Ethics of Physician-Assisted Suicide Name: Naila Zafar Student ID: 210945210 Course: HLST 4010 Date: April.4. 2014
Physician assisted suicide is a widely spread controversial ethical issue. This paper is written in an effort to highlight some important points discussing whether assisted suicide should be legalized or not under certain circumstances. Various ethical and social factors that play key role in prohibiting and permitting the legalization of assisted suicide will be discussed such as respecting autonomy and self determination of patients. Besides, role of physicians and medical profession in the end of life decision making process will also be discussed. Finally, I will shed light on struggle of policy makers to make just and fair legislations regarding end of life decisions without violating biomedical principles, patient’s rights and social norms. Physician assisted suicide an ethical dilemma:
Assisted suicide is the act of intentionally killing oneself with the assistance of physician who provides a patient with medical means and medical knowledge. Assisted suicide is slightly distinguished from withholding or withdrawing life- sustaining treatment where the patient or the patient’s proxy refuses the treatment based on its advantages and disadvantages. There are various views and arguments about the legalization of physician assisted suicide based on the physical situation and self determination of the patient. Several countries have adopted laws that allow physician assistance in dying with limitations (Heidi, 2013). A key situation in the jurisdictions that have allowed the assistance in suicide is that physicians are only allowed to provide assistance if patients voluntarily request for it and if medical treatment is of no help anymore. Each country has its own ethical and moral beliefs and regulations about involving physicians to help patients committing a suicide. However, in struggling with the issue of physician- assisted suicide, one must understand not only the patient’s rights and autonomy but also the situation and level of medical profession and individual physician (Latimer & McGregor, 1994). Various personal, legal and moral concerns need to be measured while making end of life decisions because assisting someone to kill themselves based on the belief of respecting person’s autonomy might not be appropriate for medical profession where physician is supposed to provide care to the patients in any circumstances. Therefore, law makers, health professionals and researchers face increasing pressure to solve this dilemma of should physicians participate in bringing the death of a terminally ill patient and whether these practices should be accepted by the society? Permitting Physician assisted suicide:
To begin with, I would discuss why physician assisted suicide should be legalized or supported by the society and by law. Supporters of assisted suicide believe that this act benefit terminally ill patients by relieving their suffering. This is probably one of the reasons why Netherlands court determined that a physician is allowed to prevent severe and irreversible suffering, even if it reduces patient’s life (Bosshard et al, 2002). The act of assisted suicide or active euthanasia is allowed in Netherlands, Switzerland and Oregon under different conditions and legislations. The situation can be seen differently in places, where by moral and legal discourse; assisted suicide is interpreted as the freedom or right of the individual as in Switzerland and some states of US. From the ethical perspective, patient’s choice of suicide represents an expression of self- determination and while exercising self- determination people take responsibility of their lives and for the kind of person they become. They have a right to refuse the life- sustaining treatment if they don’t want to suffer anymore and according to law, physicians must respect their decisions to forgo life- sustaining treatment that are capable of making their end of life decisions. By refusing life- sustaining treatment, terminally ill people know that they are going to die soon and in order to avoid suffering or pain they ask physicians for assistance to end their life. In Canada, suicide has been decriminalized but aiding a person to commit suicide is considered a murder and is punishable (Lemmens, 1996). The debate on assisted suicide in Canada is very controversial among groups who believe that these laws are taking away patient’s right to make a decision about their life while suffering from severe pain or a “right to die”. An example of assisted suicide is the case of Sue Rodriguez, where she was suffering from amyotrophic lateral sclerosis that was leading to total loss of physical control and dependence on a respirator. She wanted to maintain as much control over her own dying and death as possible and this is why she applied in Supreme Court to get permission for assisted suicide (Sneddon, 2006). But the Supreme Court rejected her request and ignored the fact that this prohibition discriminates against those who can not commit suicide without assistance and they are prevented by law from doing something that physically able are permitted to do. These laws might serve the goal of equality of autonomy but on the other side comes at the rate of being unfair. Such regulations prohibit the rights of competent vulnerable, disabled, and terminally