Psychology Degree Guide: Physician-Assisted Suicide
Assisted suicide is the term for when a person helps another person to end his or her life. This may include providing drugs or medical equipment, but it can extend to a wide variety of actions that contribute to causing a death. Assisted suicide is a matter of great controversy involving the fields of medical ethics, law, philosophy, public policy and psychology.
The debate over an individual’s “right to death” has been ongoing for the past several decades, and has resulted in new legislation in several states. In some, assisted suicide is legal, though in many it is illegal or is tightly regulated on a case-by-case basis. In many cases where the laws are not clear, physicians who assist patients with suicide have been charged with manslaughter and sentenced to years in jail.
This resource is meant to provide teachers, students and interested parties with valuable information on physician-assisted suicide. In an ongoing effort to provide the best resources on psychology, compiled below are lists of useful links on the subject.
There is a long and complex legal history of assisted suicide debate and legislation, beginning at the start of the 20th century. In 1906 the first euthanasia bill was drafted in Ohio. Though it did not succeed, it brought the debate into the popular culture and eventually led to the establishment of the first euthanasia society in London in 1935. In 1938 Rev. Charles Potter established The Euthanasia Society of America in New York. While there was much discussion in the intervening years (Glanville Williams’ book The Sanctity of Life and the Criminal Law; Lael Wertenbaker’s Death of a Man in which she detailed her actions to help her husband end his life; and the first living will written by Louis Kutner in 1967) the first legislation on the matter was not proposed until Dr. Walter W. Sackett’s right-to-die bill, introduced to the Florida legislature. It was not successful.
In 1976 Karen Ann Quinlan’s parents disconnected her respirator—it was her wish for them to do so. Though Quinlan lived for another eight years, hers became a landmark case in the right-to-die controversy. That same year the California Natural Death Act was passed, giving legal clout to living wills and protecting doctors against law suits for “failing to treat incurable diseases.” This was followed by the passage of natural death laws in ten more states.
The following years saw an explosion of artistic projects aimed at exploring the right to die. These included: Commonsense Suicide by Doris Portwood; Whose Life is it Anyway? A play about a quadriplegic artist who wants to die; Artist Jo Roman’s public suicide after being diagnosed with terminal cancer; and Hemlock’s how-to guide Let me Die Before I Wake.
It wasn’t until Dr. Jack Kevorkian’s highly publicized assisted suicide of Janet Adkins and subsequent fight with the Michigan legislature to continue to euthanize his terminally ill patients that the issue became consistent headline news in the United States.
The ongoing debate raises many questions about the sanctity of life and free will. It is impossible to discuss assisted suicide without mentioning the Catholic Church, a particularly vocal organization on the issue. In Catholicism, suicide is a sin. As such, many Catholics are unilaterally against assisted suicide. However, in 1957 the pope did issue a doctrine “distinguishing ordinary from extraordinary means for sustaining life.” This still does not allow a patient to choose to die in a number of other circumstances (a short life expectancy or extreme pain, for example) but it does permit patients to choose whether or not to allow their doctors to use extreme lifesaving measures like respirators or invasive emergency surgeries.
From 1990 to 2011, a series of court cases have shaped legislation though issues like government-funded health care have complicated rulings. Today organizations like Compassion in Dying in Washington state, The Oregon Right to Die and the Death With Dignity Center in California have been instrumental in shaping legislation in those states, where assisted suicide is legal.
- Death With Dignity offers a comprehensive time line of assisted suicide legislation, important landmarks in the history and details about the court decisions.
- Religious Tolerance offers a history of the debate, though it does have a religious bias which should be kept in mind while reading.
- Time Magazine offers a brief history of assisted suicide with information on important legislation, publications and public figures involved in the debate.
- Northwestern University provides an introduction to assisted suicide with details of the history of the debate, legislation and the consequences for families.
Current status of Assisted Suicide Around the World
Assisted suicide is legal in Belgium, Luxembourg, the Netherlands, Switzerland and three American states: Oregon, Montana and Washington. In the American states in which assisted suicide is legal, many limitations apply.
- Assisted Suicide offers a resource on assisted suicide laws around the world. From the website, “Assisted suicide laws around the world are clear in some nations but unclear – if they exist at all – in others.”
- Wikipedia offers a complete guide to worldwide legislation of assisted suicide alongside resources for further reading.
- Euthanasia offers information on assisted suicide laws state-by-state.
From the World Right-to-Die Newsletter: “A great many people instinctively feel that suicide and assisted suicide are such individual acts of freedom and free will that they assume there are no legal prohibitions. This fallacy has brought many people into trouble with the law. While suicide is no longer a crime – and where it is because of a failure to update the law it is not enforced – assistance remains a crime almost everywhere by some statute or other.”
Generally, people who are “suicidal” are thought to be mentally ill and unable to make life or death decisions rationally. In the case of assisted suicide, patients are not mentally ill. Still much of the debate centers on whether or not they are capable of making the decision to end their own lives considering the emotional burden of extreme illness and pain.
