Should physician-assisted suicide be legalized nationally?

Left: Challenging the argument is Ashton Gergen, a Junior communication studies major
Right: In defense of physician-assisted suicide, Miranda Ehrlich, a student pursuing a Master’s degree in public affairs

This is the third in an occasional college debate series hosted by Today’s Question where we invite debate clubs to frame and guide the day’s discussion. Positions taken by the debaters don’t necessarily reflect their views. As always, personal attacks aren’t allowed in this space. The comment thread continues to be open to all. Join in!

For this series, we welcome members of the University of Minnesota debate team to defend or challenge the argument for the national legalization of physician-assisted suicide.

Defending the argument is Miranda Ehrlich, a 2015 graduate of the University of Minnesota – Twin Cities where she double-majored in political science and communication studies. She is currently pursuing a Master’s degree in public affairs at the University of Wisconsin – Madison.

Some of you may be familiar with the story of Brittany Maynard, a young woman who was diagnosed with brain cancer at the age of 29. Maynard, who was newly married, had no desire to die. But after enduring invasive surgeries that failed to stop the growth of the tumor, she was out of effective treatment options. Faced with the prospect of a dying process that could include severe, drug-resistant pain, personality changes, and loss of verbal, cognitive and motor function, Maynard decided to reassert control. She moved to Oregon, one of the five states where physician aid-in-dying is legal, and obtained medication from a doctor so that she could control the timing and circumstances of her death.

Maynard’s experience exemplifies the case for physician aid-in-dying. While the quality of palliative care is better than ever, a portion of terminally ill patients still face a dying process that involves severe pain that cannot be alleviated. Some of these patients prefer a hastened death to the alternative. Failing to honor this choice condemns patients to prolonged suffering against their will. Allowing for physician aid-in-dying is compassionate and respects patient autonomy.

One potentially compelling objection to physician aid-in-dying is the possibility that individuals, particularly those with disabilities, may be coerced into taking their own lives. However, a strong regulatory system can be put into place to prevent these abuses from occurring. In Oregon, a comprehensive study found that physician aid-in-dying had no disparate impact on various groups originally thought to be at-risk, including the elderly, minorities, and people with disabilities. While opponents of physician aid-in-dying often draw from the Netherlands and other European countries to build their case, studies from Oregon should be given greater weight because they more accurately account for the culture and regulations surrounding physician aid-in-dying in the United States.

Thus, physician aid-in-dying should be legalized for mentally competent, terminally ill adults with a prognosis of six months or less to live.

Arguing against physician-assisted suicide is Ashton Gergen, a Junior communication studies major at the University of Minnesota – Twin Cities. She can be followed on Twitter @ashton_gergen.

One of the foremost standing issues in the argument of physician-assisted suicide (PAS) is cost. Patients who would be candidates for PAS are often paying for medical care to treat their condition. These treatments are often expensive – PAS treatments tend to cost just a few hundred dollars. This discrepancy in cost creates an unjustified pedestal for the option of PAS.

From a government health care standard, health care costs are high for these cases, both to pay for and produce them, whereas the PAS treatment only costs between $30 and $50, which could lead to an over prescription of the procedure to cut on costs. This, as stated by the International Task Force on Euthanasia and Assisted Suicide, “could fill the void from cutbacks for treatment and care with the ‘treatment’ of death.”

Those who have made claims for the legalization of PAS have made arguments about end of life pain and suffering. We have to take into account arguments like those of Dr. Herbert Hendin in his book, “Seduced by Death,” that “some terminally ill patients have suicidal thoughts, but ‘these patients usually respond well to treatment for depressive illness and pain medication and are then grateful to be alive.’” It would make sense for patients diagnosed terminally ill to face an emotional downturn, in most circumstances, learning that we do not have as much time as expected would cause such a reaction. But as Dr. Hendin claims, with the realization and treatment of that, patients can manage pain and live out the rest of their lives enjoying what time they have and can gain, through treatment. Some have made claims that PAS being illegal would be like government mandated suffering, but this, according to executive director Rita Marker and policy analyst Kathi Hamlon for the International Task Force on Euthanasia and Assisted Suicide, is like claiming “laws against selling contaminated food are government mandated starvation.” Laws against PAS are to protect patients from abuse and unfair treatment.

