One of the greatest dangers facing chronic and terminally ill patients is the grey area regarding PAS. In the Netherlands, there are strict criteria for the practice of PAS. Despite such stringencies, the Council on Ethical and Judicial Affairs (1992) found 28% of the PAS cases in the Netherlands did not meet the criteria. The evidence suggests some of the patient’s lives may have ended prematurely or involuntarily. This problem can be addressed via advance directives. These directives would be written by competent individuals explaining their decision to be aided in dying when they are no longer capable of making medical decisions. These interpretations are largely defined by ones morals, understanding of ethics, individual attitudes, religious and cultural values.
The practice of using continuous sedation (CS) to reduce or take away the consciousness of a patient until their death follows is a similar grey area in healthcare. This was addressed in Washington v. Glucksberg when Justice O’Connor’s statements proclaimed that CS was legal and ethically acceptable. The case also suggested the availability of CS renders the legalization of PAS as unnecessary (Raus, Sterckx & Mortier, 2011). This argument leaves a great deal of life ending treatments up to individual interpretation. PAS is illegal in some states in the United States but passive euthanasia or the right to refuse medical treatment, including life-sustaining medical treatment, is well-established in the US by common law and landmark court decisions.
Even when regulations are present, they are not always followed. The Oregon Department of Human Services’ Death with Dignity Act (2007) requires a patient be referred to a psychiatrist or psychologist for treatment if the physician is concerned the patient’s judgment is impaired by a mental disorder. In 2007, none of the people who died by lethal ingestion in Oregon had been evaluated by a psychiatrist or a psychologist, despite considerable evidence that patients who are depressed are more likely to request euthanasia compared with those that are not (Breitbart, Rosenfeld, & Pessin, 2000). Literature also suggests patients who wish to die, once treated for depression, often revoke their request for PAS (Breitbart, Rosenfeld, & Pessin, 2000).
PAS is an effective means to die and an increasing number of patients are seeking it in states where PAS is allowed. A study of patient requests and physician responses to PAS in Washington State found that almost 10% of the patients who requested a prescription for PAS, but did not get one, committed suicide using means not provided by a physician (Back, Wallace, Starks, & Pearlman, 1996). These means included carbon monoxide poisoning, gunshot wounds, and medication overdoses. The result of successful PAS is 100% mortality. In a study of PAS, of the patients who received a prescription for the purpose of suicide and took it as directed, one-third died within one week of...