Introduction to Ethics & Social Responsibility - SOC 120
Physician Assisted Suicide
Prof. Harold Engle
September 2, 2011
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Physician assisted suicide is a choice that reminds me of the game show “what would you do”. When your so terminally sick and your quality of life is nothing anymore, what does a person do. Anymore there are very few options on how to handle terminal illnesses. You can wait it out and risk all the pain that may or may not come, or you can explore more in depth options with your physician. As a terminally ill patient and hoping to have fulfilled your bucket list, your options are minimal and can have a greater effect on the ones we love.
Only one state and one country has passed an act that may be helpful to those who have a terminal illness. Physician assisted suicide, now more commonly known as physician aid-in-dying or PAD is an available option for those terminally ill patients. Physician aid-in-dying refers to a practice in which a physician provides a competent, terminally ill patient with a prescription for a lethal dose of medication, upon the patients request, which the patient intends to use to end his or her own life (Braddock, Starks, Dudzinski, & White 2010). Although it is voluntary and once a person is given the medication it is entirely up to them to decide to take it. Between 1997 and 2001, 141 lethal prescriptions were issued according to Oregon state records but only 91 of those patients actually used their prescriptions to end their life (Singer, 2003).
This term that was once and most commonly known as physician assisted suicide, has created a lot of controversy. It was a term that when used by people was felt as an accurate reflection of the relationship between doctor/patient and refer to the etymological roots of suicide as “auto killing” or “self killing” (Braddock, Starks, Dudzinski, & White, 2010). The term physician aid-in-dying is used to describe the practice that is authorized in Physician Assisted Suicide p. 3
certain states and under certain laws passed for this particular reason and is also meant to reflect the requirement that eligible persons must be decisionally competent and have a limited life expectancy of six months or less (Braddock, et al.).
There are two types of physician assisted suicide, also known as euthanasia. There are both voluntary and involuntary. Voluntary is physician assisted suicide where death is performed by another person with the consent of the person who is ultimately die (LeBaron, 1999). Involuntary is the more obvious where death is placed upon a person without their consent (LeBaron).
Under the Death with Dignity Act passed in Oregon, it allows physician aid-in-dying to be a legal action. However, under this act there are strict guidelines and patient criteria that must be met before it can happen. Part of the eligibility criteria includes limiting access to competent , legal residents of the state over the age of eighteen, that have a terminal illness which has been confirmed by two independent physicians (Braddock, Starks, Dudzinski, & White, 2010). For the sake of this act, terminal is defined as an estimated life expectancy of six months or less. There is also a requirement for two oral requests with a fifteen day period between the two, as well as a written request that was done in front of a witness (Braddock, et al.). Any prescription for the purpose of dying once everything has been approved must be written no less than forty-eight hours after the receipt of the written request and the patient must be able to self-administer the medications themselves. The last major provision under the act is that any physician has the right to decline prescribing medication for the purpose of ending life (Braddock, et al.).
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Many believe that physician aid-in-dying is the same as euthanasia. However, it is not necessarily the same as there are different criteria that sets them apart. Although, both acts use lethal medications to deliberately end a life, the major difference is WHO acts to end the patients life (Braddock, et al.). Under physician aid in dying, the physician will provide the medication and the patient will decide whether and when to take the lethal dose. When it comes to euthanasia, a third party administers the medication or will act directly to end the patients life (Braddock, et al).
Looking at whether physician aid in dying is the same as euthanasia, all of it questions the ethics of the act. It is a controversial subject that is debated often. There are arguments that are for this act and arguments that are against it. Typically when one is arguing for physician aid in dying the argument that is used is one that states that this is a rational choice for a dying person who is choosing to escape unbearable suffering at the end of their life (Braddock, et al.). These arguments that come on whether physician aid in dying is ethical or not relies a great deal on respect for individual autonomy, recognizing the right of competent people to choose the timing and manner of death in the face of a terminal illness (Braddock, et al).
