Perspective 1

Liberal View/Democrat

Focus: Recognize the right to die with dignity, with a physician’s assistance

 Legalize physician-assisted suicide and make it a socially accepted, stigma-free medical procedure for those patients who need it.

 Enact rules to determine that patients seeking such assistance are mentally competent, in great pain or mental anguish, and intent on ending their lives.

 Prosecute physicians who assist in ending life when these various rules have not been met.

 Require insurers to provide health and life insurance benefits to people who die with medical assistance.

Arguments For This Approach

· Society has a pressing interest in preserving life, but not when further treatment is futile, pain is intolerable, or when the patient wishes to die.

 Society should recognize the needs and wishes of individuals who are near death. They deserve compassionate assistance, and should be able to get such assistance openly.

 This approach respects individual autonomy and the need for personal dignity. It does not force the terminally ill to linger helplessly and hopelessly, often at great cost.

 Physician-assisted suicide, which is generally accomplished by administering a lethal drug, is more humane than the current practice of withdrawing life-sustaining treatment.

 Many physicians secretly help incurable patients to end their lives. Making such assistance legal would permit the practice to be regulated, which would prevent abuse, and permit physicians to be do legally what many are currently doing illegally.

 There is no real difference between recognizing the legal right to medical assistance in dying, and the already accepted practice of responding to the patient's desire to end life- sustaining treatment.

 As long as regulations about the circumstances under which individuals may seek a physician's assistance in dying are clear and consistently enforced, the danger of abuse can be kept to a minimum.

Arguments Against This Approach

 The severe pain that leads many patients to consider suicide is treatable.

 Seriously ill patients who consider suicide are not necessarily close to death. It is often hard to determine whether patients are terminally ill. But doctors are in a better position to make that determination than patients are.

 Many suicidal people are not terminally ill, they are depressed. They need treatment for depression, not assistance in dying.

 The right to die could easily become the duty to die. By recognizing the right to physician assistance in dying we condone situations in which people especially the old and the poor are deprived of medically necessary treatment.

 If physician-assisted suicide is legally sanctioned, the practice is likely to get out of hand. Severely incapacitated patients might feel emotional or financial pressure from relatives, or insurers, to end their lives.

 Recognizing the right to die compromises society's commitment to life.

 Under growing pressure to control the cost of health care, physicians who have the option of helping patients end their lives would face a severe conflict of interest.

Perspective 2

Moderate

Focus: Give comfort and recognize the patient’s preferences

 Take additional steps to improve patients' comfort and quality of life, rather than helping to hasten their death.

 Allow patients to issue directives, not just preferences, about end-of-life care and treatment, and provide additional incentives for medical professionals to follow those directives.

 Improve training so medical professionals are able to provide relief from pain, and also the emotional support people need as they near death.

 Expand palliative care in medical facilities. Even acute care facilities should be able to provide as much comfort and pain relief as possible.

 Expand hospice care, both facilities designed specifically for this purpose and in-home hospice care.

 Remove barriers to effective pain management, such as overly restrictive regulation of narcotics.

 Provide mental health care for terminally ill patients, who are prone to suffering and depression

Arguments for this approach:

 Many hospital patients endure needless pain. If patient care were improved and additional measures taken to reduce pain and suffering, fewer patients would want to hasten their deaths.

 If medical professionals consistently honored the right to refuse treatment, which is already recognized, there would be less demand for physician-assisted suicide.

 Many terminally ill patients would be better served, at lower cost, by hospice care than by acute care hospitals. Health coverage should be expanded to include hospice care.

 Most suicidal people suffer from depression. If depression among seriously ill patients were treated seriously, fewer people would seek assistance in dying.

 Unwanted treatment of terminally ill patients wastes money and medical resources.

Arguments against this approach:

 If terminally ill people want to die, they have the right to do so. Some people would prefer to end their lives rather than lingering in a coma-like state induced by heavy sedation and opiates.

 Medicating patients to the point of death is a form of mercy killing, which skirts the central moral and legal issues in the right-to-die debate.

 By calling for more attention to patients' preferences about end-of-life treatment, this choice ignores a fundamental fact: physicians are the medical experts, and they are in the best position to determine when illness is terminal.

 Hospice care is strictly limited. It is appropriate only when patients have given up hope for a cure or treatment that might extend their lives.

 Short of terminally sedating patients, physicians cannot relieve the pain experienced by many patients. It's unrealistic to think that additional attention to pain relief would reduce the number of cases in which people seek assistance in dying

Perspective 3

Conservative/Republican

Focus: Reaffirm the commitment to preserve life

 Enact a federal law banning all forms of physician-assisted suicide, and strike down initiatives such as Oregon's Death with Dignity Act that seek to legalize it.

 Strengthen criminal laws to deter physician-assisted suicide. Prosecute and penalize physicians who practice it.

 Enact civil laws to deter physician-assisted suicide, including measures to make it easier to bring malpractice suits against physicians who do so.

 Insist that physicians make every effort to sustain life except when patients and their families explicitly decline further treatment.

 Respond to requests for physician-assisted suicide with mental health treatment and counseling

Arguments for this approach:

 By prohibiting physician-assisted suicide, society affirms the unconditional value of human life.

 Suicide is a tragic individual act. Legalizing suicide would make this tragedy the social norm, and encourage others to kill themselves.

 The physician's only role is to save lives and relieve symptoms. Permitting doctors to assist suicides would compromise their role and undermine trust in the medical profession.

 By prohibiting physician-assisted suicide, we minimize the likelihood that patients will feel pressured to end their lives as a way of relieving emotional or financial strains on their family.

Arguments against this approach:

 Government shouldn't force people to live when they want to die. In a free society, individuals should be able to control how and when they die.

 The purpose of medicine is to alleviate suffering. Sometimes ending a life is the only way to do that.

 If patients are denied the right to die, medical professionals are likely to continue costly and aggressive end-of-life treatment.

 Physician-assisted suicide is widely practiced in secret. It's in the public interest to make it legal, and minimize error and abuse by regulating it.