Freedom in Death: Legalizing Physician-Assisted Suicide

Death is the one thing we are all guaranteed to experience, yet have a difficult time discussing. And as a teenager, it isn’t something we often dwell on at our young age. But the reality is, according to the National Institutes of Health, there were approximately 1 million patients receiving end-of-life care in the United States in 2011, cared for by approximately 2.3 million caregivers, demonstrating that end-of-life care affects not just those in it, but those surrounding it. While palliative care is focused on keeping the patient comfortable in their last moments, it often is anything but. In a study of dying cancer patients in Colombia, Angelica Arango-Gutierrez, et al. found that 79.9% of caregivers believed their terminally ill loved one was experiencing moderate to extreme suffering, with over half labeled as extreme. With this, a statistically significant 34.5% of caregivers also reported that intervening care led to the prolonging of their patient’s suffering. Not only do these patients have to suffer, but their loved ones do as well, both emotionally and physically. According to Aloudiny, et al., at Princess Nourah Bint Abdulrahman University in Saudi Arabia, more than half of caregivers reported feeling caregiving was a moderate to high physical and emotional burden. These facts start discussion for ideas such as the legalization of physician-assisted suicide. 

When this topic is initially brought up, it is often someone’s initial reaction to jump quickly against the idea of initiating the death of someone or encouraging something such as suicide, however, this may not be the case in these situations. In a research review by Jesus Martin-Martin, et al., published by the International Journal of Nursing Studies, anecdotal evidence cited by Martin-Martin suggests while one might initially conclude caregivers would want their loved one to live with them as long as possible, many caregivers reported they felt almost “disappointed” when their patient seems so close to death and yet their suffering is continued. While it may seem that families would have to let go of their loved ones before they should, the majority of the time, patients are not the same as they used to be. The relationships have been reshaped long before the patient's last breath, and the final memories are often not good ones that reflect who the patient truly was. The Journal of the American Geriatrics Society presents quotes given by a caregiver about their experience, saying that “all of a sudden [the patient] would just burst out into tears and she would get angry and then she would throw things. She never showed her emotions like this before”. The relationship between the caregiver and the patient is no longer what it used to be, and now poses a risk to the patient and the caregiver’s safety. Another study also reported that in some cases, patients plead for a higher dosage of pain medications “simply to cloud their consciousness,” illustrating that some patients do not desire to live any longer and are experiencing extreme suffering. This suggests that physician-assisted suicide would be an option some patients would prefer, as they no longer wish to be conscious. 

However, there are large ethical concerns that also arise with the discussion of making physician-assisted suicide a legal option in the United States. It is essential that if physician-assisted suicide were to be legalized, the patient would freely and autonomously make the decision, honoring the freedoms of our country and human rights. Patients in these stages of life are most often not mentally competent or even able to express their opinions, but consent and autonomy are the most important aspects. Rather than just making physician-assisted suicide a legal option, legalizing it in the form of a legal document provided in

the patients medical file rather than a decision after admission to end-of-life care would honor each of these principles and address any concerns. This would be similar to existing documentations such as living wills and do not resuscitate orders, which are proactive measures for end-of-life decisions, exactly what I am proposing here. . Because the patient would have to go to a medical professional and seek this documentation themselves, this ensures free will and autonomy. There would be no time constraint, minimizing pressure and the opportunity to be coerced. It allows the patient to decide before they are declining, ensuring that they are still mentally competent. Nevertheless, the argument still remains that physician-assisted suicide causes unnatural death and is therefore unethical. However, providing the option does not mean patients have to participate. Instead, it would support free will as patients would have control over their experience and method of care. 

As a teenage CNA, I see these things daily. I see the pain in family members’ faces as they look at a patient who used to be a loving face, now unrecognizable and unable to recognize them back. I see the pain in the faces of the patients as well, and the need for help written beneath their eyes. It holds my care to a higher standard, but also gives me the thought that I don’t ever want to put such a burden on my family members or live my last moments in such a state. It has caused me to think a lot about the idea of physician-assisted suicide, and I hope to spark thought and conversation about this idea in others as well.