Physician Assisted Suicide in Patients With Unbearable Suffering or the Terminally Ill One of the most hotly debated issues today is physician-assisted suicide. Recently, California became the fifth state to legalize physician-assisted suicide, and there is an increasing likelihood that other states will follow suit in the foreseeable future. The purpose of this study is to determine if the factors chosen have any bearing on those who choose to end their life with physician assisted suicide. In support of this purpose, the objectives of this study were as follows: (a) to research scholarly articles regarding physician-assisted suicide and gather pertinent information into a comprehensive profile; (b) to research whether unbearable suffering is the dominant motive to request physician-assisted suicide; (c) to research whether the race and level of education of the patient are contributing factors when physician-assisted suicide is requested; and, (d) to research whether the type of terminal illness the patient has been diagnosed with is a factor when requesting physician assisted suicide.

Table 1. Part One: Survey demographic data

Table 2. Part Two: Likert-scaled statement results

Table 3. Survey response percentages

Table 4. Custom survey instrument design steps

List of Figures

Figure 1. Dr. Jack Kevorkian's Volkswagen microbus containing his

"death machine"

Figure 2. U.S. population pyramid

Figure 3. Current legislative status of physician-assisted suicide in the U.S.

Figure 4. Responses to the statement, "I believe that unbearable suffering

is the dominant motive for most people requesting physician-assisted

suicide"

Figure 5. Responses to the statement, "Physicians have a moral obligation

to relieve patients' unbearable suffering"

Figure 6. Responses to the statement, "Physicians shouldn't play God by helping people die"

Figure 7. Responses to the statement, "The type of diagnosed terminal

illness has a major impact on the decision to seek physician-assisted

suicide"

Figure 8. Responses to the statement, "Members of low-income minority

groups are more likely to want physician-assisted suicide compared

to more affluent white Americans"

Figure 9. Responses to the statement, "Legalizing euthanasia would

leave vulnerable people without sufficient legal protection"

Figure 10. Responses to the statement, "Legalizing euthanasia would send the message that the lives of the sick and disabled are less valuable"

Figure 11. Responses to the statement, "Legalizing euthanasia would

establish clearer guidelines for doctors to deal with end-of-life

decisions"

Figure 12. Responses to the statement, "Legalizing euthanasia would give

people who are suffering an opportunity to ease their pain"

Figure 13. Responses to the statement, "When a person has a disease that

cannot be cured and is living in severe pain, doctors should be

allowed by law to assist the patient to commit suicide if the patient

requests it"

Chapter One: Introduction

Background of Study

In 2015, California became the fifth U.S. state to legalize physician-assisted suicide, and so-called "death-with-dignity" legislation has become one of the most hotly debated issues in recent years. Even as the debate ensues, though, the trend is clear and more than a dozen states have already introduced death-with-dignity legislation or have committed to do so by year's end (Slew of states to consider aid-in-dying bills, 2016). While a majority of Americans continue to approve of physician-assisted suicide under certain circumstances, opponents charge that the practice places too much power in the hands of physicians who may misuse or abuse it, especially for minorities or lower-income patients. Other critics charge that family members may exploit these laws to rid themselves of the elderly or infirm who demand enormous amounts of personal care. Against this backdrop, identifying the primary motives for requesting physician-assisted suicide, determining whether patients' race and educational levels plays a role in this decision and what types of terminal illnesses are most frequently a factor when requesting physician-assisted suicide has assumed new important and relevance as discussed further below.

