The ethical perspective of Inquiry

The ethical perspective of Inquiry

Physician-assisted suicide(PAS) is an emotive issue that has elicited a lot of debate over a long period. Due to its implication on the lives of patients and health care workers, it has been a pertinent issue in many human rights discussions. Health workers continuously deal with ethical issues and have to choose between complicated options and are frequently obligated to use their moral reasoning to address these issues that arise(Elis & Hartley,2007). Laws on Physician-assisted suicide is still ambiguous despite advances in technology and science. Health workers and patients may be exposed to unnecessary risks because of this ethical dilemma. This paper discusses the moral and cultural perspective of Physician-assisted suicide and its implications.

The ethical perspective of Inquiry

The decision to end one’s life is vital, especially for many elderly and terminally ill people in the United States. Physician-assisted suicide (PAS) is a viable option, but very controversial. The enactment of the Oregon Death with Dignity Act (DWDA) in 1997 laid the framework for the legalization of Physician assisted suicide (“Miller, Harvath, Ganzini, Goy, Delorit, and Jackson,2004”). Death with Dignity allows a physician to prescribe a lethal dose of barbiturates. To qualify for this kind of treatment, the following treatment must be met; A formal written request in the presence of a witness, The patient should be informed of other alternative forms of treatment such as palliative care, The patient should be 18 years and above, The doctors should have determined that the patient has six months or less to live.

Following the successful passage of the Death with Dignity Act in the state of Oregon, a case was filed in the Ninth Circuit Court of Washington. The “Compassion in Dying v State of Washington” case pointed out how inconsistent the laws concerning Physician-assisted suicide are, It read in part, “We see no ethical or constitutionally recognizable difference between a doctor’s pulling the plug on a respirator and his prescribing drugs which will permit a terminally ill patient to end his own life.”  This led to the legalization of Physician assisted suicide in the state of Washington. The state of Vermont legalized PAS through legislation and the state of Montana and New Mexico through a court order. The total number of countries that have legalized Euthanasia is five (Eckhold, 2014).

The American medical association (AMA) code of ethics requires that a physician demonstrate values of “care, compassion, respect, and dignity.” We shall look at two diverging views on the issue of Physician-assisted suicide.

The first view opposes Physician-assisted suicide. “Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and information to enable the patient to perform the life-ending act e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide.” While it is understandable that terminally ill patients may opt for death over life, allowing physicians to engage in this kind of practice will do more harm than good. It is against the Hippocratic oath mandates doctors to sustain the life of their patients, not terminate it. Doctors should, therefore, endeavor to remain with the patient until they become incapacitated, must respect the patient’s wishes, offer emotional support, and ensure that the patients receive the necessary palliative care.

The second view argues that physicians can act according to their conscience without breaking any professional rules. In light of this argument, Physicians have an active duty to their patients with whom they have a strong relationship. As such, if a physician sees that prolonging treatment or alternative treatment will not add any value to the physical and emotional well-being of their patients, Physician-assisted suicide can be considered as a viable option. However the following issues should be considered; The treatment option undertaken by the Physician should not burden them psychologically, affecting their ability to care for the patient, the actions taken should not discriminate against the patient which may adversely affect public perception of the medical profession, Be careful that their actions do not burden their fellow professionals, uphold highest ethical standards by informing the patient of alternative forms of treatment, Continue providing therapy to the patient until their life is terminated.

We shall look at the ethical theories and how they related to Physician assisted suicide.

Utilitarianism. Focus on the option that gives the greatest benefit to most people regardless of personal feelings and existing laws. There is rule-utilitarianism and act-utilitarianism. Rule utilitarianism chooses the option that benefits the largest number of people through the most ethically acceptable means available. Act utilitarianism is about achieving maximum good and may infringe on the personal freedoms of an individual. Consider a patient who his chronically ill and in a lot of pain may want a lethal injection prescription to speed up their death. Using rule utilitarianism, an exception may be made to the “do not kill the rule.” This implies that rule utilitarianism advocates for patient assisted suicide the reason being it will benefit the patient by ending the pain for them; it will eliminate the financial and emotional burden placed on the family of the patient. The act utilitarian will use the same logic to allow Physician assisted suicide. The action taken may be viewed as breaking a moral code. However, breaking the rule causes maximum utility where one’s interest takes precedence over everyone else.

Deontology. It states that “People should adhere to their obligations and duties when engaged in decision making when ethics are at play. A person will follow his rules and obligations to another person or society because upholding one’s duty is what is considered ethically correct.” Relating to Physician-assisted suicide, terminating the life of a patient is wrong no matter what the circumstances are. Even though the Physician will create happiness for the patient, it still breaks the principle of “perfect duty to self ” and “perfect duty to others,” which are inviolable.

Virtue ethics. This theory states that “A person is judged by their character rather than actions that may deviate from their normal behavior. It takes into account the person’s morals, reputation, and motivation when rating an unusual or irregular behavior that is considered unethical.” Relating to Physician-assisted suicide, it would be difficult to determine the motivations of the Physician because we may not know his history.

Sentiments against Physician-assisted suicide as it pertains to money, power, and control argue that the treatment being voluntary will, in turn, become involuntary. Following this slippery slope means that vulnerable people in the society, such as  “ the mentally ill, the elderly, terminally ill, will be subjected to undue pressure to choose Physician-assisted suicide.” Doctors can start killing patients without their permission to reduce health care costs or free up beds in healthcare facilities.

Cultural perspectives of Inquiry

Cultural perspectives about Physician-assisted suicide to differ according to the country’s origin, race, gender, level of education, and religious affiliation. Various authors posit that Africans are opposed to the practice of Physician assisted suicide, most viewed it a western phenomenon. Studies show that white people are more inceptive of the method. Physicians and patients in western countries are open to the practice compared to their compatriots in far eastern countries. Males are more receptive to Physician-assisted suicide compared to females. Religious affiliation plays a significant role in people’s opinions about Euthanasia. Christians and Muslims are general are against Euthanasia as it goes against their spiritual teachings.

The people affected most by Physician-assisted suicide are people living in western countries. There has been an explosion of terminal illnesses such as cancer, and more patients are opting for end of life treatment. Five states have legalized Euthanasia. One of the key impediments to Euthanasia is that most cultures believe in the sanctity of life, and Physician-assisted suicide is equal to murder.

References

Batlle JC. Legal Status of Physician-Assisted Suicide. JAMA. 2003;289(17):2279–2283. doi:10.1001/jama.289.17.2279

Ellis, J.R. & Hartley, C.L.. (2013). Nursing in today’s world: Trends, issues, and management

Miller, L. L., Harvath, T. A., Ganzini, L., Goy, E. R., Delorit, M. A., & Jackson, A. (2004). 48 Attitudes and experiences of Oregon hospice nurses and social workers regarding assisted suicide. Palliative Medicine, 18, 685–691.

American Medical Association(2019).Physician-Assisted Suicide.Retrieved from https://www.ama-assn.org/delivering-care/ethics

Madeline, J.The Ethical Considerations of Physician-assisted Suicide.Retrieved from https://digitalcommons.acu.edu/cgi/viewcontent.cgi?article=1049&context=dialogue

Schweda, M., Schicktanz, S., Raz, A., & Silvers, A. (2017). Beyond cultural stereotyping: views on end-of-life decision making among religious and secular persons in the USA, Germany, and Israel. BMC medical ethics, 18(1), 13. doi:10.1186/s12910-017-0170-4