Reasons for Requesting Physician-Assisted Suicide

Doctor holding patient's hand in hospital
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According to the American Medical Association, physician-assisted suicide (PAS), "occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act."

Basically, PAS means that 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.

The Choice of 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, "fear of future suffering" was given as the most important reason for over 70% of the patients with cancer, but only 28% of those with neurological diseases.

On the other hand, nearly half of all the patients (regardless of what their underlying illness was) 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 roles as healers.

Before Moving Forward With Physician-Assisted Suicide

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

Emotional Issues

If you are a patient or the loved one of someone who is desiring assistance with dying (or 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.

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 (a patient may feel like a burden to others) can be articulated, worked through, and resolved.

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.

Legal Issues

Regardless of a person's desire to undergo assistance with dying, PAS is only currently legal in the following states and countries

  • California, Colorado, Montana, Oregon, Vermont, Washington, and the District of Columbia
  • Netherlands
  • Belgium
  • Luxemburg
  • Switzerland
  • Columbia
  • Canada
  • Part of Germany (seven of 17 states)

In addition, within the U.S., each state has slightly different protocols and requirements (that continue to evolve) 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.

While not an exhaustive list (but 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:

  • 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 fifteen days (an exception is if the patient's life expectancy is less than 15 days).
  • 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.

Moral/Ethical Issues

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

A physician does not have to provide PAS just because it is legal in the state where they practice medicine.

A physician 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.

Moreover, even if your physician is morally and ethically OK with providing PAS, he may not believe it is the right decision for you.

Perhaps, he believes depression is clouding your judgment (he 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).

In some cases, a physician (while not legally obligated) may refer a patient to another physician who provides PAS, or to a resource that can further help with this request.

Even if your doctor refuses PAS, rest assured—your doctor can still help you. In fact, their ability to provide you with comfort, regardless of whether your illness is curable or not, is their primary role and mission.

When talking with their patients, most physicians will want to dive deep into their patient's concerns and reasons behind even inquiring or desiring about PAS in the first place.

This way, the physician can get to the bottom of their patient's suffering and address it with one or more of the following forms of care:

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

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

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Medical Association. (n.d.) Ethics: Physician-Assisted Suicide

  2. 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.

  3. 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.

  4. 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.

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

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