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Terminally ill patients do not want to end their lives with pain and suffering. Many of these patients turn to their doctors for help in assisted suicide. Even though not all patients get this kind of help from their physicians because it is illegal, physician assisted suicide happens more than people think. According to William H.A. Carr, "Many doctors already secretly and illegally help terminally ill patients end their suffering" (73). There are many questions as to what is the definition of physician-assisted suicide. There have been many surveys and interviews taken that show how terminally ill patients, their physicians, and other people feel about physician-assisted suicides. Some people feel that physician assisted suicide is immoral, but under certain circumstances, it can be both morally and ethically acceptable. Individuals also have a constitutionally protected right to make decisions regarding their lives, including the choice to end their lives. Many believe that if physician assisted suicide was legalized the doctors would abuse the practice, but it could be regulated to prohibit any abuse. There are also many psychiatric and psychosocial perspectives that contribute to the interest of physician-assisted suicide. Although there are many concerns, physician-assisted suicide should be legalized to help terminally ill patients die with dignity.

The number of physician-assisted suicides has been increasing. Richard Ferri, Richard Witt, and Victoria Sharp surveyed 228 physicians, with only 137 responding and 118 in clinical practice. Fifty three percent of the 118 respondents reported they had assisted in a patient's death at least once. With the growing number of HIV patients, some physicians are helping in some of the suicides of these patients. Ferri, Witt, and Sharp found that, "In the multivariate analysis, four factors were positively associated with a physician's likelihood of assisting in a patient's suicide: a higher intention - to - assist score; a higher number of AIDS patients who had died; a higher number if indirect requests for assistance; and the physician's stated sexual orientation as gay, lesbian, or bisexual." In San Francisco more than 50 % of physicians who have cared for patients with AIDS have helped at least one commit suicide.

Doctors William Breitbart and Barry Rosenfeld define physician assisted suicide as involving a physician providing medications or advice to enable to patient to end his or her own life. Some ask what is the difference in withholding life support from a dying patient and a suffering patient who is not on life support wanting to end his life? Ronald Dworkin quotes Leon R. Kass, a physician and professor of medicine and bioethics at the University of Chicago, by stating, "When a doctor withholds or removes life support the patient's death results from his or her fatal illness, but when a doctor prescribes a lethal dose of medication to a patient, he contends, the doctor's actions rather than the result of terminal illness are the cause of the patients death" (55). Many people do not see a difference and believe that physician assisted suicides should be legal. The patient is going to die either way, so why not help them die with dignity?

Most terminally ill patients are in pain and become dependent on other people to do things for them. They feel as if they are a bother to their friends and families. The thought of not being able to do everyday things for themselves becomes very frustrating. Haleh V. Samiei, Don Colburn, and Gregory Matt from the Washington Post interviewed 70 terminally ill cancer patients. They found that " among those patients, whose median survival after the interview was 44.5 days, 73 percent supported the idea of legalizing such practices [physician assisted suicide]." The main reason for those who agree physician-assisted suicide should be the choice of the patient is because of the intolerable pain (Samiei, Colburn, Matt). The few that are against physician assisted suicide had moral and religious issues that kept them from agreeing with the idea.

Physicians often see their patients suffering from fatal illnesses. When they are asked by the patient to assist them is suicide, the physician has an important decision to make that can affect the rest of his career. Oregon is the only state that allows assisted suicides. Clinican Review surveyed over 1,900 physicians from a wide range of practices. They reported, "Of all respondents, 18.3% reported that they had been asked to assist in a patient's suicide, and 11.1% had received requests specifically for lethal injection. Sixteen percent of the physicians who were asked to hasten death by these means agreed to do so" ("Who"). Most physicians who complied with the requests of assisted suicide by lethal injection had it administered by someone else ("Who").

No one likes to see a friend or family member suffering. Many of them want to end the pain and suffering of a loved one. Sometimes it is the family members or the spouses that turn to the physician for help. Time took a poll on people's opinions about death. One of the questions asked was, ("Death") "Do you think doctors if they choose - should be able to prescribe fatal doses of drugs to patients who are dying and in great pain?" Over half (51%) of the people who answered the poll believe that doctors should be able to prescribe lethal doses of drugs to patients if that's what the patient and doctor want to do ("Death"). The patient is the one making the decision, not the doctor. The doctor is merely doing as the patient wishes.

