Assisted Suicide

Assisted suicide refers to a practice in which a physician, upon the patient's request, provides a competent, terminally ill patient with a prescription for a lethal dose of medication that the patient intends to use to end his or her own life.

Such practice is most commonly referred to as physician-assisted suicide. Those who oppose using this term because of the stigma around suicide feel that it might be better to call such practice die with dignity, patient-directed dying, or physician aid-in-dying. It is important to differentiate this practice from euthanasia, which is an illegal termination of life by another.

The use of this practice is debatable and controversial at best. There are many ethical issues involving the voluntary termination of life. Supporters of assisted suicide claim that a person has a right to die and that society has an obligation to relieve the suffering of its members and respect their desire to die with dignity. Those who oppose assisted suicide argue that society actually has a moral duty to protect and preserve life and that to allow people to assist others in dying violates that very fundamental duty.

Both sides of the debate have solid arguments. Those making the case against assisted suicide urge us to preserve life, and those making the case for assisted suicide appeal to our compassion to support an individual choice, respect rights, and minimize suffering.

Competency is a very important prerequisite for assisted suicide; this is why when mental illness impairs insight and clouds judgment, intervention to stop a suicide is ethically warranted. Most physicians treat suicidal clients as though their decision-making capacity is compromised or lacking.

Those in favor of assisted suicide argue that this practice respects the principles of autonomy and justice and treats suffering with compassion. Those against assisted suicide argue about the sanctity of life and the principle of do no harm.

Physician-assisted dying has been legal in the state of Oregon since 1996 and in the state of Washington since 2009. In both states, the Death with Dignity Act has strict patient eligibility criteria, limiting access to competent, legal residents of the state, over the age of 18, with a terminal illness (defined as an estimated life expectancy of 6 months or less) that is confirmed by two independent physicians. In addition, the patient must be able to self-administer the medications. Providers may choose to decline to prescribe medication under the act.

Palliative care physicians recommend the following process for evaluating and responding to requests of physician-assisted dying:

• Wait to directly respond to the request until you have explored the reasons for the request.
• Discuss various ways of addressing the patient's pain, suffering, hopes, and fears. If time permits, tell the patient that you would like to talk more about this at a subsequent appointment.
• Evaluate for depression or other psychiatric conditions and treat appropriately.
• Assess the patient's decision-making competence.
• Engage in discussion surrounding the patient's diagnosis, prognosis, and goals for care.
• Evaluate patient's physical, mental, social, and spiritual suffering. Be sure to take into account the patient's support system as well as personal and professional pressures and stressors.
• Discuss all alternative options like palliative care and hospice.
• Consult with professional colleagues regarding the patient's situation. Where appropriate, ask for help from a palliative care specialist to ensure that all options have indeed been explored.
• Help the patient complete advance directives, do not resuscitate (DNR) orders and physicians' orders for life-sustaining treatment (POLST) forms as appropriate, and ensure that preferences are followed.

If the patient continues to request to die, and the physician agreed to participate in the practice, the physician has the following

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