Each year in the United States, nearly 50,000 people take their own lives by suicide 鈥� more than the total deaths from motor vehicle accidents, according to the federal Centers for Disease Control and Prevention. These suicides often are tragic and violent. Others, however, happen in cooperation with medical professionals and are considered by many to be a peaceful and dignified end of life.
But are these actions ethical, should their legality be challenged and are terminally ill people always able to choose their fate? A professor in USF鈥檚 (COPH) presents an argument in a comprehensive new paper, 鈥�,鈥� published in the Case Western Reserve Journal of Law-Medicine.
Dr. , interim department chair of , looks at both sides of the subject, its regulatory environment and the difference between physician-assisted suicide (PAS) and self-induced suicide.
Everybody wants compassion and dignity at the end of their life, but this is about what鈥檚 happening with some of these PAS support organizations. The significance is about relabeling something that鈥檚 otherwise a potentially serious criminal action.
Dr. Katherine Drabiak
PAS is legal in 11 states, where physicians cannot be prosecuted for prescribing medications to hasten death to adults. Although laws may differ across the country, all states require that patients requesting PAS satisfy four criteria:
- Terminal illness through a prognosis of having six months or less to live
- Competence and intact judgment
- The decision must be voluntary
- The patient must self-administer the lethal medication
Drabiak analyzed the ethical arguments behind permitting PAS and explained the harms of expanding the practice. She also addressed proposed changes in eligibility requirements for PAS:
- Permitting assistance with administration or allowing euthanasia
- Changing the requirements around patient decision-making capacity
- Eliminating the requirement for terminal illness
- Allowing PAS for mental illness
Some physicians, legal scholars and ethicists that support PAS (although not all) assert that principles of parity and fairness mean that more people should be able to access PAS. They believe that people with other types of illness, such as amyotrophic lateral sclerosis ALS, should be able to have a physician administer the lethal drug; or that people with dementia and developmental disabilities should be able to choose PAS; or it should be available to patients who experience unrelenting suffering.
PAS is illegal in Florida, on the grounds that it involves assisting a suicide by advising, encouraging, aiding or abetting a person to intentionally end their own life. But some proponents 鈭� such as Death with Dignity 鈥� are lobbying to change this. Its most recent effort was bill HB-471, also known as the Florida End-of-Life Options Act, aimed at establishing a legal framework for terminally ill patients to request medications to end their life. However, it did not pass the Health Professions and Programs subcommittee.
鈥淥ur goal is to ensure people with terminal illness can decide for themselves what a good death means in accordance with their values and beliefs, and that should include having an option for death with dignity,鈥欌�� the pro-PAS group states on its website. 鈥淲e won鈥檛 stop until that is a reality in every part of the country.鈥欌��
Proponents have garnered public support by portraying PSA as distinct from suicide, calling it a mechanism for patients with terminal illness to achieve a peaceful death, enhance autonomy and reduce suffering, Drabiak said. Some groups are changing the language to 鈥減hysician-assisted death鈥欌�� or 鈥渕edical aid in dying鈥� to deflect the reference to suicide.
One PAS support group, Compassion and Choices, has used a combination of model state legislation, crafting public messaging campaigns using sympathetic patient stories and introducing ballot initiatives across multiple states, Drabiak notes in her paper. Persistent and systematic efforts by these groups have resulted in multiple states legalizing PAS.
Physicians, policymakers and voters should not only reject these propositions, but affirm that PAS is not the solution to address patients鈥� need for comfort, security and assistance at the time when they are most in need.
Dr. Katherine Drabiak
Medicalized killing, as she calls it, relies on a contortion of ethical principles, where the optimal way to relieve suffering and promote beneficence is to assist with killing the patient, according to the paper. The American Medical Association Code of Ethics says that physicians must treat patients with care, compassion, respect and dignity. However, 鈥淧AS radically changes the purpose of the medical profession from curing, healing or supporting the patient who is dying or ill,鈥欌�� Drabiak said.
She argues that PAS is a crime because it harms the individual and society and is neither a beneficial medical treatment nor an end-of-life care option. A danger of PAS, she concludes, is it changes the attitudes of society, patients and physicians to make subtle judgments about people鈥檚 quality of life, where people start to believe that too much suffering or illness renders life no longer worth living.
What they (PAS support groups) are trying to do is lower people鈥檚 guard and soften the terms about suicide and use words such as compassion or dignity to mask what鈥檚 really happening. It demonstrates a disregard for human life and is averse to the public's health.
Dr. Katherine Drabiak
鈥淚t also induces a shift,鈥欌�� she adds, 鈥渢oward accepting that certain lives can simply and cleanly, be ended at will.鈥欌��
Drabiak has also published a number of short essays on the laws and ethics relating to PAS, appearing in and the .