Some believe that killing patients or helping them commit suicide is always morally wrong. However, withholding or withdrawing treatment from terminally ill patients and allowing them to die is morally right. It is the doctor's duty to relieve a patient's pain and suffering, in some cases death being the only relief. Physicians face a moral dilemma when it comes to choosing between preserving life and the equally important responsibility to ease suffering. David A. Bennahum, a professor of medicine and family at the Center for Ethics, Law and Humanities at the University of New Mexico in Albuquerque, states, " I know that being alive is not the same as having a life. We need a philosophy and an ethic that allows each of us to die with dignity" (25). It would be morally wrong for a doctor to kill a patient without the patient's consent. It would not be morally wrong for a doctor to aid a terminally ill patient in committing suicide because it would be the patient's decision.

Stephen R. Permut says that the six interests of the states are, " preserving life, preventing suicide; avoiding undue involvement and influence of the third parties; protecting families and loved ones; protecting the integrity of the medical profession; and avoiding the adverse consequences of a statute being found unconstitutional." However, proponents of physician assisted suicide say the right to privacy established in Supreme Court decisions regarding abortion and medical treatment extends to the right to die. Jeffery Rosen, a legal affairs editor of New Republic argues that, "the legalization of abortion was based on a woman's right to privacy in decisions about death and dignity" (64). Federal District Court Judge Barbara Rothstein stated that as long as they were competent, terminally ill patients have the right to get help from a doctor to commit suicide (qtd. in Rosen 57). She believes that terminally ill patients thinking about assisted suicide are protected by the 14th Amendment. William Bartholome believes that the laws against assisted suicide are not clear enough to know they were intended to apply to the actions of licensed physicians.

Many believe there are different ways to alleviate pain and suffering and that legalization of physician assisted suicide would create an unethical and dangerous society. This is believed because it would not be limited to those that are competent, meaning that those that are incompetent would be making decisions to end their lives.

David Orentlicher, former director of the American Medical Association's Division of Medical Ethics believes that, "states could require thorough and systematic evaluations by psychiatric specialists of each patient requesting aid in dying to determine if their decisions to die was freely chosen and rational" (81). If legalized, physician assisted suicide would have to be regulated to prevent any kind of abuse, even though Herbert Hendin and Gerald Klerman believe it would be licensing the right to abuse and exploit the fears of the ill and depressed (123). Society should allow safeguards instead of prohibition to be able to help the terminally ill. Laws should allow doctors to assist in the suicide only if the patient is terminally ill, which would also help prevent the abuse of the practice (Orentlicher 81).

Breitbart and Rosenfeld believe that, "The desire for death, the consideration of suicide, the interest in physician assisted suicide, and the relationship of these issues to depression and other psychosocial issues appear to be of paramount importance." In addition to pain and physical control, attending to depression is very important for reducing distress of patients wanting to commit suicide. Depression mostly comes from pain, increased disability, and fears of becoming a burden to their friends and family. To avoid depression and suffering, Breitbart and Rosenfeld believe that pain medications should be used to help the patient live their life the best they can before they are ready for the doctor to assist in their suicide. However, Carr believes that "To think that all patients can be helped with more pain relieving medication and treatment for depression is naïve" (76).

Physician assisted suicide should be up to the patient and the doctor; however, according to Doctor Timothy E. Quill, "Suffering can be lessened to some extent, but in no way eliminated or made benign, by the careful intervention of a competent, caring physician" (115). Patients are people suffering and in excruciating pain, and should have the right to decide how they wish to handle their suffering. They should be able to decide whether life is still worth living or not. Physician assisted suicide is a crime, even though the patient wants to die (Carr 74). The interviews and surveys show that most terminal patients, many doctors and people feel that physician assisted suicides should be legal. The existing laws against physician-assisted suicide do not save lives, but cruelly prolong deaths. They keep terminally ill patients in physical and emotional pain. Everyone wants to be remembered for all the good deeds they have accomplished in life, not for how they suffered before they died. Physician assisted suicide should be legalized so these terminally ill patients can die with dignity.









