Physician-Assisted Death Does Not Undermine Human Morality

This past semester I spent much of my time researching physician-assisted death and the ethicality behind it. I created two products from my research: the classic research paper and a persuasive, rhetorical speech. My last assignment for my class was to find a way to share my speech-- to get a larger audience to read my writing. Since my speech is based off of my research paper, I feel that I cannot share one without also sharing the other. So I've decided to publish both my paper and my speech. Please note that there is a list of sources at the end of the article with plenty of links to papers, studies, and other articles filled with great information for further exploration of this topic.

Physician-Assisted Death Is An Acceptable Option: The Speech

When you think about death, what do you envision? If it's not the ominous drone of medical machinery, the sterile smell of a doctor’s office, a terminal diagnosis, or an overpriced prescription, then you're thinking about death incorrectly. Modern death is characterized by debilitating, chronic conditions such as heart disease, diabetes, and cancer-- all of which are illnesses that lurk in the shadows, waiting to prey upon their next victim. Even though new studies from Stanford, the National Institute of Health, and other scientific leaders have shown that 90% of Americans now die from incurable, terminal diseases, modern medicine often fails to provide proper comfort at the end of life. For years, many terminal patients have been throwing out the idea of hospice care and painful procedures in favor of physician assisted death, which is an end of life option that allows those with less than six months to live to self administer a painless, lethal dose of medication. We must respect and accept physician assisted death as a valid option for the terminally ill as it embodies qualities that are central to the foundation of our human morality such as peace, dignity, and compassion.

Terminal death is like a relentless tide. Each new physical symptom, painful procedure, emotional battle is a wave that envelops unsuspecting patients and drags them further into the depths of their suffering. The fact that the human body shutdown process is a two sided coin that causes both emotional and physical turmoil makes this month long progression brutal. Patients are expected to happily through the rest of their days with the knowledge that they will experience the excruciating pain that accompanies organ failure along with digestive issues, extreme exhaustion, weight loss, poor circulation, and hallucinations. Furthermore, imagine having the knowledge that your days are numbered. Imagine waking up only to realize that you were one day closer to a life characterized by immobilizing pain, perpetual anxiety, and complete loss of self, independence, and dignity. Physician assisted death grants the gift of ultimate peace. Additionally, it gives these people--who have lost so much, whose lives have been dictated by doctors and their disease--a choice. A recent survey conducted by the Yale Department of Biology and Medicine revealed that 90.6% of Oregonians undergoing the death with dignity process were concerned about losing their autonomy. In 2017, Don Monroe, a resident of Arizona, found himself in a similar situation after being diagnosed with a rare form of terminal throat cancer. His condition landed him in the intensive care unit where he was intubated without anesthesia due to being underweight. Don Monroe made the only choice he had when he shot himself less than twenty-four hours after his discharge. Physician assisted death places the most important medical decision back into the hands of terminal patients; it provides people with a compassionate choice, a kind opportunity, and a peaceful option. It allows those who are suffering to die on their terms.

As the population ages, terminal illnesses will only become more commonplace in our society. You will know someone who is diagnosed with cancer or heart disease, or you might be given a terminal sentence yourself. We must remember and respect that terminal death doesn't have to mean white hospice wings, noisy ventilators, and bottles of pills. Better ways of dying exist--we just have to open our minds to them. For those looking for an option that embodies our widely accepted human morals of compassion, kindness, and dignity, physician assisted death is the answer.

Physician-Assisted Death Does Not Undermine Human Morality: The Research

“If we ask for a dignified death it is because we are tired of all the illnesses that overcome us,” explains Victor Escobar. A few weeks ago, Escobar became the first person to end his life using Colombia’s new assisted death law despite being a devout Catholic in a country where 70% of the population follows this belief system that opposes suicide (Beltrán). In 2008, Escobar suffered two strokes and had since been diagnosed with a litany of other debilitating conditions. After living for over a decade in excruciating pain that even morphine failed to subside, Escobar opted to petition the courts to allow his physician to assist him in dying (Suárez). As the population ages and medical technology advances, cases like Escobar’s have become more common. Despite the concern that physician-assisted death contradicts human morality, countries such as the Netherlands, Belgium, and Luxembourg, and even several states, have protected this end-of-life option for years (Emanuel). Further exploration into the topic of physician-assisted death reveals that the idea is based upon traditional, widely-accepted morals such as compassion, acceptance, and the pursuit of peace. Allowing people to make end-of-life choices including physician-assisted death does not undermine our generally accepted view of human morality.

