Running head: HOT TOPIC PAPER: ASSISTED SUICIDE 1

Hot topic paper: assisted suicide

Angèle C. Wright

Frostburg State University

Assisted Suicide

With the advent of advance medicine, people are now able to survive ailments and

diseases that, in the past, would have caused their demise. In addition, the evolution of patient

rights now grants the patient the autonomy to make decisions about their treatment plans and

care as well as the power to determine when extraordinary measures are no longer wanted.

Patients are now able to communicate their wishes in a legal document to their loved ones and

healthcare providers should they lose the ability to speak for themselves due to illness or trauma

in the form of a living will, power of attorney, or health care proxy. But what happens to the

patient who is suffering from a terminal illness with a poor prognosis and wishes to have control

over when and how his or her life ends? If one is allowed to refuse treatment that can prolong

their life, should one also be allowed to determine when they can end their life while they can

still speak for themselves? This dilemma is at the crux of the ethical controversy surrounding

assisted suicide.

Assisted Suicide is “an action in which a physician voluntarily aids a patient in bringing

about his or her death” (Pozgar, 2016, 132). Assisted suicide differs from refusal or withdrawal

of treatment; the latter deals with the right to refuse treatment or withdraw care and is protected

by the constitution, whereas, all but five states have banned assisted suicide. In order for one to

qualify for assisted suicide, one must be mentally competent, have a terminal illness diagnosis

with less a than six month life expectancy that has been confirmed by two different physicians,

and have residency in one of the states that allows assisted suicide (Oregon, Washington,

Montana, California, and Vermont). In addition, the patient will have to make two oral and one

written requests as well as a 15-day waiting period. Finally, the prescribing physician must be

licensed in one of the three states that support assisted suicide.

Surprisingly, the road to legalize assisted suicide has roots in the landmark case, Roe v.

Wade. In the case of In re Quinlan, the New Jersey Supreme Court determined that the

“constitutional right to privacy protects a person’s right to self-determination. This right to

privacy was broad enough to encompass a patient’s decision to decline medical treatment under

certain circumstances; in the same way […] it encompasses a woman’s right to terminate

pregnancy under certain conditions” (Pozgar, 2016, 127). Dr. Jack Kevorkian, a Michigan

physician who believed that assisted suicide was a constitutional right, faced homicide charges

when he actively and publicly assisted a chronically ill patient commit suicide on June 4, 1990

(Pozgar, 2016, 132). His refusal to comply with subsequent Michigan legislature that banned

assisted suicide not only ended with him in jail but it also lead to a national conversation

surrounding the legality of criminalizing the act of assisted suicide and eventually gave birth to

the Oregon Right to Die PAC, a political action committee who authored the first Oregon Death

with Dignity Act in 1993.

With the defeat of Measure 51 (the counter legislation to the successful Measure 16),

Oregon was the first state to successfully pass and defend its residents’ right to assisted suicide in

1997 (Death with Dignity, 2016). At the helm of the pro-assisted suicide movement is the Death

with Dignity Political Fund, the political arm that “campaigns, lobbies, and advocates for Death

with Dignity legislation in the […] states that lack them” (Death with Dignity, 2016). Under

their leadership and support, Maine was the next state to debate if its citizens had the right to

actively end their lives with Question 1, and in 2000, the legislation was denied with a 51 percent

to 49 percent vote (Death with Dignity, 2016). In 2008, two states legalized assisted suicide

using two different avenues. During the November elections, the organization, Death with

Dignity Political Fund authored the successful Initiative 1000, which made Washington the
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second state to legalize assisted suicide (ProCon.org, 2016). In December, it was determined the

Montana residents have the right to physician-assisted suicide in the case Baxter v. State of

Montana. The following year, this decision was upheld in the Montana Supreme Court; which

“protected physicians from prosecution for helping terminally ill patients die, [but] […] declined

to rule if assisted suicide is a right guaranteed under Montana’s Constitution” (ProCon.org,

2016).

In November 2012, the Massachusetts voters decided against the Death with Dignity

ballot measure during the state elections and the following year, Vermont was the first state to

legalize assisted suicide using the legislative process when Governor Peter Shumlin signed the

“End of Life Choices” bill into law (ProCon.org, 2016). 2015 brought two important decisions

regarding assisted suicide; with the New Mexico Court of Appeals overturning the lower court’s

2014 decision to legalize assisted suicide in a 2-1 ruling and California Governor Jerry Brown

signing a measure that was modeled after Oregon’s Measure 16 Death with Dignity Act

(ProCon.org, 2016). Although this measure was passed, it will not go into effect until 90 days

after the Legislature adjourns its special session on healthcare (ProCon.org, 2016). Additional

states, such as Colorado, Connecticut, Maryland, and New York, have made efforts to introduce

legislation in their respective state Houses. Their current future is unsure at this time but it is

clear that the discussion on the state level surrounding assisted suicide is alive and well.

