Pawel Czerwinski

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The argument of whether assisted suicide legislation is the decision of the government, physicians, or patients is still up for debate. Research continues to assess physician opinions on the matter and there is yet to be unanimous support for the legalization of assisted suicide. Research has demonstrated that, compared to the public, physicians continue to demonstrate lower support for the legalization of assisted suicide, as seen in countries such as the United States, Australia, and countries within Europe. Support from the public, however, continues to rise. Compared to the research from 2013, 67 percent of the US public now supports the legalization of assisted suicide. Concurrently, we are seeing a global increase in assisted suicide legalization. Assisted suicide was legalized in Australia in 2017, Austria in 2021, decriminalized in Italy in 2019, and Canada in 2016, for example. The issue of assisted suicide legalization continues to pose the question of whether physicians’ opinions matter, as they are the ones performing this practice.

Regardless of their position for or against assisted suicide, physicians may be unwilling to perform the practice for various reasons, such as; lack of training, being out of scope with their practice, religious or spiritual beliefs, legal implications, and ethical or moral opposition. In regard to a lack of training, a study on palliative care physicians in Switzerland reported that physicians did not receive adequate training for providing assisted suicide. Many were not confident in handling requests for assisted suicide or felt discordance between their role as a palliative care physician and upholding patient autonomy. In a study published in 2021, physicians described the personal impact of assisted suicide on their position. Many of the physicians cited feeling an emotional toll toward the practice, while others raised concern over the social stigma that may be associated with working in a setting that provides assisted suicide. Many professional societies also continue to oppose the legalization of assisted suicide, including the American College of Physicians and the World Medical Association, yet, it is increasingly legalized. Despite opposition by physicians, this could be seen as evidence that physicians have little say in this matter. Other physicians, however, felt satisfaction, both personally and professional, for upholding patient wishes to pursue assisted suicide. These opposing standpoints demonstrate the deeply personal nature of assisted suicide and how it ultimately places two ethical principles in direct opposition; autonomy of the patient and non-maleficence.

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While patient autonomy is one of the guiding bioethical principles, are we taking this too far? The practice of assisted suicide is a slippery slope. While countries have increasingly legalized physician assisted suicide, some are broadening their criteria for inclusion. In Canada, for example, Medical Assistance in Dying is set to become available in 2024 to patients whose sole medical condition is mental illness. The legislative change has been met with resistance by physicians who fear that the practice may become “death on demand” in the interest of patient autonomy. Physicians are not merely “service providers,” but their moral opposition begs another question of whether physicians should be allowed to conscientiously object to providing patient care based on their personal beliefs. This is another complex discussion that is ongoing within challenging fields of medicine, such as assisted suicide.

There are many questions that have yet to be resolved in regard to the debate on assisted suicide. Could physicians' moral distress worsen as more countries legalize or decriminalize assisted suicide? Should physician opinions be consulted in legislative decisions? Is the decision entirely up to patients to uphold their autonomy? These questions may never be resolved; however, they warrant consideration from policymakers and legislative bodies.