In my term paper I am going to be answering the question is Physician-Assisted Suicide (PAS) ethically justified? The debate on Physician-Assisted Suicide has been a topic of debate for many years. Born and raised in Michigan I remember all of the news on Dr. Jack Kevorkian assisting terminally ill patients in their death and the controversy on it. The dilemma is whether or not a physician should be allowed to assist a person in ending their life even if they are terminally ill. According to a recent article on The New York Times website, New Mexico just legalized Physician-Assisted Suicide for terminally ill patients. This ruling would make New Mexico the fifth state to allow physicians to prescribe to their terminally ill patients a fatal dose of medications to end their life (Eckholm, 2014).
Proponents of Physician-Assisted Suicide believe that terminally ill people should have the right to choose go to the doctors and ask for their help to end their lives and stop their suffering. Of course there would have to be certain steps taken to make sure they were making the right choice. Many supporters of Physician-Assisted Suicide believe that there should be some psychiatric evaluation to make sure that the patient is of a sound mind in their decision to end their life.
Opponents of Physician-Assisted Suicide believe that a person does not have a right to end their own life and that it goes against the oath a doctor takes to keep people healthy. Many also believe that it is against God’s will to take their own life even if it physician-assisted because God should be in full control of the moment a person takes their last breathe.
In this paper I will discuss the problems that many people have with physician assisted suicide and also the reasons why people think it should be legal. 1 Identify the Problem
Terminally ill patients do not have the right in many states to choose to end their suffering by State the problem in more detail. One of the main reasons that many people are against physician assisted suicide is that they do not feel the decision to end someone’s life is any ones decision to make except for God. The problem with that is that some of these terminally ill people are suffering with no hope of getting better. This is where the term “meaningless suffering (Fenigsen, 2012)” comes in to play. According to the Philosophy of Euthanasia article, is there really a meaning for suffering? The answer changes depending on which point of view you are looking at. Religiously speaking people will never understand the reason behind the suffering only God understands its purpose. Biologically speaking the suffering is just a part of healing or dealing with the injury or illness. The true ethical dilemma is should the choice to end their suffering be the choice of the person suffering or the legal system. A person should have the right to choose if they want to live or die but the choice should not be made quickly or without the ability to think it out clearly. There should be laws still in place to protect the people from any wrong doings to them by family or friends they may have other ideas in mind besides the wellbeing of the terminally ill person. The wellbeing of the terminally ill person should be the only thought regardless of whether or not physician assisted suicide is ever legalized in all states. 2 Clarify Concepts
Euthanasia – means good death, Dutch definition is intentional termination of another’s life at the specific request of that person. Advanced Directives – Document created by a person stating what their wishes are pertaining to their end of life care. Physician Assisted Death – The death of a person that was assisted by a physician. Meaningless suffering – suffering that a terminally ill patient has when there is no cure in site. Terminal illness – prognosis of death within six months.
3 Identify Possible Solutions to the Problem
Side A: Physician assisted suicide is morally acceptable because it would end the suffering of a terminally ill patient. These patients have no way of getting better they are just suffering through the days ahead waiting to die. They sometimes become a financial burden to their family members or to the government. Side B: Physician assisted suicide is not morally acceptable because the day that someone dies is the choice of God. According to religious beliefs it is wrong to commit suicide in any form and the person would be subjected to an eternal life in Hell. 4 List Assumptions of The Opposing Sides
Side A: Physician assisted suicide should be legal because a terminally ill patient should have the right to decide they no longer want to live. This decision should not be the governments. The government is not the one suffering through the pain and suffering it is the terminally ill patient. The government is not the one that feels like they may be burdening their loved ones by having to have them care for them. The decision to end their pain and suffering should be left up to the terminally ill patient. Side B: Physician assisted suicide should not be legal because some of the terminally ill patients may not make the right decision on if they want to live or die they may choose to die without thinking it out clearly. The day a person dies is the choice of God and by choosing to go through with a physician assisted suicide you are playing God. The belief that life is a gift from God is a belief by many. If the religious beliefs are true then the terminally ill patient that chose to commit physician-assisted suicide will spend the rest of their eternal life in Hell. 5 Gather Information
The article by Menzel and Steinbock 2013 discusses physician-assisted death when dealing with a patient that has dementia. According to some guidelines of physician-assisted death dementia patient would not be candidates for the treatment because they are not of sound mind. This article discusses the possibility of using advance directives as a means of documentation to allow these patients the right to choose to end their life this way. According to the article, “many people are more afraid of living in a severely demented state for years than they fear a few months of suffering at the end of life? (Menzel & Steinbock, 2013)” Terminally ill patients should be able to choose to end their lives even if they have dementia as long as the decision was made before they reached the advanced stages of the disease and are not of sound mind and body. These individuals would have written the advanced directives when they were fully competent and would express their desire for physician-assisted suicide once they get dementia. Many question why it is okay for a person to refuse medical treatment that could possibly save their lives but it is not okay for a person to choose physician-assisted suicide when they are already dying.
