Editing Terminal illness (section)

=== Physician-assisted suicide ===
[[Assisted suicide|Physician-assisted suicide]] (PAS) is highly controversial, and legal in only a few countries. In PAS, physicians, with voluntary written and verbal consent from the patient, give patients the means to die, usually through lethal drugs. The patient then chooses to "[[die with dignity]]," deciding on their own time and place to die. Reasons as to why patients choose PAS differ. Factors that may play into a patient's decision include future disability and suffering, lack of control over death, impact on family, healthcare costs, insurance coverage, personal beliefs, religious beliefs, and much more.<ref name="Hendry-2013"/>

PAS may be referred to in many different ways, such as aid in dying, assisted dying, death with dignity, and many more. These often depend on the organization and the stance they take on the issue. In this section of the article, it will be referred to as PAS for the sake of consistency with the pre-existing Wikipedia page: [[Assisted suicide|Assisted Suicide]].

In the United States, PAS or [[Medical aid in dying in the United States|medical aid in dying]] is legal in select states, including Oregon, Washington, Montana, Vermont, and New Mexico, and there are groups both in favor of and against legalization.<ref name="Compassion and Choices">{{Cite web|url=https://www.compassionandchoices.org/wp-content/uploads/2016/02/FS-Medical-Aid-in-Dying-is-Not-Assisted-Suicide-FINAL-1.27.16-Approved-for-Public-Distribution.pdf|title=Medical Aid in Dying Is Not Assisted Suicide|last=Compassion and Choices|website=Compassion and Choices}}</ref>

Some groups favor PAS because they do not believe they will have control over their pain, because they believe they will be a burden on their family, and because they do not want to lose autonomy and control over their own lives among other reasons. They believe that allowing PAS is an act of compassion.<ref name="Sulmasy-2017">{{Cite journal|last1=Sulmasy|first1=Lois Snyder|last2=Mueller|first2=Paul S.|date=2017-10-17|title=Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper|journal=Annals of Internal Medicine|volume=167|issue=8|pages=576–578|doi=10.7326/M17-0938|pmid=28975242|issn=0003-4819|doi-access=free}}</ref>

While some groups believe in personal choice over death, others raise concerns regarding insurance policies and potential for abuse. According to Sulmasy et al., the major non-religious arguments against physician-assisted suicide are quoted as follows:
* (1) "it offends me", suicide devalues human life;
* (2) slippery slope, the limits on euthanasia gradually erode;
* (3) "pain can be alleviated", palliative care and modern therapeutics more and more adequately manage pain;
* (4) physician integrity and patient trust, participating in suicide violates the integrity of the physician and undermines the trust patients place in physicians to heal and not to harm"<ref>{{Cite journal|last1=Sulmasy|first1=Daniel P.|last2=Travaline|first2=John M.|last3=Mitchell|first3=Louise A.|last4=Ely|first4=E. Wesley|year=2016|title=Non-faith-based arguments against physician-assisted suicide and euthanasia|journal=The Linacre Quarterly|volume=83|issue=3|pages=246–257|doi=10.1080/00243639.2016.1201375|issn=0024-3639|pmc=5102187|pmid=27833206}}</ref>
Again, there are also arguments that there are enough protections in the law that the slippery slope is avoided. For example, the [[Oregon Ballot Measure 16 (1994)|Death with Dignity Act in Oregon]] includes waiting periods, multiple requests for lethal drugs, a psychiatric evaluation in the case of possible depression influencing decisions, and the patient personally swallowing the pills to ensure voluntary decision.<ref>{{Cite web|url=http://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ors.aspx|title=Oregon Health Authority : Oregon Revised Statute : Death with Dignity Act : State of Oregon|website=www.oregon.gov|access-date=2017-12-04}}</ref>

Physicians and medical professionals also have disagreeing views on PAS. Some groups, such as the [[American College of Physicians]] (ACP), the [[American Medical Association]] (AMA), the [[World Health Organization]], [[American Nurses Association]], Hospice Nurses Association, [[American Psychiatric Association]], and more have issued position statements against its legalization.<ref>{{Cite web|url=https://www.ama-assn.org/delivering-care/physician-assisted-suicide|title=Physician-Assisted Suicide {{!}} American Medical Association|website=www.ama-assn.org|access-date=2017-12-04}}</ref><ref name="Sulmasy-2017" /><ref>{{Cite web|url=http://www.heritage.org/health-care-reform/report/always-care-never-kill-how-physician-assisted-suicide-endangers-the-weak|archive-url=https://web.archive.org/web/20170206170606/http://www.heritage.org/health-care-reform/report/always-care-never-kill-how-physician-assisted-suicide-endangers-the-weak|url-status=unfit|archive-date=6 February 2017|title=Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality|last=Anderson|first=Ryan|website=The Heritage Foundation|access-date=2017-12-04}}</ref>

The ACP's argument concerns the nature of the doctor-patient relationship and the tenets of the medical profession. They state that instead of using PAS to control death: "through high-quality care, effective communication, compassionate support, and the right resources, physicians can help patients control many aspects of how they live out life's last chapter."<ref name="Sulmasy-2017" />

Other groups such as the [[American Medical Student Association|American Medical Students Association]], the [[American Public Health Association]], the [[American Medical Women's Association]], and more support PAS as an act of compassion for the suffering patient.<ref name="Compassion and Choices" />

In many cases, the argument on PAS is also tied to proper palliative care. The International Association for Hospice and Palliative Care issued a position statement arguing against considering legalizing PAS unless comprehensive palliative care systems in the country were in place. It could be argued that with proper palliative care, the patient would experience fewer intolerable symptoms, physical or emotional, and would not choose death over these symptoms. Palliative care would also ensure that patients receive proper information about their disease prognosis as not to make decisions about PAS without complete and careful consideration.<ref>{{Cite journal|last1=De Lima|first1=Liliana|last2=Woodruff|first2=Roger|last3=Pettus|first3=Katherine|last4=Downing|first4=Julia|last5=Buitrago|first5=Rosa|last6=Munyoro|first6=Esther|last7=Venkateswaran|first7=Chitra|last8=Bhatnagar|first8=Sushma|last9=Radbruch|first9=Lukas|title=International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide|journal=Journal of Palliative Medicine|volume=20|issue=1|pages=8–14|doi=10.1089/jpm.2016.0290|pmid=27898287|pmc=5177996|year=2017}}</ref>