Assisted suicide is a topic that spans across ethical, medical, philosophical, and religious

aspects. While debating the ethical viewpoints of assisted suicide, it is difficult to have a

discussion on the state level without marginalizing or diminishing the belief system or rights of

at least one religious or secular group. Those who belong to groups of faith believe that life is

given by a higher power and the difficulties and suffering experienced during life are supposed
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to bring about a level of enlightenment and surrender to their faith and specific deities. The

excessive use of painkillers and ultimate employment of assisted suicide would be seen as a sign

of distrust in their faith and higher power (Ontario Consultants on Religious Tolerance, 2010).

For those who identify with religious groups, assisted suicide would be considered a sin because

a life was ended and “only God can create life and only God should be allowed to end life” and

as members of society, it is our goal to protect life, not seek ways and methods to end it (Ontario

Consultants on Religious Tolerance, 2010). Conversely, those who have more secular

viewpoints believe that individuals should be allowed to determine the course of their lives, and

once an illness becomes so burdensome or painful that that person is no longer “living a full

life,” should also be allowed to determine how and when their pain ends. With the separation of

church and state in government, this group believes that the pursuit of life, liberty, and happiness

listed in the U.S. Constitution supports their belief that self-determination should allow them to

determine when life is no longer worth living and should end. For both groups, there is a

concern that the opposing philosophy will be adopted and used to govern their lives, granting

privileges that do not accurately reflect the other group’s belief system.

Critics of assisted suicide are also concerned that legalizing assisted suicide will allow

the terminally ill to seek out assisted suicide not because they want to die but rather because they

no longer want to burden their family members with their care or worse, these individuals can be

unfairly influenced by family members to accelerate the dying process for their family members’

selfish gains. Other concerns list the needs of the medical professionals who then have to assist

in ending a life and the possible toll that it may have on them and their belief systems (Andre,

Velasquez, 2015). Assisted suicide is contrary to the American Medical Association’s Code of

Medical Ethics, which states “Physician-assisted suicide is fundamentally incompatible with the
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Assisted Suicide

physician’s role as healer, would be difficult or impossible to control, and would pose serious

societal risks” (Lagay, 2003). Those in favor would counter that although it is legal to seek

assisted suicide, the law cannot force that physician to participate in physician – assisted suicide

if he or she opposes it due to philosophical beliefs or professional ethics (Lagay, 2003). In

addition, without a physician’s medical assistance, an unsuccessful suicide attempt can prove to

be even more traumatic than the reasons that drove the patient to initially contemplate suicide

and compound the symptoms experienced or worse yet, require family members to assist in

completing the attempt to ultimately help the patient (Lagay, 2003).

At the heart of the matter is the life of the person who is ill with no hope of a cure. This

person is now in pain, requiring the help of others to help with their basic functions. To live with

the pain may be too overwhelming to bear and may require the use of narcotic pain relievers that

leave them also unable to participate in activities of daily living. So these patients may be in too

much pain to live or too sedated to live. It is this picture that drives those who are in favor of the

assisted suicide. Those in favor state that the power in determining when one’s life end can be

extremely liberating for one whom is suffering from a terminal illness and may be feel powerless

in the context of their daily lives. By having assisted suicide as an option, this individual regains

a sense of power that was lost to them during the course of the illness now ravishing their bodies.

Those against assisted suicide see as it the threshold to a slippery slope where innocents who are

deemed worthless or undesirable by society may be euthanized as a form of mercy killing.

Those against believe that in the fight that violates the right of the individual, they are

“upholding the moral duty to protect and to preserve all life” (Andre, Velasquez, 2015); a tenant

they believe supersedes the right of the individual.

As a somewhat devout Catholic who once aspired to be a nun, I was taught to believe in

God and have faith in His plan. As a Catholic, it is a sin to question the Mysteries; that God does

not give you more than you can handle and you will be rewarded in the afterlife for your spiritual

obedience and surrender to Him. My relationship with God centered me during a very tough

childhood and bound me to loved ones, like my grandmother, who received so much joy in

worship and praise. Had I been asked then what my position on assisted suicide, it would have

been an unequivocal no and that suicide in any form is wrong.

In my early twenties, following my grandmother’s accidental death from a diuretic

overdose, I questioned my blind faith and moved away from the Catholic Church. I also

struggled with a deep depression and luckily found a wonderful therapist who helped me work

through my unresolved childhood issues and form more productive coping mechanisms that I

still employ today. I sought out to understand why pain and sadness existed in our world and

when I asked my priest, I was told that I was committing a sin and should not question but just

accept and surrender. This did not satisfy my questions and so, I moved on to other religions to

see if I could somehow find the peace that I was seeking. In my early thirties, I stumbled upon

Buddhism and learned that its teachings focused on the Four Noble Truths; the first one stating

that pain is inherent to life and once we accept that and the fact that life as we know is in

constant flux, we can control our cravings and need to eliminate the pain and thus, surrender to

it. This resonated with my need to understand how fear has previously controlled and

manipulated me and I no longer tried to control it. Had I been asked during this period on my

stance on assisted suicide, I would have stated that I did not believe in it because I was no longer

afraid of the pain.

