolonged suffering in the face of imminent death, extracts an overwhelming toll. The emotional impact on family and caregivers is also an immense burden; often triggered an elevated level of guilty and hopelessness in the terminal individual.
One of the many duties of medicine is to relieve suffering; arguable even if that relief results in an unpainful death. Patients should have the right to choose death in the face of unending suffering, especially if it allows them to maintain dignity leading up to the time of their last breath. This concept is embodied by the medical principle of beneficence.