One of the biggest objections to physician aid in dying or sometimes also referred to as euthanasia, is that even when it is voluntary it is really suicide. A critic of physician assisted suicide or physician aid in dying, theologian Joseph Fletcher states that “personal integrity is a value worth the loss of life, especially since there is no hope of relief from the demoralizing pain and no further possibility of servicing others (Young, 1997). Another common objection is that euthanasia or physician assisted suicide, when voluntary, is murder. Fletcher refutes “the motive and the end sought are entirely different in euthanasia from the motive and intent in murder, even though the means of taking a life happens to be the same (Young).
The arguments against this act typically outweigh by far, the arguments for it. Another round of arguments is that there is no morally significant distinction between passively letting someone die and actively hastening death; sometimes killing is morally justifiable; that society should determine the ethos of medicine; that this is essentially a private matter; and lastly, that legalization can ensure that there are constraints on the practice of physician assisted suicide and euthanasia (Young). These arguments of those who are against it and who condemn both voluntary and involuntary call the voluntary form of physician assisted suicide or euthanasia a compounded crime of murder and suicide if administered by the physician, and suicide alone if administered by the patient himself. They call the involuntary form straight out murder (LeBaron).
It is common that when this topic is mentioned that you will hear people say that performing assisted suicide or “mercy killings” are contrary to medical tradition and medicines internal morality (Young, 1997). It has been suggested and states that there is no moral difference between suicide and the withdraw of treatment (Young). It is said to not be an ethically permissible act because physician aid in dying runs directly counter to the traditional duty of the physician to preserve life and to do no harm. The argument that this is abuse has become a recent side. For example, the disabled, poor or elderly might be covertly pressured to choose physician assisted suicide or physician aid in dying over a more complex and expensive form of palliative care options (Braddock, Starks, Dudzinski, & White, 2010).
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Many different organizations like the World Health Organization or WHO, are concerned that the nature of the physician - patient relationship will be irrevocably altered for the worse if physicians are given a license to “kill”. (Young). However, advocates for physician assisted suicide like Margaret Battin will argue that physicians whom alone society has entrusted custody of the means of ensuring a good death, have a positive duty to help terminally ill patients in intractable pain who wish to die, which is a duty grounded in the bioethical principles of beneficence and non-malfeasance (Young).
Battin points out that patients have not only the negative right to self determination but also the positive right to assistance from a physician. She believes that if a human being is fully emancipated then they are answerable to no one but themselves (Young). Physicians and philosophers who support this topic, along with Battin emphasize considerations such as mercy in the face of immitigable pain; self-determination in matters of life and death; and human dignity as residing in control over the manner and timing of ones death (Young).
There are so many different ways and theories that analyze physician assisted suicide or physician aid in dying. Utilitarianism is an ethical theory that determines the moral and value of an act in terms of its results and if those results produce the greatest good for the greatest number (Mosser, 2010). When you consider physician assisted suicide, there is no single utilitarian perspective but there are several different versions of how utilitarianism will analyze it.
One of the major perspectives, act-utilitarianism, it suggests the right action is the one that of all the actions open to the agent, and has consequences that are better than, or Physician Assisted Suicide p. 7
at least no worse than, any other action open to the agent. No matter which perspective you use, utilitarianism counts only pleasure and pain, or happiness and suffering, as intrinsically significant (Singer, 2003).
A utilitarian might suggest that voluntary euthanasia, or physician assisted suicide follows under the rules that it is always wrong to kill an innocent human being. However, the idea of a right to life does not provide basis for opposing voluntary death (Singer). Utilitarian’s sometimes claim that patients whoa re terminally ill cannot rationally or autonomously choose physician assisted suicide because they are liable to be depressed. This would show that they are not in the right mind set to make such a huge decision (Singer). In fact the term in itself evades the mental health connotations that are associated with the word suicide. People who object to the use of “physician aid in dying” suggest that it could include practices that are clearly outside the legal bounds of the act. For example, a person who receives assistance ingesting the medication would or could constitute euthanasia (Braddock, Starks, Dudzinski, & White, 2010).