Physician-assisted death is a procedure that allows terminally ill patients to legally end their lives with the assistance and supervision of a medical professional (Dugdale). Often incorrectly referred to as physician-assisted suicide, this form of death differs from traditional suicide in the sense that these patients are not depressed, but are simply waiting for their terminal conditions to catch up with them (Goy). The movement began in the United States in 1975, when Derek Humphry helped his wife with terminal breast cancer end her life. After her death, he formed the Hemlock Society, America's first major right-to-die organization. Humphry and the group focused on advocating for assisted death laws and helping terminal patients achieve peaceful deaths. Attention surrounding the assisted death movement skyrocketed in 1990 when Dr. Jack Kevorkian invented a machine that allowed people to inject themselves with lethal doses of prescription medication in the back of his van. In the span of eight years, an estimated 130 people suffering from terminal conditions ended their lives in Dr. Kevorkian’s presence. Dr. Kevorkian explained that he believed physicians had several responsibilities and “those responsibilities include assisting patients with death” (Childress). In 1994, Oregon became the first state to approve an assisted death bill, known as the Oregon Death with Dignity Act. Since this historic piece of legislation was ratified, nine other states and territories have passed similar laws allowing physician-assisted death (States with Legal).

Further expansion of the movement has been met with varied reactions. In 2018, a poll conducted by Gallup revealed that 54% of survey respondents from the United States believed physician-assisted death was morally acceptable (Brenan). The main concern cited by the remaining 46% was that the legalization of physician-assisted death would cause a slippery slope effect that would increase suicides among those suffering from non-terminal chronic conditions and lead to the eventual legalization of non consensual euthanasia. In 2004, an extremist group known as Final Exit arose, claiming to be another right-to-die organization. However, Final Exit’s three thousand plus members believed that everyone, regardless of physical or mental health status, should have the right to kill themselves legally. True right-to-die organizations distanced themselves from Final Exit, and in 2009, four of the groups’ leaders were arrested and charged in court for illegally assisting hundreds of people in dying and running a “suicide ring” (Childress). While it has been seen that the right-to-die movement provides an outlet for groups with nefarious purposes to spread their ideas, the strict criteria listed in death with dignity legislation makes it difficult to act outside of the laws’ boundaries without legal repercussions. With the exception of the state of Montana, which allows physician-assisted death only through court rulings, all current legislation regarding the right-to-die movement is fairly uniform (States with Legal). All individuals must be at least eighteen years of age, have less than six months to live, reside in the state whose law they plan to use, make two formal oral requests to their physician to receive the lethal medication, sign a written request in the presence of two witnesses, undergo a psychological evaluation for mental competency, sit through a fifteen day waiting period, and only then can they receive the prescription which they then must administer themselves. In addition to this, all of these steps must be documented in the state database (Chapter 70.245 RCW). With all of these regulations and roadblocks in place, it is highly unlikely that a slippery slope effect would be successful. Since physician-assisted death creates a conflict of interest for doctors who are most concerned about saving lives, acquiring a true understanding of how this end-of-life option morally fits into our society requires a look at the complex role of medicine.

While modern medicine has benefited human society, its techniques often prolong death and suffering. In the past several decades alone, new medical innovations including ventilators, chemotherapy, cardiopulmonary resuscitation, and the creation of the intensive care unit have added years to the average American’s life expectancy (Gordon). But at what cost? At the beginning of the 20th century, most people died as a result of accidents or sudden illnesses such as influenza. A study conducted in 1994 revealed the top two leading causes of death in America to be heart disease resulting in 25.7% of deaths and cancer-causing 20%. Chronic conditions such as these are the direct cause of over 90% of Americans’ deaths (Death and Dying). According to the Center for Disease Control and Prevention, six out of ten adults suffer from a chronic disease that reduces their overall quality of life (About Chronic Diseases). This coupled with the fact that over one-third of the American population is over fifty years old means that death intervening technology has only become more commonplace in our society (Rogers). However, doctors’ and scientists’ current hyperfocus on death prevention is at odds with medicine’s traditional purpose to mitigate patients’ suffering and provide them with comfort. This is a larger issue when applied to patients who are terminally ill. Are intrusive medical procedures and painful resuscitation attempts the best option for someone with mere days to live? In 2012, Corinne Johns-Treat, a faithful Christian, was diagnosed with stage three lung cancer. That year she had a portion of her lung removed and underwent several rounds of chemotherapy. In March of 2015, Johns-Treat discovered her cancer had spread to her neck, chest, and brain. After a second failed surgery to remove the tumors in her brain, she was given only several months to live. With all other medical options exhausted, Johns-Treat began to research physician-assisted death. Though she lived in California, where physician-assisted death was legal, she was criticized for even considering that route by others in her faith community. They believed the process to be suicide and against the will of God, but Johns-Treat saw this a different way. “When science can’t offer life-sustaining treatments anymore, then the role of medicine should be to relieve suffering,” explained Johns-Treat who was still facing excruciating headaches and undergoing chemotherapy at the time. She added that though she hadn't definitively decided on the procedure, she felt that it was in line with her morals and that God was showing compassion by presenting physician-assisted death as an option (Johns-Treat). This desire to achieve peace after a long medical journey is a common motivation for many considering physician-assisted death.

