Tulsa L. Rev.: Gonzales V. Oregon and Physician-Assisted Suicide: Ethical and Policy Issues

By Levy, Ken | Issues in Law & Medicine, Summer 2008 | Go to article overview

Tulsa L. Rev.: Gonzales V. Oregon and Physician-Assisted Suicide: Ethical and Policy Issues


Levy, Ken, Issues in Law & Medicine


While the policy arguments for physician-assisted suicide are strong they are not strong enough. They are counteracted by even stronger policy arguments against physician-assisted suicide. Importantly, the latter arguments apply with greater force to physician-assisted suicide than to withdrawal of lifesaving medical treatment or palliative but death-hastening treatment.

First, the undue pressure argument predicts that legalizing physician-assisted suicide will put serious financial pressure on terminally ill patients, especially those who are poor, to choose this option rather than the option of lifesaving medical treatment. Because physician-assisted suicide will be significantly cheaper than life-sustaining treatments, it is highly likely that Medicare and Medicaid officials, health and life insurance companies, viatical settlement companies, and managed care plans--all of which are concerned at least to minimize their costs and possibly to maximize their profits--will much more frequently recommend against lifesaving medical treatment than they would have if the much cheaper option of physician-assisted suicide were not available as a legal alternative.

Needless to say, this situation would be highly undesirable. We do not want patients choosing--no less being forced to choose--physician-assisted suicide simply for financial considerations. First, financial considerations are simply the wrong kind of basis for decisions that have such significant non-financial (i.e., personal, inter-personal, and spiritual/religious) significance and ramifications. Second, the financial pressure may be so overwhelming that it would render many less affluent patients' decisions to elect physician-assisted suicide non-voluntary and non-consensual.

This financial pressure will only be compounded by psychological pressure as well. Too many terminally ill patients wish to die because they feel--or worse, have been made to feel--like annoying nuisances to their families and doctors. Legalizing physician-assisted suicide would simply intensify this guilt and therefore the "subtle coercion" of these patients to take this now legally available route. When physician-assisted suicide is illegal, patients do not have to justify their failure to exercise this option. It is simply not an option in the first place. If anything, they would have to justify why they still wish to die in spite of this legal roadblock. But if physician-assisted suicide were legalized, then the burden would suddenly fall on patients to justify why they are continuing to live--and thereby inconveniencing everybody around them for the indefinite future--rather than choosing this now legally available alternative. And they will feel themselves unable to satisfy this burden precisely because they will have internalized the attitude of rejection that they perceive all around them. They will deem themselves unworthy of continued existence precisely because every body else around them deems them unworthy of continued existence.

Second, the patients who would feel themselves unable to satisfy this burden of justifying their continuing to live would then be dying too early--too early relative to when they would have died had their preferences been optimized. As a society, we simply don't want people choosing to die prematurely for the wrong reasons. And one very wrong reason would include a sense of worthlessness, a sense that one is not worth the inconvenience and financial hardships that one's continuing to live might impose on others.

There are very few situations in which palliative care, when made available, is insufficient to alleviate a patient's pain and suffering. Unfortunately, it is not always made available. But this is not an argument for physician-assisted suicide. This is an argument for improving the current situation and extending adequate palliative care to every patient who needs it.

Too many patients wish to die because they suffer less from physical pain and more from "psychic" pain, i. …

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