The article by Fenigsen 2012, discusses meaningless suffering and unbearable suffering and how it pertains to the right to choose physician-assisted death. The article states that “the suffering and the pain are meaningful in so far as they elicit reactions that tend to reduce the injury (Fenigsen, 2012)”. The suffering and the pain are there to help in the care of the illness or injury. When you break a bone the pain is there to remind you of the break so that you are more careful and allow for the bone to heal. It also discusses the right to self-determination about his or her life. The article also tells stories of men and women that really did not want to die but chose to do so because they were coerced into the decision by their spouse. The article also discusses the patient’s family being involved in the decision. According to the article there is a conflict of interest with physician-assisted suicide because on one hand some say that it is a doctors duty to end a patients suffering even if it means helping them end their life and on the other hand some say it is the doctors duty to preserve the life of everyone no matter what the circumstances may be.
Quills 2012 article discusses several last resort options available to aide in the death of a terminally ill patient. It discusses accelerating pain medicines, stopping the therapy that is keeping them alive, palliative sedation, and stopping eating and drinking to just name a few. There are ways the doctor can help a terminally ill patient die without breaking any laws. The author of the article is a physician that has assisted several patients in committing physician-assisted suicide. The article discusses physician-assisted suicide being a “last resort” and should only be done after palliative care is no longer an option.
Baranzke’s 2012 article discusses physician-assisted death and the beliefs of it by analyzing religious and philosophical ideas. According to the article religious beliefs do not allow for the person to choose physician-assisted death even if they are terminally ill. This article questions if there is a difference between killing a patient and letting them die without any form of prevention. In this article Kant discusses his beliefs on physician-assisted death and the ethics involved in its choice.
Gibson’s 2012 article provides definitions of many of the words that are common in the discussion of physician assisted suicide. Some of the definitions in the article are euthanasia and physician assisted suicide. It also discusses “do not resuscitate” orders and how they pertain to physician assisted suicide.
Eckholm’s 2014 article informed readers of New Mexico passing the law for physician assisted suicide. The law would allow for a physician to prescribe fatal drug doses to terminally ill patients that the patient would then use to end their lives. The article states that the ruling is unclear in regards to whether it made it legal for the whole state or just the one particular county. According to the article Oregon was the first to adopt what is called “Death with Dignity Act” in 1997. 6 MORAL REASONING
The ethical theory from the textbook that is most fitting is Utilitarianism. According to the textbook Utilitarian ethics “is the act that produces the greatest benefits for everyone” (Waller, 2011). The textbook states there are a few misconceptions about utilitarian ethics. It states that it is not encouraging you to act in a gross, egoistic, self-centered, short-sighted hedonism. The intent of utilitarian ethics is too gain the maximum amount of pleasure and the least amount of suffering. There are two different divisions of utilitarian ethics. One division is act-utilitarian’s and the other division is rule-utilitarian. Act-utilitarians think about what particular act needs to be done to produce the maximum pleasure and the least amount of suffering. If I were to apply act-utilitarian ethics to physician-assisted suicide I would give the example of the physician prescribing a fatal dose of medications to the terminally ill patient so that the patient would die and they would no longer have pain or suffering. Rule-utilitarians look more deeply into the situation and how what they have the choice to do can affect them. If I apply rule-utilitarian ethics to physician-assisted suicide I could use the example of a person being completely against physician-assisted suicide until they have a terminal illness and they do not want to suffer or be in constant pain. That same person would go against what they initially agreed upon if they then chose to seek out a physician to help them end their pain and suffering.
