Physician-Assisted Suicide

By Meg Marinis, Director of Research Mar 04, 2010
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In Episode 618, Suicide is Painless, patient Kim Allan suffers from an extremely difficult battle with Stage IV large cell lung cancer. Dr. Teddy Altman removed a second mass from her right lung, but tests indicate that the cancer had already spread to her lymph nodes and liver. Unfortunately, due to the disease's advanced progression, palliative treatment remains the only option for Kim. And since Kim now faces a daily struggle to even breathe, the next step would be intubation. However, she has strongly communicated that she does not want to live with a breathing tube down her throat. In fact, Kim has a different request for Teddy...

... Kim wants to die by physician-assisted suicide.


What is physician-assisted suicide, and is it legal?

Physician-assisted suicide is when a doctor provides either the equipment or a lethal dose of medication to a terminally ill patient so that they may end his or her own life. Recently made legal in Oregon, Washington, and Montana, physician-assisted suicide remains an ongoing and closely contested political issue for many states in the U.S. However, for our patients at Seattle Grace Mercy West Hospital, the Washington Death with Dignity Act, Initiative 1000, passed on November 4, 2008.

What are the actual parameters for the patient to make the request? (Please note that I will be discussing the provisions set aside in the state of Washington due to the fact that Grey's Anatomy takes place in Seattle).

The measure applies to mentally competent and terminally ill patients, determined to only have six months left to live or less. The patient must also be a resident of the state of Washington. He or she needs to request the prescription verbally and in writing; then, fifteen days later, the patient needs to make a second verbal request. The patient also needs to have two witnesses at the initial request, and one of the witnesses cannot be an heir, related to the patient, or employed by the health-care facility caring for the patient. No witnesses need to be present when the patient self-administers the prescription.


What about the parameters for the physician? Must they agree with the patient?

Well first of all, a physician possesses the right to refuse to write a prescription for a lethal dose of medication. However, if they agree, they also must follow a set of standard practices. The physician must determine that the patient indeed acts with sound judgment, and he or she has made this decision of their voluntary will. The physician must inform the patient of their medical diagnosis, prognosis, and the risks and probable results of using the prescription. The physician must communicate all alternative treatments to the patient, including palliative care and hospice services. The physician needs to make sure the patient understands that he or she may rescind their request at any point in time. The physician must refer the patient to a second consulting doctor who must agree that the patient indeed has only six months to live and acts with a sound mind (the death certificate will need two separate signatures from these two physicians). The physician also should recommend that the patient notify their next of kin. And finally, the physician must make sure to write up all events of the process in a detailed report and patient chart.


What are some of the arguments for physician-assisted suicide?

- Many patients struggle to live with terminal diseases that bring only terrible pain and suffering, moving toward a slow and agonizing death. These patients could be saved from this horrible process, once doctors can see their prognosis is limited to six months or less. These patients would be allowed to die with dignity.

- The patient's family and friends would have time to prepare for the pain and anguish that comes with the death of a loved one from a terrible disease. Patients would receive the chance to say their final goodbyes.

- Without the law, terminally ill patients may take the matter into their own hands and commit suicide in a traumatic way.

- The right to die should be a freedom for each person—if the terminally ill patient and family mutually agree, then he or she should be able to choose. The Constitution does not state that the government has the right to deny any citizen this choice.


And what are some of the arguments against physician-assisted suicide?

- The act violates doctors' Hippocratic Oath, especially the part of, "First, do no harm."

- Doctors and families may be led to give up hope too soon—miracle recoveries CAN occur. Scientific and medical advances seem to be constantly in the works.

- It could lead to non-critical patient suicides and other abuses, if the law ever started to loosen. Patients with emotional and psychological problems may somehow convince their doctors' to misuse the privilege and grant them a prescription to end their lives.

- With this law, doctors possess too much power, and their actions could be wrong or unethical. Patients and their loved ones trust their doctors and will believe them when they deliver their prognoses. Doctors should not have the ability to decide who to encourage or discourage to attempt recovery.