Then I became a mother at age 35 after 17 years of being told that I was unable to have

children. My whole life’s purpose is to now help my sons become the very best versions of

themselves and I need as much time as possible. I want to meet girlfriends, attend graduations

and weddings, coach on how to handle first days, breakups, proposals, births of new babies and

everything in between. I want to be around for as long as possible because they need me as

much as I need them. I do not know if I could end my life without knowing what would happen

to my boys. But I do know that I do not have the right to push my beliefs onto those who may

want to pursue assisted suicide. It is for that reason that I am in favor of assisted suicide.

According to Provision 1.2 of the Codes of Ethics for Nurses, “nurses establish

relationships of trust and provide nursing services according to need, setting aside any bias or

prejudice. […] Respect for patient decisions does not require that the nurse agree with or

support all patient choices” (ANA, 2016). As a nurse, I am capable of fulfilling my ethical duty

to support a patient’s decision to end their life, should they qualify for assisted suicide. I would

do that because it is my duty as a nurse and as one who falls in the Rights and Responsibilities

Lens, I “fulfill the rights and responsibilities of the ethical actor” (ELI overview of lenses, 2016).

I also believe that if someone is of sound mind, they should be allowed to speak for themselves

and determine how they should live or die. Patients and family members are allowed to sign

DNRs and passively die by removing or restricting life sustaining treatments; how is assisted

suicide for someone who is so sick that they relegated to lying on their back, too frightened to or

unable to move ever be considered living? They should be allowed the same privilege for self-

determination before they are forced to merely just exist.

During nursing school, I spent my final semester in the Oncology unit of a local hospital

and I cared for a patient suffering from breast cancer with metastasis to her brain for the six out
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of 10 clinical weeks. This patient was unable to speak, would experience tonic-clonic seizures

whenever she was moved or repositioned and had skin breakdown on her sacral area. She

required three people to help change her because she had gained so much weight from the

steroids administered to control the inflammation. Sometimes, it would take 10-15 minutes to

clean her because she would experience a seizure while she was being cleaned and experience

incontinence, requiring more cleaning and possibly another seizure. So we would proceed

slowly; moving her at a snail’s pace as to avoid any movements that could trigger a cascade of

seizures. What struck me most about her were our similarities. She was two months younger

than me and at that time, we both had two children. And it made me so sad to see her tears of

sadness and frustration after her children left or when she had two or three seizures in a row. If

she lived in one of the states that sanctioned assisted suicide, I would understand if she decided

to end her life because of her constant pain and poor prognosis. And despite the fact that I may

not choose that path for myself; as her nurse, I would have willingly sat there and held her hand

during the last moments of her life if she chose to actively end it.

The experience of caring for this patient was a bittersweet gift; it was horrible for the

patient but it broadened my paradigms on how things are versus how things should be. In that

situation, I was more than just a nurse. I was a small source of comfort to her during a very dark

period in her painfully short life and although her suffering exceeded my time spent in that

Oncology unit, not a day goes by that she does not spring to mind and I wonder about her well-

being and pray that she is no longer in pain. That experience was life-altering and saddening

because I wondered if put the same position, would I be able to exist in a state of continuous pain

as gracefully as she did because assisted suicide is not a viable option in Maryland.
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References

American Nurses Association. (2016). Code of ethics for nurses with interpretive statements.

Retrieved from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-

Nurses.html

Andre, C., Velasquez, M. (2015, November 16). Assisted suicide: a right or a wrong?

Retrieved from https://www.scu.edu/ethics/focus-areas/bioethics/resources/assisted-

suicide-a-right-or-a-wrong/

Death with dignity. (2016). Faqs death with dignity. Retrieved on April 18, 2016 from

https://www.deathwithdignity.org/faqs/

EthicsGame. (2016). ELI overview of four ethical lenses. Retrieved from

https://frostburg.blackboard.com/bbcswebdav/pid-676951-dt-content-rid-

2495545_1/courses/2162_3302/ELI_Overview_FourEthicalLenses.pdf

Lagay, F. (2003, January). Physician assisted suicide: the law and professional ethics. Vol

5(1). Retrieved from http://journalofethics.ama-assn.org/2003/01/pfor1-0301.html

Ontario Consultants on Religious Tolerance. (2010, September 3). Ethical aspects of physician

assisted suicide: all sides. Retrieved from http://www.religioustolerance.org/euth7.htm

Pozgar, G. (2016). Legal and ethical issue for health professionals. (4th Ed.). Burlington, MA:

Jones & Bartlett Learning.

ProCon.org. (2016, February 18). Historical timeline euthanasia. Retrieved from

http://euthanasia.procon.org/view.timeline.php?timelineID=000022.