Examples of Regulations and Statements for and against Physician Assisted Suicide

The previously proposed bill in 2015 was not passed.  One shudders to imagine the regulation, oversight, and implementation of a department of dying and of what burden this would place on medical providers.  Diagnoses of how long someone has to live are conjectures and sometimes prove to be very wrong.  This bill for England and Wales to legalise assisted suicide has received over 1,000 amendments.  It has reached the stage of being read in the House of Lords, but it is meeting opposition.  Scotland’s bill, tabled in 2024, proposes assisted suicide for adults (over 16 years of age) with terminally ill diseases and who have six months to live.

The Disability Rights California (DRC) Proposals:

In the United States of America, the federal government does not pay for suicides, but states may.  The states where assisted suicide is legal: California, Oregon, Washington, Montana, Colorado, Mew Mexico, Illinois, Delaware, New Jersey, Vermont, Maine, and Hawaii.  Washington and New Jersey are considering amendments.  It is also legal in Washington D.C.  States considering the legalization of assisted suicide are: Minnesota, Missouri, Indiana, New York, Pennsylvania, New Hampshire, Massachusetts,   Rhode Island, Virginia, North Carolina, and Tennessee. 

Let us consider the principles proposed by Disability Rights California (DRC) for California in 2015, which are much briefer than the bill before the UK Parliament.  The proposals state:

Any legislation or initiative about physician-assisted suicide must:

- Ensure and document the patient is safe from coercion or influence at all times, including during the written and oral request and after the initial request for the drug.

- Ensure if the patient changes their mind, the drug is no longer available.

- Ensure and document that the patient requested assisted suicide; forbid health providers or insurers from offering or suggesting it.

- Ensure and document how the physicians and witnesses determine whether the patient is clear in their wishes, is not under duress or experiencing coercion or undue influence. If the decision conflicts with a previous statement, such as one requesting continuing treatment or extraordinary life-sustaining treatment, the reason must be documented.

- Ensure and document that each patient who requests a lethal drug is provided information about and guaranteed provision of alternatives, such as palliative care, hospice care, personal assistance services, further medical treatment and peer support and counseling. Providing a list of services does not satisfy this requirement. The patient has the right to refuse the alternatives and the refusal must be in writing.

- Ensure that people with disabilities are not discriminated against. Ensure people with disabilities, including seniors, are offered medical treatment on a non-discriminatory basis. Require the treating physician to sign a statement stating no treatment was denied because of the nature or extent of a person’s disability. The patient has the right to refuse any medical treatment and the refusal must be in writing.

- Ensure managed care entities and health insurance companies have not overruled the physician’s treatment decisions because of the cost of care. Require the treating physician to sign a statement that the physician’s recommended treatment was not denied by the managed care entity or health insurance company.

- Prior to prescribing a lethal drug, require and document a review of the individual’s Advance Directive and Physician’s Order for Life Sustaining Treatment. Ensure the person’s instructions about withdrawal of treatment and palliative care have been honored. For people without an Advance Directive or Physician’s Order for Life Sustaining Treatment, provide information and independent help to complete an advance directive prior to authorizing a lethal drug.

- Allow the patient to decide whether the official cause of death is the lethal drug or the underlying diagnosis.

- Require stakeholder involvement, including California’s protection and advocacy agency and other representatives of people with disabilities, to design regulations, oversight, specific safeguards, reporting requirements, and the collection and publishing of data on a variety of measures. The data must include information about the 2 race, ethnicity and income of people requesting the lethal prescription. Data must be provided about whether predictions of date of death by doctors who prescribe the lethal dose are accurate. The data must include patterns of prescription, which might be related to “doctor-shopping.”

- Prohibit broad protections for physicians or others who act “in good faith” even if the physician misdiagnoses, declines to provide medical treatment for the underlying condition, declines to approve palliative care, encourages assisted suicide as preferable to other alternatives, or knows about and does not report coercion or influence.

- Prohibit anyone with a financial stake in the death, including heirs and facility staff (e.g., nursing home staff) from being a witness to the written declaration requesting assisted suicide. - Prohibit any witness without significant knowledge of the patient from assessing whether the patient is under duress, fraud or undue influence.

- Prohibit physicians who are new to the patient (e.g., nursing home attending and consulting physician) to make and confirm a diagnosis and approve the lethal drug.

The care put into such proposals seems unaware of the consequences of implementation.  The amount of regulation and the affect this would have on the practice of medicine is immense.  Yet the underlying question to all this is whether assisting people to kill themselves is right.

Opposition to Suicide and Assisted Suicide

In October, 2019, the World Medical Association approved the ‘WMA Declaration on Euthanasia and Physician-Assisted Suicide’ declaration at the 70th WMA General Assembly in Tbilisi, Georgia:

The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life. Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide....

No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.

Separately, the physician who respects the basic right of the patient to decline medical treatment does not act unethically in forgoing or withholding unwanted care, even if respecting such a wish results in the death of the patient.

One Christian group in the UK opposed to the legislative push to legalise assisted suicide is CARE, which stands for stands for Christian Action, Research, and Education.  CARE states:

All life has intrinsic value and dignity—regardless of its condition.  We recognise how immensely difficult it is to suffer or to see a loved one enduring pain, but, as Christians, we are called to protect those who are vulnerable and assist people to live—not to commit suicide.  And we want to advocate for a better way: excellent palliative care, so that those approaching life’s natural end can have confidence that death can be dignified and pain can be managed.

