Many Americans have "living wills" which, in most cases, limit aggressive care should their chance for a meaningful recovery be deemed hopeless. Many others, facing physical or mental deterioration due to advanced age or chronic illness, place limits on their medical care, declining cardiopulmonary resuscitation, intubation, ventilator support, feeding tubes or other measures. Finally, the rise of palliative care and hospice services has significantly reduced suffering for those in the final days, weeks or months of their life.
Some physicians, myself included, feel that another option should be available to those losing their independence due to a medical condition for which effective therapy does not exist. While assisted suicide is legal in some countries and in the States of Oregon, Washington and Vermont, this humane intervention is officially illegal throughout most of the U.S; even the progressive States permit assisted suicide only if the patient is expected to die within six months. Yet, many individuals with dementia, brain injury and chronic, progressive, incurable illness face years, or even decades, of total dependence and a life that they might have chosen to escape.
Objections to the use of assisted suicide generally arise from religious beliefs or from the concern that such a policy might lead to enforced euthanasia to reduce healthcare costs. Those of us who support this option emphasize that it should always be initiated by the patient or his/her designated surrogate(s), never by insurance companies, hospital administrators or government officials; on the other hand, the patient's primary care provider and specialists should be involved in the process, certifying that the individual's medical condition is, indeed, irreversible. In the end, the goal is to permit a dignified death for those who find the prospect of a dependent existence unacceptable.
