Physician Assisted Suicide and Its Legal Ramifications, Research Paper Example

Most adults in today’s society remember the Jack Kevorkian case. Kevorkian is best known for advocating physician assisted suicide. Physician assisted suicide is defined as the situation in which “a doctor gives a patient (usually someone with a terminal illness) the means to carry out their own suicide” (Lee Stingl, 2014). However, there are many arguments to both sides of the debate regarding physician assisted suicide. Significantly, these arguments are based on many factors, including “medical, ethical, legal, religious, economic, psychological, and social” (Lee Stingl, 2014). Some of the strongest debates are within the medical and legal fields. For instance, “there is controversy over whether assisted suicide directly contradicts the terms of the Hippocratic oath” (Lee Stingl, 2014). Within the legal field, there is controversy over “whether assisted suicide violates the Controlled Substances Act, a federal law governing the distribution of drugs” (Lee Stingl, 2014). However, the proponents of physician assisted suicide view it with the “right to die” and “death with dignity” viewpoints and promote “civil liberties and freedoms,” including the provision for physician assisted suicide (Lee Stingl, 2014). Therefore, this study is an analysis of the statistics of physician related suicides.

History and Legalities of Physician Assisted Suicide

As of 2014, “four states have legalized physician assisted suicide” (Lee Stingl, 2014). The first state to allow physician assisted suicide was Oregon. This legislation was passed in 1994 and is known as The Death with Dignity Act. This Act allows “terminally ill patients, who are residents of Oregon, of sound mind, and who have voluntarily decided to end their own lives, to make a written request for lethal doses of medication” (Lee Stingl, 2014). Similar legislation was passed in 2008 and 2013 in Washington and Vermont. Furthermore, in a case in 2008, the Montana First Judicial Court “ruled that a terminally ill, mentally competent patient has a legal right to die using the assistance of his or her physician to obtain a prescription for a lethal dose of medication” (Lee Stingl, 2014).

Within the United States culture, ‘assisted suicide’ is a new concept. In reality, euthanasia has existed for many years. In fact, there were ancient civilizations in which “doctors routinely ended their patients’ lives if they were asked, and infants with disabilities or congenital abnormalities were often abandoned and left to die” (Lee Stingl, 2014). However, there are distinctions between euthanasia and physician assisted suicide. Regardless, there is a common argument given by opponents that “human life has intrinsic value and that killing, for whatever reason, can never be justified” (Lee Stingl, 2014). Thus, according to proponents, euthanasia is “sometimes called ‘mercy killing’” (Lee Stingl, 2014). In contrast, opponents utilize the fact that Nazi Germany killed children with disabilities to argue against physician assisted suicide. However, proponents of physician assisted suicide are careful to distinguish between euthanasia “which may be voluntary or involuntary, from assisted suicide, which always requires the patient’s active consent” (Lee Stingl, 2014).

Despite compelling arguments for physician assisted suicide, opponents voice arguments that the allowance for physician suicide “will lead to situations in which more and more people may be helped, or even coerced or forced, to take their own lives, including those with reversible illnesses, disabilities, or those in emotional pain” (Lee Stingl, 2014). However, proponents counter this argument by insisting that “proposed legislation permitting assisted suicide would include safeguards and strict regulations to prevent such abuses of the system” (Lee Stingl, 2014).

Opponents of physician assisted suicide commonly include those groups that advocate for those with disabilities. The major argument for these particular opponents is due to “a history of medical discrimination against people with disabilities, particularly those who are poor” (Lee Stingl, 2014). It is argued that physicians who are biased to this group of people sometimes are pessimistic towards the people in this group and/or their families due to “cost considerations or bias” (Lee Stingl, 2014). As a result, opponents of physician assisted suicide commonly state that this possibility may “dissuade patients from pursuing potential treatments or may negatively influence their beliefs about whether they will be able to attain a satisfactory quality of life” (Lee Stingl, 2014). Another such group that opposes physician assisted suicide is called Not Dead Yet. This group argues that the legislation may not be enforced equally or fairly, creating biases against “individuals with disabilities, the elderly, and the poor” (Lee Stingl, 2014).

One proponent for physician assisted suicide is Compassion and Choices, one of the largest advocacy groups. This particular group considers physician assisted suicide is allowable due to “democratic principles and personal freedoms, emphasiz[ing] the importance of death with dignity and believes that individuals with terminal illnesses associated with great physical suffering should be allowed the medical option of aid in dying” (Lee Stingl, 2014). In fact, many proponents for physician assisted suicide consider ‘suicide’ to be inaccurate and misleading in these situations. This is because the proponents of physician assisted suicide “only support the practice in cases where death is imminent and where the patient and doctor are merely attempting to ensure a more pain-free, peaceful death rather than a painful, drawn-out end” (Lee Stingl, 2014).

