Physician assisted suicide is a modern concern that is generating controversy throughout the medical field, as well as segments of society. Assisted suicide has generated many debates on a number of issues, such as physician's role, patient autonomy and doctor/patient relationships. Representatives have expressed many persuasive opinions on all sides of the issue. Strong arguments from religious groups, medical professionals and scholars illustrate the heated discussion on the topic. The purpose of this essay is to examine the issues that surround physician assisted suicide in order to get a better understanding of the persuasive opinions set forth by representatives on both sides of the issue.

Physician-assisted suicide is most commonly defined as the act of ending the life of an individual suffering from a terminal illness, as by lethal injection or the suspension of extraordinary medical treatment. There are three basic types of physician-assisted suicide that have caused the current debate, including voluntary, involuntary and non-voluntary. Voluntary physician assisted suicide is the most common and is when the patient makes a voluntary request to receive assistance. Involuntary physician-assisted suicide is when the patient makes it clear that they oppose euthanasia, but their requests are ignored. Non-voluntary physician assisted suicide is when the patient is not competent enough to request assistance (Young). With these three types of physician-assisted suicide, there is a very fine line between whether it is in the patient's best interest. This fine line that separates the three, is what has lead many to have very different viewpoints on the whole issue of assisted suicide.

Many arguments have been suggested against assisted suicide. The most common deals with the opinion that it is not the physician's role to terminate life at the request of a patient. There are religious and moral arguments that support the idea that it is not the role of a physician to assist a patient in ending their life. On an ethical aspect, James Boehnlein states: "Medical healers are viewed with trust and respect, and with the explicit expectation that the physician will treat illness and preserve life" (8). The role of a physician is to merely use the knowledge and skills that they obtained during their medical education and then use this detailed information to enhance the life of their patients.

Another group of scholars that are in agreement with this concept include Mak, Elwyn and Finlay who argue: " Doctors should strive to relieve suffering, not end the life of the sufferer: the authority to terminate life would undermine their trustworthiness" (213). Boehnlein, Mak, Elwyn and Finlay all argue that allowing physicians to make a decision of life or death on their own, is not their role and would lead to changes in the way that the society views doctors. The common perception of doctors being trustworthy healers would merely be diminished.

Those with religious opinions on the matter also have a similar argument. As the moral argument suggests, it is not the physician's societal role to assist in suicide. Similarly speaking, the religious minded individual believes it is not the role of a doctor as well. Cristina L. Traina argues that according to Roman Catholics, "efforts either to hasten death or to prolong life interferes with God's plans for the soul" (1149). This means that any type of assisted suicide, or any unnatural act reflecting the length of time a person spends on earth is looked down upon by God. Assisted suicide not only prematurely ends the life of an individual, but could also cause certain repercussions in the after-life. Common religions such as Hinduism and Buddhism believe that "artificially shortening life in order to relieve physical suffering in the short term may actually increase existential suffering in the long term" (Traina 1148). This further emphasizes the common opinion from a variety of religions that ending life unnaturally is spiritually wrong. Clearly, there are many points of view expressing apprehension towards a physician being placed in a role that is thought by many to be wrong in a variety of ways. If physicians were allowed to assist patients in suicide attempts, not only would a negative light be shined on their profession, people would begin wondering why someone in the business of saving lives had suddenly decided to end lives at society's request.

Another argument of physician-assisted suicide deals with the idea of personal autonomy. Many people believe that a person she be able to make their own decisions regarding their life, including the decision to live or die. Sharon Fraser and James Walters state: "A democratic society that honors justice and liberty should acknowledge and permit these divergent opinions and allow dying people a degree of freedom in when and how the end comes (123). There are some, however that believe that the idea of personal autonomy is often misleading. Boehnlein argues: The process of physician-assisted suicide is not truly autonomous…there can be unconscious coercion by family members or care providers, including the tendency to choose irreversible actions, including suicide, when faced with the helplessness experienced in the face of death" (7). If a patient is influenced by family and others in society, then they make a decision that is not in reality what they wish for.

Boehnlein, Mak, Elwyn and Finlay all share their views opposing physician-assisted suicide, however all scholars do not share their views. There are many scholars that believe that assisted suicide is beneficial for patients in certain circumstances. Peter Rogatz is one scholar that firmly believes that there are some patients that endure terrible suffering and anything that can be done to help them, should be done. Rogatz main argument is that many patients seek physician-assisted suicide due to the depression and misery that goes along with a personal loss of dignity. Rogatz claims: "There is a growing awareness that the loss of dignity and of those attributes that we associate particularly with being human are the factors that most commonly reduce patients to a state of unrelieved misery and desperation (32).

