What is physician-assisted suicide? Why “death with dignity” is so troubling

NOTE: This article was originally published on the ADF blog on March 25, 2022.

Over the past month, Alliance Defending Freedom has taken legal action to combat the expansion of access to physician-assisted suicide and to defend physicians from being compelled to facilitate their patients’ deaths.

In California, a group of Christian physicians sued the state over a law that requires doctors to participate in physician-assisted suicide against their religious convictions and professional ethics. In Massachusetts, ADF participated in oral arguments in support of a Massachusetts law that prohibits physician-assisted suicide.

These cases are just the tip of the iceberg of a dangerous ongoing effort to expand access to physician-assisted suicide across the country.

Advocates for physician-assisted suicide describe the practice as “death with dignity.” In reality, it is a weapon used to target the vulnerable and the sick that only harms those who need competent and compassionate medical care and community services.

What is physician-assisted suicide?

Physician-assisted suicide is often mistaken as synonymous with euthanasia, but the distinction between the two is important. Physician-assisted suicide is when a physician facilitates a patient’s death by providing him with a lethal dose of medication, knowing that the patient may commit suicide by taking that lethal dose. Euthanasia is when another person administers the dose or otherwise personally assists in ending a person’s life. With physician-assisted suicide, the patient himself takes his own life with the prior assistance of a doctor, while euthanasia involves another person killing the patient.

Physician-assisted suicide is not the withdrawing of life-sustaining treatment; rather, it is the active introduction of a lethal agent into the patient’s body, intentionally causing death.

In states that allow physician-assisted suicide, patients are required to have a “terminal illness” in order to qualify for lethal medications. However, these laws often have broad definitions of what qualifies as a “terminal illness” for these purposes.

For example, “terminal illness” typically covers both situations where death will occur within six months even with treatment and situations where death would likely not occur if the patient sought and received treatment. This means that someone who has a treatable disease or condition (for example, diabetes) and refuses treatment or is denied insurance coverage for certain treatments is eligible to request and receive lethal drugs to commit suicide.

What’s wrong with physician-assisted suicide?

Physician-assisted suicide laws facilitate a culture of death

Laws that legalize physician-assisted suicide have effects beyond the act of enabling physicians to help their patients commit suicide. By opening the door to easier access to suicide, these laws facilitate a culture of death that is hard to stop once it starts.

For example, look at the role that insurance companies play in physician-assisted suicide. There have been instances where insurance companies have paid for physician-assisted suicide instead of treatments for terminal illnesses. Sadly, it’s easy to see why they would do that: insurance companies are businesses, so it makes economic sense for them to cover lethal drugs instead of expensive, life-sustaining treatments.

Further, some physician-assisted suicide laws have dangerous loopholes when it comes to when and where patients commit suicide. Once the patient has the lethal dose, there is no accountability as to what happens next. No one has to watch the patient take the prescription, and no one is ensuring that only that patient takes it.

Physician-assisted suicide laws normalize death, creating a slippery slope to a culture of convincing and pressuring vulnerable people to end their lives prematurely.

Physician-assisted suicide laws violate the rights of conscience for objecting physicians

Physician-assisted suicide laws compromise the medical profession, turning doctors’ Hippocratic Oath on its head. Participating in your patient’s suicide is anything but upholding the promise not to “give a lethal drug to anyone.” In fact, the American Medical Association’s Code of Ethics calls physician-assisted suicide “fundamentally incompatible with the physician’s role as healer” and says it “would pose serious societal risks.”

While most laws legalizing physician-assisted suicide affirm the right of health care providers to decline to write prescriptions for lethal medication, some laws require health care professionals to provide, upon request, information about assisted suicide to patients and to refer and transfer patients to another provider for lethal prescriptions. Similarly, while a health care facility may maintain a policy against providing assisted suicide, it nevertheless must “coordinate” the transfer of a patient requesting physician-assisted suicide to a willing provider. Such actions violate the consciences of many health care providers.

And assisted suicide isn’t just an issue for religious people. In Massachusetts, for example—where ADF attorneys filed an amicus brief in defense of the commonwealth’s prohibition on the practice and argued the case in court—an atheist academic also filed a brief supporting the law. Dr. Kevin Yuill of the University of Sunderland in the U.K. wrote that physician-assisted suicide “can never be implemented in a safe and limited way.”

“Rather than seeing the debate in the simplistic terms of outdated religious precepts versus secularism, we should analyse the value of so-called Christian precepts such as Thou Shalt Not Kill before we jettison them entirely,” he wrote.

Many doctors rightly see the act of referring a patient to a physician who will help them commit suicide as facilitating the patient’s death. Doctors shouldn’t be forced to participate in the death of a patient they’ve sworn to protect.

Which states allow physician-assisted suicide?

Currently, 10 states and the District of Columbia allow physician-assisted suicide, and in recent years, we’ve seen an increasing number of states consider that deadly path, representing a disturbing trend. Unfortunately, it seems that more states are attempting to legalize physician-assisted suicide, and we are fighting hard to keep this from happening.

Moreover, the states that have already legalized physician-assisted suicide are going back and amending their current laws to make it even easier for patients to access lethal medication. For example, some states have a 15-day reflection period as a compromise with legislators opposed to physician-assisted suicide. Now, activists are going back into those states to get rid of the reflection period so that patients can get their lethal drugs more quickly.

These amendments are not only problematic expansions of the ability to legally commit suicide, but they also demonstrate how even those bills that seem mild or were designed as a compromise still pave the way to further expansion of physician-assisted suicide.

 The slippery slope of physician-assisted suicide

Assisted suicide is neither compassionate nor an appropriate solution for those who are suffering. America’s most vulnerable citizens—the elderly, the terminally ill, the disabled, and the depressed—are worthy of life and equal protection under the law. Life should be protected from conception to natural death, and those who object to participating in a culture of death should be defended from being forced to do so.

There is a double standard in our society where we teach suicide prevention while prescribing suicide to the most vulnerable among us. By allowing the legalization of suicide and forcing physicians to be parties to it, we compromise the foundation upon which our society is built: the preservation of life. It raises the question: where does the prescribing of death end?

Read more about ADF’s efforts to combat the expansion of physician-assisted suicide.