Physician-assisted death allows patients to avoid the inevitable emotional and physical pain surrounding their deaths. For terminally ill patients, death is an excruciating experience due to the human body’s shutdown process. This process, which can begin as soon as months before a person’s ultimate death, is gradual. In the first stages, one experiences decreased circulation, poor brain function, and extreme exhaustion. This progresses to include weight loss, digestive issues, hallucinations, and difficulty breathing that lasts until one’s heart eventually stops (The Physical Process). At this point, death is often a welcome visitor, its arrival signaling that the sufferer can finally lose consciousness and slip into a permanent, painless peace. The knowledge that they are to endure agony as their organs shut down in the months leading up to their final moments is one of the top reasons terminal patients ultimately choose physician-assisted death. One study by the American Medical Association reveals that the majority of their fifty-six survey goers who were on the list for physician-assisted death placed “concerns about future pain” at the highest level possible (Goy). Aside from experiencing physical pain, patients must additionally face the emotional turmoil of knowing that their days are numbered and that they will be forced to live out the rest of their time feeling unlike themselves. The same American Medical Association study also asked questions regarding emotional motives and saw patients list reasons such as “loss of mental clarity”, “poor quality of life”, “inability to care for oneself”, and “loss of dignity” as significant (Goy). All patients surveyed resided in Oregon, a “death with dignity state”, so they were able to go through with their intended procedures. Those suffering from terminal illnesses in other states still experience these same concerns, and many also look for ways to avoid the inevitable pain. Dr. James L. Werth, a psychologist involved in conducting the study, explains: “Many more people with serious illness end their lives through some other negotiated means, such as ceasing medications, withholding food or drink, refusing life-­sustaining treatment or signing ‘do not resuscitate’ orders (Weir).” The fact remains that those who are set on escaping their pain will find ways to do so, even if those ways are less humane. Don Monroe, a resident of Arizona, began experiencing pain radiating from his ear to his jaw along with difficulty swallowing in 2017. After two years of suffering from these pains, Monroe was diagnosed with a form of throat cancer. By this time, his condition had progressed to the point where he could no longer eat, speak, or hear and he was admitted to the intensive care unit due to extreme weakness. Because he was underweight, he could not be fully sedated as he was intubated and given a feeding tube. His wife, Robin Toole, described her husband as being in constant fear and pain. When Monroe was released from the hospital twenty-four hours later, he chose to take his life with a gun rather than suffer a single second longer. Toole explained that her husband didn't believe anyone should suffer and that he would have chosen physician-assisted death over traditional suicide had it been an option (Toole). While physician-assisted death allows people to gain freedom from pain peacefully and humanely, the desire to have the ability to make decisions regarding one’s own death is another gift this option grants to the dying.

Physician-assisted death allows patients to have control over their deaths, which is a leading concern of those interested in this option. The American Medical Association study results also revealed that the desire to have “control of the circumstances of death” was the highest ranked reason (Goy). A separate survey conducted by the Yale Department of Biology and Medicine showed that 90.6% of Oregonians undergoing the death with dignity process were concerned about losing their autonomy. The survey report written by a panel of doctors explains that the reason for this is simple: “Patients accustomed to making their own healthcare decisions throughout life should also be permitted to control the circumstances of their deaths ” (Dugdale). If people go their entire lives having control over their bodies and the ability to make their own medical decisions, what disqualifies someone from making the final, most important one? This desire to have control over the circumstances of death was a leading motivation for Brittney Maynard. Best known for her involvement in several states’ eventual legalization of physician-assisted death, Maynard was diagnosed with terminal brain cancer at the age of twenty-nine. Upon her diagnosis, Maynard lived in California, which did not allow for physician-assisted death at the time. When she was given six months to live and started experiencing seizures, Maynard and her husband made the decision to move to Oregon so that she could use the state’s Death with Dignity Act. She had planned to spend a few weeks traveling with her family, but had to cut that time short as her debilitating headaches, strokes, and seizures made it difficult for her to continue. She decided to undergo the procedure while she was still coherent enough to make the decision. “I am choosing to go in a way that is less suffering and less pain,” Maynard explained. She additionally stated the importance of having the ability to choose a peaceful death, explaining how it brought both her and her family comfort. “The thought that I can spare myself the physical and emotional pain of that, as well as my family, is a huge relief (Death With Dignity).” Allowing patients to have the choice to control their deaths provides a significant amount of peace.

Physician-assisted death falls within the guidelines of human morality as it provides compassion, acceptance, and peace to the dying. Death is the ultimate human experience, and being able to have control in death is just as crucial to that experience as having control in our lives. In his last few days, Victor Escobar explained that he looked forward to the tranquility of his death and saw his end as the beginning of something else. “It is the door so that a patient like me, with degenerative diseases, has the opportunity for a dignified death (Suárez).” Physician-assisted death can give people the chance to close the last chapter of their lives in a meaningful way that avoids suffering, which is something we should all find morally correct. Morality exists to guide humans through life, and we must learn to understand how physician-assisted death and other manners of dying abide by this concept to create a future more accepting of death as a whole.

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