ill people who are well aware of their situation that they will never get back to their healthy life and request to end life. From moral perspective, they face injustice by not getting the right to control their life. Making assisted suicide legalized will provide them justice and they will get peace of mind by having freedom of choosing the way they want to end their life. Besides, one of the greatest concerns by the patients facing terminal illness and their families is that they might not be able to receive adequate medication for their pain relief. Families do not want to see their loved ones suffering at the end stage of their life as well and would request physicians to give lethal dose to end patient’s suffering. Proponents of assisted suicide argue that when physicians use terminal sedation at the last stage of patient’s life to relieve his suffering, they are fully aware of the side effects of these dosages which can hasten death in serious cases, and then they are somehow intentionally participating in killing the patient. These arguments encourage patients and their families to raise a question; “If terminal sedation can be used as a mean of ending patient’s life, then why it is prohibited for physicians to provide lethal dosage to patients who voluntarily want to end their life?” Furthermore, legalizing assisted suicide can reduce the burden on families of the patients who suffer every moment with pain and become dependent on their family. Families of terminally ill or disabled patients face financial stress because in this situation they must have an adequate financial resource to provide appropriate care to the patient. It is obvious that some wealthy families who can afford to keep a dying family member alive would not require the law of assisted suicide as compared to the families who are not wealthy and are unable to bear the burden of dying family member for long period of time. In countries, where majority of people do not have health insurance, it is not easy for them to get treatment especially for terminally ill people who would feel depressed and consider themselves burden on their family for rest of their life. In such situations they are most likely to consider suicide the only option. All investigations must be examined to ensure that patient want this act of assisted suicide only due to medical condition and suffering and not because of financial or other sort of influence. Fears of legalizing assisted suicide:
There has been a majority of religious, ethical and legal conflict on legalizing assisted suicide in terms of respecting patient’s autonomy and self determination. There is a fear that once assisted suicide is legalized, physicians will have to help in dying to anyone who wants it regardless of their reasons (Sneddon, 2006). There are more chances that depressed and hopeless people will ask for assistance to suicide more than terminally ill and disabled people who cannot get back to normal life. Opponents of physician assisted suicide argue that death is a predictable consequence of morally justified withdrawal of life- sustaining treatment only in the cases of fatal conditions (Dickens et al, 1997). They believe that permitting these acts are divergent to the respect for human life which is at the core of social values. These moral values do not allow us to treat dying humans with cruelty for the sake of relieving their pain and if we accept the act of assisted suicide then it will contribute to an increasingly casual attitude towards private killing in society. There has been a serious concern about this issue that requests for assisted suicide do not always come with the desire to avoid suffering but due to clinical depression, fear of being dependent on others and a desire to maintain personal control (Dickens et al, 1997). Allowing health care providers to participate in the death of patients will lead towards the slippery slope to abuse where patients will no longer trust the physicians to cure their illnesses and provide medical treatment that will bring them back to healthy life and may damage the physician- patient relationship. Furthermore, care of dying person must be based on the rights, autonomy of the patient and the medical procedure that must not encourage them to end their life. Our current policies and treatment procedures leave too many dying patients without adequate pain management, depression treatment or supportive services for their families (Roscoe, 1998). By providing dying patients psychological and spiritual support in a setting of comfort care, there are more chances of maximizing the patient’s sense of control and less possibilities of getting assisted suicide requests from those patients. Therefore, opponents of assisted suicide argue that permitting assisted suicide opens doors to the policies that carry more risks and if this act is permitted then there is a strong debate about permitting euthanasia. Even the Canadian government supports human dignity and right to live by opposing assisted suicide. The government argues that it is a reflection of states policy that value of human life should not be depreciated by allowing one person to kill another and that risks inherent in assisted suicide are too great (James, 2012). Majority of jurisdictions and medical profession supports that use of terminal sedation by physicians is morally acceptable in a way that HCPs are motivated by their obligation of beneficence to relieve the patient’s pain or suffering. In this sense, physician is performing his moral duty of doing well to the patient by giving them high dosage with the intention of reducing the pain without focusing much on the side effects of the medication. If patient dies during this process then physicians do not get the blame for this act because his intention was morally justified. Physicians and Biomedical ethics:
