As our country considers new legislation on patients’ rights and healthcare, physician-assisted suicide will undoubtedly join the conversation.
Physician-Assisted Suicide, or PAS, occurs when a doctor provides a patient with the means to commit suicide by prescription medication.
It's currently legal in California, Oregon, Washington, Vermont, Colorado, Montana, and Washington, DC.
This isn’t just an ethical issue, it’s a feminist one.
Most “right-to-die” legislation includes provisions to protect a patient’s autonomy in this decision -- such as minimum age of 18, a terminal diagnosis with six months or less to live, multiple requests for assisted suicide, and a mental evaluation.
When Montana legalized PAS, it was determined by the State Supreme Court (Baxter v. Montana), which mentioned “competent” and “terminally ill” in its ruling, but failed to define these terms or specify patient protections. With so little regulation, a patient might be more easily pressured into thinking suicide is her best, or only, choice.
Ethical reservations about PAS include this concern, that external pressures could push patients toward an unwanted suicide.
And several cultural norms in the United States indicate a woman may experience more external pressure than a man to hasten her own death.
So this isn’t just an ethical issue, it’s a feminist one. Here are 10 reasons why:
Note: Rather than discuss the moral implications of legalizing physician-assisted suicide, the purpose of this article is to highlight underlying issues that might force an expedited death on a person who feels he or she has no other options.
- Rates of depression among women are twice as high as men. In a country with inadequate mental health resources, untreated depression more easily leads to suicide.
- Since women outlive men, they are more likely to be alone as they age. This leaves elderly women with fewer advocates and a shrinking support system, as they navigate end-of-life issues.
- With unrealistic cultural pressure to be physically beautiful at any cost, a woman could feel unnecessary, additional despair at the diagnosis of a deteriorating, terminal disease.
- Self-sacrifice is an elevated virtue for women. A woman might view PAS as the ultimate gift of self-sacrifice for her family, despite personal wishes to continue living.
- As healthcare providers continue to dismiss women's health concerns, this could lead to an oversight in care for a terminally ill woman.
- Women have lower net wealth than men, which could leave them without personal resources to alleviate the mental and physical toll of a terminal diagnosis. They might view PAS as their most affordable solution.
- Since women are twice as likely than men to be caregivers, they understand the stress and isolation that can come with long-term care for another. Not wanting to become a burden, a woman may feel less worthy of long-term palliative care.
- As women outlive men, they are more likely to depend on their adult, middle-aged children for care. The stress this brings to households often leads to the outsourcing of elderly care to nursing homes, where more than 70 percent of nursing home residents are women. One survey by Hemlock Society founder Derek Humphry, who supports euthanasia and PAS, found that 30% of seniors would rather die than live permanently in a nursing home.
- Healthcare providers prescribe less pain-relieving medication to women, and are more likely to dismiss women's experiences of pain. As a result, women patients might be more susceptible to choosing suicide as their best option to alleviate pain.
- Our nation's for-profit healthcare system is more likely to err toward expediency and cost-saving measures than a patient’s preferences for treatment. Even with PAS legal in only a few states, claims have already surfaced of insurance companies denying further treatment while offering to cover PAS, in these states.
There's a careful, conscientious balance between unnecessarily prolonging life at any expense and accepting impending death.
While this decision point is best discerned by those closest to the situation, undue pressure from outside sources may strong arm patients - especially female patients - toward premature death, instead of palliative care and support.
More than 70 percent of nursing home residents are women.
The United States Conference of Catholic Bishops expresses similar concerns that physician-assisted suicide and euthanasia could unfairly target the vulnerable and the marginalized, observing that legalizing physician-assisted suicide for terminal patients was followed by an increase in suicides generally:
"Oregon’s law allowing physician-assisted suicide took effect in late 1997. In 2015 the state’s health department said “The rate of suicide among Oregonians has been increasing since 2000” and as of 2012 was “42% higher than the national average”; suicide had become “the second leading cause of death among Oregonians aged 15 to 34 years.” These figures are in addition to deaths under the Oregon assisted suicide law, which legally are not counted as suicides."
While some would shrug and wave bon voyage to those who find death more welcoming than life, we can advocate, instead, for initiatives that give patients options and support: re-frame sickness as a natural part of life, better communicate palliative care and hospice options, mandate insurance companies cover medical treatment for any condition that’s covered by physician-assisted suicide, build intergenerational communities, incorporate quality mental treatment into standard healthcare, better regulate nursing home standards of care, improve conditions for elderly in poverty, revise standards of feminine beauty to include aging and illness, properly frame self-sacrifice as a healthy virtue, not a death sentence, and challenge medical professionals to listen and respond to women's healthcare concerns.
Without addressing these related issues of physician-assisted suicide, our society will unduly pressure those most sick among us, those with statistically less advocacy and fewer resources -- women in particular -- to accept expedited death as the only option in their most difficult hour.