Ethical Issues in Physician-Assisted Suicide Essay

Introduction

Physician-assisted suicide can be described as the act of an individual committing suicide aided by a physician who provides knowledge on the means of doing so (Steinbock, 2014). Some people cite the negative connotations in the word "suicide" and hence prefer replacing it with "physician aid-in-dying" for moral reasons. There is a clear distinction between physician-aided suicide and euthanasia which is also another procedure for ending one's life. In physician-aided suicide, doctors are allowed to give a patient medications meant to end his/her own life if the patient meets the set strict criteria. The doctor is however not permitted to provide medication himself and the patient should have the ability to administer it on himself/herself. On the other hand, euthanasia allows a physician or another individual to administer the life-ending medication. Whereas euthanasia is prohibited in the U.S., physician-assisted suicide is legal in some states such as Oregon (Emanuel, 2017). However, there has been a raging debate on the morality and ethics surrounding the assisted suicide act with some people defending it and others opposing it. The essay shows a discussion of both sides of the arguments. The discussion will focus on autonomy and dignified death as arguments for assisted suicide. There will also be a discussion about the sanctity of life and slippery slope as arguments against the life-ending procedure. Finally, a stand will be taken on the arguments and the opposing views refuted.

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Historical Cases Regarding Assisted Suicide

While some countries legally allow people to willingly end their lives through physician-assisted suicide, many people continue to oppose the act citing ethical issues. However, there have been compelling reasons given by those who support the act on its importance. There have been numerous court cases in many countries regarding the same. For instance, the case between Compassion in Dying and Washington State in 1994 ignited the debate on not only the legality but also the ethical stand of assisted suicide. In this case, three patients who had a terminal illness, four doctors, and a non-profit organization sued Washington State claiming that its ban on assisted suicide was a violation of the federal constitution. The case was presented to the Supreme Court and Washington State won with the ban on assisted suicide reigning (Marcoux et al., 2015). In 2002, a U.K. lady named Miss B who was suffering from paralysis went to court demanding that the doctors should stop administering treatment to her against her wish. The High Court granted Miss B her wish and she had a peaceful death after the doctors disconnected the ventilator that was supporting her life. Just recently in May 2018, a scientist by the name David Goodall aged 104 chose to travel from Australia to Switzerland to undergo physician-assisted suicide as it was illegal in Australia while Switzerland permitted it. Mr. Goodall was not terminally ill but cited his deteriorating quality of life as a reason he chose to end his life. This reignited the debate on the ethical issues surrounding assisted suicide as some groups supported his decision while others condemned it.

Arguments for Assisted Suicide

Autonomy

The main reason cited by those supporting physician-assisted suicide is autonomy. According to this argument, a choice on when and how a person dies should be permitted due to autonomy and personal dignity. An adult who has lived a significant portion of his/her life and happens to be terminally ill and of sound mind should be given the liberty to choose a humane and dignified death instead of being reduced to a state of desperation and helplessness that comes with being incontinent or sedated. Old age and the nature of his/her death is very important as they will stick to the memories of the loved ones he/she left behind. Supporters of the physician-assisted suicide claim that adult patients are entitled to make their own life-limiting choices concerning their treatment as long as they have good mental capacity. The debate on the autonomy of patients was greatly contributed by two philosophers; John Stuart Mill and Immanuel Kant. Adults have the right to self-choices so long as their deeds do not bring harm to others (Steck, Junker, Maessen, Reisch, Zwahlen, & Egger, 2014). Kant, however, stands by the notion that adults should be given autonomy but it should be regulated by rational choice. Mill refuted this by emphasizing the significance of desires and preferences instead of rationality. According to Mill, patients and doctors usually negotiate the goals of treatment in everyday healthcare practice. Trained doctors with their skills in the medical field only advise and recommend treatment options to patients. On the other hand, patients who are in control of their own lives take part in decision-making by giving their personal views and preferences (Steck et al., 2014). Mill's notion gives a patient total control over the wish to commit suicide.

Moreover, supporters of assisted suicide even claim that permitting physician-assisted suicide is, in fact, ethical as it relieves the pain and suffering of terminally ill patients. The proponents of this act claim that a person's right to autonomy, especially towards the final days of his/her life, supersedes the notions of life preservation. In addition, conditions such as terminal illnesses dramatically diminish life's sacredness. Ethical standards themselves demand that human beings have a duty to end a fellow human being's suffering. When this suffering cannot be ended through treatment, dying through assisted suicide then automatically becomes ethical due to lack of choices (Steck et al., 2014). Nevertheless, the supporters of physician-assisted suicide recognize the significance of laws that ensure that patients are not forced or coerced to make life-ending decisions and that they decide to commit suicide solely by themselves with sound minds.