In the context of assisted suicide, it is important to talk about the role and limitations of physicians who are mainly responsible for treating the terminally ill and disabled patients. Permitting physicians to participate in assisted suicide can emerge various concerns regarding medical profession and well being of patients. Firstly, permitting physicians to perform this act would be incompatible with their moral and professional commitment as healers to care for patients and to protect life. Secondly, physician’s assistance in suicide will make patients fearful that medication was not intended to treat, but to kill and eventually they will lose trust on their physician which will change the medical purposes and goals of healing the sick (Bachman et al, 1996). Thirdly, assisting incompetent vulnerable patients to end their life upon request of the family members put whole burden on physician to bring that patient’s death before time. If a physician under serious circumstances cannot tolerate patient’s pain during last hours of his life and with the permission of the family gives lethal injection, then he is disobeying the standards of professional integrity and the principle of beneficence. Therefore, physician’s agreement or disagreement of participating in this act of suicide is very important. One of the studies in Oregon revealed that personal and religious beliefs of physicians strongly influence their participation. Also the location of the physician’s practices predicts their willingness to participate in assisted suicide suggests that threats to confidentiality and social disapproval may make such participation riskier for physicians, patients and their families (Lee et al, 1996). That is why various physicians have different attitudes towards legalization of assisted suicide such as some physicians will be willing to give lethal injection at the last stage of patient’s life based on the level of pain and suffering, while some will stick to their professional duty of providing care to the patients till the end. Solution to the dilemma and policy makers:
It is quite difficult to discuss one scenario that fits all patient situations. That is why all ethical based cases need individual consideration by the law makers, social and professional groups. Since assisted suicide happens between two or more people then consideration of individual autonomy will not be enough to make legislations. If suicide is decriminalized in Canada and other countries, then equality calls for extra measures should be available for disabled people to ensure that they have access to legally permitted option regarding their end of life decisions (Sneddon, 2006). At this point in time, no one has essential information to judge whether moral tradition, medical and legal standards should be enlarged to include assistance in dying. Proponents of legalizing assisted suicide supports one side of the picture based on their experiences and ethical knowledge, while opponents argue about other side of the picture by making religion and dignity of medical profession their focal point . From religious, legal and ethical perspective, we cannot serve the patient’s good by eliminating the patient under any circumstances. These discussions of what is morally right and what is wrong about the end of life decisions for a patient have increased confusion and tension among parliament and courts regarding which act should be legalized and which one should be prohibited. Moreover, there are enormous end of life cases where some acts of physician assisted suicide are morally justified (Beauchamp, 2000) such as use of pain control medication. There is also a belief that lack of adequate palliative care leads patients and their families towards depression and they request to end their life. Courts in some countries such as US, do realize that some cases do exist where an individual patient’s right to die supersedes the State’s interest in preserving life (Roscoe, 1998). To get the solution of this ethical dilemma, policy makers should give serious consideration to all the cases of suffering and disability while figuring out the possible medical solution to such situations. On one hand, legalizing assisted suicide should be limited only to the cases where there is no hope of life and it is ethical to provide dying patients with piece of mind. Such decisions are helpful in some situations to prevent people from committing crimes such as taking poison and asking family members to assist in ending their life. On the other hand, there is a fear of disobedience of principle of beneficence and loss of respect of physician as a care giver. In short, it requires the full commitment of researchers, policy makers, and medical professionals to make policies regarding end of life decisions based on the situation that will not violate the moral and social norms of the society.
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