Another significant Christian group opposed to assisted suicide in the UK is Christian Concern, which states:

Legalising euthanasia or assisted suicide is unnecessary, dangerous, and wrong.

It is unnecessary because alternative treatments are available. Good palliative care should be available for all. Killing is not care – it is not kinder to take a life instead of caring for it.

It is dangerous because when people are ill, they are vulnerable and can easily be pressured to make decisions that they may later regret. Society should protect the weak and vulnerable rather than allowing them to be killed.

It is wrong because it devalues human life which is sacred. All historical codes of ethics have agreed that euthanasia is wrong. Disability organisations consistently oppose assisted suicide and euthanasia.

Christian Concern has resources on euthanasia and assisted suicide, including a booklet by this title, a number of articles, videos, testimonies, and several key legal cases.  The 38-page booklet has the following sections: ‘What is Euthanasia and Assisted Suicide (EAS)?’, ‘What does the Bible say?’, ‘What does the law say?’, ‘Reasons not to legalise EAS’, ‘Isn’t the public in favour of EAS?’, ‘What about countries where EAS is legal?’, and a conclusion.

In the United States of America, the Christian Medical and Dental Associations have two relevant statements, one on suicide and one on physician-assisted suicide, with additional explanation.  Regarding suicide, it stated in 1992:

We, as Christian physicians and dentists, believe that human life is a gift from God and is sacred because it bears God's image. One of the ramifications of societal acceptance of suicide is further devaluation of the biblical view of human life.

The role of the physician is to affirm life, to relieve suffering and pain, and to give compassionate, competent care as long as the patient lives. The physician as well as the patient will be held accountable by God, the giver and taker of life.

Suicide is an intentional act with the express purpose of ending one's own life, often occurring in the context of isolation, pain, or mental illness that may alter the victim's perceptions, thinking, and judgment. We believe it is only for God to judge the ultimate moral culpability of those who take their own lives.

Suicide is in opposition to the sovereignty of a loving God, the Creator of all life, and it is an inappropriate exercise of the control that God has given us over our own lives as created beings.

Release from suffering is thought by some to justify suicide. However, suffering is a part of the current state of God's redemptive plan. Relief of family or societal burden is thought by some to justify suicide. However, the biblical view of family and community includes an obligation to attempt to meet the needs of the individual.

For those family members who feel stigmatized by a sense of shock and shame when a relative commits suicide, our task is to be agents of grace and healing in the midst of their loneliness, their isolation, their grief, and anger.

We do not oppose withdrawal or withholding of artificial means of life support in patients who are clearly and irreversibly deteriorating, in whom death appears imminent, and who are beyond reasonable hope of recovery.

The Christian Medical & Dental Associations advocate appropriate use of treatment for clinical depression and physical pain as well as support for depressed or suffering individuals by family, church, and community.

Regarding physician-assisted suicide, the Christian Medical and Dental Associations stated in 1992:

We, as Christian physicians and dentists, believe that human life is a gift from God and is sacred because it bears God's image. Human life has worth because Christ died to redeem it, and it has meaning because God has an eternal purpose for it. We oppose active intervention with the intent to produce death for the relief of pain, suffering, or economic considerations, or for the convenience of patient, family, or society. Proponents of physician-assisted suicide argue from the perspective of compassion and radical individual autonomy. There are persuasive counter arguments based on the traditional norms of the medical professions and the adverse consequences of such a public policy. Even more important than these secular arguments is the biblical view that the sovereignty of God places a limit on human autonomy. In order to affirm the dignity of human life, we advocate the development and use of alternatives to relieve pain and suffering, provide human companionship, and give opportunity for spiritual support and counseling. The Christian Medical & Dental Associations oppose physician-assisted suicide in any form.

Conclusion

Governmental or organizational decisions to allow assisted suicide find themselves in a considerable effort to define, legislate, regulate, oversee, adjudicate, protect, and so forth.  They not only provide death as a means of care but also introduce a social change at several levels.  A regulatory office for suicide, judges, requirements and guidance for medical practitioners, and a general view of end of life matters in society at large are all instituted.  The introduction of euthanasia under strict restrictions easily expands to cover other reasons for suicide.  As we have seen before regarding suicide, even in antiquity, and in regard to other matters, most recently the expansion of youth claiming to be transgender or bisexual, social trends are introduced when legislation brings such practices to citizens’ attention.

Having noted Christian objections to suicide and assisted suicide, one major concern is how governments intend to handle such objections.  Will Christian doctors be forced to provide suicide or pass their patients on to suicide-performing doctors?  How will such legislation affect pharmicists who object to providing poisons for suicide prescriptions?  How will a Christian nurse relate to a doctor’s order for assisted suicide?  Will Christian counsellors be forbidden to provide counselling against suicide when the client desires to do—as they have been in the matter of homosexual identity in the UK?  Will a Christian praying that a patient not proceed with suicide be arrested, as Christians praying near abortion clinics have been in the UK?  Will teachers claiming to act in kindness and aware of an adult student’s desire to commit suicide be able to withhold this information from Christian parents?  Perhaps we might expand these sorts of scenarios, but the basic question is how a society might engage groups diametrically opposed to governments allowing and regulating assisted suicide.