Ironically, the strength of this argument is on its ethical nature. Contrary to the notion that it is unethical to allow someone to end their own life, the autonomy argument, in fact, proves the ethical nature of assisted suicide. As mentioned above proponents of assisted suicide even claim that permitting physician-assisted suicide is, in fact, ethical as it relieves the pain and suffering of terminally ill patients. Therefore, the strength of the autonomy argument lies in the fact that it tries to prove its ethical nature in addition to its sensible nature.

Dignified death

Another argument in support of assisted suicide provided by proponents of assisted suicide is that people should be allowed a dignified death. They claim that a person's who has lived a good and dignified life should not be forced to live the last moments of his/her life with suffering from pain; dependent on other people for feeding and body hygiene; declined mobility, vision, and hearing; and mental deterioration. Family and loved ones must not be forced to witness such suffering of a patient who has lived his/her entire life with dignity (Riley, 2017). Rather, the last impression of such a patient from his/her loved ones should be that of respect and even joy. In the above-mentioned case of Miss B, she was paralyzed and dependent on the ventilator with little hope of cure or recovery. She filed a case to end her own life citing that she wanted to die with dignity of not having to depend on people for the rest of her life (Steck et al., 2014). In 2014, a 30-year-old lady in California U.S. by the name Brittany Maynard decided to end her life because she had terminal brain cancer. She moved to Oregon from California to undergo the physician-assisted suicide procedure claiming that she wanted to have a dignified death on her own terms (Steck et al., 2014). Maynard was then used in many right-to-die campaigns to push for the adaptation of laws permitting assisted suicide.

The strength of this argument is on its sensible nature. It would make little sense to continue keeping a very elderly person who is at the homestretch of his/her life alive and watch them suffer to death. There are some circumstances where doctors have put a timeline to a person's life due to some medical condition such as terminal illness. In such cases, the cost-benefit analysis may require the family members to be sensible and let the patient undergo assisted suicide, but only if they consent to it themselves.

Arguments against Assisted Suicide

Sanctity of life

Sanctity of life can simply be described as life's inviolability and it is the main argument opposing physician-assisted suicide. This argument is especially championed by religious groups and churches whose principles hold dear the sanctity of life. Those opposing physician-assisted suicide usually describe life as a creation of divinity and cite natural and religious laws in protecting it prior to death by natural course. The opponents also campaign for life prolongation through medical interventions (Yang & Curlin, 2016). This argument claims that assisted suicide infringes on God's prerogative by stopping life and hence interfering with the divine timing of a person's death. Generally, using this argument, the resistant to assisted suicide is based on a sensible value judgment that life is superior to death in any given circumstance. Others simply put it that the society has a moral obligation to preserve and protect every given human life regardless of the circumstances. Therefore, allowing physicians to assist other people in ending their lives violates this ultimate human duty of respecting and preserving human life.

Some religious groups recognize an individual's choice to withdraw a life-sustaining process such as a mechanical ventilator as it allows natural ending of life. They, however, oppose assisted suicide or euthanasia where a drug is actively administered to end one's life. The groups who are not necessarily religious but support the sanctity of life claim that there must be something sacred in the existence of humans. The voluntary stopping of an individual's life due to mental or physical suffering is a statement that the sanctity of life only holds when the benefits of life supersede its cost and this is wrong. It will also mean that one's life is only about the level of pleasure they get and that there is no deeper meaning in life other than the greatest pleasure (Yang & Curlin, 2016). Finally, it would also mean that there is no purpose in discontent, pain, suffering, and hardship in life which is wrong.

The strength of life sanctity argument is that it appeals to the religious belief of most religions. Therefore, most people who follow various religions are bound to be appealed by it. It is very difficult to convince people to adopt practices that are not in line with their religious belief. Therefore, this argument can easily win especially when presented to religious groups as they make the majority of people.

Slippery slope

Those opposing the physician-assisted suicide argue that the legalization of this act would leave gaps in assisted-suicide process and inevitably lead to involuntary suicide. Once this process is allowed for competent individuals facing terminal illnesses, it will eventually open the way to physicians and other people offering it to patients who are not sufficiently mentally competent. Assisted suicide can be offered to individuals who are in any form of distress but not facing terminal illness. It is feared that permitting assisted suicide would open a Pandora's Box to a myriad of other issues (Paterson, 2008). Undoubtedly, Peterson (2008) claims that legalization of physician-assisted suicide would prompt individuals and organizations to also seek the legitimization of involuntar...