Today’s Question: Should physician-assisted suicide be legalized nationally?

  • PaulJ

    You wouldn’t treat a dog in the way some lives end, but any changes in the system should acknowledge that killing people has psychological repercussions.

  • Sue de Nim

    A right to die should go hand in hand with a right to medical care. A right to die that’s not paired with a right to medical care would create perverse incentives for family members to urge patients to choose a quicker and cheaper death over more expensive life-extending treatment and palliative care, and for patients to choose preserving their estates for their families over having more time with their families.

    • Yanotha Twangai

      I agree but would add one more right that should go along with those other two: a right for medical care providers to withhold futile medical care, such as trying to resuscitate a person whose heart stops in the final stages of a terminal disease, or keeping a brain dead patient on a ventilator in the ICU except to preserve the organs for transplant.

      • minnesotalistener

        Yanotha, I feel that these “rights” already exist in the end of life medical directives people are encouraged to complete, or am I not understanding your point?

        • Yanotha Twangai

          No, I’m referring to the opposite problem. I mean if a patient (or family) is unreasonably demanding medically futile treatment, the medical care providers shouldn’t have to provide it.

    • Luke Plutowski

      Given the outrageous costs of medical care in this country, it is very easy to imagine terminally ill patients feeling undue pressure to take their own life rather than prolong medical treatment. Read any study on false confessions in the criminal justice system — vulnerable people under a great deal of stress will basically admit to anything.

      • Miranda Ehrlich

        Luke, you make a compelling claim, but the data simply don’t bear this out. A comprehensive study in Oregon (referenced in my original post) has shown that aid-in-dying has not been forced upon the poor, or the elderly, or any other vulnerable group. In fact, the vast majority of those who choose aid-in-dying are highly educated, well-insured, and enrolled in hospice. The safeguards in place have proven sufficient to prevent this from happening.

        • Sue de Nim

          Actually, I’d expect that the pressure to accept “aid-in-dying” to be felt mostly by the rich and middle classes, whose families have the most to lose from the high cost of American medical care. If you have no assets or no heirs, it wouldn’t matter to you as much if you linger in a nursing home for a few months with the tab being paid by Medicare and Medicaid.

          • Miranda Ehrlich

            Hmm, that’s an interesting point. But even though the middle class and the rich potentially have more to lose, they are also more likely to be well-insured and be secure enough in their finances to pay for hospice care. I think that this argument probably holds most true for families just above the line for Medicaid and Medicare eligibility. I do agree with you that a right to medical care should also be established — it would alleviate many of the concerns that you’ve raised.

  • Eduard Meijer

    We are not talking about ‘killing people’. The right to die is a personal decision that is made in consultation with one’s personal physician, close family and a third party medical consultant to verify that the person requesting a life ending treatment is indeed terminally ill and has no possibility of recovering from the illness. Both my father and father-in-law chose this option over 20 years ago and passed away surrounded by their family. There is no more peaceful way to die. Both were terminally ill and a matter of weeks away from a natural, very painful and prolonged death.

  • Nightowl

    Sure it should be legalized nationally using Oregon’s checks and balances. Unfortunately, only the most progressive states are likely to pass this.

  • Rich in Duluth

    Yes, physician assisted suicide should be legalized nationally. This should be a matter of personal freedom and should be governed by reasonable rules, such as those in Oregon.

    Read a book like “How We Die”, by Dr. Sherwin Nuland. It will show you that we have not evolved to die pleasantly. The availability of PAS would give us a sense of some control over our last days.

    • Sue de Nim

      As soon as we recognize nationally a right to medical care, I’ll agree with you.

      • Rich in Duluth

        Sadly, we’re probably a lot closer to a right to die than a right to medical care. I had really hoped that The President would have held out for Medicare for All when he pushed for health care reform. Unfortunately, he just gave the insurance companies, who add nothing of value to the health care system, a wind fall.

  • Khatti

    Yes physician-assisted suicide should be legal. And I would like to add one more category for the right to die: suicide as a political protest.

    • Floyd R. Turbo

      You don’t need anyone’s permission to do that. You just go right ahead.

      • Khatti

        Well I believe the idea is to be public about it–but thanks for the encouragement.

