Physician-assisted Death: What Everyone Needs to Know

Abstract

With Oregon's Death with Dignity Act on the horizon in the 1990s, The Center for Ethics in Health Care at Oregon Health and Science University convened an interdisciplinary group of professionals to consider guidelines for implementation. The task force did not take a position on the referendum that established the first physician-assisted suicide law in the country. Rather, we considered practical implications, such as how health professional regulatory boards would handle complaints regarding possible violations of the law. That task force wrote a guidebook, “The Oregon Death with Dignity Act: A Guidebook for Health Care Providers,” which was first published in 1998 and is in its second iteration.For medical regulators who want a deeper understanding of the context and impact of this topic, however, there is “Physician-assisted Death: What Everyone Needs to Know,” a comprehensive, well-researched book from author L.W. Sumner.Published by Oxford University Press, Professor L.W. Sumner's book covers a range of end-of-life care issues while focusing on physician-assisted death. In it, he poses a series of essential questions on the topic. Dr. Sumner's aim is to provide readers with resources on this controversial debate. With international references, it is clear that Dr. Sumner has comprehensive knowledge of the subject, often referencing Oregon's law — which has proven to be the model statute. One significant difference between the law in Europe and in the United States is that several European countries include access to physician-assisted death to patients who have serious, incurable illness causing intolerable suffering, which is more expansive than simply requiring a terminal diagnosis.The book offers a comprehensive view in chapters touching on all aspects of physician-assisted death. Its first four chapters examine why discussions of death and dying are important, definitions of end-of-life-care, and the ethical cases to be made — both for and against — physician-assisted death. Chapters five through eight focus on legal factors related to physician-assisted death, including legal history, current legalization frameworks, and the arguments that are generally made for both the legalization and prohibition of assisted dying. Its final two chapters look forward to questions and concepts that will need to be tackled in the future, as the concept is increasingly discussed — including the role of advance directives and challenging topics such as physician-assisted death in cases of dementia.In exploring the history, ethics and legality of physician-assisted death, Dr. Sumner makes the case for and against allowing it as a legal end-of-life option. Perhaps unavoidably, he is persuaded that not only is physician-assisted death humane, but further states that physician-assisted euthanasia is more humane because it does not require that the patient be able to ingest a lethal medication. Dr. Sumner also states that physicians have a professional duty to participate in physician-assisted death, if it is legally adopted within the jurisdiction in which they practice. Having participated in the workgroup convened by the Center for Ethics, and having served as Executive Director of the Oregon Medical Board, I believe many physicians would disagree with this premise.Interestingly, Dr. Sumner argues that while Oregon has not expanded the statute, in practice it has expanded the definition of who qualifies for physician-assisted death to include psychological suffering because the main reasons cited by persons who request a prescription are psychological or existential. While control over the manner and timing of one's death is the primary reason for requesting a prescription, there is the underlying requirement that a patient have a terminal diagnosis. One of the reasons Oregon's law has served as a model, and its implementation has been so successful, is that there are reasonable safeguards in place which have prevented abuses. The requirement for a terminal diagnosis is one such safeguard.This provocative book causes one to reflect on the many implications of end-of-life suffering and the role of physicians in alleviating that suffering.