I’ve been trying to figure this one out for some time. My first reaction to physician assisted suicide was negative. After all, I took an oath to do no harm and that’s been hard enough to uphold in my regular practice since every treatment course I’ve prescribed has had the potential to cause harm. Prescribing medication sure to cause death seemed downright unethical.

There’s also the fact the medical community has done everything in its power to keep people from killing themselves. If a person expressed suicidal ideas we stripped them of their basic rights and held them captive in a medical or psychiatric facility until a psychiatrist deemed they had no more desire to end their life, usually after significant medical and counseling therapy. The patient had no right to refuse treatment-they were held involuntarily. The only other way a patient could get released was by a court order. Thus, for all intents and purposes, suicide was illegal.

But aside from the ethical and legal aspects of physician assisted suicide there was something else I’ve struggled to understand. Why did we need physician assisted suicide if we could already provide excellent end-of-life hospice care? No matter what the illness we should be able to keep people comfortable and at their highest quality of life until their natural passing. And wasn’t that the best death we could hope for?

Reading about Brittany Maynard and Jennifer Glass, who was quoted in an NPR article as saying “No one should have the right to prolong my death”, I can now answer my own question. Dying comfortably in hospice is not the best death we can hope for. The best possible death is one we have complete control over. It’s one where we haven’t let our bodies fail to the point we have no ability to carry out basic daily functions such as feeding and toileting, or where our bodies have become so wasted or swollen they are painful for our loved ones to see. It’s one where we can have one last, great day and say, ‘Yep, that was perfect, this is enough, I’m ready now.’ It’s one where the looming inevitability no longer remains a mystery, but something you can plan precisely. Should everyone have the right to die their best death? I think they should.

But I’m still struggling with how. Physicians may be doing more harm to their patients by preventing them from dying their best death, thus my ethical issue is solved, but I’m not confident we understand enough about the dying process to be its best dispensers. As it is we aren’t doing a good enough job preparing people for end-of-life. In a profession so heavily focused on treat-treat-treat with pill after pill after pill will this be just another pharmaceutical plan? And how should we treat patients with chronic major depression recalcitrant to treatment who have been begging us to have their best death for years?

Another issue that bothers me is the permanence of physician assisted suicide. There is no other medical treatment I know that is quite so permanent. The one constant in life is change. We age, we sicken, we improve, all in a never-ending cycle until the unknowable end. But to be responsible for making it knowable and unchangeable-maybe this frightens me most of all. I don’t know if I’m ready for that responsibility.

As the legality of physician assisted suicide changes my hesitancy toward it will also change. I’ve already come to believe we should have the right to die our best death. And even if I’m not convinced doctors are prepared to take on this awesome responsibility right now, one day with the right training and experience we just might be.