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Should Physician-Assisted Suicide be Legal
Krystle Hunter
PHI 103 An introduction to Logic
Instructor: Cecil Mayhill
4/27/2013

Should Physician Assisted Suicide be Legal? The debate for physician-assisted suicide has been going on for a long time. This debate can be trace back to the Greek and Roman times. Physician-assisted suicide debate originally was centered on the Hippocratic Oath and the condemnation of the practice. There are many Christians and many physicians continued to condemn the practice. Many are for physician assisted suicide to be legal and there are many against it. You have some people to believe that physician-assisted suicide insist that terminally ill individuals should have the right to end their suffering. On the other hand, others believe if the practice of physician-assisted suicide becomes acceptable, society will pressure patients into choosing death instead providing them with quality end-of-life. This is a controversy subject. Although this debate has been a lengthy one and many issues discussed over the centuries are repetitive, new ideas and concerns. I will provide some pros and cons of physician-assisted suicide. The standard arguments in favor of a legal right to physician-assisted suicide are hardly news. It is frequently asserted that there ought to be a right to physician-assisted suicide under United States law in order to enable qualified patients to avoid unnecessary suffering, to enable qualified patients to die with dignity, and to respect those patients’ right to autonomy or self-determination (Lesser, 2010). For one thing, it is essential to distinguish between reasoning from authoritative legal sources to conclusion about what the law is and reasoning from moral premises to what the law ought to be. “The Philosophers’ Brief” purports to consist of purely legal reasoning. “These cases do not invite or require the court to make moral, ethical or religious judgments about how people should approach or confront their death or about when it is ethically appropriate to hasten one’s own death or ask others for help in doing so (Lesser, 2010). In response to the claim there is a right to die, there was detailed article published in the Hastings Center Report about the evolution of rights. According to the original liberal thinkers on rights, the right to commit suicide goes against the idea of a natural right. The philosophical arguments go to show there is no historical precedent for a right to be made dead, let alone requiring others to help. The essence of individual freedom is a sense of not belonging to someone else, not merely doing whatever you please. The current positing of rights to do whatever one pleases is a modern development and is seldom upheld in courts (Kass, 1993). Although there may or may not be a right to die, there are other arguments for physician-assisted suicide. Quill (1991) showed how compassion can lead to the assisting of one’s death. However at the same time Quill has discussed how a patient asking to die may not always be making a legitimate request. His idea is that this request should lead to query about death and the options should be explored, instead of a simple yes or no answer. His example of a fifty five year old woman who requested to die was really a response to not wanting to undergo any more treatment for cancer and a desire to take a more symptom-related treatment path. Some patients are in a spiritual crisis, psychosocial problems, and even clinical depression. All of these requests for help, with proper discussion of options can lead to a more positive end of life experience. Physician can feel sympathetic to a situation where there is nothing they can due to alleviate the pain of a patient. For many, simply side-stepping the question is unethical since the question can represent a cry for help (Quill, 1991). So the compassion for a patient who is in terminal pain can lead physicians to aid in physician-assisted suicide now even though it is illegal. Although there is now legal, medical or philosophical historical precedent to allow physician-assisted suicide, physicians believes in physician-assisted suicide enough to knowingly break the law. One issue that is difficult to resolve is the morality of physician-assisted suicide. Many physicians and patients have a moral dilemma with physician-assisted suicide. Another aspect involves the morality of the nurses who are involved with a possible action of physician-assisted suicide. If they object do they refer the patient to another nurse, or how do they voice their opinion against this action without involving the patient in the conflict between the physician and nurse (Haddad, 1997)? Besides the nurse there are many others who are involved as well. How do institutions make their policy clear enough ahead of time to alleviate any problems especially in the situation with terminally ill patients? What is the pharmacist’s moral responsibility in this scenario? Do they ask the patient if the medication is for committing suicide? If they consciously object to physician-assisted suicide how do they perform their function? Do they not fill the prescription outright, nor do they only fill the prescription to a level where the patient can not commit suicide? Another aspect of this is the responsibility of the doctor to provide further care. What happens if the suicide is botched somehow, or if other complications make the suicide impossible? There are many issues involved with the act and how it affects all of the people involved in the health care of the patient (Alpers & Lo, 