A PANEL of legal experts in Hawaii recently concluded there was nothing in preexisting state law that outlawed terminally ill patients from receiving aid in dying from their physicians. As a result, Hawaii joined Oregon, Washington and Montana as the only states currently allowing physician-assisted suicide. In addition, Vermont has just introduced a bill that, if passed, could add it to the same list. Though it is a controversial topic with a multitude of differing angles, the right to physician-assisted suicide was correctly deemed legal in Hawaii and could be extended to Vermont and other states.
Challengers of the practice claim that allowing physicians to prescribe medication that, when taken, will quickly end the patient's life is a violation of the Hippocratic oath that doctors take. Killing, they argue, is the direct opposite of the curative steps that doctors should be taking. Other opponents declare that physicians acquiescing to a patient's request for help in committing suicide violates the sanctity of life. As one bishop claimed, allowing a patient to determine when his life is concluded makes it so "life is no longer precious but just another commodity in the business of living."
Yet legalizing physician-assisted suicide is an ethically permissible act. The laws in the four states that allow physician-assisted suicide only concern terminally ill, mentally stable patients. Because the patients are terminally ill, no procedure or medicine administered by a physician can cure their disease or ailment. Without the option of physician-assisted suicide, many patients have no option other than enduring a period of potentially painful or undignified decline while they wait for death.
Terminal patients often are taken off dialysis or have feeding tubes and other life supporting apparatuses removed, yet such actions are not considered a violation of a physician's oath. Might prescribing lethal medication be put on the same level as removing life support? In both cases, the patient has acknowledged his situation and wishes to bring about death on his own terms. Allowing terminally ill patients to die as they see fit is both a way that doctors can preserve patient dignity as well as respect patient autonomy.
There is little that is dignified about withering away in the midst of crippling pain or requiring machines to perform necessary actions when the inevitable end is death. Even if the road to death will not be painful, patients who know that their affliction will kill them should have the right to judge how they would like to cope with death, whether by waiting until the end or by ending their lives just a bit prematurely.
Furthermore, the physician is not actually doing any killing by prescribing medicine that will bring about the death of a patient. The patient has the conscious choice to take the medicine. It is not as if the physician directly kills the patient. Once the medicine is put in the hands of the patient, it is not guaranteed that the patient's death will occur via the medicine.
This offers a distinction between physician-assisted suicide and euthanasia. Administering a lethal injection to a patient could be considered a breach of a physician's oath to a much greater extent than prescribing deadly medication because the physician is the only one who could have brought about death in that situation. In fact, it would seem that stopping a pacemaker or discontinuing treatment at the request of a patient is more directly causing death than prescribing medicine that the patient may or may not ingest. In these instances, the physician's action directly results in patient death: The patient requests something of his doctor that will surely be deadly, and the physician applies the action to the patient.
A system of physician-assisted suicide does not take all the power away from the physician, either. Like dealing with other patient requests, those physicians who feel uncomfortable about prescribing the necessary medication are not obligated to do so. They can attempt to reason with the patient and discuss other end-of-life alternatives that the patient can consider.
In reality, having the viable option of physician-assisted suicide may lead to better patient-doctor interaction where the subject of death is concerned. A physician may not condone the request of his patient and could attempt to persuade him otherwise. In the process, the patient may become aware of previously unknown alternatives and could forsake his former suicidal wishes.
Nevertheless, patients' ability to receive medication that will end their lives should have limits as it does in the states that allow it. Laws permitting the practice need only refer to terminally ill patients who are deemed mentally competent of making their own medical decisions. The law in Washington, for instance, allows physician-assisted suicide only for those patients who have less than six months to live. This makes sense because if the rule is extended to non-terminal patients, then physicians risk going down a potentially dangerous path. If there is a possibility of a cure for a sickness or injury, then physician-assisted suicide should not be an option.
The law as it is in Washington, Oregon, Montana and Hawaii could ethically be spread to every state. Terminally ill patients would then be able to die peacefully without jeopardizing the curative nature of the medical profession. And physicians would be able to help patients who are facing death do so in a way that is in the patients' best interest.
Alex Yahanda's column appears Thursdays in The Cavalier Daily. He can be reached at a.yahanda@cavalierdaily.com.
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