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Deciding When to Die

Canada is the latest country to legalize physician-assisted suicide. In the United States, the subject is still fraught.
(Photo: Anna Jurkovska/Shutterstock)

(Photo: Anna Jurkovska/Shutterstock)

On Friday, Canada’s Supreme Court overturned a decades-long ban on physician-assisted suicide, giving each province a year to work out what the new right-to-die laws might look like. The decision places the country in a minority group of nations that allow the practice: Belgium, the Netherlands, Luxembourg, and Switzerland are among the few countries that have legal pathways to physician-assisted death, whereby doctors prescribe life-ending medications and patients self-administer them. (Laws that permit euthanasia, where doctors actually administer the life-ending substances, are even more rare.)

In the United States, the decision to allow physician-assisted suicide is determined on a state-by-state basis. Even though a handful of states have opted for right-to-die laws, physician-assisted suicide is still a fraught issue.

A 2013 Gallup poll suggests that, for the general public at least, our opinions on physician-assisted suicide could come down to phrasing. The vast majority of Americans—70 percent—supported the measure when asked if doctors should be allowed to “end a patient’s life by some painless means.” A very narrow majority of Americans, only 51 percent, were in favor of the process when the description included the word "suicide."

The majority of patients that seek life-ending treatments have incurable diseases, are in great pain, and have little time left to live. Like the rest of the population, their opinion is also divided. Highlighting the complexity of the issue, a 2012 study found that many patients didn’t have a clear opinion on the measure, making physicians’ opinions even more critical. The authors wrote:

Physicians seem to have an important role to play when patients make decisions on grave matters such as euthanasia. Apart from the relatively few patients advocating making their own decisions and seeing euthanasia as a means to empowerment, all the other patients indicated a need for physician involvement not only in performing euthanasia, but also in decision making to various degrees: from providing information on prognosis and possibilities to making euthanasia decisions for those opting for a paternalistic style of care.

Even if more U.S. states follow Canada's lead, it will ultimately be up to individual physicians to decide how they respond to their patient’s requests for life-shortening interventions. And doctors, normally tasked with keeping their patients alive and well, are no less divided on the issue. Nearly 70 percent of physicians in the U.S. are opposed to physician-assisted suicide. Support for the practice was influenced by several factors, according to a 2008 survey. Physicians with more experience caring for people with life-threatening illnesses were more likely to oppose the practice. Regional location, ethnicity, and religious traditions also played a role in doctors' opinions: Midwesterners, minorities, and Catholics or Hindus were all more likely to object to administering life-ending measures.

The U.S. population, and the rest of the world for that matter, is aging rapidly. And as the odds of contracting a terminal illness increase with age, it becomes ever more likely that we’ll each have to confront how we feel about physician-assisted suicide when we or our loved ones decide it's time to die.