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Individual liberty vs.

A complete prohibition against PAD excessively limits personal liberty. Therefore, PAD should be allowed in certain cases. Honesty and transparency: Some acknowledge that assisted death already occurs, albeit in secret. The fact that PAD is illegal in most states prevents open discussion, in which patients and physicians could engage. Legalization of PAD would promote open discussion and may promote better end-of-life care as patients and physicians could more directly address concerns and options. Protection of life: Religious and secular traditions upholding the sanctity of human life would be diminished by PAD.

In addition, government has a strong interest in the preservation of human life. Depression is a significant issue for many terminally ill patients, and often very difficult to diagnose. Requests for PAD may be withdrawn if pain and depression are adequately treated. Passive vs. A valid refusal of treatment that allows a person to die passive is justifiable, whereas PAD equates to killing active and is not morally justifiable.

Protection of vulnerable groups: Vulnerable populations, lacking access to quality care and support, may be pushed into assisted death. Furthermore, assisted death may become a cost-containment strategy. Burdened family members may encourage loved ones to opt for assisted death and the protections in legislation can never catch all instances of such coercion or exploitation.

To protect against these abuses, PAD should remain illegal. Protection of the ethical integrity of the medical profession: Historical ethical traditions in medicine are strongly opposed to taking life. Some major professional groups American Medical Association, American Geriatrics Society oppose physician assisted death. Palliative care and hospice: Effective and available palliative care can diminish the reasons often cited for requesting PAD, such as physical, emotion, and spiritual pain.

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Home and inpatient hospice care can further reduce the need for PAD. Supreme Court rejected this argument in Vacco v. Quill, U. The law is in accord. While suicide is not a crime in Vermont or any other state, assisted suicide is generally understood to be a crime under common law. In recent decades, patients have become more active in medical decision-making. No longer are medical decisions left exclusively in the hands of medical professionals. At stake in the debate over physician aid in dying is whether in some circumstances there might also be a positive right to die i.

The U. Supreme Court has twice ruled that the U. Constitution does not establish a positive right to physician assistance in dying. Two states, Oregon and Washington, have statutes that authorize PAD under strictly controlled circumstances described below. Both statutes were passed by voter referendum.

The Oregon law has withstood several court challenges and PAD has now been practiced there for over 13 years. In addition, Montana legalized PAD through a court decision in ; however, the Court in that case sidestepped the question of whether PAD is a state constitutional right and merely upheld the state law prohibiting prosecution of physicians for helping terminally ill patient die. In Vermont, past legislative efforts to legalize PAD failed. For a more detailed discussion of the constitutional legal issues involved in PAD, see Legal Analysis below.

Glucksberg, U. See also: Cruzan v. Director Mo. State, Mont. According to the Bioethics Briefing Book of the Hastings Center, a non-partisan bioethics resource center, the public remains deeply divided on the question of whether to permit physician-assisted death. In most surveys, approximately two-thirds of the population of the United States approve of it as an option for terminally ill patients with intractable suffering.

This split probably reflects the inherent tensions in the debate. On the one hand, most people know of cases of severe suffering, even with excellent palliative care, where the need for some predictable escape is very compelling.


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On the other hand, there are real fears that physician-assisted death could be used as a detour that avoids effective palliative care or as a way to eliminate the suffering of vulnerable patients by eliminating the sufferer. Oregon was the first state to authorize PAD. The Oregon law strictly limits the circumstances in which PAD may be used and the law contains a number of procedural safeguards to prevent abuses.

Health care providers are not required to participate in implementing the law. To be eligible for PAD in Oregon, a person must be 18 years old or older and must be suffering from a terminal disease in which death is expected to occur within 6 months. He or she must have decision-making capacity. Additional features of the Oregon law include:. The patient has the right to rescind the request for medication to end his or her life at any time. Having met the above requirements, the patient is entitled to a prescription for medication to end life.

Studies of the Oregon law to date indicate that PAD use is stable and relatively rare deaths over the first 12 years. As medicine has advanced and to continues to advance, PAD has arrived at the intersection of constitutional privacy law and medical technology. Government has a general interest in preserving life and prohibiting intentional killing and suicide.

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Euthanasia and assisted suicide. Attitudes and practice in countries where they have been legalised

Many individuals hold similar positions on assisted suicide and euthanasia. Others find assisted suicide more acceptable, either because of the nature of the actions or because of differences they see in the societal impact and potential harm of the two practices.


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For some, assisted suicide and euthanasia differ intrinsically. A physician who writes a prescription for a lethal dose of medication, for example, is less directly involved in the patient's death than a physician who actually administers medication that causes death. With assisted suicide, the patient takes his or her own life, usually when the physician is not present. Accordingly, factors such as the physician's intentions may be more complex.

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In some cases, a physician may intend to make it possible for a patient to commit suicide so that the patient feels a greater sense of control, but may hope that the patient does not take this final step. In addition, because the patient's own actions intervene between the physician's actions and the patient's death, the physician's causal responsibility may be less clear.

When assisted suicide occurs, the final act is solely the patient's. It would therefore be more difficult to 22 The Vatican's "Declaration on Euthenasia" describes euthanasia as "an action or an omission which of itself or by intention causes death, in order that all suffering may in this way be eliminated.

Euthanasia and assisted suicide. Attitudes and practice in countries where they have been legalised

Government Printing Office, , Appropriate decisions to forgo extraordinary or disproportionately burdensome treatment would not be considered euthanasia, however. This report does not discuss the criteria that characterize appropriate decisions to forgo life-sustaining treatment.

The Task Force has addressed this issue in previous reports. By contrast, some patients would be too embarrassed or intimidated to express uncertainty to a physician on the verge of giving a lethal injection, or would be concerned that the doctor might be hesitant to administer the injection at a later time.

Some individuals therefore distinguish cases when a physician assists a suicide by providing information or a prescription, which they believe should be permitted, from instances when the physician is present at the time of the suicide and directly aids or supervises the act, posing a greater risk. Whatever differences may exist do not justify a policy of accepting one practice while forbidding the other. This view is shared by some who support both practices and by others who oppose both. Howard Brody writes: "There are psychological reasons to prefer patient control over physician-assisted lethal injection whenever possible.

The normal human response to facing the last moment before death, when one has control over the choice, ought to be ambivalence. The bottle of pills allows full recognition and expression of that ambivalence: I, the patient, can sleep on it, and the pills will still be there in the morning; I do not lose my means of escape through the delay.

But if I am terminally ill of cancer in the Netherlands and summon my family physician to my house to administer the fatal dose, I am powerfully motivated to deny any ambivalence I may feel. Watts and T. Quill, C. Cassel, and D.

Ethical Challenges About Voluntary Assisted Dying

Graberand J. An opponet of both practices likewise argues: "If the right to control the time and manner of one's death - the right to shape one's death in the most humane and dignified manner one chooses - is well founded, how can it be denied to someone simply because she is unable to perform the final act by herself? Some claim that while both should be allowed, assisted suicide would be a preferable option in any particular case, in order to minimize the possibility of error. In New York and many other states, while both practices are felonies, assisting suicide is generally classified as manslaughter, while euthanasia constitutes second-degree murder.

These values have always been pursued within a social context, accompanied by commitments to promote the overall good of society and protect vulnerable individuals from harm. For some, the exercise of 29 D.