1995). Equally, there is an argument on the other side which seeks to settle the matter quickly, namely the argument that suicide is always morally wrong; therefore assisting it is always morally wrong; and therefore, even if it is considered that there is no point do to someone who commits suicide and punishing those who fall in the attempt is unlikely to be a deterrent, assisted suicide should always be a crime (Wellman, 2003). Again, this too simple; apart from the fact that the view that the moral wrongness of an act is a sufficient reason for making it illegal has been subjected to a great deal of criticism, to put it mildly, the argument could at best justify forbidding actions which are agreed to be wrong, and not ones like assisting suicide, about which there is genuine disagreement. So we cannot argue from the fact that suicide is always morally wrong to the conclusion that assisting suicide should be illegal (Wellman, 2003). While physician-assisted suicide is not legal in the United States except in Oregon, the Supreme Court ruled on the state’s right to decide individually on the legality of physician-assisted suicide. The two cases were Vacco v. Quill and Washington V. Glicksberg, where the court upheld the right for the states to criminalize physician-assisted suicide; however the Supreme Court did not say there was a right to physician-assisted suicide (Vacco, et. al, 1997). The Supreme Court did say in the concurring opinions that the patient had a right to palliative care. They did believe that when a physician gave pain medications to relieve the suffering of a patient such treatment would be permissible even if another consequence of that pain medication is a shortening of the patient’s life. The Supreme Court did allow states to pass their own laws on the subject and allowed a discussion of the right to physician-assisted suicide in the public (Vacco, et. al, 1997). In the case Lee V. State of Oregon, the courts ruled that there was not enough protection for the terminally patient that may end up in a premature death who may actually want to live. This lack of protection came from the absence of a mental health professional consult when physician-assisted suicide is requested (Lee, et. al, 1996). So the courts do say there is a state interest in protecting patients who may want to live. While the states interest in protecting patients is one key legal argument against physician-assisted suicide and making physician-assisted suicide illegal. So the courts have upheld the pillars of protecting the patient. However, in attempting to protect the patient the courts have incorporated the psychiatrist, who brings up the dilemmas of the psychiatry previously mentioned (Lee, et. al, 1996). Many physicians agree with the ruling that palliative care is very important and should not be restricted (Burt, 1997). However, they also agree that the debate for physician-assisted suicide is not over. Some however disagree with the idea of a right to palliative care. They do not disagree with the idea of comforting patients at the end of their death, but they do think sedating someone to death is ethically problematic. The claim is that terminal sedation is equivalent to a slow euthanasia, if ones sedate someone to deep sleep and then withdraws food and water; does this ethically follow the guidelines of right to refuse medical treatment? The physician is putting the patient in a position where artificial support can be legally removed. Dr. Orentlicher claims the court rejected the idea that terminal sedation “is covert physician-assisted suicide.” He also claims that in rejecting a right to physician-assisted suicide they embraced a direct form of euthanasia, which can be easily abused (Orentlicher, 1997). While terminal sedation can be abused and at best there is still debate on the permissibility of terminally sedating a patient and withdrawing life support, the courts have upheld a right to palliative care, as long as the primary purpose of the sedation is to relieve pain and not hasten death (Orentlicher, 1997). Since the discussion of physician-assisted suicide surrounds feelings and uncertain situations, the discussion has turned somewhat from why to have physician-assisted suicide to how. A proposal has been published on the conditions of physician-assisted suicide (Quill, et. al, 1992). The first requirement is that the patient must have a condition that is incurable and associated with severe, unrelenting suffering and understand the prognosis. Second, the physician must be sure the request is not made because of inadequate pain control. Third, the patient must clearly and repeatedly request to die. Fourth, the physician must be sure the patient’s judgment is not distorted. Fifth, the physician-assisted suicide should be only carried out in a meaningful doctor patient relationship. A physician should not be forced to participate in any act that they deem unethical. Sixth, consultation with another experienced physician is required to ensure it is a sincere request. Seventh, all of the steps should be clearly documented (Quill, et. al, 1992). This policy takes reasonable sets to ensure the procedures are not abused, but the chance of abuse is always present (Quill, et. al. 1992). While the assisted suicide proponents look at the issue as a matter of personal freedom and private choice, many on the other side of the debate think about the issue in terms of ethics and religion. In the medical profession, many doctors and nurses have expressed concerns about assisting someone as they die since they consider it to be their duty to help people live instead.
