End-of-Life Issues

Many individuals are uncomfortable thinking or talking about their impending death, especially when they are suffering from terminal illnesses, such as liver cirrhosis. However, it is necessary to talk in advance with the loved ones and health care providers about the end-of-life arrangements in order to lessen fears. The end-of-life arrangements will help the loved ones and health care providers to handle matters in the most favorable manner. Health care providers should consider ethics when dealing with end-of-life issues, such as euthanasia and physician-assisted suicide. In some cases, health care providers help deal with the suffering of their terminally-ill patients in an unethical manner. For instance, health care providers may employ euthanasia or physician-assisted suicide with the aim of ending the suffering of a terminally-ill patient. This paper will consider both the positive aspects and negative aspects of physician-assisted suicide as one of the end-of-life issues. 

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Physician-assisted suicide (PAS) refers to the voluntary termination of a patient’s life through the administration of lethal substances with the indirect or direct assistance of physicians. It is evident that the physician does not allow the patient to die from the underlying terminal illness but as a result of the lethal injection. In some cases, such as euthanasia, physicians allow the terminally-ill patients to die from the underlying terminal illnesses by withholding the life-support measures, or administration of narcotic painkillers in terminal cancer with the aim of hastening death indirectly. The use of PAS or euthanasia requires physicians to consider the benefits and consequences. In addition, physicians should abide by the codes of ethics that govern their medical and nursing profession. Physicians should weigh the benefits against the consequences before making the final decision on whether or not to assist in terminating the patient’s life. Studies have shown that PAS has both positive aspects and negative aspects. 

Positive Aspects of Physician-Assisted Suicide

The proponents of PAS consider that realizing autonomy, reducing suffering and pain, and providing psychological reassurance to the terminally-ill patients as the main benefits of legalizing physician-assisted suicide. In addition, individuals support legalization of PAS because they link to reducing the cost of treating terminal illnesses. Autonomy has been an essential value that Americans cannot dismiss. It has been controversial whether legalizing PAS is a requirement to realizing autonomy among the terminally-ill patients. The patients suffering from terminal illnesses, such as cancer, should have the right to decide how and when they would like to die peacefully. However, studies have suggested that most individuals do not consider securing individual autonomy an adequate justification for making PAS a legal alternative. Intentional ending of a terminally-ill patient’s life requires the participation of another person and requires giving the other person, especially a physician, enough reasons to participate in assisted suicide. Without sufficient reasons beyond personal life plans or preference, people would not allow PAS to take place. Proponents of PAS argue that a physician can provide a terminally-ill patient with the service of assisted suicide if the patient initiates and repeatedly requests PAS. Terminally-ill patients have the right to request for PAS it is the best alternative available for relieving the uncontrolled physical suffering or unremitting pain. It is apparent that relieving uncontrolled physical suffering and unceasing pain is a sufficient justification for PAS. 

Suffering and pain are different but related words that describe the emotional distress and physical pain a victim ensures due to injury or chronic illness. In the medical field, experts have come up with standardized measures that physicians use to assess pain, as well as determine the extent of pain that a patient is experiencing. Understanding of pain has led to the invention of codified interventions for alleviating pain. The modern medical technology has achieved significant feats in sustaining the lives of individuals who have complications, such as difficulty breathing, brain injury, heart disease, and other fatal complications. For instance, respirators can help support a patient’s malfunctioning respiratory system, and medicines can help sustain the physiological processes of the patient. It is evident that medical technology is a significant gift to mankind for the patients with a realistic chance to survive an accident or illness. However, for the terminally ill patients, advanced medical technology is just a way of prolonging suffering. 

The primary aim of medicine is to relieve the suffering that patients undergo due to the action of disease causing organisms. It is a contradiction that the advanced medical technology gives the terminally ill patients more pain and suffering until their last days on Earth. In the past, some terminally ill patients have requested their doctors for lethal drugs with the aim of doing away with pain and suffering forever. For instance, as Ronald Dworkin narrates, Lillian Boyes, who was experiencing severe rheumatoid arthritis, requested her doctor for a PAS since she could not stand the pain any longer. In some cases, the pain medications fail to alleviate the terminally-ill patient’s pain which leads to suffering. Therefore, terminally-ill patients should rightfully request for PAS since it is the only alternative available for ending end the persistent pain due to the terminal illness. Competent terminally-ill patients should have the option of PAS since it is in the best interest of the patients. 

Studies show that many people associate the PAS or euthanasia with reducing the cost of treating terminal illnesses. People perceive that the United States has been spending an excessive amount of money on the advanced health care technology for the terminally-ill patients. Many commentators have noted that about 27 percent of the Medicare budget goes to the medical and nursing expenditures on the 5 percent of the Medicare terminally-ill patients who die every year. The commentators have also observed that the medical and nursing expenditures increase on an exponential basis as death approaches. The last month of the terminally-ill patient’s life accounts for about 30 percent of the medical and nursing expenditures in the patient’s last year of life. Therefore, savings from the reduced use of costly technological interventions during a terminally-ill patient’s last days are both desirable and necessary to many.