			Sonia Cano Rhetoric November 17, 2000 Physician Assisted Suicide Should Be Legalized to Help Terminally Ill Patients Die With Dignity Terminally ill patients do not want to end their lives with pain and suffering. Many of these patients turn to their doctors for help in assisted suicide. Even though not all patients get this kind of help from their physicians because it is illegal, physician assisted suicide happens more than people think. According to William H.A. Carr, "Many doctors already secretly and illegally help terminally ill patients end their suffering" (73). There are many questions as to what is the definition of physician-assisted suicide. There have been many surveys and interviews taken that show how terminally ill patients, their physicians, and other people feel about physician-assisted suicides. Some people feel that physician assisted suicide is immoral, but under certain circumstances, it can be both morally and ethically acceptable. Individuals also have a constitutionally protected right to make decisions regarding their lives, including the choice to end their lives. Many believe that if physician assisted suicide was legalized the doctors would abuse the practice, but it could be regulated to prohibit any abuse. There are also many psychiatric and psychosocial perspectives that contribute to the interest of physician-assisted suicide. Although there are many concerns, physician-assisted suicide should be legalized to help terminally ill patients die with dignity. The number of physician-assisted suicides has been increasing. Richard Ferri, Richard Witt, and Victoria Sharp surveyed 228 physicians, with only 137 responding and 118 in clinical practice. Fifty three percent of the 118 respondents reported they had assisted in a patient's death at least once. With the growing number of HIV patients, some physicians are helping in some of the suicides of these patients. Ferri, Witt, and Sharp found that, "In the multivariate analysis, four factors were positively associated with a physician's likelihood of assisting in a patient's suicide: a higher intention - to - assist score; a higher number of AIDS patients who had died; a higher number if indirect requests for assistance; and the physician's stated sexual orientation as gay, lesbian, or bisexual." In San Francisco more than 50 % of physicians who have cared for patients with AIDS have helped at least one commit suicide. Doctors William Breitbart and Barry Rosenfeld define physician assisted suicide as involving a physician providing medications or advice to enable to patient to end his or her own life. Some ask what is the difference in withholding life support from a dying patient and a suffering patient who is not on life support wanting to end his life? Ronald Dworkin quotes Leon R. Kass, a physician and professor of medicine and bioethics at the University of Chicago, by stating, "When a doctor withholds or removes life support the patient's death results from his or her fatal illness, but when a doctor prescribes a lethal dose of medication to a patient, he contends, the doctor's actions rather than the result of terminal illness are the cause of the patients death" (55). Many people do not see a difference and believe that physician assisted suicides should be legal. The patient is going to die either way, so why not help them die with dignity? Most terminally ill patients are in pain and become dependent on other people to do things for them. They feel as if they are a bother to their friends and families. The thought of not being able to do everyday things for themselves becomes very frustrating. Haleh V. Samiei, Don Colburn, and Gregory Matt from the Washington Post interviewed 70 terminally ill cancer patients. They found that " among those patients, whose median survival after the interview was 44.5 days, 73 percent supported the idea of legalizing such practices [physician assisted suicide]." The main reason for those who agree physician-assisted suicide should be the choice of the patient is because of the intolerable pain (Samiei, Colburn, Matt). The few that are against physician assisted suicide had moral and religious issues that kept them from agreeing with the idea. Physicians often see their patients suffering from fatal illnesses. When they are asked by the patient to assist them is suicide, the physician has an important decision to make that can affect the rest of his career. Oregon is the only state that allows assisted suicides. Clinican Review surveyed over 1,900 physicians