A utilitarian should not find anything wrong in the doctors action, either because the desire to die was considered preference or because no one was in a better position to decide whether a persons life contained a positive or negative balance of experience (Singer). The bottom line is that the utilitarian perspective may cause the family to keep an individual alive. The argument for this is that it could be that the family may decide that it is harmful to society to weaken the value of life and that is there is a possibility of saving life, in any condition, it should be done for the good of everyone (LeBaron, 2010). The other side of this argument is that it may lead the family to conclude that the individual Physician Assisted Suicide p. 8
should be allowed to die, and that they believe that society would be forced to bear the financial burden of an individual utilizing such expensive medical care and that such resources might be better allocated if they were used on someone else with a lesser diagnosis (LeBaron).
An act like physician assisted suicide is seen from a utilitarian perspective but it is an ethical egoism act. Ethical egoism is the view that all human behavior should be regarded as done in the self-interest of the individual person to satisfy that persons goals and desires (Mosser, 2010). Under ethical egoism, physician assisted suicide is not only considered “intrinsically evil” and that the fabric of social morality will be damaged by sanctioning them (LeBaron, 1999).
When you compare physician assisted suicide with ethical egoism, you will find that it operates from the general rule that if any action increases a persons own good and then it is right. It is argued that we cannot help but act in our own self-interest, and therefore, such acts are ethical (LeBaron). Ethical egoism in the context of euthanasia or physician assisted suicide would not contend that if a person wants or does not want to end their life using euthanasia that the desire is motivated by a self-benefit, and therefore it is an ethical action (LeBaron).
However, ethical egoism could lead the family to chose to keep an individual alive because they are unable to live with the knowledge that they pulled the plug on a loved one or went along with PAS. It could also entice the family to choose to allow the individual to die (LeBaron). There are many sides to the way ethical egoism could go but the main priority is that people will work harder and work against physician assisted Physician Assisted Suicide p. 9
suicide for the ones they loved. Ethically people will see it as being a bad thing and an immoral act.
At the end of the day I would consider myself to be a utilitarian who would agree more with the ethical egoism approach to physician assisted suicide, and/or physician aid in dying. I believe that it is a person personal choice to make and one that they obviously have to make with great knowledge of what they are getting into. I have been a caretaker for someone who was a close family member, who had the terminally ill diagnosis. If it were legal in the state in which we lived, I believe she would have opted for it. She suffered so much every day with no relief ever. Her quality of life went from something amazing to something where she was laying in bed, crying out in pain when she was not drugged up. Physician assisted suicide is something that you cannot take lightly. There are strict guidelines one must meet before they can even be considered a candidate and from there, there are more hurdles to jump through. Having this option available is not a bad thing and it does not make someone a bad person. It simply helps those who have no other option or no other help available to them.
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Braddock, C; Starks, H; & Dudzinski, D; & White, N. (2010). Physician Aid-In-Dying. Retrieved on August 22, 2011 from http://depts.washington.edu/bioethc/topics/pad.html LeBaron, G. (1999). The Ethics of Euthanasia. Retrieved on September 1, 2011 from
http://www.quantonics.com/The_Ethics_of_Euthanaisa_By_Garn_LeBaron.html Mosser, K. (2010). Introduction to Ethics and Social Responsibility. San Diego, Bridgepoint Education Inc. Retrieved from https://content.ashford.edu[->0] Singer, P. (2003). Voluntary Euthanasia: A Utilitarian Perspective. Retrieved on August 25, 2011 from http://www.nd.edu.~bthames/docs/phil101/readings/singer%20-%20voluntary%20Euthanasia.pdf Young, E. (1997). Physician-Assisted Suicide. Overview of the Ethical Debate. Retrieved
on August 22,2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1304318/pdf/westjmed00346-0042.pf
[->0] - https://content.ashford.edu/