On November 1st 2014, after receiving a terminal brain cancer diagnosis, Brittney Maynard chose to end her life under the auspices of the Oregon “Death with Dignity Act”. This well publicized event brought the topic of euthanasia back to the forefront of the public conscious and sparked numerous debates about the ethical implications of such “Right to Die” legislation within the United States 1. Ever since its creation during the sixties, the Right to Die movement has been a point of severe contention due to the fact that it in essence makes physician assisted suicide legal for the qualifying subset of the American population and originated from the same Progressive agenda which inspired such negative social experiments as eugenics and forced euthanasia 2. Due to the cultural and religious stigma that hangs over the concept of suicide, the “Right to Die” movement had been continually stalled in State Legislatures despite the overwhelming support of a majority of the patients who would be most directly affected by the changes.

The “Death with Dignity” movement would most likely have been condemned to legislative purgatory if it had attempted to simply echo the same debates used by previous iterations of the movement. Yet, the recent example of Britney Maynard, and her husband who continues to champion the cause, has revitalized the flagging fortunes of the “Right to Die” due in part to a number of social factors and a general cultural shift which has overtaken the sphere of American public policy 3. Part of the reason behind the movement’s resurgence is the fact that Brittney Maynard has become the posterchild of the flagging movement. The young and charismatic persona of Brittney stands in stark contrast with the past and macabre nature of the movement’s previous champion, Dr. Jack Kevorkian, who was most popularly known by the sobriquet Dr. Death after he administered voluntary euthanasia to over a hundred patients 4.  It is hardly surprising that the new posterchild of the “Right to Die” movement has elicited a more sympathetic response from the American public, which has empathized with her decision to end her life on her own terms instead of merely playing the part of the victim and waiting for the inevitable, painful end 5.

The changes in public opinion towards such a divisive issue over such a short period of time almost indicates that a massive shift in popular opinion with regards to how comfortable we are discussing the painful issues that surround Hospice and end of life care. The rapid growth of public support can also be linked to a series of social trends that are occurring within the American electorate. The first and most obvious of these cultural shifts is the aging of the Baby Boomer generation, who are becoming even more preoccupied with ensuring their end of life plan. The second trend which has contributed to the increased support of the ‘Right to Die” movement is the growing support that it has garnered among the younger, more liberally minded. The reason behind this growth in support is thought to be the fact that many members of this demographic value independence and see the “Right to Die” movement as a way to reclaim a bit of this self-determination in the face of an otherwise hopeless situation 6. This increased acceptance and popularity of the “Right to Die” movement, especially among younger generations, has prompted a rapid response from multiple state legislatures. In the current legal situation four States have enacted these “Death with Dignity” statutes and seventeen other states are currently considering passing similar regulations in the coming legislative session 7.  The possibility of such rapid change occurring in state codes of practice for physician assisted suicide means that it is impossible to ignore the ethical implications that these laws will have on the relationship between a physician and patient.

The medical community is extremely fractured on how to most appropriately honor their obligations to the patient with regards to end of life treatment with both sides claiming moral rectitude. According to the most recent issue of the AMA’s code of medical ethics the practice of euthanasia by a licensed physician is still ethically proscribed even in cases when the law allows for such a practice 8. The rationale behind this continued prohibition on doctor-assisted suicide is that the practice of euthanasia is entirely against the role of a physician as a healer since the physician must assume the role of ending his or her patient’s life. This argument is dismissed by one of the leading proponents of physician aid in the legalization of dying, who state that it is a physician’s obligation to honor the wishes of their patients when it comes to end of life choices. In fact that the Death with Dignity movement goes so far as to state that a physician’s moral objection to administering such a treatment is a “red flag” for the fact that “they may not practice patient centered care” 9.  The contrast between the two views of a physician’s interactions with a candidate for physician assisted suicide indicate the intricacy of the moral dilemma that will ,in all probability, become more common as further legislation is passed. The law allows a physician to refuse to administer euthanasia for any reason and also gives healthcare providers the freedom to refuse such treatment should they have an ethical or religious objection to the practice. However, the growing popularity of the “Right to Die” movement begs the question: What is a doctor’s obligation to terminally ill patient who desires to end life on their own terms?