        • Khatti

          And, in theory anyway, a doctor is less likely to botch it than you are alone.

          • Floyd R. Turbo

            Hey, whatever point you’re trying to make, if you’re willing to kill yourself to make it, I’d sure be convinced!! Maybe if we’re lucky lots of other rabble rousers and trouble makers will do that, too. Then we could really get some positive change in this country!

          • Khatti

            See! Everyone wins all around!

  • Bradley Williams

    Please consider these specifics:
    By
    Oregon and Washington law all family members are not required to be
    contacted. A single heir is allowed to initiate and execute the lethal
    process without a witness, thus eviscerating intended safe guards. Everyone
    involved in the lethal process gets immediate immunity. A witness is not
    required to confirm the dose was self-administered so if they struggled and
    changed their mind who would ever know?
    In
    addition these laws prohibit investigations or public inquiries leaving no
    recourse for surviving family members who were not contacted. Does that sound like good public policy to
    you? This is a very dangerous public policy that allows for the exploitation of
    elders and people with disabilities of all ages. However, it serves the
    health insurance corporations very well.

    Unfortunately all of these loopholes are embodied in California’s ABX2-15.

    • Yanotha Twangai

      I thought the patient had to personally initiate the process, and that a phych eval would be done to determine that it was a rational, uncoerced choice. Was I wrong about that?

      • Miranda Ehrlich

        Yanotha, you are correct about that. Bradley, I’m not sure where you are getting your information from, but my understanding is that a heir is not able to “execute the lethal process” — only the patient themselves can do that by law. Psychological evaluations are required as well beforehand.

  • Bradley Williams

    Psch evaluations are rare. In Oregon and Washington the first step is filling out a form then submitted. If you read the bills and weigh how they could be administered it will serve you and your state well.

    • Miranda Ehrlich

      According to the Oregon Death with Dignity Act, the following steps must be taken in order to receive a lethal prescription:

      The patient must make two oral requests to his or her physician, separated by at least 15 days.
      The patient must provide a written request to his or her physician, signed in the presence of two witnesses.
      The prescribing physician and a consulting physician must confirm the diagnosis and prognosis.
      The prescribing physician and a consulting physician must determine whether the patient is capable.
      If either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder, the patient must be referred for a psychological
      examination.
      The prescribing physician must inform the patient of feasible alternatives to
      DWDA, including comfort care, hospice care, and pain control.
      The prescribing physician must request, but may not require, the patient to notify his or her next-of-kin of the prescription request.

      You are correct that a psychological evaluation is not always required, but two physicians must weigh in on the matter, and the patient must make multiple requests, all which prevent a decision from being being made in haste or under coercion.

  • Bradley Williams

    Then after the lethal script is written over site stops. No witness required to confirm that the dose was self administered, even as this is a key promotional point, you know “must be self administered”. There is a lot of room for abuse especially since only half never use the script. I would require a witness and then leave the records available for public inquiry for the sake of good public safety policy.

    • Yanotha Twangai

      That’s an argument about how it should be done, not whether.

    • Kimberly

      Patients are given prescriptions daily for different drug classes. Once the MD has written the prescription it is up to the patient if they get it filled and actually take it as prescribed. As a nurse I see this all the time. The solution is not to send the patient home with a supervisor as you suggest, but to educate the patient and the family about what the medication is for, directions on when and how to take it, the effects of it and potential complications. This is in the context of a lucid patient. Supervision with home care is effective for patients that are confused and in that case they would not meet the criteria for this prescription.

  • Kimberly

    As part of the medical community and the disabled community the above arguments against DWD are merely propaganda. Suggesting that all pain can be controlled by palliative support is simply not true. Sure, you could technically do it if you induce delirium or unconsciousness. But then we’re back to the argument about quality of life and enjoying those last moments consciously and comfortably with your loved ones. I agree that there are patients who have amazing peaceful deaths. There are also patients who have horrendous deaths and drawn out suffering. The government not making it legal doesn’t force people to endure unimaginable suffering but it also doesn’t offer these patients another option. We all believe that our answer to this complicated law is correct. And certainly it’s easy to make a decision when ‘suffering’ is no more than a word to you. But shouldn’t we be asking is it appropriate and compassionate for this individual, in this specific situation, at their own request?