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Resources - Advocacy Position Statements
Statement on Physician-Assisted Suicide
We, as hospice and palliative care providers, believe that human life has worth and meaning.
We oppose active intervention with the intent to produce death for the relief of pain, suffering, or economic considerations, or for the convenience of patient, family, or society.
While proponents of physician-assisted suicide argue from the perspective of compassion and individual autonomy, there are counter arguments based on the traditional norms of the medical profession and the adverse consequences of such a public policy. And, we believe that human autonomy is not without limits.
In order to affirm the dignity of human life, we advocate the development and use of alternatives to relieve pain and suffering, provide human companionship, and give opportunity for spiritual support and counseling.
The Arizona Hospice and Palliative Care Organization opposes physician-assisted suicide in any form.
Approved by the Arizona Hospice and Palliative Care Organization (AHPCO).
June, 2000 – Phoenix, Arizona
Explanation
Physician-assisted suicide occurs when a physician helps a person take his or her own life by giving advice, writing a prescription for lethal medication, or assisting the individual with some device which allows the person to take his or her own life. The physician lends expertise, the person does the act.
Voluntary euthanasia occurs when another person, out of compassion, does an action with the intention of ending the life of a suffering patient at his or her request. Non-voluntary euthanasia is a similar compassionate act, but in circumstances where the patient is unable to make a voluntary request (e.g. amentia; an unconscious, retarded or demented adult; an infant or child). Involuntary euthanasia is a compassionate act to end the life of a patient who is perceived to be suffering and could make a voluntary request, but has not done so.
Distinction between active euthanasia and passive euthanasia is not helpful, and often confusing. It is clearer to limit the term euthanasia to situations in which one person acts to cause the death of another (which is what many people mean by active euthanasia). And what about acts of discontinuing treatment with the realization that patients will die of their disease? According to this understanding, these acts do not constitute euthanasia. Thus using the term passive euthanasia to describe such acts is a misnomer. When discontinuation is done with the intention of ending the life of someone who is not already unavoidably in a dying process, it is morally objectionable for many of the same reasons that euthanasia is objectionable. But since discontinuation in other situations is morally acceptable, it is helpful not to refer to discontinuation under any circumstances as a form of euthanasia.
Historical Perspective
Societal changes of the 1960's - 1990's have led to a focus and emphasis on an individual's right to self-determination. While this includes some increased acceptance of suicide as a rational option for an individual who feels that life has become too burdensome, the act of suicide is still often viewed by others as a tragic and lonely experience. This is especially true when the means of self destruction involves violence (e.g. guns and other self-inflicted wounds, hanging, jumping from heights, etc.). Thus there has been a move to depersonalize suicide by involving others (assisted suicide) and to sanitize it by making it a medical procedure (physician-assisted suicide and euthanasia).
Proponents of legalization of euthanasia offer several reasons why society should allow physicians to be involved in these acts: some people have no loved one who can help them; some people are unwilling or unable to help their loved ones commit suicide; physicians know the prognosis so are better able to assess the appropriateness of a request; physicians have access to and know how to use lethal drugs; medical expertise can prevent botched up suicide attempts; physicians know how to obey standards; and, physicians can be more objective because they are not emotionally involved.
Legal Perspective
Euthanasia has been openly practiced by physicians in The Netherlands since 1984, and such acts were decriminalized in 1993, although legal and judicial oversight continues. The best estimates are that about 9% of all deaths in that country are induced by physicians. There is public debate about extending the availability of euthanasia to children and incompetent adults, and there is a professional inclination to change the system to physician-assisted suicide rather than direct physician involvement.
The Northern Territory of Australia legalized physician-assisted suicide and physician- administered euthanasia in 1995.
