Physician-Assisted Suicide (PAS) is one of the major political battles of our day, having now been legalized in the states of Oregon, Vermont, Washington, California, and Colorado, the District of Columbia, and legislated by judicial order in Montana.  In the 2016-17 legislative session, the bills LD 347 and LD 1066, which would have legalized PAS, were narrowly defeated, actually passing in the state senate, but losing in the house. Similar bills have been introduced in Maine multiple times before, clearly showing that PAS proponents will not stop trying to legalize PAS any time soon.

In PAS, a doctor prescribes a lethal dose of medication to a terminally-ill patient, which they use to kill themselves.  This is clearly a grave moral evil.  Many voters and legislators, however, do not understand the dignity of all human life or the moral problems inherent in PAS.  Because of this, opponents of PAS must understand how to argue against PAS without using moral arguments alone. There are two major forms these arguments can take; they can demonstrate that PAS is unnecessary, because it won’t actually accomplish any good that can’t already be accomplished in other ways, and they can show the many bad consequences that it would bring about.

There are many reasons why PAS is unnecessary. Proponents of PAS often portray patients seeking PAS as primarily seeking relief from uncontrollable pain; the truth, however, is that when the patients are asked about reasons for wanting to die, pain does not even make the top five. The top five are: loss of autonomy (91.5%), decreased ability to engage in enjoyable activities (88.7%), loss of dignity (79.3%), loss of control of body (50%) and becoming a burden on others (40%). Even when both actual pain and just the fear of pain are categorized together, it still comes in at number six with only 23% mentioning it as a major concern.

Furthermore, doctors can effectively bring almost all pain down to a reasonable level, and the patient often stops desiring PAS once this is done. According to Pain Management and Care of the Terminal Patient,

“…[A]dequate interventions exist to control pain in 90- 99% of patients. (Research shows that only .04% of patients treated with morphine become addicted.)”

We frequently see patients referred to our Pain Clinic who request physician assisted suicide because of uncontrolled pain. We commonly see such ideation and requests dissolve with adequate control of pain and other symptoms, using combinations of pharmacologic, neurosurgical, anesthetic, or psychological approaches. (July 1991 Journal of Pain and Symptom Management, Dr. Kathleen Foley, chief of Pain Services at the Memorial Sloan Kettering Cancer Center in New York)

Patients can even request palliative sedation if they want to. In conclusion, it does not appear that pain is a good reason to legalize PAS.

In fact, the true cause of the desire to die is often depression, a treatable condition:

“When people are facing death from illness, only a small percentage are suicidal,” said Dr. Aaron Beck, a psychiatrist at the University of Pennsylvania. “And what makes them suicidal is depression, not the physical condition.”

The symptoms of depression include a deep despair and hopelessness. Dr. Beck said other common symptoms included a preoccupation with death and an inability to see more than one option for solving problems that can lead patients to fixate on suicide as the only way out of their suffering.

“Clinically, we find it’s possible to correct these misperceptions with therapy,” Dr. Beck said. “Afterward, these same patients who were so intent on suicide tell you they’re grateful they’re still alive.” (“Missing in Talk of Right to Die: Depression’s Grip on a Patient”, New York Times, December 4, 1991) 

Finally, PAS itself is sometimes far from a peaceful, dignified death. According to Derek Humphry [co-founder of the Hemlock Society, now Compassion and Choices, author of the suicide manual, Final Exit, Letter to the Editor, New York Times, 12/3/94, p. 14]

“[I]n 20% of the patients who received a barbiturate [orally], a muscular relaxant [curare-like injection] was needed to end life after the five hour time period.” Death by medication overdose can be long and excruciatingly painful, sometimes lasting up to two days.

In addition to not accomplishing the good it is supposed to, legalizing PAS would bring about many unfortunate side-effects.  This is evident from the places in the United States, such as Oregon and California, where PAS is already legal.

Many terminally-ill patients seeking suicide are suffering from depression. Statistics from Oregon, however, show that only three out of 105 patients seeking PAS in 2014 were given a formal psychiatric or psychological screening, meaning that many who could have, with proper treatment, have come to appreciate what was left of their lives were killed instead. (Oregon Public Health Division, 2014 Report on Oregon’s Death with Dignity Act, released February 12, 2015.) People often find the end of their lives to be among the most rewarding and fruitful times in terms of personal growth. In the words of Elisabeth Kübler-Ross:

“Lots of my dying patients say they grow in bounds and leaps, and finish all the unfinished business. But assisting a suicide is cheating them of these lessons, like taking a student out of school before final exams. That’s not love, it’s projecting your own unfinished business. “

Legalizing PAS will not only make suicide an option for those who want it; it will also pressure many people who don’t want it to accept it anyway. One source of pressure will be insurance companies, who would rather pay several hundred dollars for a dose of lethal medication than the thousands of dollars sometimes needed to pay for treatment for the very ill. This has already happened in several cases, such as Barbara Wagner and Randy Stroup, who both had cancer and lived in Oregon. The state run Medicaid insurance plan refused to offer them treatment, but did offer to pay for their suicide-medications.

In California, Stephanie Packer, who, despite being terminally ill, very much wanted to live and spend time with her children for as long as possible, was denied the treatment that she and her doctors wanted; they would, however, give her suicide pills for $1.20 copay. Only the very rich who can pay for expensive medical treatment themselves will have any “choice in dying”; for everyone else, death will be mandatory.

Furthermore, the fear of being a burden was listed as a major concern by 40% of those seeking PAS in Oregon. Terrible as it sounds, once PAS is seen as a normal medical treatment, many patients who may want to live will be choosing death so as not to inconvenience friends and family, or even their doctors.

The safeguards in PAS laws are never very good and leave plenty of room for abuses. An heir or other family-member can pressure or threaten a patient into requesting PAS, and can then serve as the witness for the request. This makes elder abuse a real possibility, especially since there is no provision that the doctor actually be present when the drugs are ingested, or even that family members are informed of the decision! After the drugs are picked up from the pharmacy, a process that does not require presenting an ID in most states, what happens with them is entirely out of the state and the doctor’s hands. In fact, a physician or medical provider was only present in twenty out of 105 cases in 2014.  (Oregon Public Health Division, 2014 Report on Oregon’s Death with Dignity Act, released February 12, 2015.)

PAS also leads to a general disregard for human life and to the belief that suicide is a viable option. In Oregon, after legalizing its “Death with Dignity” act in 1997, suicide rates in general went up by 25.5% from 2000 to 2012, not counting the legal physician-assisted-suicides.

Finally, life-expectancy estimates are often wildly wrong. Somebody who allegedly only has six months left could survive for several years more or even recover in some cases.

PAS should be a major concern for all responsible citizens. It directly violates the most basic of all rights, the right to life, and reduces human beings to how much pleasure they can enjoy, or how much they can accomplish. Even those who don’t acknowledge this, however, ought to be strongly opposed to PAS. It doesn’t accomplish the good that its supporters say it does, and actually would lead to the deaths of many who want to live.