Within the general population, however, the idea of physician assisted suicide is considered to be a personal issue. This is one of the few things that proponents and opponents agree on in relation to the topic. In fact, many people within the general population “have had to participate in the decision about whether to pursue treatment for a family member who was close to death” (Lee Stingl, 2014). This type of experience influences decisions regarding the issue of physician assisted suicide. As a result of personal viewpoints and those that have had to make these type of decisions, the vast majority of the American population “believe decisions about whether or not to end life should be made by individuals, families, and physicians and should not be influenced by the government” (Lee Stingl, 2014).

In 1997, Washington was sued by a group of doctors, stating that the “ban on [physician] assisted suicide was unconstitutional” (Lee Stingl, 2014). This case was argued in the Supreme Court, which “ruled that the right to assisted suicide is not a constitutional right and that states can either choose to ban or permit the practice” (Lee Stingl, 2014). This ruling began the wave of legislation regarding physician related suicide. Oregon voters, for instance, “chose to uphold the state’s Death with Dignity Act, which had been on the books since 1994 but not yet implemented” (Lee Stingl, 2014). The requirements of this act was the patient must be a resident of Oregon, older than 18 years old, and diagnosed with a terminal illness that is expected to result in a maximum of six months to live. However, the Act was “challenged by attorney generals John Ashcroft and Alberto Gonzales but upheld by the US Supreme Court in 2006 in Gonzales v. Oregon” (Lee Stingl, 2014).

There are two major legal cases that have sparked the debate regarding physician suicide today. The first one was the famous 1999 Jack Kevorkian case. This physician advocated physician assisted suicide and is assumed that “Kevorkian assisted in the suicides of about 100 patients, most of whom self-administered the lethal doses of medication” (Lee Stingl, 2014). Despite this, Kevorkian continued to publicly state he would assist in helping patients commit suicide, regardless of the fact that it was against Michigan law. However, Kevorkian was only convicted of one case in which the patient “was in the final stages of amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), gave his consent, but Kevorkian administered the injection that killed him” (Lee Stingl, 2014). The second famous case was in 2005, regarding Terri Schiavio. In this situation, Schiavio had “severe brain damage who had been comatose since 1990” (Lee Stingl, 2014). In this case, there was an ongoing legal battle between Schiavio’s husband and parents regarding “whether or not her feeding tube should be removed, ending her life” (Lee Stingl, 2014). This case was not considered physician assisted suicide because Schiavio could not consent or take action. Rather, this case “highlighted the issue of end-of-life care” (Lee Stingl, 2014).

Finally, a ballot initiative was introduced in Massachusetts in 2014, known as the Death with Dignity Initiative. This failed to be passed. In New Mexico in 2014,  it was ruled by the Second Judicial District that “terminally ill, mentally competent patients have a right to physician assisted death” (Lee Stingl, 2014) This case has since been “appealed to the New Mexico Supreme Court” (Lee Stingl, 2014). In Quebec, Canada, there was legislation that was adopted regarding the right to die in 2014. Finally, 2014 brought the Aid in Dying for the Terminally Ill Act, passed by the New Jersey Assembly. However, the “state senate referred to committee and which the state governor vowed to veto” (Lee Stingl, 2014). Globally, physician “assisted suicide and euthanasia are legal in the Netherlands, Belgium, and Luxembourg, [whereas only] assisted suicide is legal is Switzerland, Germany, Albania, Colombia, Japan, and four US states” (Lee Stingl, 2014).

Statistical Problem

Based on the preliminary research, there have been numerous physician assisted suicides conducted over the years. Furthermore, preliminary research shows that, for those states and countries that allow physician assisted suicide; there has been a long and difficult battle for those advocating the right to die. However, self-inflicted suicides are continuing. Therefore, this statistical analysis is considering the rate of assisted suicide in comparison to suicide rates within Oregon, Germany, France, Italy, and Switzerland. This state was chosen because it was a pioneer in legalizing physician related suicides, whereas the countries utilized were selected because they are considered to be within the top five countries in terms of assisted suicide rates. The time period being used is from 2003 to 2011.

Methodology and Hypothesis

For the purposes of this study, the independent variable is suicide rate and the dependent variable is assisted suicide rate. The hypothesis for this study is: Assisted suicides do not have a relationship with suicide rates. The null hypothesis is: Assisted suicides do have a relationship with suicide rates. The data used to determine this came from primary sources, such as the Oregon Health Authority, WHO, and Dignitas. Since the available data was in small quantities, it may not be entirely reliable. Therefore, within this study, the sample size was not sufficient and statistically, a small arrow range exists. To analyze the existing data, central tendency measures were computed and progression and regression analyses were conducted.