Attempts in several states in the U.S. to pass legislation allowing physician-assisted suicide and/or euthanasia failed by narrow margins in the late 1980's and early 1990's. In 1994, the state of Oregon passed a voter initiative --Measure 16: a Death With Dignity Act--to allow physician-assisted suicide with restrictions. The U.S. District Court issued an injunction temporarily restraining the Implementation of Measure 16.
Case law (as opposed to statutory law) in the U.S. addressed the issue of physician- assisted suicide in early 1996. The 9th Circuit Court of Appeals in San Francisco and the 2nd Circuit Court of Appeals in New York declared unconstitutional state laws in Washington and New York (respectively) which prohibited physician-assisted suicide. Different legal arguments were used in the two cases. In 1997, the State of Oregon voted against Measure 51, which would have repealed the Oregon Death with Dignity Act. And, in 1998, Oregon presented its first legal physician-assisted suicide.
Medical Perspective
Physician-assisted suicide and euthanasia were explicitly proscribed in the Hippocratic Oath. Although this was a minority opinion when introduced 2500 years ago, the Hippocratic ethic gradually became the dominant influence for practitioners of modern medicine and dentistry. Practitioners have adopted the role of healer with the goals of healing when possible, and relief of suffering. While there have doubtless been individual physicians and dentists over the centuries who have occasionally helped their patients to die, this activity has clearly remained outside the boundaries of acceptable medical treatment.
There is professional concern that acceptance of physician involvement in either direct or indirect induced death would seriously undermine the trust that is a necessary component of the physician-patient relationship. If euthanasia becomes accepted, a physician might be tempted to end a patient s life without a request, either out of compassion, or out of self-interest (e.g. when the care of a patient becomes too difficult or burdensome). In addition, there is concern that there might be less impetus to continue work on the significant gains made in good palliative care in the past 20 years.
Psychological Perspective
Yielding to the call of compassion to take a life or assist in the ending of a patient’s life is misguided for another reason as well. It is all too easy to underestimate self-centeredness of human nature, particularly when the people in view seem to have the needs of others at heart. The statements of so-called mercy killers in the past have often been telling in this regard. "I killed her because I could not bear to see her suffer," generally means what it says---that first and foremost the action reflected the killer’s need to be free from his or her own discomfort. Barriers to killing patients or assisting them to kill themselves not only protect society in general and patients in particular but also protect physicians and surrogate decision-makers from their own weaknesses---from subtly self-centered decisions that may well haunt them for the rest of their lives. The AHPCO’s statements on Physician-Assisted Suicide and Euthanasia are designed to uphold such protections while affirming more constructive expressions of compassion.
Ethical Perspective
The absence of suffering is, generally speaking, something good. But it is not the highest good. We believe that it is our obligation to be compassionate and to relieve suffering, but not at any expense. Contrary to some views within our contemporary society, happiness is not what life is all about. And suffering is not the ultimate evil to be avoided at all costs. Indeed, it could be argued that one of the most meaningful acts within someone’s life is in how he or she deals with suffering in the face of death.
Hospice Perspective
The concept of hospice care emerged in this country in response to the unmet needs of the terminally ill and their families; an effective alternative to there being "nothing left to explore." Palliative care provided by hospice extends an opportunity to correct errors in prognosis and/or to benefit from skilled intensive symptom control. Palliative care can improve the quantity and quality of one’s remaining life. Formerly unattainable goals may become attainable. Beyond physical and psychological comfort, spiritual comfort is an important goal of hospice care. Physician assisted suicide obliterates the opportunity to transcend suffering and find meaning—also in the existence of one’s relationship with self and loved ones.
Hospice provides a wonderful setting for the terminally ill and their loved ones. This type of care is ethically responsible and distinctly different from the administration of a drug whose primary intent is to end life. It also does not leave loved ones to contemplate whether death was the only method of relieving a patient’s suffering. The very presence of euthanasia as an option can erode trust that the health care system will do everything possible to relieve suffering before terminating life. Rather, euthanasia provides a clever disguise that encompasses harm to the patient, family, and society at large.