On Tues. Nov. 8, voters in Colorado voted for Proposition 106: The End of Life Options Act by a 2-1 margin. This proposition allows terminally-ill patients with a prognosis of six months or less the right to request and self-administer medication to voluntarily end their life. Colorado is now one of six states in the Union that has legalized physician-assisted suicide.
While this is certainly a victory for the autonomy movement, the concept of physician-assisted suicide raises some serious questions among healthcare professionals and ethicists.
While many arguments against physician-assisted suicide are rooted in the idea that life is sacred, the logistics and medical ethics of this proposition are more concrete.
“There are a few concerns about the ethics of euthanasia broadly and the Colorado law specifically,” medical humanities professor Jane Hartsock said. “More broadly, in terms of euthanasia, some of the more compelling arguments that I’ve heard is that it significantly alters the nature of the physician-patient relationship. So if you think about the nature of the physician-patient relationship being rooted in the Hippocratic Oath, with the ‘do no harm’ concept, the idea that you are participating in killing someone or ending their life, questions ‘is this doing harm?’ It is incompatible with the goal to heal.”
“The other argument that is offered by both physicians, ethicists and attorneys is that physician-assisted suicide is risky because of the slippery slope argument,” Hartsock continued. “Not that any particular law as it exists is necessarily unethical, but it opens a kind of Pandora’s Box to things that are very unethical. You might think of the Oregon law as being a good example of a thoughtful transparent physician-assisted suicide structure. The definition of the law is very clear and transparent. All the lines are very neat and clean. The question is just whether you can take that law as a starting point and expand it into something that would not be ethically permissible.”
“The most compelling arguments to me are in fact not the sanctity of life arguments. Those arguments are hard to make and require you to have very abstract philosophical views that most people aren’t really willing to engage in. But I do think that when physicians say that these laws do materially change their professional identity, some deference should be given there.”
While only a little over 10 percent of states have physician-assisted suicide laws on the books, Hartsock believes it will eventually become a trend.
“The autonomy movement has been on the rise for some time now. Most people think of it kicking off with Roe. v. Wade, and autonomy matches well with our American ideals,” Hartsock argues. “Individualism and control over one's own fate are kind of American values. It is a trend, and that data suggests that there is a growth of support for it among citizens of the United States, even though there doesn’t seem to be a correlating growth of support among health care providers individually.”
The Colorado proposition has extensive regulations to ensure that the law is not taken advantage of. For example, the proposition takes mental illness and stability into consideration:
“If either a primary or consulting physician believes the individual is not mentally capable of making an informed decision about receiving the medication, that physician must refer the individual to a licensed psychiatrist or a licensed psychologist before the request process may proceed. This mental health professional must communicate his or her findings in writing to the referring physician. If a person is found to be mentally incompetent, he or she is no longer eligible for medical aid-in-dying.”
However, even with these safeguards in place, many ethicists are concerned about the aforementioned slippery slope that could be created as physician-assisted suicide picks up momentum in the United States.
“I’m aware of the concern that insurance companies would cover PAS but not cover long term care for people who are chronically ill or have a disability or disease that is deteriorating,” Hartsock said. “I can see it going both ways. I could see in a really jaded, cynical world people saying ‘well, why don’t they just perform PAS,’ but the other thing i can see happening with that is a really involved cultural conversation about the way that we view death.”
“That could be meaningful to us, because we have a cultural abhorrence of death. We try not to think about it much, we pretend it doesn’t exist and we are always surprised by it, yet it is the inevitable. It would be interesting to see whether we could have a conversation about how the way that people die is a very important to their sense of how they lived.”
In the future, we could see physician-assisted suicide become the norm. If that day comes, professor Hartsock predicts it will happen at a state level as opposed to a federal level.
“I could see it being regulated on a state level, because it has already been decided at a federal level that you don’t have the right to physician-assisted suicide. So, the autonomy movement met its head at that point. Secondly, the Presidential election that we just had signals that we will have a much more conservative court than we have had in years, probably more so than we’ve had in 50 years,” Hartsock continued. “And the consequences of the court tend to affect laws for quite some time. The decisions that come out of that court will likely be anti physician-assisted suicide, and will likely be very anti-autonomy for reasons that have to do with religious teachings.”
Whether or not the United States will see physician-assisted suicide become a common practice in the future is yet to be seen. However, activists for the autonomy and Death With Dignity movement will surely continue to fight for the rights of the terminally ill to have a say in their end of life care.