Physician-assisted suicide
Physician-assisted suicide (PAS) refers to the practice where a physician prescribes lethal medication to a terminally ill patient, who then self-administers the medication to end their life. This practice is distinct from euthanasia, where a physician or another party directly administers the life-ending medication. As of 2024, PAS is legal in nine U.S. states and the District of Columbia, with specific legal provisions often requiring patients to have a prognosis of six months or less to live. In contrast, euthanasia remains illegal across the United States. Internationally, several countries, including the Netherlands, Belgium, and Canada, have more permissive laws regarding physician involvement in assisted suicide. Supporters of PAS advocate for the right of terminally ill patients to choose a dignified and painless death, while opponents raise concerns about potential misuse, ethical implications, and the risk of normalizing suicide among vulnerable populations. The debate surrounding PAS has intensified in recent years, especially during the COVID-19 pandemic, as it raises complex questions about autonomy, medical ethics, and societal values regarding life and death.
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Subject Terms
Physician-assisted suicide
Assisted suicide is a broad term referring to the involvement of a second party in the termination of a consenting person's life. Physician-assisted suicide, also called physician-assisted death, is the taking of lethal medications prescribed by a physician for the express purpose of ending one's life.
Ethics
The legal and ethical debate surrounding assisted suicide has stratified the polarizing topic into several different categories, but the most medically relevant version in the United States is known as physician-assisted suicide (PAS). By 2024, physician-assisted suicide (PAS) was legal in nine US states and the District of Columbia, and is defined as suicide resulting from the self-administration of a lethal dose of a medication prescribed by a physician explicitly intended for the self-termination of life. This is not to be confused with euthanasia, where the physician or a second party actively administers the life-ending medication, as opposed to the patient.
PAS has been legalized in California, Colorado, Hawaii, Oregon, Washington, Maine, New Jersey, New Mexico, Vermont, and the District of Columbia. However, the restrictions vary from state to state. PAS is only legal in cases of terminally ill patients with a prognosis of less than six months to live. In Montana, a 2009 court ruling established that there is no law against PAS, but that the state's constitution does not guarantee a right to it; thus, in the absence of prohibiting legislation, doctors can cite this ruling as a defense if they are charged in connection with a case of PAS. In contrast, euthanasia remains illegal in all states, and physicians could face criminal charges if they directly administer life-terminating medication to a patient, even with an explicit request and informed consent.
Several other countries have less restrictive laws regarding physician involvement in suicide. In the Netherlands, Belgium, and Luxembourg, it is legal to directly administer medication that ends another person's life with an explicit request and their full informed consent, a set of conditions known as “voluntary active euthanasia.” By 2024, assisted suicide had been legalized or decriminalized in these and a handful of other countries, including Switzerland, Canada, Colombia, Ecuador, and New Zealand. Germany legalized PAS in 2020, and the Crown Dependency of Jersey became the first of the British Isles to legalize PAS, despite it remaining illegal in the rest of the United Kingdom. In 2021, Spain legalized PAS as well as physician-administered suicide. Canada also legalized physician-administered suicide that year.
Proponents of assisted suicide argue that patients with terminal illnesses should be afforded the right to die “with dignity” in a comfortable, nonviolent manner, and with the aid and expertise of a medical professional, if they so choose. Opponents of PAS argue that more widespread adoption of physician-assisted suicide could be a “slippery slope.” That is, if physician-assisted suicide becomes widely adopted and accepted practice with terminally ill patients, it may be utilized against the disabled community, people with normal life expectancy, and those who are unable to consent to death, such as comatose patients. Other arguments against PAS are based upon on moral, legal, and religious beliefs.
The legality of physician-assisted suicide within the United States continues to spread—Hawaii legalized it in 2018, Maine in 2019, and New Mexico in 2021—with multiple additional states considering similar legislation.
The COVID-19 pandemic complicated the already intense debate over the legalization of PAS, with opponents arguing that suicide should not be something that is easier to achieve during the heightened physical and mental stress of the pandemic. Those who support it claim that the dangers of COVID-19 call for more options and freedoms during the end-of-life period. Between 2021 and 2022, California and Vermont enacted legislation to make accessing end-of-life medication easier. In 2023, Vermont became the first state to remove residency requirements from its assisted-dying law.
Bibliography
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