Proponents of PAS have continued to link legalization of PAS with the effort to cut down the high financial cost of death. Managed care or managed death with the use of PAS can be extremely less expensive than extended survival and fee-for-service care. Some of the legal briefs presented to the Supreme Court showed the same logic of the significance of PAS in reducing the cost of medication and nursing on the terminally-ill patients. Decreasing availability of free hospital beds, as well as increasing expenditure on the terminally-ill patients’ health care may intensify the pressure to opt for PAS.  The cost effectiveness of ending the lives of the terminally ill patients is extremely recommendable. The earlier the death of a terminally-ill patient, the less costly is the medical and nursing care. It is surprising that the Supreme Court recognizes the importance of cost-saving motives that influence legalization and utilization of PAS. The Supreme Court speculates that legalization of PAS may allow many people to relieve their families of the substantial financial resources, which could cater for the end-of-life health care costs.

Negative Aspects of Physician-Assisted Suicide

Legalization of physician-assisted suicide can lead to potential harms, which include undermining the medical profession’s integrity; creation of psychological distress and anxiety in the terminally ill patients; coercion of patients to use physician-assisted suicide; provision of PAS to terminally-ill patients prior to implementation of optimal palliative care interventions; provision of PAS to terminally ill patients without full informed consent due to mental illness; psychological harm and distress to immediate family members; and ending of sacred life.

Whether PAS or euthanasia harms the noble medical profession has been an interpretive issue that depends upon various factors, including the profession’s social role, which varies over time. In particular, ethical issue of PAS or euthanasia is not only whether assistance in suicide and suicide can be morally justified, but it is morally significant to determine whether it can be allowable for physicians to assist in ending the life of a terminally ill patient. Studies have indicated that while in most cases medical practitioners do not regret participating in PAS or euthanasia, a significant minority of physicians regret and are not ready to participate again. Performing PAS or euthanasia can negatively affect a physician and lead to a significant change in normal practice patterns. In an adequate ethical accounting of PAS, appeal to Medicine’s internal morality, as well as the virtue of professional integrity should supplement appeal to the virtues, rules, and principles of common morality. Professional integrity in the field of medicine requires that the physician should observe the virtues, norms, and values that are characteristic and distinctive of physicians. The virtues, norms, and values require the physicians to work toward ensuring their patients gain stable conditions. Assisting terminally ill patients to die violates the virtues, norms, and values of the medical field.  

Physician-assisted suicide or euthanasia can create psychological distress and anxiety in terminally ill patients. PAS will not only lead to the corruption of medical professionals but also affect the terminally-ill patients since it threatens to basically distort the physician-patient relationship, significantly reducing patients’ trust of physicians and the physicians’ undivided commitment to the provision of effective medical services. Studies show that PAS can disrupt the trust that should sustain the physician-patient relationship thereby generating psychological distress. The patients may not consider physicians as the individuals committed toward saving the lives of other people, but as individuals who can easily give up in the cases when complications arise. Legalization of PAS can have a significant impact on the behaviors of medical professionals. It is necessary to understand that a law can shape culture, which in turn can shape people’s beliefs and behaviors. Therefore, the laws governing the medical profession can shape the behavior of medical professionals and hence shape the physician-patient relationship. 

Another negative aspect of PAS is the coercion of terminally-ill patients by the family members or health insurance companies to request for assisted suicide as a result of either care giving or financial burdens. However, the literature concerning the coercion of terminally-ill patients to request PAS is insufficient.  Studies show that many terminally ill patients requesting PAS do so because of the coercion or pressure they experience from family members and health insurance companies. Most of the terminally ill patients believe that they have become a burden to their families because the financial resources and efforts the family members commit to the medical and nursing care. Some anecdotes have revealed the coercive pressures, including the DeLury case in which a husband pressured his wife to voluntarily end her life because she suffered from multiple sclerosis, which was a terminal disease. According to the husband’s diaries, the reason for coercing his wife to seek PAS was to do away with the care giving burden and financial pressures. 

In 2010, about one-fourth of terminally ill patients died after consuming excess medicine in Washington and Oregon because they wanted to remove the nursing and financial burden on the family members. The cases raised a concern that the family members coerced the patients to seek for assisted suicide. The Death with Dignity Act in Oregon has provided an instance of the embedment of coercion in the state law. It is apparent from the Act that two witnesses are necessary during the request for PAS. The two witnesses include a family member and a friend to the family member. Terminally-ill patients can also encounter coercion from healthcare payers, including health insurance companies who fund the PAS, but not the palliative care or treatment of disease. Coercion poses a great threat to vulnerable individuals who may lack adequate access to nursing and medical care. Lack of alternatives may pressure terminally-ill patients into seeking for PAS. In 2008, the Oregon state health plan denied Barbara Wagner coverage for medication for treating her cancer and extending her life. However, the state health plan was ready to finance the cost-effective option of PAS.      