According to the article written by Fenigsen 2012, meaningless suffering is a value judgment derived from the utilitarianism principle. Who benefits from keeping a terminally ill patient alive? It’s definitely not the patient because most of the time they are suffering from their illness. The families are usually burdened by their illness. Sure they do not want to be without their family member for their own selfish reasons. In the end it is usually the insurance companies, pharmaceutical companies, and physicians that benefit off of the care of the terminally ill patients.
Solution A – Allowing physician-assisted suicide will lead to less suffering for the terminally ill patients. It will also lead to less unnecessary medical expenses to keep people alive even though they will never get any better only worse. This solution would also lead to more doctors that will help the terminally ill patients end their suffering because they will no longer fear prosecution for doing so.
Solution B – Banning physician-assisted suicide will lead to continued medical expenses for terminally ill patients, prolonged suffering with no cure for the patient, and more terminally ill patients that choose to end their lives without the assistance of a physician. The terminally ill patient may choose to end their life in a more drastic and painful way. They may also be unsuccessful at their attempt to commit suicide and end of even worse off than they initially were.
Given these two lists, the greatest benefit that provides the least amount of pain over pleasure is to allow the terminally ill patient to end their life with the assistance of a physician if that is indeed what they want to do. The terminally ill patient is the main person to benefit in this debate over what solution should be best. Solution A clearly helps the patient end their pain and suffering while solution B does not help the terminally ill patient do anything but adhere to the laws that are in place from stopping them seek a physician’s help to end their life.
In my view solution A clearly outweighs solution B simply because it causes less pain and suffering to the terminally ill patient and that is what really matter in this situation. 7 Conclusion and Consequences
Terminally ill patients should have the right to choose when they no longer want to continue to suffer with the illness they have. After all that same patient can choose to not accept any of the treatments that are supposed to aid them in their medical treatment. These patients should not have to suffer through the remaining days of their life simple because some people think it should be against the law to seek the help of a physician to end their lives. Of course this decision should not be taken lightly and there should be a system in place to make sure that they truly want to proceed with a physician-assisted suicide. The system should consist of counseling that allows the patient to discuss this decision at a time when they are still of sound mind and body to make this decision. No one but the patient should be allowed to make the decision. If the patient is not of sound mind and body then the decision to pursue physician assisted suicide should not be an option. If physician assisted suicide was legalized in all states, then there would still be plenty of terminally ill patients who chose to not pursue it because of their own beliefs against it. Legalizing physician-assisted suicide would allow the terminally ill patients that want to do it the ability to do so without fear of prosecution if caught in the act. It would also allow the physicians the legal right to assist them in doing so without fear of prosecution or loss of their medical license for doing so.
Menzel, P. T., & Steinbock, B. (2013, Summer). Advance directives, dementia, and physician-assisted death. Journal of Law, Medicine & Ethics, 41(2), 484+. Fenigsen, R., & Fenigsen, R. (2012, Fall). Chapter XXI: the philosophy of euthanasia. Issues in Law & Medicine, 28(2), 244+. Quill, T. E. (2012, Spring). Physicians should "assist in suicide" when it is appropriate. Journal of Law, Medicine & Ethics, 40(1), 57+. Baranzke, H. (2012). "Sanctity-of-life"--a bioethical principle for a right to life? Ethical Theory and Moral Practice, 15(3), 295+. Gibson, R. (2012). The case for euthanasia and physician-assisted suicide. ISAA Review: journal of the Independent Scholars Association of Australia, 11(1), 55+. Eckholm, E. (2014, January 13). New Mexico Judge Affirms Right to 'Aid in Dying'. Retrieved from The New York Times: http://www.nytimes.com/2014/01/14/us/new-mexico-judge-affirms-right-to-aid-in-dying.html?ref=assistedsuicide&_r=0 Waller, B. N. (2011). Consider Ethics Theory, Readings, and Contemporary Issues. Upper Saddle River: Prentice Hall.