Physician-assisted suicide
Abstract
For ages, many debates have been held on the concerns regarding the physician terminating a patient’s life, with opponents and proponents not having gained significant ground for justifying or condemning the practice. For example, proponents view it as a favorable, painless and peaceful death while opponents view it as a sure way to legally and ethically taint the professional image of the nursing profession. Undoubtedly, this is a significant moral issue in contemporary America, especially considering the increased number of patients suffering from various painful diseases such as cancer, and even those who experience terrible injuries that make their existence a very painful experience. Consequently, owing to this dispute in health care, the medical profession is now compelled to resolve this problem head on. This paper focuses on physician-assisted suicide (PAS) and seeks to determine if it is morally right or wrong. It will attain this objective by first defining what morality entails and then defining the varied elements of this concept and highlighting the arguments surrounding it. It will then give a host of pros and cons of physician-assisted suicide from a moral standpoint and make a final decision its moral rightness or wrongness.
Definition and Introduction of the Moral Issue
Morality hinges on the cognitive dimension of the thought processes or behaviors of human beings, which entails how they conceptualize wrong and right and reason on how human beings should behave. As implied by Sikka & Grey, moral issues occur when people face questions such as how they should act or what they should do or not do. In light of this, one of the most divisive issues in contemporary America is physician-assisted suicide (PAS). There is much conflict surrounding the moral justification of this issue because of the difficulty of dealing with issues affecting the sanctity of life. The American Medical Association (AMA) (2020) describes PAS as the instance of a physician facilitating a patient’s death through giving the patient the required means to execute the life-terminating act. Today, the opinions on PAS indicate the intense controversy surrounding the issue especially in the nursing profession specifically because it entails deciding on if and when to end a human life to end a patient’s emotional and physical agony (Llamas, 2018).
Physician-Assisted Suicide (PAS) as a Moral Issue
PAS is an outstandingly contentious moral issue because it entails going against the moral principles that govern the medical profession. There are many risks associated with violating such principles, including the potential legal ramifications as well as the likelihood of violating the moral obligation of medical specialists of respecting the sanctity of life and doing everything to promote patient wellness and safety. A good example of a principle advocating for patient wellness is the “Hippocratic Oath,” which emphasizes on medical professional acting in the best interest of their patients and doing them no harm as implied by Hajar (2017). The moral obligation of physicians in this regard is to practice to their best ability for the patient’s good and to ensure that their prescriptions and acts do not compromise patient wellness in any sense. This premise highlights the controversy that arises out of a physician having to decide if and when to kill their patients.
Arguments on PAS
The moral concerns about this issue are the result of the still unclear direction on why and when a physician should deem it reasonable to end a patient’s life. For instance, if a patient suffering from a chronically painful terminal disease such as cancer requests the doctor to end their life, should the doctor end the patient’s life considering the fact that is morally abject to kill someone and how should the doctor approach this issue based on patient autonomy? According to Sedig (2016), a patient reserves the right to decide on their medical care without the interference or influence of the physician in making the decision. It means that patient autonomy allows for the physician to teach and inform the patient but bars the provider from making the decision on the patient’s behalf. As such, a patient can choose to refuse treatment despite the choice leading to the patient’s death.
Based on patient autonomy, a possible argument is why it should then be illegal to refuse a patient the right to determine when to end their life especially when they are experiencing severe pain and have no hope for improving. Another argument revolves around the moral duty of the physician alleviating the patient’s suffering especially when there is no other option, and the obvious end is the patient’s prolonged suffering and ultimate death. There are other arguments based on the fact that with the modern-day advancements in technology, doctors have saved the lives of critically ill patients, thus rendering the shortening or termination of a patient’s life immoral. All these arguments then beg the question, from a moral standpoint, is physician-assisted suicide right or wrong? Answering this question requires examining the pros and cons of physician-assisted suicide, which are covered in the ensuing section.
Pros of Physician-Assisted Suicide (From a moral perspective)
One advantage that renders physician-assisted suicide morally right is the aforementioned respect for the patient’s autonomy. Autonomy denotes the right for a person to govern their own actions, meaning that a patient has the right to determine which medical interventions to consent to or refuse as noted by Fortune, Shotwell, Buccellato & Moran (2016). The implication is that once the doctor thoroughly explains the risks and benefits of any decision the patient desires to take, the patient can then make the decision to end their suffering, for example by declining treatment despite the likelihood of the patient’s death. Another pro relates to the moral right associated with allowing a patient to die with dignity. Dugdale, Lerner & Callahan (2019) note that legislation related to death with dignity satisfies the requisite criteria that allows a patient to make autonomous choices. The criteria include comprehension of the intended procedure, lack of duress, the capacity for weighing an array of choices, and mental competence. If all these critical aspects are duly met by the doctor and the terminally patient is informed of all the outcomes, the patient can then decline treatment without incriminating the medical practitioner for violating patient welfare.
The third moral justification for PAS is the moral obligation of alleviating a terminally ill patient from suffering. As aforementioned, death with dignity regulations allow eligible terminally-ill grown-ups to make voluntary requests to get a prescription medication to quicken their death (Death With Dignity, 2020). Some patients undergo so much irredeemable psychological and physical torture that makes PAS a compassionate response to their excruciating suffering. In fact, Dugdale, Lerner & Callahan (2019) observe that patients have made many of the persuasive arguments advocating for PAS as a humane way to relieve suffering. Further, PAS is morally justifiable in the sense that it is an innocuous medical practice because physicians can ascertain death in a manner that suicide by other approaches cannot. As such, assisted suicide becomes a justifiable alternative to care for the dying, especially considering that many states advance several safeguards to avert abuses and to also give a structure for an undertaking that most terminally ill patients will do anyway, although more randomly and dangerously. Some of such safeguards comprise informing the patient of all the options for ending life and having the confirmation of two witnesses confirming that the patient’s request for assisted suicide is autonomous and free of coercion.
