Physician Assisted Suicide

Physician Assisted Suicide (PAS) has long been an issue of intensive debate. Given a broad range of involved stakeholders – including, but not limited to, patients, physicians, families, nurses and courts – PAS has often been discussed in a multitude of perspectives, mainly ethical, medical and legal. Further, surveys and comparative studies show nonconsensual applications across practices and boundaries. This paper, accordingly, aims to problematize PAS as ethically demoralizing, medically inappropriate and legally indefinite.

Against a broad definition of PAS as a practice which ranges between euthanasia and withdrawal of life-sustaining treatment, ethicality of PAS practices has long been in question. Given patient differential attitudes towards PAS and palliative options, ethicality has been a major factor in PAS decision-making. Moreover, actual application of PAS laws in specific constituencies has only highlighted concerns of weighing options and reasons in PAS decision-making – hence much exacerbating ethicality of PAS, particularly so when family members are central to decision-making process. Medically, physicians are hard-pressed between inadequate care skills for dying patients, shifting care strategy from treatment to PAS and double effect principle and, not least, better physician-patient communication as regards death institutionalization. Additionally, PAS stakeholders – essentially, families and courts – further problematize physicians' capacity for a well-balanced decision accounting for patient's need for pain relief and legal considerations of PAS decisions. Consequently, PAS decision-making becomes a complex process whereby physicians are no longer bound by sheer medical reasons for PAS but also must factor in a complex set of variables all contributing to final decision-making.

Legally, PAS is, at best, divisive. Although, PAS is legal in few US constituencies, PAS legality is even more controversial when compared to cross-border constituencies. Patient attitude – a compelling factor in PAS decision-making – further complicates PAS legal considerations. Ostensibly, legalization is not enough for final decision making given different attitudes patients adopt on PAS. In constituencies where PAS is legalized, patients' attitudes based on medical (pain), human rights (freedom of choice), religious and moral factors seem central to final decision, notwithstanding legality status. Hence, PAS legal status – practically applied or not – in some constituencies does not guarantee consensus among stakeholders on whether palliative care methods should be pursued or not as opposed to PAS decisions.

In conclusion, Physician Assisted Suicide remains a highly problematic issue ethically, medically and legally. Due to a multitude of compelling factors and a broad range of stakeholders, PAS requires frequent reviews by highly representative panels in order to particularize, manage post-PAS and elaborate future decisions.