from a wide range of practices. They reported, "Of all respondents, 18.3% reported that they had been asked to assist in a patient's suicide, and 11.1% had received requests specifically for lethal injection. Sixteen percent of the physicians who were asked to hasten death by these means agreed to do so" ("Who"). Most physicians who complied with the requests of assisted suicide by lethal injection had it administered by someone else ("Who"). No one likes to see a friend or family member suffering. Many of them want to end the pain and suffering of a loved one. Sometimes it is the family members or the spouses that turn to the physician for help. Time took a poll on people's opinions about death. One of the questions asked was, ("Death") "Do you think doctors if they choose - should be able to prescribe fatal doses of drugs to patients who are dying and in great pain?" Over half (51%) of the people who answered the poll believe that doctors should be able to prescribe lethal doses of drugs to patients if that's what the patient and doctor want to do ("Death"). The patient is the one making the decision, not the doctor. The doctor is merely doing as the patient wishes. Some believe that killing patients or helping them commit suicide is always morally wrong. However, withholding or withdrawing treatment from terminally ill patients and allowing them to die is morally right. It is the doctor's duty to relieve a patient's pain and suffering, in some cases death being the only relief. Physicians face a moral dilemma when it comes to choosing between preserving life and the equally important responsibility to ease suffering. David A. Bennahum, a professor of medicine and family at the Center for Ethics, Law and Humanities at the University of New Mexico in Albuquerque, states, " I know that being alive is not the same as having a life. We need a philosophy and an ethic that allows each of us to die with dignity" (25). It would be morally wrong for a doctor to kill a patient without the patient's consent. It would not be morally wrong for a doctor to aid a terminally ill patient in committing suicide because it would be the patient's decision. Stephen R. Permut says that the six interests of the states are, " preserving life, preventing suicide; avoiding undue involvement and influence of the third parties; protecting families and loved ones; protecting the integrity of the medical profession; and avoiding the adverse consequences of a statute being found unconstitutional." However, proponents of physician assisted suicide say the right to privacy established in Supreme Court decisions regarding abortion and medical treatment extends to the right to die. Jeffery Rosen, a legal affairs editor of New Republic argues that, "the legalization of abortion was based on a woman's right to privacy in decisions about death and dignity" (64). Federal District Court Judge Barbara Rothstein stated that as long as they were competent, terminally ill patients have the right to get help from a doctor to commit suicide (qtd. in Rosen 57). She believes that terminally ill patients thinking about assisted suicide are protected by the 14th Amendment. William Bartholome believes that the laws against assisted suicide are not clear enough to know they were intended to apply to the actions of licensed physicians. Many believe there are different ways to alleviate pain and suffering and that legalization of physician assisted suicide would create an unethical and dangerous society. This is believed because it would not be limited to those that are competent, meaning that those that are incompetent would be making decisions to end their lives. David Orentlicher, former director of the American Medical Association's Division of Medical Ethics believes that, "states could require thorough and systematic evaluations by psychiatric specialists of each patient requesting aid in dying to determine if their decisions to die was freely chosen and rational" (81). If legalized, physician assisted suicide would have to be regulated to prevent any kind of abuse, even though Herbert Hendin and Gerald Klerman believe it would be licensing the right to abuse and exploit the fears of the ill and depressed (123). Society should allow safeguards instead of prohibition to be able to help the terminally ill. Laws should allow doctors to assist in the suicide only if the patient is terminally ill, which would also help prevent the abuse of the practice (Orentlicher 81). Breitbart and Rosenfeld believe that, "The desire