Introduction

Mr. Wagner has been informed that all medical treatments have been exhausted and that nothing more medically can be done. He is being told that he is going to die. His request for a Seconal suggests that Mr. Wagner has lost all hope and, likely, that he anticipates and fears pain and intractable suffering. A fatal dose of Seconal will allow Mr. Wagner to plan and control the timing and nature of his death.

It is important to ascertain whether or not the patient is competent to ask for assistance with suicide. Mr. Wagner has only been recently informed that there are no further treatments options. His response to this information is likely impulsive and reflects fear and shock. There may be other issues prompting his request: financial fears, lack of caregivers, depression, feelings of isolation, loss of control and fear of the dying process. The underlying meaning of Mr. Wagner's request must be explored. He needs to be given time to comprehend the magnitude and ascertain the inner certainty of his request.

A physician needs to be prepared based on her/his values when asked to assist in a patient's suicide. If a physician is ambivalent, examining his/her own feelings and values is essential. A physician may not support assisted suicide on moral grounds, yet she or he may feel guilty when refusing a patient's request to alleviate their suffering. Whether in support or opposition to physician assisted suicide, a physician needs to be emotionally and clinically prepared to engage in a discussion with the patient that offers compassion and expertise within a reassuring relationship.

By involving an end-of-life specialist, a physician would insure that Mr. Wagner is fully informed of options for care and assured that physical symptoms can be expertly managed. This resource may, in fact, provide the information and reassurance needed to encourage Mr. Wagner to continue to live and to die naturally.

Finally, a physician should be willing to seek guidance regarding physician-assisted suicide, i.e., medical literature and colleagues.

Religion is a distinct set of beliefs including beliefs about the nature of God, of human life and ultimate values. Religious objections to physician-assisted suicide are founded on principles derived from these beliefs. The long standing opposition to physician-assisted suicide from all the major faith traditions, Judaism, Christianity and Islam, rests in the belief that God is the source of all life and human beings are obligated to preserve life (rejecting the autonomy of human life). Physician-assisted suicide results in the intentional taking of life. The intentional taking of another person's life honors human judgment above the absolute sovereignty of God. It sanctions killing and, since there is no right to kill, physician-assisted suicide is morally wrong. Based on these major principles, a physician's responsibility is to cure the patient and to prolong life.

In the Buddhist tradition, suicide is not recommend where one is trying to avoid a situation by killing oneself. Buddhists do not believe in a god that is outside of oneself, therefore “opposition” to suicide is based on belief in karma (the law of moral cause and effect; also the moral impact of one’s actions. Buddhism acknowledges the reality of suffering as an inevitable aspect of human existence, but suicide provides no final solution. The karma will continue on to the next life. Physician –assisted suicide would be discouraged for similar reasons.

However, Though Islamic law and Roman Catholic teaching strictly forbid physician-assisted suicide, there is no consensus on the issue. The morality of physician-assisted suicide is a source of significant debate in each of the religious traditions. For example, in the tradition of Reform Judaism support for physician-assisted suicide is found in the belief that Reform Jews have a fundamental right to self-authority. In the Christian tradition, support can be found among those who argue the need for compassion in cases where all options for care have been exhausted and where pain and suffering remain intolerable.

Religious beliefs can provide a framework within which to understand illness, death and dying. Those who believe that it is strictly forbidden to intentionally end one's own life may find strength and solace in their learned belief that the successful endurance of pain and suffering will achieve eternal life. For those who consider physician-assisted suicide as a means to end an intolerable and meaningless existence, religious support can assist in exploration of this wish. Religious belief can be a source of wisdom and guidance as one struggles for meaning and understanding about life and its finitude. It offers a context and an opportunity for life review.

Rituals and symbols of this faith can provide comfort and help manage the profound burdens associated with illness, death and dying. Scripture and prayer are invaluable resources to some patients. These practices often mediate isolation and feelings of abandonment, as well as nurture hope and spiritual comfort.

Many people rely on clergy and religious counselors when they have extraordinary health care concerns or when facing end-of-life decisions. Hospital chaplains, or other qualified religious leaders, can assist a patient to explore questions and doubts through the medium of religious belief, and to confront guilt, loneliness, pain, isolation, failure, grief, and other experiences commonly associated with dying.

A person can be spiritual without being explicitly religious. Spirituality is the essence of what gives meaning to one's life. People have a variety of ways through which they find meaning in their life. When these sources of meaning are perceived as no longer viable, i.e, due to debilitating illness, a crisis ensues. It is important to know what a person believes and how it will influence their decisions for medical treatment.

Physicians can help patients deal with an unfavorable diagnosis by being willing to discuss and suggest care that is compatible with their beliefs.

Emanuel, L.L. "Facing Requests for Physician-Assisted Suicide." JAMA. 1998:280.

Freeland, R. "Euthanasia and Islamic Law." Medico-Legal Journal. 1997:65.

Keown, D. and Keown, J. "Killing, karma and caring: euthanasia in Buddhism and Christianity." Journal of Medical Ethics. 1995:21.

Jakobovits, I. "Death and the Dying - Treating the hopeless patient." Israel Journal of Medical Sciences. 1996:32.

McCormick, R. "Physician-Assisted Suicide: Flight from Compassion." The Christian Century. December, 1991.

Perrett, R.W. "Buddhism, euthanasia and the sanctity of life." Journal of Medical Ethics. 1996:22.

Reines, A.J, Zlotowitz, B.M, Seltzer, S. "Dialogue and Responses [selections from a series of articles debating assisted suicide in Journal of Reformed Judaism]." Journal of Psychology and Judaism. 1990:20.

Disclaimer: Clinical information is provided for educational purposes and not as a medical or professional service. Persons who are not medical professionals should have clinical information reviewed and interpreted or applied only by appropriate health professionals.