Physician-assisted suicide: The patient’s right

Is suicide a constitutional right? The answer is complicated. In The United States, citizens can take their own lives at any time, but what about when a person is looking for permanent relief from a terminal illness? Physician-assisted suicide (PAS) is an option for qualifying terminally ill patients who feel death is favorable to life. The practice is illegal in most of the United States. PAS is available in only eleven states and is not an accessible or easy process. Generally, the patient must qualify as an adult with a sound mind, terminally ill, and have six months left to live. All of the criteria up to the discretion of an attending physician. As a physician, what is the benefit to participation? 

“Physician-assisted suicide (PAS) is an option for qualifying terminally ill patients who feel death is favorable to life.”

The answer is patient autonomy. The Oregon Health Division examined the first year of legalized PAS in Oregon (1997). The report found, compared to a control group, there were no significant differences between the reasons for considering PAS for patients. The reasons were concerning financial issues, insurance coverage, or concern over being a burden to loved ones. The primary distinction was about bodily autonomy and the loss of one’s bodily autonomy. PAS is achieved through a mix of barbiturates and narcotics. These prescriptions are tailored for each patient, ensuring a safe and peaceful death. The patient or a trusted agent can pick up the prescription, meaning the patient has a choice over the time and place of their death. Patients participating in PAS are concerned with the quality of life – not the length of it. 

On August 29, 2023, two patients and two physicians filed a lawsuit against the New Jersey government. Judith Govatos and Andrea Sealy are both patients with cancer who wish for access to PAS and the gift of choice over their manner of death. Dr. Paul Bryman and Dr. Deborah Pasik, both licensed in New Jersey, are contacted by out-of-state patients who are looking for PAS, yet Dr. Bryman and Dr. Pasik are unable to help without penalty due to their state laws. Together, the four are filing the lawsuit because the requirement of the residency status violates the Privileges and Immunities Clause (Art. IV, § 2), the Commerce Clause (Art. I, § 8), and the Equal Protection Clause (Amend. XIV, § 2) of the United States Constitution.

The legalization of PAS in the United States is protected under the Death with Dignity Act, enacted in 1994. Its goal is “…to ensure people with terminal illness can decide for themselves what a good death means in accordance with their values and beliefs.”

Even though the Death with Dignity Act is expanding to other states, PAS is still a laborious process for patients. After a patient finds a participating physician, there are still multiple forms, requests, and agreements needed to be eligible. Chin, Hedberg, Higginson, and Fleming found that five of the twenty-one patients seeking PAS had died without any control from their terminal disease before being able to obtain a prescription for a peaceful death. In 1998, most hospitals in Oregon did not participate in PAS, and 40% of patients seeking PAS were not able to begin the prescription process with their first physician. PAS was, and still is, a highly contested medical practice, leading to many participating physicians feeling isolated from their colleagues. Death is an all-consuming notion that weighs on both the patient and the physician. Both for the patients who want control over their death, and the burden the physicians must carry assisting such death. PAS is surrounded by a hazy cloud of misunderstanding, where patients have little to no outlet to express their experiences and emotions. Physicians who are not willing to perform PAS contribute to patients feeling a loss of autonomy during the end of their life.

PAS and its support from the DDA are meant to provide patients with a feeling of control over their life and how it will end. Many patients have been through an arduous battle with their terminal illness. These patients have faced pain for too long and need another option. Death is such a personal journey that the patient should have as much control over as they are able to. PAS offers physicians a place to ensure a safe, comfortable death with as little pain as possible. There is no perfect answer to the question at hand, but people like Judith, Andrea, Dr. Bryman, and Dr. Pasik are hopeful to expand, with the DDA, the accessibility of PAS to the entire nation.