Supporters of the right-to-die believe every individual has sovereignty over his or her life and should be able to make the decision about when that life ends. “The right of free choice includes the right to end one’s life when we choose.” Many ill people are unable to end their own lives in a dignified manner and so, they ask for help. Supporters believe this desire should be respected and honored. They also believe it is a human responsibility to relieve the suffering of others when asked. Supporters believe it is cruel and inhumane to ignore pleas for help from people who are suffering and looking forward to months or years of continued suffering. When medical science can do nothing to help these people, medical science should help them end their lives.
Opponents of the right-to-die believe that it is the job of the law to protect people from danger, and to protect the lives of innocent people. They argue that assisted suicide is a slippery slope and that, if we are willing to assist in the death of one patient, what will stop us from assisting or even urging death upon a slightly less eager patient who is also suffering. They ask what will happen to those who change their minds after giving consent. They ask where we draw the line of value—whose life is worth saving and whose is not? They also wonder how competence is determined—is a senile woman permitted to end her life even if she is clearly impaired? What about a handicapped child?
- Derek Humphry’s Liberty and Death: A Manifesto Concerning an Individual’s Right to Choose proclaims “that every competent adult has the incontestable right to humankind’s ultimate civil and personal liberty – the right to die in a manner and at a time of their own choosing.”
- An essay by Claire Andre and Manuel Velasquez from Santa Clara University explores the philosophical debate surrounding assisted suicide.
- The Guardian offers a section on assisted suicide with many articles, personal essays, videos and statistics about the ongoing debate.
- Ira Byock’s article, “The Assisted-Suicide Debate” asserts that the legalization of assisted-suicide would not “address the major problems that exist in caring for the dying.”
- MSNBC reports on the assisted-suicide debate in the article, “Assisted-Suicide Debate has Passed Dr. Death By.” The article examines the ongoing debate and the role of Dr. Kevorkian in stoking the fires of controversy.
- A CBS/New York Times Poll found that Americans are split nearly evenly on the assisted-suicide debate. This is a video resource.
The Psychology of the Right to Die
In 1998 the American Psychological Association appointed a subcommittee under the APA Board for the Advancement of Psychology in the Public Interest (BAPPI) to evaluate the psychological aspects of the right-to-die debate. The subcommittee’s report acknowledges the complex nature of the debate, the gray area “end of life” necessarily includes and the added complications in cases of underage terminally ill patients or patients with mental illness. The conclusion of the report was as follows:
“Sweeping advances in public health, biomedical sciences, and clinical medicine over the course of the twentieth century have dramatically altered the ways in which people die in the United States. During the last 100 years there have been changes in longevity as well as in patterns, causes, and places of death. In some respects these changes “have made living easier and dying harder” (Field & Cassel, 1997, p. 14). More effective treatments may significantly extend life but may also confront dying individuals, their families, and health care providers with a prolonged period of dying that involves complex choices about end-of life care. These changes have resulted in the need to address end-of-life decision-making from many perspectives including medical, legal, ethical, moral, spiritual, economic, and psychosocial dimensions. There is likely to be an increasingly sophisticated demand for psychosocial services in dealing with end-of-life decisions. Furthermore, the specific issue of assisted suicide promises to become one of the most contentious and difficult social issues of our time.”
The common end-of-life challenges the report focused on were: End-of-Life Tasks and Decisions; Futility (medical intervention prolongs suffering without offering a cure or beneficial treatment); Advance Care Directives (the preparation of a living will, which few people do before they are faced with end-of-life decisions); Terminology, Definitions and Other Barriers to Communication (recognizing the cultural avoidance of discussing dying and death before it becomes imminent, and the complexity of medical terminology that makes it difficult to thoroughly inform patients about end-of-life decisions); The Term “Hastened Death” (the ways in which terminology colors the debate and implies advance agency on the part of the physician); The Term Assisted Suicide (another misnomer that is a barrier to communication—suicide is, by definition, self-inflicted, and word choices have significant psychological consequences on people making difficult decisions.); Issues of Access and Variability in Health Care at the End of Life (the disparity in care between people of different socio-economic groups); and Diversity Issues in End-of-Life Decision-Making (cultural differences that complicate communication and decision-making).
This report and psychology articles on the subject point to the importance of psychological counseling and education at the end-of-life. However, this type of counseling is a unique field, differing significantly from everyday psychotherapy. Psychologists can also serve as advocates, arbitrating between doctors and patients and between patients and their families.
- The APA offers a full-text version of this report.
- Peter Cave’s article, “Assisted Suicide and Euthanasia” in Psychology Today investigates the arbitrariness of arguments against voluntary euthanasia, comparing them to other voluntary rights.
- Elana Premack Sandler’s article, “Promoting Hope, Preventing Suicide” argues that assisted suicide undermines attempts at preventing suicide in non terminally ill people.
- An article from the journal, Suicide and Life Threatening Behavior entitled, “Physician-Assisted Suicide: A Mental Health Perspective,” examines the right-to-die from the perspective of psychiatry, calling for a more active role in the debate.
- A study from the Memorial Sloan-Kettering Cancer Center entitled, “The Euthanasia and Physician-Assisted Suicide Debate: Issues for Nursing,” investigates the role of nursing in end-of-life issues as they pertain to cancer patients.
- Northwestern University offers a six-step protocol for evaluating requests for assisted-suicide.