Perhaps part of the answer to this delicate bioethical debate can be found by outlining the clear difference in euthanasia and physician aid in dying. The former describes the process of a physician administering lethal drugs to a patient who has a passive role in their own death, while the latter more broadly refers to a physician giving a patient the means with which they can end their own life 10. While this distinction may at first appear to be just semantics, these terms should not be used interchangeably due to the different roles prescribed to the doctor and patient in these distinct procedures.  Currently all of the law regarding “death with dignity” in the United States have been focused on physician aid in dying. This is not the case with other developed countries, such as the Netherlands, where euthanasia is often the preferred method. Through the lens of these two definitions, the argument that physician aid in dying is ethically permissible since it is patient administering the lethal dose of the prescribed drug gains credibility. Thus it is not wrong to state that the morality of physician aid in dying can be justified as the ultimate consummation of self-determination for an individual faced with the impossible situation of enduring the final stages of a debilitating and terminal illness.

The debate over the ethical implications of euthanasia and doctor assisted suicide is far from over, yet it is not too early to begin to discuss the effect that the ultimate decision will have on the practice of medicine. Many doctors, particularly those involved in the fields of oncology and palliative care, may soon be forced to reevaluate the meaning of their Hippocratic Oath as it pertains to taking an active role in facilitating a patient’s death. As the baby boomer generation continues to age it is a near certainty that the demand for doctor assisted suicide shall increase concurrently. The growth of this movement will also see the addition of more interested parties who wish to undergo the process of physician assisted suicide for illnesses which may stretch the terms of terminal illness. Indeed other industrialized nations have already begun allowing those suffering from mental illnesses and disabilities to proceed with physician assisted suicide. The growth of the “Right to Die” movement indicates that soon our society will have to set the parameters for what qualifies a person to be in severe enough suffering to merit this procedure. When this happens doctors, both individually and as a collective unit, will have to make the difficult ethical choice of whether their duty to a suffering patient obliges them to assist that patient in taking their own life.

 

  1. Ray, K., Ph.D. (2014, December 11). Bioethics.net. Retrieved March 10, 2016, from http://www.bioethics.net/2014/11/why-the-right-to-die-movement-needed-brittany-maynard/
  2. Ten Have, H., M.D., Ph.D. (2003, December 03). Book Review — NEJM. Retrieved March 10, 2016, from http://www.nejm.org/doi/full/10.1056/NEJM200312043492327
  3. Ray, K., Ph.D. (2014, December 11). Bioethics.net. Retrieved March 10, 2016, from http://www.bioethics.net/2014/11/why-the-right-to-die-movement-needed-brittany-maynard/
  4. Bernstein, E. (2015, July 8). Jack Kevorkian. Retrieved March 10, 2016, from http://www.britannica.com/biography/Jack-Kevorkian
  5. Aviv, R. (2015, June 22). Who Has the Right to Die? Retrieved March 10, 2016, from http://www.newyorker.com/magazine/2015/06/22/the-death-treatment
  6. Aviv, R. (2015, June 22). Who Has the Right to Die? Retrieved March 10, 2016, from http://www.newyorker.com/magazine/2015/06/22/the-death-treatment
  7. Take Action – Death With Dignity. (2016, March 10). Retrieved March 10, 2016, from https://www.deathwithdignity.org/take-action/
  8. Opinion 2.21 – Euthanasia. (1996, June). Retrieved March 10, 2016, from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion221.page
  9. Take Action – Death With Dignity. (2016, March 10). Retrieved March 10, 2016, from https://www.deathwithdignity.org/take-action/
  10. Braddock III, C. C., M.D., M.P.H., Dudzinski, D., M.D., Tonelli, M. R., M.D., Starks, H., M.D., Ph.D., & White, N., M.D. (2013, April). Physician Aid-in-Dying. Retrieved March 10, 2016, from https://depts.washington.edu/bioethx/topics/pad.html