Reasons for Requesting Physician-Assisted Suicide

Essentially, physician-assisted suicide (PAS) is when a doctor provides a patient with a prescription for medication (often an oral barbiturate, which is a sedative) and gives information on what a lethal dose would be with the understanding that the patient possibly intends to use those pills to end their life.

By learning about the motivations or the reasons behind why a person may seek out assistance with dying, you can hopefully get a better sense of the tremendous emotional, ethical, moral, and legal issues surrounding this deeply controversial practice.

Doctor holding patient's hand in hospital
Ariel Skelley / Getty Images

Why Some Choose Physician-Assisted Suicide

Opting for physician-assisted suicide is not something that most take lightly or decide on quickly, and the why behind such a decision is highly personal.

According to a Canadian study of 112 patients who received medical assistance in dying, the main reasons people requested it included:

  • Loss of control and independence
  • Loss of ability to participate in enjoyable and meaningful activities
  • Illness-related suffering (for example, pain or nausea)
  • Fear of future suffering

Most of the patients in this study were suffering from cancer, a neurological disease, or end-organ failure. Interestingly, their number one and two reasons for wanting physician-assisted suicide varied somewhat by what illness they had.

For instance, "illness-related suffering" was given as the most important reason for over 70% of patients with cancer, but only 28% of those with neurological diseases. On the other hand, more than half of all the patients (regardless of their diagnosis) reported a "loss of control and independence" as a primary reason.

Based on additional research, other possible reasons for requesting physician assistance with dying include:

  • Loss of sense of purpose
  • Unacceptable quality of life and/or inability to enjoy life
  • Loss of physical ability (for example, walking, or speaking)
  • Hopeless suffering and prospect of recovery

Loss of Autonomy at the End of Life

Overall, loss of personal autonomy seems to be a driving force for why a person may desire or choose physician-assisted suicide.

A person may feel like their life is out of their control—oftentimes, they cannot take care of themselves (e.g., bathing, getting dressed, or even eating) and/or cannot engage in meaningful activities (e.g., visiting with their grandkids or enjoying hobbies).

They may feel trapped in their bodies, unable to ease physical, emotional, and/or mental suffering.

Physician-assisted suicide may feel like a way for a person to regain some control. If a person cannot control the illness, they can at least control how they die.

That said, physician-assisted suicide still remains an incredibly disputed practice—one that many physicians, especially in the United States, believe goes against their oath.

Considerations

Stepping back a bit, it's important to consider the emotional magnitude and gravity of an inquiry about or request to receive assistance with dying. There are also family, legal, and moral/ethical issues to consider.

Legal Issues

First off, regardless of a person's desire to undergo assistance with dying, PAS is only currently legal in the following U.S. states:

  • California
  • Colorado
  • District of Columbia
  • Hawaii
  • Maine
  • Montana
  • New Jersey
  • Oregon
  • Vermont
  • Washington

In addition, each state has slightly different, evolving protocols and requirements for moving forward with PAS.

For example, according to the Death with Dignity Act of Oregon, only a terminally ill person who is at least 18 years of age and resides in Oregon can request physician-assisted suicide.

Terminal illness is an illness that will lead to death within six months. This is determined in Oregon by a prescribing and a consulting physician.

To give you a sense of the firm legal aspects that must be addressed to pursue PAS, here are a few more of the qualifications required by Oregon's Death with Dignity Act (this is not an exhaustive list):

  • The patient must be capable of making healthcare decisions for themselves, as determined by both the prescribing and consulting physician.
  • The patient must make two verbal requests to their prescribing physician separated by at least 15 days. (Exception: If the patient's life expectancy is less than that.)
  • The patient needs to also make a written request, and this written request must be signed in the presence of two witnesses, one of which cannot be related to the patient.

Internationally, physician-assisted suicide is available in:

  • Australia (Victoria and Western Australia)
  • Austria
  • Belgium
  • Canada
  • Columbia
  • Finland
  • Germany
  • India
  • Luxemburg
  • Netherlands
  • Switzerland

Emotional Issues

If you are a patient desiring assistance with dying—even if the thought is simply crossing your mind—it's OK and sensible to reach out to a therapist, social worker, or spiritual counselor who has experience working with people near the end of their life.

These types of experienced professionals are part of most hospice programs. They can shed light on the dying process and how this can be approached in a natural yet dignified, compassionate, and comforting manner.

They can also help you navigate any conflicting feels you may have and assist in weighing how your emotional state is factoring into your decision making.

Family Issues

A person's decision to request PAS will undoubtedly affect their loved ones. This is why doctors often try to encourage meetings with close family members and caregivers (if the patient allows).

These meetings can sometimes help bring to fruition therapies, besides PAS, that can ease a patient's suffering. In some instances, the primary reason behind desiring PAS can be articulated, worked through, and resolved. For example, some patients may consider PAS because they feel like a burden to others.

While a family member does not have the legal power to deny their loved one's request for PAS, in some states (e.g., Oregon), physicians may be obligated to request—although not require—that patients notify their next-of-kin of their decision.

Moral/Ethical Issues

Even if a patient requests physician-assisted suicide and they meet the legal criteria, their physician may not oblige.

A physician does not have to provide PAS just because it is legal in the state where they practice medicine. They may believe that engaging in such an act would do more harm than good, or that such an act is incongruous to their primary role as a healer.

Is It Right For You?

This is a personal decision. From your doctor's perspective, however, even if they are OK with providing PAS, they may not believe it is the best option for you from a clinical standpoint.

For example, perhaps your doctor believes depression is clouding your judgment (they may request a psychological evaluation), or that your symptoms are not being adequately managed (and that if they were, you would not request assistance with dying).

When discussing the matter, most physicians want to dive deep into their patients' concerns and reasons behind inquiring about or requesting PAS in the first place.

In doing so, the physician can get to the bottom of their patient's suffering. They may end up recommending one or more of the following forms of care as an alternative:

  • More aggressive palliative or hospice care
  • Psychological care and support
  • Improved symptom management
  • Withdrawal of life-sustaining therapies (e.g., stopping dialysis or medications)

If a doctor refuses PAS, they may refer a patient to another physician who provides PAS or to a resource that can further help with this request, though they are not required to do so.

A Word From Verywell

Death is a natural part of life's journey, but the path to get there can be full of physical and emotional suffering and anguish. Whether or not physician-assisted suicide becomes a more common practice in the United States remains unknown. Regardless, remaining compassionate for those who are dying and upholding their dignity to the end continue to be paramount goals for the healthcare community.

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Article Sources
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  3. Nuhn A, Holmes S, Kelly M, Just A, Shaw J, Wiebe E. Experiences and perspectives of people who pursued medical assistance in dying. Can Fam Physician. 2018 Sep;64(9):e380-86.

  4. Georges JJ, Onwuteaka-Philipsen BD, Muller MT, Van Der Wal G, Van Der Heide A, Van Der Maas PJ. Relatives’ perspective on the terminally ill patients who died after euthanasia or physician-assisted suicide: a retrospective cross-sectional interview study in the Netherlands. Death Stud. 2007;31(1):1–15.

  5. Quill TE, Battin MP. Physician-assisted dying: Understanding, evaluating, and responding to requests for medical aid in dying. In: UpToDate, Arnold, RM, (Ed), UpToDate, Waltham, MA, 2014.

  6. Oregon Health Authority. Oregon's Death With Dignity Act.

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