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The term assisted suicide is defined as a situation when a terminally ill patient voluntarily made a suicide request from a doctor and he will assist him by supplying equipment and lethal drugs to hasten the patients death. Eight states in the United States of America namely California, Colorado, the District of Columbia, Hawaii, Oregon, Vermont, Washington and Montana have legalized assisted suicide (Death with dignity, 2019). Chin, Hedberg, Higginson, and Fleming (1999) reported that during the first year when assisted suicide is legalized in Oregon, the decision to request assisted suicide was associated with patients concern of the inability to control their bodily functions. Besides, they also highlighted that the choice of assisted suicide was not associated with the level of education or health insurance coverage. The steps to assisted suicide involve five crucial phases as shown in Figure 1, which are requesting assisted suicide, getting a diagnosis from a physician, the doctor prescribing lethal drugs for the patient, documentation and payment process and lastly, the patient taking his own life.
During the initial stage, the patient will seek a formal verbal request with the assigned doctor and the doctor has to acknowledge that his patient has assisted suicide in mind. Two weeks later, the patient has to make another verbal request to the doctor. This step is pivotal in ensuring that the patient is confident with his decision. The discussion will include the patient’s reason to assisted suicide and learning the effects of assisted suicide. Sulmasy and Mueller (2017) said that the suffering of dying patients is intense as they are pressured with somatic symptoms such as extreme pain and nausea daily and the existential suffering would make one feel hopeless, indignity or the belief that ones life has ended in a biographical sense but not yet ended biologically. For example, if the patient is diagnosed with a severe illness or incurable disease where death is the only way to get out of it, he has the right to request for assisted suicide from the doctor but the whole initial stage of assisted suicide could not proceed until the doctor receives an official letter from his patient and is signed by two witnesses which can be a family member or the nurse. Then, the doctor will discuss with his patient the procedures and regulations that should be followed during the process. The patient himself can join a patient-advocacy group for further information regarding the law in assisted suicide process.
The second step is getting a diagnosis from qualified healthcare professionals. Based on the legal foundation of assisted suicide which is known as the Death with Dignity Act (DWDA) that has been enacted by Oregon and Washington in 2008, the patient must be at least 18 years of age, a legal resident of the state, capable of making and communicating health care decisions, and diagnosed with a terminal illness that will lead to death within six months before assisted suicide can proceed (Jennifer & Andrea, 2011). The patient will undergo consultations with the treating practitioners. Then, the psychiatrist will diagnose the patient mental state and made a thorough review of their condition and create a case file. This evaluation is to determine the patient’s condition whether it is unbearable and untreatable psychological suffering or not (Thienpont, L., Verhofstadt, M., et al., 2015). The consultations also include treating practitioners telling patients about other alternatives such as hospice care and advising the patient to confer with the family or next of kin. They also have to remind the patient that it is fine to change their mind at any time. By law, a second physician must review the case and sign off on the first doctors diagnosis.
Next, the doctor prescribes lethal drugs to the patient. This phase is important as the doctor has to explain what the patient should do and how the lethal medication works in their body. Only three lethal medications namely secobarbital, pentobarbital, and phenobarbital have been used according to Oregon state statistics, aside from anti-nausea and anti-anxiety medications to combat side effects (Oregon Public Health Division, n.d.). The doctor should instruct patients to take the lethal dose on an empty stomach to increase the rate of absorption. If the patient has diseases that may slow or alter normal organ function, it could affect the speed and number of drugs absorbed in the small intestine which later would be sent to the rest of the body. Therefore, patients may require larger doses (JoNel, 2017).
Documentation and payment of medical consultations is the fourth phase in assisted suicide. On the day of the event, the patient has to answer questionnaires to ensure he clearly understood what is going on and the patient is not under duress. This process is important as the patient has to be able in making healthcare decisions and understand the processes of assisted suicide. As assisted suicide is a procedure under extremely strict conditions, the doctor must confirm for the last time that the patient is identified with an incurable disease that may lead to death occurring within six months and the patient needs to be proficient of consuming the assisted suicide medications provided (Death with Dignity Act, 2018). The price of lethal drugs such as barbiturates, a nervous system depressant drug could cost over $1000 for a dose and a 10 grams lethal dose of pentobarbital powdered drug costs about $125 for a prescription (Engber, 2005).
The final step of assisted suicide is the patient taking his own life by swallowing or injecting a lethal dose of legally prescribed pills. Most of the time assisted suicide occurs at the patient’s home. Assisted suicide laws mandate that the patient take the medication himself and the procedure must be done alone by the patient itself without any help, but the patient may be accompanied by a family member or home care nurse nearby. If the person becomes too advanced in their illness to pick up or swallow the medication, the pills could be crushed and introduced via a feeding tube or other means prepared by their caregivers (Hendin & Foley, 2008). The rate of this process depends on the type of lethal prescribed pills used in excessive dosage. Barbiturate is faster than pentobarbital because the procedure is a consumed liquid whereas pentobarbital is through an intravenous drip. Typically, the patient will slip into a coma about five minutes after taking the barbiturate, with death coming within about half an hour (Engber, 2005). The time of death is determined by the home care nurse who checks the pulse every few minutes until he passes away.
References
- Anonymous (2019). Death with Dignity as an End-of-Life Option. Retrieved from https://www.deathwithdignity.org/faqs/
- Anonymous (2018). The Death with Dignity Act. Retrieved from https://www.lawteacher.net/free-law-essays/medical-law/the-death-with-dignity-act-medical-law-essay.php
- Chin, A. E., Hedberg, K., Higginson, G. K., & Fleming, D. W. (1999). Legalized Physician-Assisted Suicide in Oregon The First Years Experience. New England Journal of Medicine, 340(7), 577-583. doi:10.1056/nejm199902183400724
- Engber, D. (2005). How does assisted suicide work? A guide to ‘Death with Dignity’ in Oregon. Retrieved from https://slate.com/news-and-politics/2005/10/how-does-assisted-suicide-work.html
- Hendin, H., & Foley, K. (2008). Physician-assisted suicide in Oregon: A medical perspective. Michigan Law Review, 1613-1645
- FAQs – Physician-Hastened Death. (n.d.). Retrieved from https://www.deathwithdignity.org/faqs/
- Jennifer, F., & Andrea, F. (2011). Physician-assisted suicide. American Journal of Health-System Pharmacy, 68(9), 846-849
- Joel, A. (2017, February 16). Docs in Northwest tweak aid-In-dying drugs to prevent prolonged deaths. Kaiser Health News. Retrieved from https://khn.org/news/docs-in-northwest-tweak-aid-in-dying-drugs-to-prevent-prolonged-deaths/
- Oregon Public Health Division. (n.d. ). Oregon’s Death With Dignity Act-2016, Retrieved from https://public.health.oregon.gov/ProviderPartnerResources/Evaluation Research/ Death with DignityAct/Documents/year19.pdf.
- Sulmasy, L. S., & Mueller, P. S. (2017). Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Annals of Internal Medicine, 167(8), 576. doi:10.7326/m17-0938
- Thienpont, L., Verhofstadt, M., Van Loon, T., Distelmans, W., Audenaert, K., & De Deyn, P. P. (2015). Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study. BMJ open, 5(7), e007454. doi:10.1136/bmjopen-2014-007454
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