Proponents that agree with Rogatz believe that if someone is in a state in which they no longer hold personal dignity, then it is morally wrong to ignore personal requests for assisted suicide. Fraser and Walters also argue that once people lose their sense of personal dignity, then there is no right in making them suffer any longer. Portraying an undignified life, Fraser and Walters support their ideas with the story of an old man that is one the verge of death. They explain that the patient "described an incontinent, pain-wrecked, totally dependent existence that was exacerbated by watching the suffering of his wife as she cared for him. He was immensely grateful that he could end his life in a dignified and compassionate manner" (Fraser and Walters 120). Fraser and Walters agree with Rogatz, believing that it is not wrong for the man to request assistance in ending his life now, in hopes to have his family remember him as a noble and capable human being rather than incapable and dependent.

In agreement with Fraser and Walters argument, is another case similarly discussed by Lesley and Len Doyal. Lesley and Len Doyal tell a story of a woman with a motor neuron disease and the experience of her deteriorating body. "She faces a death that she believes will entail indignity and suffering, and cannot kill herself (Doyal and Doyal 1079). Doyal and Doyal agree with Fraser and Walters, in the believe that it is morally correct to agree to a patients request, when that patient is on the road to an undignified death. They believe that there is no sense in making a human suffer any longer in this undignified life.

Once again opposing this idea is Mak, Elwyn and Finlay that state that "patients might feel obliged to request euthanasia to avoid being a burden, particularly as acts to end life already occur without the patients explicit requests (Mak, Elwyn and Finlay 213). While Fraser and Walters where attempting to portray an undignified life, they also discussed the idea that this patient that was miserable as he watched his wife as she cared for him. Mak, Elwyn and Finlay would argue that this patient might only be requesting assistance in his own suicide, due to the fact that he felt that he was a burden to his family.

In agreement with Mak, Elwyn, and Finlay's arguments, some people could also discuss the fact that some treatment might be not only a psychological burden to their family but a financial burden as well. Daniel Callahan states "the use of useless treatment and the use of excessive financial burden is a reason to deny treatment. . . " (190). Callahan believes that some patients might only be requesting assisted suicide in order to alleviate a financial burden that they have placed on their family. Boehnlein also agrees with this argument and argues: "These decisions raise many subjective considerations about the quality of individual lives that can be subtly influenced by realistic fears of financial ruin or a belief that self-sacrifice will make life easier financially and emotionally for surviving generations" (12). The question that surrounds this concern is whether or not this is really what the patient wants, or if it is merely requested only to relieve the burdens set forth on the families of the terminally ill patients.

Many debates have occurred on the issues surrounding physician-assisted suicide and there are many different views on the concern. Many proponents argue on ideas such as undignified life and personal autonomy. Many opponents emphasize possible dangers for patients and physicians. Indefinitely there will always be a debate on the issue of physician-assisted suicide. There is always going to be those that believe it is up to the chooser to decide whether they wish to live or die, and there will always be those that believe that nobody should decide a person's fate. While looking at the similarities and differences among many arguments set forth by representatives on all sides of the issue, we get a better understanding of why the debate on physician-assisted suicide as become such a controversial one.

Boehnlein, James K. "The Case Against Physician Assisted Suicide." Community Mental Health Journal 35.1 (1999): 5-14.

Callahan, Daniel. "Vital Distinctions, Moral Questions: Debating Euthanasia and Health Care Costs." Arguing Euthanasia. Ed. Jonathan Moreno. New York: Simon and Schuster, 1995. 173-90.

Doyal, Len, and Lesley Doyal. "Why Active Euthanasia and Physician Assisted Suicide Should Be Legalized." British Medical Journal 323.7321 (2001): 1079-081.

Fraser, Sharon and James Walters. "Death Who's Decision? Physician-Assisted Dying And The Terminally Ill." Western Journal Of Medicine 176.2 (2002): 120- 24.

Mak, Yvonne Y. W., Glen Elwyn, and Ilora G. Finlay. " Patients Voices Are Needed In Debates On Euthanasia." British Medical Journal 327.7408 (2003): 213-216.

Rogatz, Peter. "The Positive Virtues of Physician-assisted Suicide." The Humanist 61.6 (2001): 31-5.

Traina, Cristina L. H. "Religious Perspectives on Assisted Suicide." Journal of Criminal Law And Crimonolgy 88.3 (1998): 1147-155.

Young, Robert. Voluntary Euthanasia. 2002. 27 Oct. 2004 <http://plato.stanford.edu/entries/euthanasia-voluntary/>.

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