Complex Impacts of Legalizing Physician-Assisted Suicide: Examining the Evidence

Physician-assisted suicide (PAS) remains one of the most contentious issues in public health and ethics. Proponents often suggest that PAS could provide a compassionate option for those suffering from terminal illnesses and may even reduce total suicides by offering an alternative to nonassisted suicide. However, emerging research suggests a more nuanced and troubling picture.

What the Research Says

A comprehensive study analyzing state-level suicide rates in the U.S. between 1990 and 2013 found that the legalization of PAS was associated with a 6.3% increase in total suicides (including both assisted and nonassisted suicides). This effect was even more pronounced in individuals aged 65 and older, where the increase reached 14.5%.

Contrary to claims that PAS could “delay or reduce suicides,” the study found no evidence of a decrease in nonassisted suicides or an increase in the mean age of individuals who died by nonassisted suicide. These findings suggest that PAS may not serve as a substitute for nonassisted suicide and could, in fact, contribute to a cultural shift that normalizes suicide in general.

The Human Cost for Healthcare Providers

While much of the debate focuses on patients, the emotional, psychological, and spiritual burden on healthcare providers is often overlooked. Doctors and other healthcare professionals are trained to prevent premature death and alleviate suffering, but PAS challenges these foundational principles.

For healthcare providers, assisting in a patient’s death can have profound and lasting effects, including:

Emotional Distress: Physicians may experience discomfort, guilt, or doubt after participating in assisted suicide or euthanasia. And, the bills offered in New Hampshire have no funds to address this.

Moral and Spiritual Conflict: Providers may struggle with reconciling their professional obligations and personal beliefs, leading to psychological strain.

In the Netherlands, for instance, many doctors have reported feelings of discomfort following euthanasia or PAS cases, highlighting the emotional toll such decisions can take.

Impact on Palliative Care

Another critical concern is how PAS affects hospice and palliative care services. Some fear that the availability of PAS could divert funding and focus away from palliative care, potentially reducing support for comprehensive end-of-life care.

Conclusions and Implications

The evidence raises important questions about the broader societal and individual impacts of legalizing PAS:

Increased Suicide Rates: The association between PAS legalization and higher total suicide rates suggests a need for caution and further investigation.

Healthcare Provider Well-Being: No attention has been given to the emotional and professional challenges faced by healthcare providers involved in PAS.

Balancing PAS and Palliative Care: Policymakers cannot ensure that the availability of PAS does not come at the expense of palliative care resources.

While PAS is often framed as an issue of compassion and personal autonomy, these findings highlight the complexities and potential unintended consequences of legalization. As states like New Hampshire continue to grapple with this issue, a more comprehensive understanding of its effects on individuals, healthcare providers, and society as a whole is essential.

Looking Forward

Policymakers, healthcare professionals, and advocates must engage in thoughtful dialogue about PAS, ensuring that decisions are guided by evidence, ethics, and a commitment to preserving life while addressing suffering. The cost to the many may outweigh the desires of the few.