Cons of Physician-Assisted Suicide (From a moral perspective)
From a moral standpoint, there are several cons associated with physician-assisted suicide. For instance, PAS is viewed as morally wrong as it directly controverts the strong secular and religious conventions against killing someone (Lee, 2012). The perception of society is that no person has the right to take another’s life, and no individual has the right to take their own lives. Critics posit that it is morally wrong to view lives that are no longer healthy as of diminished value, which is usual the justification for PAS. Critics denounce PAS because of the contemporary developments in pain management that render it possible for physicians to control pain even in terminally ill patients. They aver that rather than assist in patient suicide, physicians must cater for the needs of terminally ill patients by responding aggressively to their needs, especially because the physicians who specialize in pain management are much more conversant about providing comfort for such patients. This viewpoint suggests that physicians and families should not abandon patient care simply because of the seeming impossibility of a cure as they are commonly doing today. PAS is thus viewed as a violation of physician morals by failing to provide patients with the required emotional support, specialty consultation, satisfactory pain control, spiritual support, among many other such vital multidisciplinary interventions.
Further, there is a high risk of portraying the medical profession as immoral because of violating the provisions of the Hippocratic Oath that upholds the need for the practitioner to protect the patient at all costs. This risk connects to another consequence that raises a moral concern regarding PAS. There is likelihood for physicians abusing the administration of PAS by providing the service to patients who do not necessarily require PAS, for instance, those without access to care. Abuse may also arise when PAS is used as a strategy to contain costs while disregarding the patient’s life. Physicians and family members may immorally encourage the use of PAS to remove the cost burden, with calls advocating for PAS to remain illegal. Benatar (2011) encapsulates this moral concern in the slippery slope argument that sanctioning the killing of patients in healthcare could lead to unexpected moral outcomes. Such outcomes include physicians coming under pressure from severely disabled patients to euthanize them so that they may alleviate their families from the burden of care. Outcomes may also include the immoral contravention of the provisions of the medical practice in failing to provide terminally ill patients with palliative care and instead opting for the seemingly easier option of euthanizing them.
Physician-Assisted Suicide Is Morally Right
From the literature provided from the varied authors, it is evident that physician-assisted suicide does more good than harm. Based on individual rights, respect for patient autonomy, and quality of life, a terminally ill patient should have the right to determine how he or she chooses to die. In any case, this practice does not cause an unexpected death; rather, they merely hasten an investable death in a more humane way than subjecting the patient to the whole process of dying a slow and excruciatingly painful death. Moreover, there exists working legal rules that govern physician-assisted suicide, which deals with the problems of possible abuse.
Conclusion
In light of this, the conditions that rationalize physician-assisted suicide include voluntary request by patient who is mentally sound and competent and joint and informed making of the patient’s decision to have assisted suicide between the physician and the patient. It is also important to have structured consultations with the patient’s family members as well as with other physicians before making the decision to grant the patient’s request for assisted suicide. Additionally, there must be a measured rejection of options characterized by a supportive yet analytical and critical setting of decision making. Lastly, it is necessary that before assisting in patient suicide, the physician holds that the patient is suffering unacceptably (terminally) and that the patient expressly states their preference for the physician assisting in ending their lives. If all these conditions are met, then physician-assisted suicide becomes a moral and justifiable option.
References
American Medical Association (AMA). (2020). Physician-assisted suicide. https://www.ama-assn.org/delivering-care/ethics/physician-assisted-suicide
Benatar D. (2011). A legal right to die: responding to slippery slope and abuse arguments. Current oncology (Toronto, Ont.), 18(5), 206–207. https://doi.org/10.3747/co.v18i5.923. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185895/
Death With Dignity. (2020). How death with dignity laws work. https://www.deathwithdignity.org/learn/access/
Dugdale, L. S., Lerner, B. H., and Callahan, D. (2019). Pros and Cons of Physician Aid in Dying. The Yale journal of biology and medicine, 92(4), 747–750. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913818/
Fortune, E.E., Shotwell, J.J., Buccellato, K and Moran, E. (2016). Factors predicting desired autonomy in medical decisions: Risk-taking and gambling behaviors. https://journals.sagepub.com/doi/full/10.1177/2055102916651267
Hajar R. (2017). The Physician’s Oath: Historical Perspectives. Heart views: the official journal of the Gulf Heart Association, 18(4), 154–159. https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_131_17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755201/
Lee, P. (2012). Say no to physician assisted suicide. https://www.cato-unbound.org/2012/12/14/patrick-lee/say-no-physician-assisted-suicide
Llamas, J.V. (2018). The moral and ethical dilemma of physician-assisted suicide. https://minoritynurse.com/the-moral-and-ethical-dilemma-of-physician-assisted-suicide/
Sedig, L. (2016). What’s the role of autonomy in patient- and family-centered care when patients and family members don’t agree? https://journalofethics.ama-assn.org/article/whats-role-autonomy-patient-and-family-centered-care-when-patients-and-family-members-dont-agree/2016-01
Sikka & Grey. Morality. Class Notes
