Physician Assisted Suicide

 

            The question of a physician-assisted suicide is a hot topic that has been alive since the times of Ancient Greece. The issue is whether it is morally acceptable for a physician to assist their patient in hastening their death, and it is still debated today, even after two thousand years. The following are arguments both for, and later against, the legitimization of physician-assisted suicide.

Part I
            (i.) The Philosophers Brief appeals to the “liberty interest” in their effort to make the case of the right to physician-assisted suicide which states that  “matters involving the most intimate and personal choices a person may make in a lifetime, choices central to a person’s dignity and autonomy are central to the liberty protected by the Fourteenth Amendment”. Death is indisputably one of life’s most important acts, taking away a person’s dignity in it is severely against the Fourteenth Amendment, as it would be dictating a person’s deeply personal decision in how and when they die.

            (ii.) The authors of the Philosopher’s Brief allow only for the assisted suicide of those who are terminally ill, and who can consciously make a well-informed decision, because as they will be dying within six months regardless of any action, their early death will be allowing them to have control over their last mortal act in their body, and will avoid pain they may face in the last remaining months of their life if kept alive.

            As for those who desire physician-assisted suicide whom are not terminally ill, this brings in both moral and legal problems. As a physician, there is no legal obligation to those who are terminally ill; that is to say a physician has no obligation to prescribe a lethal drug to a patient who wishes to die, the doctor must be willing to do so. However, a patient does have to right to deny or refuse treatment, so long as they are mentally capable of making that decision. The authors of the Philosopher’s Brief recognize that it would only endanger the lives of many patients if physician-assisted suicide were available to everyone, and not just those who are terminally ill, as they many might ask for death when it is not in their best interest. (iii.) A reason for limiting the option of physician-assisted suicide only to the terminally ill that is not provided by the Philosopher’s brief is that it is a proven fact nearly all people who have attempted suicide in the past, when asked, admit that they are glad they did not succeed in their attempt.

            (iv.) The authors of the Philosopher’s Brief make the argument that as it is already legal and permissible for a patient to refuse a life-supporting and life-prolonging treatment that would certainly bring death, this justifies the permissibility to prescribe a patient lethal dosage of a medication, which would in turn hasten death also. The rationale behind this thought process is that a patient who does in fact want to die, does not differentiate between the removal of treatment to bring about their death, as opposed to taking a lethal dosage of prescribed medicine to bring the same fate. The only difference a patient, and doctor for that matter, sees between these two courses of action is that the latter hastens a faster and more humane death, one that a patient can be more dignified in.

            (v.) A problem that could come of the legalization of physician-assisted suicide is abuse of the system. Patients could gain consent improperly from a physician; that is the declaration of six or less months to live.  By receiving improper consent for the ability to utilize physician-assisted suicide, lives could be put in danger because they may ask for death when it is not sincerely in their best interest. Safeguards to ensure the patient is within his/her right to choose physician-assisted suicide include two non-attending physicians must approve the mental competence of the patient, and assure that the patient knows his/her prognosis and treatment options. In addition, the patient must be deemed free of any outside influence, such as from family, friends, etc,.

            Another difficulty that may arise with the legalization of physician-assisted suicide is the problem of surrogates and prior directives. If a patient is incompetent to make decisions for themselves, and has either left a surrogate to make decisions for them, or has made a prior directive as to what to do in certain situations, a problem lies in the fact that a patient’s views may have changed since they made a directive, or appointed their surrogate. To safeguard this risk, the state maintains the right to limit any mistakes being made by reasonably regulating the decision within their jurisdiction.

            (vi.) With the previously described safeguards framing the permissibility of physician-assisted suicide, the ability to abuse the system that is set up is much more difficult. With these safeguards, the state and physicians are much more apt to assure the patient is well informed, and also that any other possible treatments have been used to help the patient. It is within a state’s right to deny a terminally ill patient the right to a physician-assisted suicide when all reasonable procedures have not been satisfied. These guidelines for physician-assisted suicides allow for a state to deny an opportunity for an assisted suicide if it is deemed by a judge to be in the best interest of the patient. As for non-terminal patients, in light of the fact that, when interviewed, people who have attempted suicide earlier in life, in most cases, are now glad they did not succeed in their attempt, this is cause enough to deny a person of the option of a physician-assisted suicide.

