Physician Assisted Suicide
Physician assisted suicide is a form of euthanasia where a doctor intentionally provides a terminally ill patient with the means to commit suicide—for example, by giving them a prescription for a lethal dose of medication which the patient then administers to him or herself.
Physician assisted suicide—called “death with dignity” by advocates—differs from the following:
- Voluntary, active euthanasia, where a doctor actually carries out a patient’s request to die, such as by injecting a lethal dose of a drug. This is illegal in all states.
- The withdrawal or refusal of life-supporting treatments, which is sometimes called passive euthanasia. This can include turning off a respirator, removing a feeding tube or IV, or allowing someone’s heart to stop without trying to resuscitate. The right of a patient to refuse life-support is protected by the Constitution and is therefore legal across the United States.
Several states have legalized physician assisted suicide under certain conditions.
Assisted suicide law in NH
Physician assisted suicide is illegal in New Hampshire. Helping someone commit suicide—whether a health care professional or a family member—can be punished by up to seven years in prison.
However, the following practices are allowed:
- As in all other states, it is legal in New Hampshire to create a living will or advanced directive that orders the withdrawal or refusal of life-saving treatments under certain conditions, allowing death to take place naturally. Your physician can help you to create a living will, as can a lawyer. There are also resources online that can help you. In New Hampshire, your living will must either be notarized or witnessed by two adults.
- Patients may also grant power of attorney to a family member or other trusted agent to make health care decisions for them in the event that they are not able to do so themselves. In the absence of an advanced directive, a designated health care agent can refuse life-saving treatment on a patient’s behalf.
In recent years, supporters have made several attempts to pass legislation allowing physician assisted suicide in New Hampshire. So far, all of them have failed.
There is no federal law authorizing or prohibiting physician assisted suicide.
The Supreme Court has ruled that the Constitution doesn’t guarantee citizens a right to assisted suicide. However, the court did not say the Constitution forbids the practice, either. This leaves the door open for states to pass their own laws.
In 1999, the federal government passed the Assisted Suicide Funding Restriction Act. This bans any use of federal money in support of physician assisted suicide—for example, spending Medicare dollars for medication intended to help a patient end her life.
Law in other states
Five states have legalized physician assisted suicide: California, Colorado, Oregon, Vermont, and Washington. Washington, D.C. has also legalized the practice.
All physician assisted suicide laws passed so far in the United States are very similar:
- Patients must be at least 18 years old and must be conscious and mentally competent—a family member or health care proxy can’t request physician assisted suicide on behalf of an unconscious or impaired patient.
- Two doctors must certify that the patient is a resident of the state, has less than six months to live, and is making the request voluntarily.
- Patients must make two oral requests for assisted suicide, spaced at least fifteen days apart, as well as a written request signed by witnesses.
- Doctors are not required to participate in physician assisted suicide. If a doctor refuses a patient’s request, it’s the responsibility of the patient to find another doctor willing to help them.
- Doctors may prescribe, but may not administer, a lethal dose of medication.
The exception is in Montana, where physician assisted suicide became legal through a court ruling. The Montana Legislature has not yet passed any laws either setting conditions for how physician assisted suicide should work or forbidding it outright.
In 37 states, physician assisted suicide is illegal, with charges varying from felony to manslaughter.
The legal status is unclear in four states, while court rulings in three others have found physician assisted suicide to be illegal even though no state law there explicitly deals with it.
Advanced directives and euthanasia
Some “death with dignity” advocates argue that patients should be able to request assisted suicide under certain conditions in their advanced health directives. They point to diseases like Alzheimers or advanced dementia that are painful, debilitating and terminal, but that make a patient mentally incompetent at the time when they would hypothetically be able to request physician assisted suicide. They argue that allowing patients to request “death with dignity” ahead of time empowers them to make their own health care choices.
Opponents express concerns about the potential for abuse, and counter that physician assisted suicide should be limited to people who genuinely want to die, and who have the mental competence necessary to make that final choice when the time comes.
In every state that has so far legalized physician assisted suicide, doctors have the option to participate or to refuse. This has led some to complain that it can become difficult for suffering patients to find a physician willing to help them if their own doctor is morally opposed and unwilling to offer a referral.
On the other hand, many physicians feel that physician assisted suicide is a violation of their ethical responsibility to heal, not hurt, their patients, or have religious objections. They maintain that assisted suicide is not an essential health treatment, and that these physicians should therefore not be forced to act against their principles.
Palliative care and sedation
Sometimes in hospice or palliative end-of-life care, doctors will recommend using morphine or other drugs to sedate a patient who is in extreme pain, with the intent that the patient remain sedated until death occurs.
This is not considered a form of physician assisted suicide, as the doses are carefully controlled to cause sedation but not hasten death.
Doctors who support this practice argue that it relieves the suffering of patients whose pain is not responding to other treatments without crossing the ethical boundary into causing death.
Opponents counter that the drugs, while intended only to sedate, may actually lead patients to die sooner than they would otherwise, dubbing the practice “slow euthanasia”.
“New Hampshire should legalize physician assisted suicide.”
- When people are in misery with no chance of recovery, it is inhumane to continue to allow them to suffer.
- The fears about misuse of euthanasia have been proven unfounded in states that have already legalized the practice. For example, patients who take advantage of assisted dying in Oregon have been shown to do so not because of financial concerns or to escape pain, but because of concerns over loss of autonomy and bodily control.
- By not allowing euthanasia, the state leaves terminally ill individuals and their families only more degrading and painful options for the end of life, such as starving themselves.
- Decisions about death and dying are intensely personal, and should be made on an individual, case-by-case basis—but the state should empower individuals to make those choices, giving them options.
- Well-meaning doctors and loving family members shouldn’t have to risk going to jail because they choose to help a terminally ill patient or loved one to end their suffering.
- We offer more humane options to criminals facing execution than we do to law-abiding citizens whose only crime was to be unfortunate enough to become ill.
The preceding points were made by former NH Rep. Rick Watrous, co-sponsor of a bill to study physician assisted suicide, in Shadowdad, a memoir of the end of the life of his father.
“New Hampshire should not legalize physician assisted suicide.”
- Physician assisted suicide doesn’t end suffering—it ends the patient. Alleviating suffering and eliminating the patient are very different acts.
- Physician assisted suicide violates the sacredness and dignity of human life, violating the Hippocratic Oath and offering vulnerable patients death instead of directing them to resources that would help them.
- People who are suicidal are often suffering from depression or other mental illness. Offering them lethal drugs instead of care and protection is a form of neglect.
- Our culture places great emphasis on productivity and autonomy, discounting the lives of those who are disabled or need help from others. This can lead ill persons to feel their lives are meaningless or a burden when they are still worthy of respect.
- The medical profession has many ways to responsibly reduce suffering and pain at the end of life without resorting to suicide, an option with many risks of abuse.
The preceding points were made by Meredith Cook, director of the office of public policy for the Catholic Diocese of Manchester, in testimony against HB 1325 (2014), which would have legalized physician assisted suicide in New Hampshire.