This often leads a large percentage of physicians to support religious beliefs during the last stages of life, so that the patient prepares and accepts what is coming. Patients, on the other hand view a "good death" differently, seeing it as a greater individual decision capability. Another study conducted here in the United States was Craig et al. (2009) the explored specifically the beliefs and opinions of physicians in Vermont. Here, about 38% believed that PAS should be legalized, a much higher percentage than national averages. According to the findings of this study, it was the main staple of autonomy that created a situation where physicians were willing to support the legalization of PAS practices. Thus, patient autonomy and individual choice still weigh heavily in terms of evaluating physicians opinions regarding the matter.
The ethics revolving around PAS are complicated. They focus on very different moral perspectives throughout modern medical history. Suicide itself was once an acceptable and honorable death in certain circumstances within Greek and Roman societies. It was essentially seen as the "preservation of one's honor," (Rubin 2009 p 771). However, this view of suicide has morphed into a deplorable concept in more modern Christian societies, where morality of honor was replaced with the concept that those who committed suicide are punishable by God (Rubin 2009). Religious affiliations have long impacted how people view death, and suicide as well. According to the research, "Different faiths have different perspectives on end-of-life care," (Curlin et al. 2008 p 114). Many of these religious affiliations see assisted suicide in an unethical light, because it essentially places the power over life and death within the hands of physicians and patients, and out of the hands of God or another deity. Most often, those who oppose assisted suicide practices are those with strong or conservative religious beliefs (Seale 2009).
Yet, there are those who see the lack of PAS practices as unethical as well. In this view, it is the individual choice which should be honored, therefore making the practice ethical in certain circumstances. Bans and a lack of support structure for PAS are essentially taking the autonomy out of crucial end-of-life decisions. Here, the research suggests that "The most commonly stated legal rationale for arguing that the Constitution protects people's ability to obtain assistance in ending their lives is the so-called right to die, which is grounded on either substantive due process or the right of privacy, the penumbra of the first eight amendments," (Rubin 2009 p 766). It is within this context that one can see the clear differences from euthanasia. Physician-assisted suicide relies on the choice of the individual which is the most important part of the situation. Essentially, it is "killing those who wish to die but cannot kill themselves," (Gorsuch 2009 p 6). Whereas, euthanasia tends to carry with it much less of the autonomous decision making that is associated with assisted suicide. The fact that the individuals themselves are making the decision is what is key here. Within this argument, it is acceptable for individuals to make such decisions regarding their own lives, and "this does not bother society," (Mitchell 2009 p 1086).
For those who believe in supporting the right for individuals to be able to choose assisted suicide if need be, it is unethical for a physician to disagree with that choice. Although the research shows that the majority of physicians disapprove of PAS measures, they would have to follow the best regiment of care for their patients. In cases where the patient is terminally ill and in extreme suffering, it would be unethical for a doctor to automatically dismiss requests for PAS. Here, the research suggests "that patients may have the right to discontinue care even when they have a suicidal intent to die, and doctors not only may intentionally assist such killings, but may have a duty to do so," (Gorsuch 2009 p 182). Assisted suicide practices stop unbearable suffering, which is essentially the primary duty of the physician to begin with (Wagner et al. 2011).
Many would believe that assisted suicide would have a negative impact on the family and friends of terminally ill patients. However, the research reflects the opposite. In fact, there are a number of instances where family and friends support the individual's right to choose their own fate, and when to end their own suffering. Moreover, one 2011 study (Wagner et al.) showed how treating assisted suicide cases like murders can actually have a negative impact of the survivors of the individual who had chosen death. The study recorded increased incidents of Post Traumatic Stress Disorder in family members and friends of those who choose to enact measures of assisted suicide (Wagner et al. 2011). This shows that when an assisted suicide takes place, it is actually counterproductive to follow up with a criminal investigation, which is the typical response in regions like the United States or Switzerland. Essentially, many who support a family member's decision to use PAS are only further tormented with the constant reminder of their lost loved ones during an impending investigation after death. It is within this context that supports many to believe that PAS should be legalized in extreme cases as to not only allow the individual to have a greater choice, but also to ensure that family members are not further aggravated by legal proceedings after the event if it does still occur.
The future is unclear in terms of what will happen next for the practice of PAS. As more and more of the public begin to show their support for assisted suicide, legislation may begin changing to allow it in extreme cases. If this is the case, the Oregon Act can be used as a model for other states to adopt similar measures. This would provide a successful structure for future supportive PAS legislation, as well as provide a structure for proven methods of regulation and control of the practice.
Moreover, future research and practice need to focus on adapting more measures into the environment from other disciplines. Thus future research could benefit from focusing on the integration of multiple disciplines into PAS practices, and what regulations govern over those practices. Psychiatric assessments could be better constructed in order to more efficiently screen for patients who are covered under PAS restrictions. This could serve as a more effective measure "to ensure any treatable psychiatric disorder, such as depression or psychosis, was not contributing to the decision to end the person's life," (Curtice & Field 2010 p 189). Also, future practice should look to make a psychiatric assessment on whether or not the individual in question is capable of making decisions autonomously for themselves. Although such regulations are in place, they should be fine tuned, in order to ensure that those individuals making the decision are in fact capable of doing so.
Finally, more research needs to be conducted in terms of what doctors and physicians believe. Recent research says relatively little in regards to physician opinions in the matter. The studies that have looked into this aspect often present mixed results. Some show clear opposition from physicians to PAS practices, while others show a larger group of support. In order to really understand physician's role and opinions regarding assisted suicide, more detailed research should be conducted on how physicians feel on the matter, and why they feel that way. More qualitative studies with open ended interview or survey questions would benefit this current lack of information, and help give a more detailed picture as to why physicians believe what they do regarding assisted suicide.
Assisted suicide will forever be a controversial issue. It is one that will exist as long as there are the right medications to end patient suffering with lethal doses. With all of the harmful conditions and cancers that can cause patients to endure tremendous suffering at the end of their lives, there will always be some degree of support for the option of assisted suicide in extreme cases of terminally ill patients who want to choose when and how they die, rather than waiting around for death in great pain.
Buiting, H.M.; van Delden, J.J.M.; Onwuteaka-Philipsen, B.D.; Rietjens, J.A.C., van Tol, D. & Gevers, J.K.M. (2009). Reporting of Euthanasia and Physician-Assisted Suicide in the Netherlands: A Descriptive Study. BMC Medical Ethics. Web. http://publishing.eur.nl/ir/repub/asset/17733/091203_Buiting,%20Hildegard%20Maria.pdf#page=35
Chambaere, Kenneth; Bilsen, Johan; Cohen, Joachim; & Onwuteaka-Philipsen, Bregje. (2011). Physician-assisted deaths under the euthanasia law in Belgium: A population-based survey. Canadian Medical Association Journal, 182(9). Web. http://ecmaj.ca/content/182/9/895.full
Curlin, Farr A.; Nwodim, Chinyere; Vance, Jennifer L.; Chin, Marshall; & Lantos, John D. (2008). To die, to sleep: U.S. physicians' religious and other objections to physician-assisted suicide, terminal sedation, and withdrawal of life support. American Journal of Palliative Care, 25(2), 112-120.
Curtice, Martin & Field, Charlotte. (2010). Assisted suicide and human rights in the…