Giving doctors and patients more open access to, and awareness of, last resort options could have several beneficial effects. One potential effect is increased opportunity for patients to get second opinions from skilled palliative care clinicians to be sure that other less extreme avenues to address seemingly intractable suffering have been considered. Another benefit is reassurance to severely ill patients who fear end of life suffering that there are some avenues of escape that can be pursued openly and predictably. These other last resort options may lessen the desire and need for PAD. Some patients in Oregon and in the Netherlands are choosing these other last resort alternatives even though they have access to PAD because, in some circumstances, these approaches are better able to address their particular needs and may be more congruent with their personal values . Finally, the added alternatives increase both clinicians’ and society’s awareness of their obligation to address intolerable suffering when it is encountered.
Questions and controversies about assisted suicide have become widespread within the health care community and society at large. In 1997 the . Supreme Court ruled that the Constitution neither permits nor prohibits PAS. In the same year, Oregon became the first state to legalize suicide. Under Oregon law any mentally competent resident of the state who has reached the age of 18 and who has a terminal illness that is expected to cause death within 6 months may make a voluntary and informed decision to terminate life by taking a lethal overdose of oral medicine prescribed for that purpose by a physician. The physician is immune from civil or criminal prosecution. Belgium and the Netherlands legalized PAS on similar terms in 2002. The American Medical Association and the American Nurses Association have issued official position statements opposing assisted suicide in all circumstances. Among objections voiced by opponents of the legalization of PAS and its integration into medical practice are the erosion of public trust in the health care professions; the radical change in the traditional physician-patient relationship, which has always been beneficial and constructive; the concern that if PAS were to become an accepted option for the "treatment" of certain illnesses, physicians might be required to present it to patients as an alternative and that managed-care or other third-party payers might favor it as least expensive; and the fear that, once legalized, PAS would be permitted for conditions not terminal, and that people other than the patient would eventually be empowered to make the decision. The debate over PAS has drawn attention to shortcomings in the care of the dying and to the preeminent obligation of health care professionals to provide responsible, respectful, appropriate, and ethically sound care. see also end-of-life care , advance directive .