Another negative aspect of legalizing PAS is the provision of assisted suicide to terminally ill patients prior to implementation of optimal palliative care interventions. Properly utilized assisted suicide are the last ditch interventions, which can be justified upon attempting appropriate palliative options. In the Netherlands, medical professionals have reported that in about 9 percent of PAS cases that take place in nursing homes, professionals did not utilize some palliative measures prior to terminating the life of a terminally ill patient. Studies show that most of the patients who seek assisted suicide do so as a result of the unbearable pain because the nursing professionals use mild painkillers, such as narcotics. Some of the terminally ill patient’s significant deterioration of health within a short time because do not receive all optimal care, including hospice care and psychiatric treatment. Most of the terminally-ill patients who acquire PAS or euthanasia do not undergo diagnosis for depression, as well as do not receive proper treatment for pain alleviation. Lack of enough palliative care services for the alleviation of psychological symptoms influence terminally-ill patients to request for PAS. Many studies in the United States and Netherlands show that many terminally-ill patients receive PAS before receiving the necessary palliative interventions. 

Another negative aspect of legalizing PAS is the tendency of premature assisted suicide when the terminally-ill patient cannot be able to give informed consent as a result of mental illness. In the Netherlands, studies show that about 20 percent of terminally-ill patients receiving assisted suicide are mentally incompetent to give informed consent about the desire to end their lives. In only about 50 percent of the cases, the patients expressed an interest in receiving assisted suicide. Recent studies in the United States have revealed that a significant proportion of PAS cases involve mentally incompetent terminally-ill patients. National surveys of physicians have shown that in about 5 percent of cases of PAS, the terminally ill patients are mentally confused about 60 percent of the time they receive the assisted suicide interventions. Studies have also revealed that about 6 percent of cases involve terminally-ill patients who are unconscious when giving consent. In some cases, professionals end the lives of the mentally-competent terminally-ill patients without allowing them to give consent. It is necessary to involve the terminally ill patients in the decision-making process concerning their end of life care. Ending the lives of the unconscious or mentally incompetent terminally ill patients without their consent will be immoral and unethical. 

The consequences of assisted suicide or euthanasia can also go beyond the terminally-ill patients and include the family members and friends who will stay with the memories of the inhumane even. Studies have shown negative long-term effects of PAS and euthanasia on the deceased individuals’ family members and friends. The family members will experience psychological harm and distress as their terminally-ill family member despairs and accepts to die. The terminally-ill patient says goodbye to the remaining family members by accepting to receive the assisted suicide intervention. However, the family members will also suffer psychologically when they see one of them suffering from terminal illness. Both terminal illness and physician-assisted suicide or euthanasia can lead to psychological harm and distress among the other family members. 

Finally, the physician-assisted suicide is again God’s will because life is sacred and no person has the authority to end it apart from Himself. Christian commits sin when they opt for PAS as a way to relieve the terminally ill patient’s pain and suffering due to the terminal illness. It is the belief of Christians that a person will live another life after death. The other life can either be in Hell or Heaven. Individuals who die unholy will go to Hell where they will experience eternal suffering while those who die holy will enjoy forever in Heaven. The use of PAS as a way of ending life is sinful and will not allow a Christian to be holy. Therefore, a Christian should continue depending on the palliative services with the aim of alleviating pain and suffering associated with terminal illnesses.                      

The Inequitable Distribution of the Harms and Benefits of Physician-Assisted Suicide

Research shows that the pressure to legalize PAS and euthanasia comes from the educated, politically vocal, and well-off individuals. Proponents of the legalization of PAS are nonreligious, financially well-off, and well-educated. These are the individuals occupying high positions of authority and are likely to stay away from the consequences of legalizing PAS or euthanasia. Studies show that the proponents of PAS have effective health insurance cover and supportive families, as well as enough social skills and knowledge that help them to get whatever they require from a bureaucratic health care system. Apparently, the harms of legalizing physician-assisted suicide fall on the vulnerable members of society. For instance, the financially less fortunate and powerless terminally ill patients are likely to experience coercion to seek PAS as a result of inadequate palliative care services. Studies show that the minority, including low-income individuals, African-Americans, and the elderly oppose legalization of PAS because they understand their interests, as well as the impact of PAS. 


In conclusion, the main benefit of the legalization of PAS or euthanasia is the improvement of the dying experience for the terminally ill patients suffering from unremitting pain. The increases in psychological distress and anxiety of other terminally ill patients have offset the benefit from the psychological reassurance of patients. The existing literature has revealed the estimate of the terminally ill individuals who have experienced coercion to request for the assisted suicide intervention. It has been evident from the recent literature that most of the terminally ill patients request for the assisted suicide interventions because they do not receive adequate palliative care. The inadequate palliative care does not alleviate the pain and suffering that the terminally ill patients undergo. Informed consent is a necessary factor that a physician should consider before making a decision to end the terminally ill patient’s life. The negative aspects of physician-assisted suicide outweigh its benefits, but the intervention has been necessary because some terminally ill patients are unable to stand the intense pain that results from the terminal illness.

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