Statement of the Problem

Physician-assisted suicide is an up-and-coming cause of death in patients with unbearable suffering and the terminally ill. In 2015, California passed the End of Life Option Act (AB 15) which allows California residents who are terminally ill or have unbearable suffering to request a prescription for medications meant to hasten death. This can take place either as a physician-assisted suicide in which the physician provides the necessary means for the patient to perform the act themselves or as euthanasia which is when the physician performs the act on the patient. Many critics, though, maintain that a problem exists with legalizing physician-assisted suicide because of the potential for abuse by family members of the elderly. For instance, Dore (2011) argues that, "Legalization of assisted suicide is a recipe for disabilities. Legalizing assisted suicide would violate official state policy preventing suicide" (p. 82). During a period in history when the United States is experiencing especially rapid growth in its elderly population, these are especially salient arguments that have important implications for all stakeholders.
Conversely, proponents of physician-assisted suicide maintain that it is a humane and compassionate way to help people relieve their suffering, especially due to terminal conditions that will claim their lives anyway. Moreover, death-with-dignity advocates argue in support of individual autonomy and counter that everyone has a fundamental right to determine the time and manner of their own deaths under certain circumstances. These diametrically opposed views about this timely and important issue make additional research needed as described below.

Purpose and Objective of the Study

The purpose of this study was to determine if the factors chosen have any bearing on those who choose to end their life with physician assisted suicide. In support of this purpose, the objectives of this study were as follows:

1. To research scholarly articles regarding physician-assisted suicide and gather pertinent information into a comprehensive profile;

2. To research whether unbearable suffering is the dominant motive to request physician-assisted suicide;

3. To research whether the race and level of education of the patient are contributing factors when physician-assisted suicide is requested; and,

4. To research whether the type of terminal illness the patient has been diagnosed with is a factor when requesting physician assisted suicide.

Rationale of the Study

It is reasonable to posit that the overwhelming majority of Americans would prefer that no one should be forced to consider suicide, with or without physician assistance, as a viable alternative, and innovations in pain management in recent years have improved the quality of life for those with terminal illnesses (Rogatz, 2011). As Rogatz emphasizes, though, "There are some patients who experience terrible suffering that can't be relieved by any of the therapeutic or palliative techniques medicine and nursing have to offer, and some of those patients desperately seek deliverance" (2011, p. 32). It is also reasonable to posit that the overwhelming majority of Americans prefer that no one should be forced to experience "terrible suffering." Therefore, studies of this type can provide valuable insights concerning the antecedents to physician-assisted suicide that can help guide death-with-dignity policymaking efforts in the future.

Definition of Terms

Death with dignity. Although no universal definition exists, Hillyard and Dombrink (2001) generally define this term the death-with-dignity movement as an effort to "define and safeguard the right of patients to orchestrate their own deaths according to their own morality" (p. 8).

Euthanasia: From the Greek for "happy death," this term refers to situations wherein physicians act directly to end a patient's life (Hosseini, 2012). According to the definition provided by Black's Law Dictionary (1990), euthanasia is "the act or practice of painlessly putting to death persons suffering from incurable and distressing diseases as an act of mercy" (p. 554).

Palliative care: The definition provided by the World Health Organization states palliative care is "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness" [achieved] "through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual" (cited in Lau & O'Connor, 2012, p. 56).

Physician-assisted suicide: The American Medical Association (AMA) defines physician-assisted suicide as follows: "Physician-assisted suicide occurs when a physician facilitates a patient's death by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide)" (cited in Dore, 2011, p. 82).

Suicide: The legal definition of this act provided by Black's Law Dictionary (1990) states that suicide is "self-destruction; the deliberate termination of one's own life" (p. 1434).

Limitations of Study

The findings that emerged from this study were limited in scope by the relatively small number (n=67) of responses collected from the administration of the custom survey instrument shown at Appendix B and the inability to follow up the survey with face-to-face or telephonic interviews. In addition, there is always a potential for researcher bias when selected peer-reviewed and scholarly sources for inclusion in a study of virtually any type (Karimov, Brengman & Van Hove, 2011). Therefore, special effort was made to select relevant secondary resources that reflected varied sides of each of the issues of interest.

Theoretical Framework

Over the past several decades, there has been a growing body of scholarship devoted to the moral and legal implications of withholding medical treatment for patients in certain circumstances as well as physician-assisted suicide and euthanasia (Hosseini, 2012). A growing consensus has emerged from this body…