A common ethical dilemma in today’s society is whether or not to allow physician-assisted suicide. It can be easy to decide that physician-assisted suicide should not be allowed. On the surface, physician-assisted suicide has characteristics that can be hard to see as different from legal concepts like abetting or even committing a murder. Like many who have not had to confront the question within their own families, I agreed with that position. However, this can be too simplistic. There are many pros and cons to the question of permitting doctor-assisted suicide. Very often, there are more considerations than many people realize.
Oregon was the first U.S. state to pass a law explicitly allowing physician-assisted suicide. The Death with Dignity Act allows “…terminally ill patients to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician…” (Printz, 2015, p 641). A related concept that does not involve the patient taking the prescribed medication on their own, is referred to as euthanasia. Merriam Webster defines euthanasia as “the act of practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy,” (Euthanasia, 2018, n.d.). “Belgium, Luxembourg, and the Netherlands are nations where active voluntary euthanasia is legally tolerated,” (Shekhar & Goel, 2012, p 629).
As implied by the title of the Oregon law, one of the arguments in favor of physician-assisted suicide or euthanasia is that it helps patients keep control. They have a sense that they can make a rational election and die with dignity. Also, using patient-centered care principles, the physician can counsel and provide advice to the patient on their prognosis, including predicted physical and mental aspects of their condition.
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With such education, the patient’s decision can be to continue or can be to not actually go through with it. A lot of people are more afraid of morbidity than their own mortality. That is, a long, lingering process, often either painful or vegetative in nature, is feared more than their own death. Here, the physician’s own ethical dilemma can be seen, because of the Hippocratic Oath regarding “Do no harm.” With which approach do they do no harm? By allowing them a long, lingering state of morbidity or by ending their life “short” of when it otherwise would occur?
Patients often get upset about the lack of end-of-life care because they are dying in hospitals full of high technology medicine and do not like the lack of choices they have. “The solution was thought to be the empowerment of patients to have a say in how they died, better education of physicians in the care of dying, and the wider availability of palliative care of hospice programs,” (Lawler & Callahan, 2012, para 3). This refers to all forms of end-of-life care, whether its hospice, refusing care, or choosing physician-assisted suicide.
“Another argument against rational suicide is that proper treatment – mental and physical – can relieve the physical and emotional pain and, as a result of that, suicidal ideation can decrease,” (Abeles & Barlev, 1999, p 232). It can be very hard to determine whether there are no more possible solutions to heal someone or take away their pain. New studies are always revealing new possibilities and clinical trials. This fact can make it difficult for a doctor to finally agree that it may actually be the end and that no more solutions are available.
“In this very intimate doctor-patient relationship, the notion of the ethical principle of autonomy is strongly stressed and sometimes overextended. As a consequence, patients and even patients without symptoms demand the premature termination of their lives in cases of incurable diseases,” (Oduncu & Sahm, 2010, p. 372). People worry that patients can think of physician-assisted suicide prematurely and may have not thought through the possible treatments. Many religions are also against suicide, as a matter of principle, whether or not physician-assistance is in the scenario. They argue that life is a gift from God and people are not to decide if life is worth living or dying (Ardelt, 2003, p 426).
The considerations regarding physician-assisted suicide can also take a significant toll on the family. It can be hard to see your loved ones suffer through a long-term disease with no hope, but no one would want to see their loved one decide to end their life.
After doing research and learning more about physician-assisted suicide and euthanasia, I have come to believe that physician assisted suicide should be legal. Although I thoroughly understand why people are against physician-assisted suicide, I think that if a patient has been checked out mentally and they have thoroughly discussed alternatives and implications with their doctor, then a patient with a terminal or incurable disease, can rationally and reasonably choose physician-assisted suicide and this should be legal. When a patient’s fear of the prospect of a life with the pain and suffering that they will have to endure, with no end in sight, greatly outweighs their fear of death, the law should not prevent a choice in favor of physician-assisted suicide.
References
- Ardelt, M. (2003). Physician-assisted death. Handbook of Death and Dying. 424-434. Retrieved from http://users.clas.ufl.edu/ardelt/physician_assisted_death.pdf
- Abeles, N., Barlev, A. (1999). End of Life Decisions and Assisted Suicide. Professional Psychology: research and practice. 30(3). 229-234. DOI: 10.1037/0735-7028.30.3.229. Retrieved from http://psycnet.apa.org.proxy.lib.odu.edu/fulltext/1999-03661-001.pdf
- Lawler, P., Callahan, D. (2012). Ethics and Health Care: Rethinking end-of-life care. The Heritage Foundation. N.P. n.p. Retrieved from https://www.heritage.org/health-care-reform/report/ethics-and-health-care-rethinking-end-life-care
- Oduncu, F. S., Sahm, S. (2010). Doctor-cared dying instead of physician-assisted suicide: a perspective from Germany. Springer Science + Business Media B. V. (13). 371-378. DOI: 10.1007/s11019-010-9266-z. Retrieved from https://link-springer-com.proxy.lib.odu.edu/content/pdf/10.1007%2Fs11019-010-9266-z.pdf
- Printz, C. (2015). Death with Dignity. Cancer. 121(5). 641-643. DOI: 10.1002/cncr.29283. Retrieved from https://onlinelibrary-wiley-com.proxy.lib.odu.edu/doi/abs/10.1002/cncr.29283
- Euthanasia. (2018). Merriam-Webster’s Dictionary Online. N.P. n.p. Retrieved from https://www.merriam-webster.com/dictionary/euthanasia
- Shekhar, S., Goel, A. MD. (2012). Euthanasia: India’s position in the global scenario. American Journal of Hospice and Palliative Medicine. 30(7). 628-631. DOI: 10.1177/1049909112465941. Retrieved from http://journals.sagepub.com.proxy.lib.odu.edu/doi/pdf/10.1177/1049909112465941