for death, the consideration of suicide, the interest in physician assisted suicide, and the relationship of these issues to depression and other psychosocial issues appear to be of paramount importance." In addition to pain and physical control, attending to depression is very important for reducing distress of patients wanting to commit suicide. Depression mostly comes from pain, increased disability, and fears of becoming a burden to their friends and family. To avoid depression and suffering, Breitbart and Rosenfeld believe that pain medications should be used to help the patient live their life the best they can before they are ready for the doctor to assist in their suicide. However, Carr believes that "To think that all patients can be helped with more pain relieving medication and treatment for depression is naïve" (76). Physician assisted suicide should be up to the patient and the doctor; however, according to Doctor Timothy E. Quill, "Suffering can be lessened to some extent, but in no way eliminated or made benign, by the careful intervention of a competent, caring physician" (115). Patients are people suffering and in excruciating pain, and should have the right to decide how they wish to handle their suffering. They should be able to decide whether life is still worth living or not. Physician assisted suicide is a crime, even though the patient wants to die (Carr 74). The interviews and surveys show that most terminal patients, many doctors and people feel that physician assisted suicides should be legal. The existing laws against physician-assisted suicide do not save lives, but cruelly prolong deaths. They keep terminally ill patients in physical and emotional pain. Everyone wants to be remembered for all the good deeds they have accomplished in life, not for how they suffered before they died. Physician assisted suicide should be legalized so these terminally ill patients can die with dignity. Sources Cited Bartholome, William G. "Physician Assisted Suicide, Hospice, and Rituals of Withdrawal." Journal of Law, Medicine & Ethics 24 (1996): 233-36. 28 Oct. 2000 <http://www.aslme.org/prb_jlme/24.3a.html>. Bennahum, David A. "Physician Assisted Suicide Is a Moral Dilemma." Physician-Assisted Suicide. Ed. Bruno Leone. San Diego: Greenhaven, 1998. 22-25. Breitbart, William, and Barry D. Rosenfeld. "Physician Assisted Suicide: The Influence of Psychosocial Issues." JMCC 6 (1999): 146-161. 28 Oct. 2000 <http://www.medscape.com/Moffit/CancerControl/1999v06.n02/cc0602.03.brei/ cc0602.03brei-01.html>. Carr, William H.A. "Physician Assisted Death Should Be Legalized." Death and Dying: Opposing Viewpoints. Ed. Bruno Leone. San Diego: Greenhaven, 1998. 73-79. "Death and Dying Poll." Time 7 Sept. 2000: 4 Oct. 2000 <http://www.time.com/time/daily/special/poll/dpoll.html>. Dworkin, Ronald. "The Constitution Protects the Right to Die." Death and Dying: Opposing Viewpoints. Ed. Bruno Leone. San Diego: Greenhaven, 1998. 55-63. Ferri, Richard, Richard Witt, and Victoria Sharp. "Physician Assisted Suicide Increases." Clinican Review 7 (1997): 140 41. 28 Oct. 2000 <http://services.medscape.com/CPG/ClinReviews/1997/v07.n04/c0704.AIDS/ c0704.al.html>. Hendin, Herbert, and Gerald Klerman. "The Dangers of Legalizing Physician Assisted Suicide." Doctor Assisted Suicide and the Euthanasia Movement. Ed. Gary E. McCuen. Hudson, Wisconsin: Gary E. Mc Cuen Publications, Inc., 1994. 117-123. Orentlicher, David. "Legal Safeguards Can Prevent Physician Assisted Suicide From Harming Society." Physician Assisted Suicide. Ed. Bruno Leone. San Diego: Greenhaven, 1998. 81-83. Permut, Stephen R. "Physician Assisted Suicide: Legal Considerations." Hospital Medicine. 34 (1998): 45-55. 28 Oct. 2000 <http://www.medsccape.com/quadrant/HospitalMedicine/1998/v34.n04/ hm3404.03.perm.html>. Quill, Timothy E. "Assisted Suicide Means Death with Dignity." Doctor Assisted Suicide and the Euthanasia Movement. Ed. Gary E. McCuen. Hudson. Wisconsin: Gary E. McCuen Publications, Inc., 1994. 110-116. Rosen, Jeffery. "The Constitution Does Not Protect the Right to Die." Death and Dying: Opposing Viewpoints. Ed. Bruno Leone. San Diego: Greenhaven, 1998. 64-72. Samiei, Haleh V., Don Colburn, and Gregory Matt. "Alternative Therapy." Washington Post 26 Sept. 2000. 4 Oct. 2000 <http://www.washingtonpost.com/wp-dyn/articles/ A17310-2000Sep26.html>. "Who Is Assisting in Assisted Suicide?" Clinican Review 8 (1998). 28 Oct. 2000 <http://pharmacotherapy.medscape.com/CPG/ClinReviews/1998/v08.n07/ c0807.lit/c0807.lit.html>.