Physician Assisted Suicide

Physician Assisted Suicide Many voters throughout the United States are taking the measure to legalize physician assisted suicide to the polls. If it is legalized, the United States will have legalized a much quicker, more humane method(as opposed to terminal sedation) of ending the suffering of terminally ill patients. The only legal process of this sort in the United States is terminal sedation, a method that can oftentimes add to a patients problems. Although Oregon is the only state to have successfully passed such a bill for the legalization of physician assisted suicide, the pressure to confront this issue is growing along with the movement for legalization. Opponents of the Oregon bill, mostly Christian conservative groups, are planning to appeal this case to the Supreme Court in hopes of a reversal of the Oregon Supreme Courts decision. Though the emotional battle of physician assisted suicide is the prerogative of voters on both sides of the issue, the fundamental question that will have to be answered by the Courts is whether or not the liberty observed by the due process clause of the fourteenth amendment contains a right to perform suicide, which itself includes a right to assistance in doing so. This clause states, No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; Nor shall any State deprive any person of life, liberty, or property, without due process of law.

(United States Constitution, Amendment 14) Tierce, 2 In order to constitutionally create a previously unspecified right the Supreme Court must conclude that such a right is either deeply rooted into the nations history and tradition, or is fundamental to sustaining the liberty provided in the Constitution. The court should also have a very specific description of what is to be entailed within this right. The difficulty in arguing for assisted suicide is that since the justification for assisted suicide is not historical or necessary for ordered liberty, the state must only prove that assisted suicide is within the perimeters of exercising what is best for the nation as a whole. The Supreme Court has earlier stated that, This requirement is unquestionably me here, citing as concerns: preserving human life; preventing suicide; protecting the integrity and the ethics of the medical profession; protecting vulnerable groups from abuse, neglect, and mistakes; and preventing a start down the path to voluntary and perhaps even involuntary euthanasia. (Annas, 1100) The possibility of legalization is, however, still quite probable, especially as one uses the Dutch government as an example, where physician assisted suicide is illegal but not prosecutable if executed under certain specified legal guidelines. The practice of physician assisted suicide in the Netherlands has been defined over many years of legal processes Tierce, 3 and medical ethics, beginning in 1973, when the first case against physician assisted suicide went to trial.

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The courts found the physician guilty of the crime, but suspended her sentence and effectively ruled out the threat of future prosecution. In many Dutch cases between 1973 and 1984 the courts established necessary conditions for not prosecuting a physician for assisting in a suicide. The patient must first make the request for euthanasia, and then repeat the request explicitly acknowledging their desire to die. The patient must also be suffering from a disease that has brought about severe physical or mental pain with no hope of recovery. The final case in 1984 resulted in the addition of a third guideline which required a physician to consult a colleague to verify the diagnosis, and to design the plan for euthanasia as to not inflict unnecessary suffering on others concerned.

Nevertheless problems arose in the Netherlands concerning the legality of euthanasia. Thus in 1993 the Dutch Parliament passed measures to clarify the state of physician assisted suicide laws. Under the new law physician assisted suicide is still punishable by up to 12 years in prison, but if the established guidelines are followed, the practice is safely shielded by the legal system. The law requires that patients be euthanized in accordance with the following carefulness Tierce, 4 requirements. (Russell, 781) The first requires that a request for death must be made entirely of the patients free will and could not be made by family or friends. The second requirement states that the request must be expressed repeatedly and show lasting longing for death.

And finally both the patient and doctor must regard the patients suffering as perpetual, unbearable, and hopeless. Classic instances where euthanasia should clearly have been an acceptable method of treatment have brought much attention to this once ignored movement. One such case was that of Cruzan v. Director, Missouri Department of Health. Nancy Cruzan was a woman in a persistent vegetative state whose parents wanted her artificial feeding discontinued. The case set the precedent for a constitutional right to refuse medical treatment. The court noted, however, that suicide has never enjoyed similar legal protection, and that the two acts are widely and reasonably regarded as quite distinct. (Hoeffler, 1102) The court reiterated the fact that patients have throughout history, invariably maintained the right to demand their bodies not be invaded without their agreement.

The courts objective in the Cruzan case was to make the clear distinction between the right to refuse undesired medical treatment and the right to physician assisted suicide. Tierce, 5 Another such case was that of Quill v. Vacco, which in the opinion of the second circuit of appeals, stated that New Yorks regulations against physician assisted suicide were unconstitutional when applied to terminally ill patients who are not sustained by life-support systems, because the laws do not accommodate these patients with balanced protection. In this case the court drew strong distinctions between what could and could not be considered when addressing the issue of physician assisted suicide. The court officially stated that patients connected to life-support systems can withdraw treatment and bring about their deaths, however, patients who are not connected to life-support systems are unable to exercise the same legal right to hasten their own death.

The Quill case represents a preliminary example of the courts handling of terminal sedation. Death brought about by the method of terminal sedation, it is argued, is practically acceptable because the death is caused by the withdrawal of food and water. The courts have consistently recognized that it is ethically and legally permissible for patients to die due to the discontinuation of life-sustaining treatment. In the case of Vacco v. Quill the court heard oral argument, which focused on the topic of terminal sedation, or sedation of the imminently dying. Tierce, 6 Terminal sedation is the introduction of a barbiturate-induced coma, followed by the withdrawal of food and water, thus leaving the patient to starve to death.

The court concluded that a state can legally countenance this form of palliative care if it is based on informed consent and the double effect. Just as a state may prohibit assisting suicide while permitting patients to refuse unwanted lifesaving treatment, it may permit palliative care related to that refusal, which may have the forseen but unintended double effect of hastening the patient death. (Annas, 1104) Although it has explicitly e …