Assisted Suicide

The 20th century, with its rapid progress in medical science, has fundamentally changed the nature of the dying process in much of the Western world. Modern advances in medicine and lifesustaining technology have resulted in a dramatic increase in life expectancy and quality of life. However, these changes have also given rise to the concern that the dying process may be unnecessarily lengthened, leading to prolonged suffering and loss of dignity for many terminally ill individuals. This concern has increased public interest in the legalization of a range of end-of-life practices, including assisted suicide.

Terminology

Assisted suicide is defined as a situation in which a person with an incurable, terminal illness requests the help of others in ending his or her life. The person providing assistance typically supplies the terminally ill patient with the means or information necessary to bring about death. When such assistance is provided by a physician, the practice is referred to as physician-assisted suicide (PAS). Assisted suicide and PAS are often confused with another end-of-life practice, euthanasia. Specifically, euthanasia refers to the act of taking another person's life with the aim of alleviating suffering. Assisted suicide and euthanasia are distinctly different practices, because PAS allows patients to be the active agents in controlling the circumstances of their death, whereas in euthanasia, the person who performs the actions leading to death is someone other than the patient. Another practical distinction is that PAS usually involves a physician's prescription of a lethal dose of medication, whereas euthanasia often involves the administration of a lethal injection.

Arguments about Assisted Suicide

The distinction between assisted suicide and euthanasia is significant, given the heated nature of the debate surrounding legalization of assisted suicide. A number of arguments have been voiced in the public discussion surrounding this issue. Proponents of legalization argue that individuals have a fundamental right to personal autonomy and that assisted suicide allows terminally ill patients to maintain dignity and control at the end of life. It is further suggested that PAS can address terminally ill patients' concerns with maintaining autonomy and quality of life, whereas pain control interventions and palliative care may be ineffective in resolving these concerns. In addition, proponents argue that assisted suicide already exists as a hidden practice, so legalization can ensure that appropriate monitoring and safeguards are enforced. Finally, PAS advocates suggest that practices that relieve suffering and respect patients' autonomy are consistent with the physician's role and conform to current ethical and medical principles.

Opponents of legalization, on the other hand, often cite the sanctity of human life and the moral unacceptability of suicide as arguments against assisted suicide. Providing assistance in a patient's suicide is explicitly prohibited by the Hippocratic oath, and some view PAS as inconsistent with the physician's obligation to preserve life. Apart from such moral and ethical objections, opponents often argue that adequate palliative care and pain management can eliminate patients' need to resort to assisted suicide. They also voice a concern that the legalization of PAS may stifle progress in the hospice movement and thwart current developments in end-of-life care. Some fear that the legalization of PAS may put pressure on patients to choose assisted suicide in order to avoid becoming a burden to family and caregivers. Finally, opponents point to the danger of a slippery slope—the concern that, over time, PAS may be applied to those who are not terminally ill, as well as those who are physically disabled or have a mental illness.

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