They do not see this as a responsibility or an ethical act as medical personnel. Still, despite these reservations, the statistics of doctors interviewed in a questionnaire-based study did make it clear that recognized the importance of a patient dying with some dignity. In the study, “sixty percent [of physicians] agreed that physician-assisted suicide should be legal in some cases” (Gupta, 2006). Others outside of the medical field propose that taking a life, even for purposes that seem to have valid reasoning is wrong. For many Americans, the most potent argument against physician-assisted suicide is not based solely on more empirically-centered questions such as the role and duties of the medical establishment, but rather on vague notions of morality and religious doctrine. “The states cannot legislate on the basis on religion faith but they can legislate on ethical grounds. They may reasonably conclude that the legalization of assisted suicide would dangerously corrode society’s moral fabric” (Marsh, 2005). These opponents refer to the Bible and Christian traditions understand of suicide and murder as grave sins. Furthermore, many of the religious groups claim to hold all life as sacred and by taking a life, even though it may ease someone’s pain, is not an acceptable act in the eyes of God or within Christian tradition (Marsh, 2005). Arguments supporting physician-assisted suicide highlight the duty to relieve patient suffering or stem from a vigorous understanding of the duty to respect patient autonomy (Syncher & Weiner, 1996). The suffering of patients at the end of life can be great. It includes the suffering occasioned by somatic symptoms, such as pain and nausea, or psychological conditions, such as depression and anxiety. It encompasses interpersonal suffering (due to dependency on other persons or to unresolved interpersonal conflicts) or existential suffering (base on a sense of hopelessness, indignity, or the belief that one’s life has ended in a biographical sense but not yet ended biologically). In certain clinical situations, some aspects of suffering cannot be satisfactorily controlled with standard pharmacologic or surgical interventions. Many proponents of assisted suicide have argued that trust is eroded when physician-assisted suicide is not an option, or an option for discussion, in these circumstances. Physician-assisted suicide is, in this view, an act of compassion that respects patient choice and fulfills an obligation of non-abandonment (Wunzer, et. al, 1993). Positions in favor of legalizing physician-assisted suicide are related to the contemporary trend toward emphasizing patient autonomy in bioethics and law. It is argued that the decision to end one’s life is intensely personal and private, harms no one else, not to be prohibited by the government or the medical profession (Brock, 1992). In the debate of physician-assisted suicide, there are many valid arguments on each side. This has been a lengthy debate. Over the years physician-assisted suicide has been discussed and many issues, new ideas, and concerns have been debated whether physician-assisted suicide should be legal or illegal. There have been many argumentative debates on both sides of the pros and cons of physician-assisted suicide. Although some of these arguments for physician-assisted suicide are strong, but many have resolved issues. Furthermore, the arguments against physician-assisted has many strong points also. Whichever path a person chooses in regards to physician-assisted suicide, moral objections need to be addressed. In this paper I have been able to touch on the surface of many arguments of physician-assisted suicide.