Central Tendency Statistical Analysis

For this study, the central tendency analysis is composed of the arithmetic mean and median. The mean and median are instrumental in providing “a measure of central tendency in a single value that attempts to describe a set of data by identifying the central position within that set of data” (Laerd Statistics, 2013). This can allow the researcher to determine the year(s) of the most assisted suicide occurrences and suicides. There was limited data for assisted suicide datasets. Therefore, this dataset was extremely limited to a time period of 9 years. This could hinder the results and/or present inaccurate data. The averages for Oregon, Germany, France, Italy, and Switzerland were 51.9, 64.3, 12.0, 3.3, and 9.7 respectively in terms of assisted suicide. The averages for Oregon, Germany, France, Italy, and Switzerland were 603.1, 10,063.4, 9,352.1, 2,600.3, and 1,105.1 respectively in terms of suicide. The medians for Oregon, Germany, France, Italy, and Switzerland were 49, 66, 12, 2, and 10 respectively in terms of assisted suicide. The medians for Oregon, Germany, France, Italy, and Switzerland were 588, 10,030, 3757, and 1,284 respectively in terms of suicide. The standard deviations for Oregon, Germany, France, Italy, and Switzerland were 12.3, 27.3, 5.4, 4.3, and 3.8 respectively in terms of assisted suicide. The standard deviations for Oregon, Germany, France, Italy, and Switzerland were 2.7, 46.1, 593.1, 3,515.1, 1,953.6, and 429.8 respectively in terms of suicide. The variance for Oregon, Germany, France, Italy, and Switzerland were 151.1, 746.5, 29.3, 18.8, and 14.3 respectively in terms of assisted suicide. The standard deviations for Oregon, Germany, France, Italy, and Switzerland were 7.5, 21, 25.6, 351,739.6, 12,355,986.9, 3,816,507.0, and 184,715.1 respectively in terms of suicide.

Population Mean

The population mean is important because it shows how biased the results are. Due to the limitations of the data, it is not possible to determine this for this study. However, a variance of the mean can be found through yearly averages. This can then be compared to the state/country sample mean. The yearly averages are shown below:

The averages for Oregon, Germany, France, Italy, and Switzerland were 51.9, 64.3, 12.0, 3.3, and 9.7 respectively in terms of assisted suicide. The averages for Oregon, Germany, France, Italy, and Switzerland were 603.1, 10,063.4, 9,352.1, 2,600.3, and 1,105.1 respectively in terms of suicide. Therefore, assisted suicide averages for Oregon and Germany were much hirer than yearly averages. The suicide averages are evenly disbursed between being higher and lower than the yearly averages.

Progression and Regression Analysis

As can be seen, from 2003 to 2010, suicide averages were consistent, ranging around 5,000 per year. However, assisted suicide rates varied tremendously. This is shown in the linear trend line. This trend line has an upwards slope, showing that an increase in assisted suicide is anticipated. In contrast, the trend line for suicide has a downwards slope, showing that a decrease in suicide is anticipated.

The degree of freedom for regression is 1. Thus, there is one independent variable in the regression. However, for residual, there are 7 independent variables. The residual SS refers to the sum of the squares of the differences of variable y predicted by equation 1 and the actual values of the variable y. The residual MS refers to the mean square error. Thus, significance F refers to the probability that the equation does not explain the variation in equation 1.

Relationship between Statistics and Problem

Due to the increasing acceptance of assisted suicide, these numbers may increase. However, the suicide rates are fairly consistent throughout the time period. Through using a statistical analysis to analyze the rates of physician assisted suicides and suicides, it may be possible to define arguments and policies that can help both groups of people, which can greatly impact public administration policies and regulations. Furthermore, the statistics can be used to identify a correlation between the assisted suicide rate and the suicide rate.

References

Dignitas. (2014). Accompanied suicides per year and residence. Retrieved from http://www.dignitas.ch/index.php?option=com_content&view=article&id=32&Itemid=34&lang=en

Laerd Statistics. (2013). Measures of Central Tendency. Retrieved from https://statistics.laerd.com/statistical-guides/measures-central-tendency-mean-mode-median.php

Lee Stingl, M. A. (2014). Assisted suicide overview. Salem Press Encyclopedia. Retrieved from http://libraries.maine.edu/mainedatabases/authmaine.asp?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=cookie,ip,uid&db=ers&AN=89158054&site=eds-live

Oregon Health Authority. (2014a). Death with Dignity Act. Retrieved from https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx

Oregon Health Authority. (2014b). Violent Deaths in Oregon: Data by Year. Retrieved from https://public.health.oregon.gov/DiseasesConditions/InjuryFatalityData/Pages/index.aspx

WHO. (2014). Intentional Self-Harm.Retrieved from http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/