Physician-assisted suicide: killing or compassion?

An aging baby boomer generation is bringing the topic of physician-assisted suicide (PAS) to the forefront of the end-of-life care debate.

Some baby boomers with ailing health and advocacy groups like Compassion and Choices are starting to turn the national attitude of doctor-assisted suicide from killing to compassion.

Proponents say that individuals deserve the right to end their lives on their own terms, without pain and suffering.

In addition, terminally ill patients may not want to prolong the inevitable, pay exorbitant medical bills or be a burden to family members.

It's a controversial topic, one that's drawing a lot of legal and ethical debate.

Bills legalizing the practice are currently being considered in Connecticut, Vermont, New Jersey, Kansas, Hawaii and Massachusetts. And bills related to the issue are under consideration in New Hampshire, New York, Arizona and Montana, according to an Associated Press report.

Where it's legal

Doctor-assisted suicide is currently legal in Oregon, Washington and Montana.

Oregon was the first to pass the Death with Dignity Act in 1997. Washington followed suit, passing the Death with Dignity Act in 2008, and Montana passed the Rights of Terminally Ill Act in 2009.

"It's important to recognize that we're not talking about legalizing all of assisted-suicide," says Rita Marker, attorney and executive director of the Patients Rights Council.

"The laws in Oregon and Washington transformed the crime of assisted suicide into the legal medical treatment of doctor-prescribed suicide," says Marker.

That's currently the discussion going on in states considering this measure, she adds.  

How the procedure works

In physician-assisted suicide, doctors provide terminally ill adult patients with the means to end their own life -- a prescription for a lethal dose of oral barbiturates.

But there are certain criteria that must be met first.

For example, to participate in Oregon, an individual must be:

• 18 years of age or older
• A resident of Oregon
• Capable of making and communicating health care decisions for him/herself
• Diagnosed with a terminal illness with only 6 months to live

The attending physician decides if the criteria have been met, but further requirements are then necessary.

Some of those include:

• Two oral requests by the patient, at least 15 days apart
• A written request by the patient signed by two witnesses
• Confirmation of diagnosis and prognosis by the attending doctor and a consulting physician
• The attending and consulting physician must determine whether the patient is capable of making health care decisions for him/herself
• Patient must be informed of feasible alternatives
• Attending physician must request the patient to notify their next-of-kin of the prescription request
• Physicians must report all prescriptions for lethal medications to the Oregon Health Authority, Vital Records

Controversy over the laws

Some of the controversy over physician-assisted suicide comes from the procedures and guidelines.

For example, while Oregon's reports indicate that PAS is working well, data for those reports is based on self-reporting by doctors who prescribe lethal medication.

Marker asks, "Do you really think that the doctors who prescribe are going to say that they didn't follow the guidelines?"

Tracking prescriptions and the abuse of them also proves to be difficult, because doctors are generally not present during the procedure, notes Marker.

"The safeguards end the minute the prescription is written," she says.

Aside from the legal issues, religious beliefs also play a big part in opposition. Many groups oppose physician-assisted suicide because it's against their religion.

"This is not for everybody. We do realize there are people that do not believe in this for religious beliefs, and I respect that. There are no issues over that," said Dr. Gary Blick, a Norwalk physician who specializes in treatment of patients with HIV and Aids in an AP report. "But there are those subsets of people that do not want to go through the suffering that they have to go through."

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