Essay: Physician Assisted Suicide (PAS)

The debate in regards to ethics in Physician Assisted Suicide (PAS) has been a popular argument that has been in the headlines for many years now. But, the questions still remain; is PAS ethical, and should more states adopt these laws? Or is PAS a violation of non-maleficence and beneficence? There is no right or wrong answers to these difficult questions, however, physicians and nurses have found themselves caught in the crossfire between the two arguments of should PAS be allowed or forbidden.
On one side of the argument there are the people that believe individuals should be able to make their own choices when it comes to death and dying; six states agree, Oregon, Washington, Montana, Vermont, California, and Colorado. Within these states persons that have been diagnosed with a terminal illness have the choice to take their own life by PAS or to let the illness progress and eventually take their life. These states allow a physician to prescribe lethal drugs with instructions on how to use them. However, the physician cannot provide a lethal injection as this would be considered homicide. (Kaplan, Porter, 2016) The World Health Organization (WHO) states, “being able to live a life with dignity stems from the respect of basic human rights including autonomy and self-determination.” (who.int, 2015) Therefore, this group of people believe, that persons who are competent and fully aware of their health and the predicament in which they are in, should be able to choose to take their own life on their terms and not the terms of the illness.
On the other side of the debate are the individuals that believe that PAS should not take place. They believe this act could be murder and is a direct violation of the code in which physicians and nurses must abide by. The code states that healthcare providers must “do good” and “do no harm,” and that health care providers should not assist their patients to commit suicide. Most of the groups that reject PAS are church groups that believe God should be in control of when, how, and where a person dies. In the article, The Ethics of Assisted Suicide by Nursing Times, it states, “…with the rise of organized religion the practice of assisted suicide was rejected, sanctity of human life being cited as the reason: what God has given, only God can take away.” (nursingtimes.net, n.d.) The article goes on to say that this is no longer accepted in our society. The American Nurses Association (ANA) makes the role of the nurse very clear, it states that in the past the role of the nurse has been to promote, preserve, and protect human life and a nurse does not act deliberately to terminate the life of any person. (nursingworld.org, 2003) As more and more states adopt laws protecting PAS the ANA may be forced to reconsider and be more supportive of when and how the patient would like to die.
As you can see this dilemma puts physicians and nurses in quite a predicament. Physicians and nurses are taught that the patient has the right for autonomy, and they have the right to make their own decisions when it comes to their care. But, if physicians were to help terminally ill patients commit suicide it could also violate the ethical principles of non-maleficence and beneficence.
In an attempt to solve this dilemma, there are a couple provisions listed with the ANA that could be applied to the case of a terminally ill patient wanting PAS. Provision 1 states, “The nurse practices with compassion and respect for inherent dignity, worth and unique attributes of every person.” This provision gives the patient the right to self-determination, which should include the right to die on their terms and not the terms of their disease. Provision 3 states, “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” If the terminally ill patient does not want to prolong their pain and suffering the nurse should advocate for the patient and their wishes. Some other potential solutions in resolving this debate may include having more laws governing the process, and to provide comfort measures such as analgesics and allow the disease to take its course.
Physician Assisted Suicide may impact the care the patient receives from the nurse in the following situations:
• If the nurse is unable to remain un-judgmental toward the patient. In this case a different nurse should be assigned.
• “While there may be individual patient cases that are compelling, there is high potential for abuses with assisted suicide, particularly with vulnerable populations such as the elderly, poor and disabled. These conceivable abuses are even more probable in a time of declining resources. The availability of assisted suicide could forseeably weaken the goal of providing quality care for the dying.” (nursingworld.org, n.d.)
Some factors that may have an impact on PAS include the fact the physicians may be confused about their role in the process. They may be afraid they may be charged with causing death, abandoning the patient, and leaving them vulnerable to litigation. Some physicians may resort to withholding vital fluids and nutrition in fear of these consequences. (Ashley, Stanley W., 2018) However, by using this method it could take weeks for the patient to die and may cause further pain and suffering for the patient and the family.
I’m sure that I will encounter PAS in my future nursing career and no case will be exactly the same. When and if I am challenged with this situation I know I will listen intently to the patient and their family, provide them with good sources about their disease and what they can expect, advocate for them ensuring this is their decision and was not influenced by another, and respect their wishes.
PAS is a very controversial issue and each and every case will be very different depending on the patient’s wants and needs. Physicians and nurses need to be very vigilant and know the state laws in which they work while advocating for their patients to ensure they are receiving proper care.