Breakdown of Debate Topic #10:
"It should be legal for physicians to openly assist in suicide for terminally ill patients who are in the last stages of disease or for whom there are no remedies remainig adn who are experiencing or who can expect to experience great suffering as a consequence of their terminal illness."

(Revised October 8, 2002)

You may want to start your thinking by exploring how we think about suicide in general. Is it legal or illegal? What are the moral arguments against suicide? Who "owns" our bodies and our lives? Why should others be empowered to make decisions about whether we want to live or die?
When you move this into a medical context we may consider whether people with a lethal diagnosis that promises to lead to great suffering can elect suicide before their illness and suffering become extreme. You will want to do some research into the kinds of medical conditions that lead suicide to be a consideration.

Related to this, you might ask whether it makes a difference if the person is likely to become so incapacitated as they get sicker that they may not be able to take their own lives if they wish. This opens the question of whether others may assist if that individual wishes to commit suicide. Another issue is whether family members or others can intervene to end the lives of loved ones who are in comas or who otherwise cannot act on their own behalf.
You ought to look at the video series with Bill Moyers, On Our Own Terms which examines your issues at length. It is in the library.

Quite a separate issue from whether people ought to be allowed to commit suicide or have help is whether medical professionals or medical institutions ought to be involved. One part of this is whether those actors can be involved if they choose to help out as has been the case with Dr. Jack Kavorkian. A different issue is why physicians may be reluctant to provide that help given their professional commitment to avoiding harm and promoting health.

A separate issue is whether nursing homes or hospitals and their staff members should assist. Not only are there liability risks for those institutions but they face problems releasing a patient who is too disabled or sick to live independently if that person wants to leave the hospital in order to commit suicide. Institutions often feel mandated to force feed patients who do not want to eat and otherwise to maintain life.

One of the troublesome issues related to this topic is that physicians obviously participate in patients' deaths all of the time through "do not resuscitate" orders and other forms of passive euthanasia. Playing an active role clearly crosses some sort of ethical line, but is that a significant or meaningful line? Much more important is the question of at what point physician involvement in the suicide of a patient becomes ethically problematic. The groups in this debate ought to come up with a formulation about where this line is so that it can be the focus of debate. If you draw the line too close to the point where a patient is on the edge of death it will become hard to argue effectively that physicians should not provide help with the final step.

Much of the criticism of physician-assisted suicide involves patients who are disabled rather than terminally ill and patients who still have a significant amount of time to live before it is expected that a terminal disease will kill them. One concern is that we do not really know how long someone will live and there are instances of spontaneous remissions. Death is final so early assisted suicide may end life prematurely and before all options have been exhausted.

More seriously, disability and serious illness are very painful for family members and significant others. Disabled people may be depressed and weak and may not be able to argue effectively on their own behalf. They may also want to do family members a favor by dying. There is significant concern that rather than committing suicide people may be coerced into death. Thus, one of the main opponents of physician-assisted suicide are disabled rights groups. Look on their websites for effective arguments.

Related to this concern is the question of who has a self-interest in very sick patients dying quickly. Family members may have an interest. Health insurance companies, nursing homes, and others that pay for care may have such an interest.

This leads to questions of whether review committees or other regulatory arrangements can be set up to provide sufficient protections for both the patients and for their caregivers. A good way to explore this question is by looking at jurisdictions where physician assisted suicide is allowed-Oregon and some countries in Europe. There is experience with this practice and empirical information about whether and how often patients seemed to be put to death prematurely.