References Alpers, A. & Lo, B. (1995). Physician-assisted suicide in Oregon: a bold experiment. Journal of the American Association, 274, 483-487. Brock, D. W. (1992). Euthanasia: Yale Journal Biology of Medicine, 65, 121-129. Retrieved from https://content.ashford.edu/books/San Diego CA: Bridgepoint Education Inc. Burt, R. A. (1997). The Supreme Court Speaks: not assisted suicide but a constitutional right to palliative care. New England Journal of Medicine, 337, 1234-1236. Gupta, D. (2006). Issues Implied Within: “Internet Journal of Pain, Symptoms Control and Palliative Care. Retrieved from www.articlemyriad.com/positive-aspects-physician-assisted-suicide/ Haddad, A. (1997). A woman with terminal bone cancer has asked her physician to help her end her life. He plans to lend assistance. If he asks you to make a lethal drug available to this patient what would you do? P. 17-20. Kass, L. R. (1993). Is there a right to die? Hastings Center Report, P. 33-34. Lee, M. A., Nelson, M. D. & Tilden, V. P. (1996). Legalizing assisted suicide-views of physicians in Oregon. New England Journal of Medicine, 334, 310-315. Lesser, H. (2010). Should it be legal to assist suicide? Journal of Evaluation in Clinical Practice. Vol. 16, (2), P.330-335. Retrieved from https://content.ashford.edu/books/ San Diego, CA: Bridgepoint Education, Inc. Marsh, E. (2005). “At the hour of death.” America, 4, 193-196. Orentlicher, D. (1997). The Supreme Court and physician-assisted suicide: rejecting assisted suicide but embracing euthanasia. New England Journal of Medicine, 337, 1236-1239. Quill, T. E. (1991). Death and dignity: a case of individualized decision making. New England of Medicine, 324, 691-694. Quill, T. E., Cassekl, C. K., & Meier, D. E. (1992). Care of the hopelessly ill: Proposed clinical criteria for physician-assisted suicide. New England Journal of Medicine, 327, 1380-1384. Synder, L. & Weiner, J. (1996). Physician-assisted suicide. Ethical choices: Case studies for medical practice. Philadephia: American College of Physicians. Retrieved from https://content.ashford.edu.books/ San Diego, CA: Bridegepoint Education Inc. Vacco V. Quill. (1997). 117 S. Ct. 2293. Wellman, C, (2003). Social theory and practice. A legal right to physician-assisted suicide defended Vol 29, (1), P. 19-38. Retrieved from https://content.ashford.edu.books/ San Diego, CA: Bridgepoint Education, Inc. Wunzer, S. H., Federman, D. D., Adelstein, S. J., Cassel, C. K., Cassem, E. H. & Cranford, R. E. (1993). The physician’s responsibility toward hopeless ill patients. A second look. New England Journal of Medicine, 327, 1384-1388.

References: Alpers, A. & Lo, B. (1995). Physician-assisted suicide in Oregon: a bold experiment. Burt, R. A. (1997). The Supreme Court Speaks: not assisted suicide but a constitutional right to palliative care. New England Journal of Medicine, 337, 1234-1236. Gupta, D. (2006). Issues Implied Within: “Internet Journal of Pain, Symptoms Control and Palliative Care. Retrieved from www.articlemyriad.com/positive-aspects-physician-assisted-suicide/ Haddad, A Kass, L. R. (1993). Is there a right to die? Hastings Center Report, P. 33-34. Lee, M. A., Nelson, M. D. & Tilden, V. P. (1996). Legalizing assisted suicide-views of physicians in Oregon. New England Journal of Medicine, 334, 310-315. Lesser, H. (2010). Should it be legal to assist suicide? Journal of Evaluation in Clinical Practice. Vol. 16, (2), P.330-335. Retrieved from https://content.ashford.edu/books/ San Diego, CA: Bridgepoint Education, Inc. Marsh, E. (2005). “At the hour of death.” America, 4, 193-196. Orentlicher, D. (1997). The Supreme Court and physician-assisted suicide: rejecting assisted suicide but embracing euthanasia. New England Journal of Medicine, 337, 1236-1239. Quill, T. E. (1991). Death and dignity: a case of individualized decision making. New England of Medicine, 324, 691-694. Quill, T. E., Cassekl, C. K., & Meier, D. E. (1992). Care of the hopelessly ill: Proposed clinical criteria for physician-assisted suicide. New England Journal of Medicine, 327, 1380-1384. Wellman, C, (2003). Social theory and practice. A legal right to physician-assisted suicide defended Vol 29, (1), P. 19-38. Retrieved from https://content.ashford.edu.books/ San Diego, CA: Bridgepoint Education, Inc. Wunzer, S

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