Doctors killing patients: The societal risks of legalizing physician-assisted suicide in the United States

In April 2001 the Netherlands became the first country in the world to legalize euthanasia, a practice that has been discreetly used by the Dutch medical profession for decades. The new law allows doctors to kill patients with terminal diseases who are in agony if they request it. Regulation requires the existence of a long term doctor-patient relationship. Physicians cannot suggest euthanasia as an option, the patient must be made aware of all other medical options, and a second professional opinion must be sought. The decision for euthanasia must be made by the patient while of sound mind but a patient may leave written instructions for a physician to use his own discretion when the patient becomes too mentally or physically incapacitated to make the decision for himself.;The United States has also been grappling with end of life issues for decades. In 1975 the case of Karen Ann Quinlan of New Jersey captured media attention and for many of us started the controversy over the "right to die" with the "right to refuse medical treatment". In 1990 the U.S. Supreme Court decided that the United States Constitution would grant a competent person a constitutionally protected right to refuse medical treatment. The "right to die" issue has now been expanded to included not only termination of treatment but termination of life and assistance in doing so, or physician-assisted suicide. But it is a stretch to go from the refusal of medical treatment to assistance in ending life.;In 1997 the U.S. Supreme Court heard two cases that dealt with physician-assisted suicide, Vacco v. Quill and Washington v. Glucksberg, and decided that there is no constitutional right to assisted suicide. The Supreme Court did however allow the debate to continue by sending it back to the states for further consideration and from this came the passage of the Oregon Death with Dignity Act on October 27, 1997. This Act allows terminally ill Oregon residents to obtain and use prescriptions from their physicians for self-administered, lethal doses of medications. Under the Act, ending one's life in accordance with the law does not constitute suicide. Physician-assisted suicide in this context is not to be confused with the practice of euthanasia in the Netherlands where a physician or other person directly administers a medication to end another's life.;Like the euthanasia laws of the Netherlands, the Oregon Death with Dignity Act has specific requirements that must be met for the determination of eligibility before requesting a prescription for a lethal medication from a licensed Oregon physician. The patient must be an adult (an individual 18 years or older), a resident of Oregon, capable (able to communicate health care decisions), and diagnosed with a terminal illness that will lead to death within six months. The process involves receiving a second opinion from a consulting physician, referral for a psychological examination should either the prescribing or consulting physician think that the patient's judgement may be impaired, and informing the patient of feasible alternatives to assisted suicide such as palliative care, hospice or pain control.;Euthanasia is legal in the Netherlands and from most accounts seems widely accepted. The use of euthanasia however has broadened. Not only are the numbers increasing but the mentality towards its use has crossed moral boundaries from voluntary euthanasia to non-voluntary and involuntary euthanasia. The Netherlands is on the slippery slope which may ultimately lead to the morality of "anything goes". It has already been proposed that the use of euthanasia be expanded to cover children under the age of twelve that are terminally ill.;Euthanasia in the Netherlands as a case study has been used to examine what the social reality of physician-assisted suicide could look like for the United States. The Netherlands is a racially and economically homogeneous country with a system of socialized medicine that allows everyone access to basic care yet they have transitioned from voluntary to non-voluntary to involuntary euthanasia even though access to health care is not an issue. The United States is not the Netherlands. We are a country of haves and have-nots and are further stratified by class and color. We have no system of universal health care that might alleviate the felt need by some to request physician-assisted suicide for economic reasons because the resources for long-term care are not available. The widespread acceptance of physician-assisted suicide in the United States would carry with it serious consequences for large segments of our population especially those whose autonomy is already compromised by lack of access to medical care, the elderly, those suffering from depression, minorities and the poverty-stricken. The risks are too great. (Abstract shortened by UMI.)...