            (vii.) The authors of the Philosopher’s Brief do not agree with the idea that there are always moral distinctions between “doing” and “refraining from doing” when it comes to treating a patient in a life and death situation. They do not agree with this because, in short, dying is dying. In a patient’s eye, if it were between dying a slower and more painful death via the removal, or the lack of initiation, of a life-supporting treatment or machine, and the option of a lethal dosage of prescribed medication, which will allow for a more humane end to their life, the latter would be the obvious choice. As for those who believe in the moral distinction between “doing” and “refraining from doing”, the act of refraining from treating a patient could cause a patient much more discomfort and pain than “doing”, and thereby prescribing a lethal medicine to hasten that patient’s death would be in the patients’ best interest

            When the patient in question has been deemed mentally competent, has been well informed regarding his prognosis and treatments, and has come to conclusion to end his life, the only moral argument against a physician-assisted suicide is the refusal of the physician to participate in the prescription.             Although a terminally ill patient does have to right to a physician-assisted suicide, the physician is not obligated to assist whenever he is asked. This is extremely relevant in the question of legalizing physician-assisted suicide, especially in that it leads to a very thorough process the patient who desires a physician-assisted suicide. The patient must not only be deemed mentally competent, but also must be well informed of his situation, along with finding a willing physician. The argument for the legalization of physician-assisted suicide also lies in the dignity and autonomy of the patient. When permissible, physician-assisted suicide allows for a much more dignified manner in death, rather than going through a painful and extremely uncomfortable, mentally and physically, last stretch of life. (viii.) Although there may not be a moral difference between “refraining from doing” and “doing”, there most definitely is a legal difference. A patient has a right to have any doctor remove, or merely never begin, life-supporting treatments due to their right to not have their body invaded. This is every physician’s duty in their profession, to respect their patients right to their body and their requests to not be treated. Every doctor must uphold these rights. In the case of physician-assisted suicides, however, doctors do not have the duty to prescribe a lethal dosage of medication to hasten their patient’s death. A terminally ill patient has the right of a willing doctor to help them hasten death, not the right of any doctor.

Part II

            (i) In John Arras’ “Physician-Assisted Suicide: A Tragic Choice”, Arras describes three ways of opposing the legalization of physician-assisted suicide. One opposition of physician-assisted suicide sees it as being inherently immoral, and that it goes against the moral rule of not killing people. Primarily those with very religiously informed views hold this opposition. A second opposition of physician-assisted suicide is against the idea that physicians are being called upon to kill patients. The reason behind this is that physicians are meant to be healers, and the fact that they have the option of participating in a physician-assisted suicide goes against everything they should represent. The third opposition is mainly opposed to physician-assisted suicide because of the great likelihood of abuse, neglect, and mistakes that have the possibility to take place in the institution of physician-assisted suicides. (ii) As for the view of the author, John Arras, they lie within the third opposition, and the likelihood of mistakes that could be made in taking part in physician-assisted suicides.

            (iii) In his writing, Arras describes two versions of a slippery slope argument. The slippery slope Arras refers to, in a figurative light, is chain of events that could follow the present legal restraints being reaffirmed or a policy of legitimization and regulation being instated. The first slippery slope argument is that after the legitimization of physician-assisted suicide, the range of people who have the right to it would only grow, eventually leading to a much broader group than originally intended. The second version of this slippery slope argument is the likelihood of abuse. (iv) In regard to the first slippery slope argument, to be eligible for physician-assisted suicide, a patient must be terminally ill, and dying will allow them to escape unbearable pain. However, Arras argues that if PAS (physician-assisted suicide) is legalized, that it will broaden from terminally ill patients, to those in unbearable pain, to even more people, and eventually the boundaries as to who has the right to a PAS will be completely blurred. In regards to the second argument, to be able to utilize physician-assisted suicide, one must 1.) Voluntarily ask for a physician-assisted suicide, 2.) Take all other possible treatments, and 3.) Be deemed mentally competent to make a well-informed decision for themselves.

            (v.) Arras expresses concern for the possibility of voluntary active euthanasia, or even non-voluntary active euthanasia, becoming legal if PAS were legalized. The major concern behind this, especially non-voluntary active euthanasia, is that infants or senile elderly patients could be at risk for being victims of this non-voluntary active euthanasia. This would be completely against the original idea behind PAS, as it is mainly based on the consent and request of a mentally competent person, which this clearly is not. This concern falls into the category of the first version of the slippery slope argument that Arras makes. He argues that the legalization of PAS will lead to the legalization of voluntary and non-voluntary active euthanasia, which will violate the qualifications in place now for PAS, however may change in the future if Arras’ first version of the slippery slope argument proves to be true.

            (vi) Arras also argues, in regards to the second slippery slope argument, that the legalization of physician-assisted suicide will be, in practice, unfair to poorer people due to their lack of ability of to pay for palliative care. Because of the fact that poorer people are unable to afford healthcare of the same caliber that others can, it does not cover in-home care they may desperately need nor would it cover the ability to explore all other possible treatments. This would cause the legalization to be unfair to those poorer people because it would essentially push them toward the decision of PAS without being able to explore all other options.

            (vii) Arras believes that in order for PAS to be legalized there must be three safeguards, previously touched upon. Firstly, the patient wishing to partake in a physician-assisted suicide must wish to do so on a completely voluntary basis. Secondly, all other measures must be taken before physician-assisted suicide is chosen as a last resort. And thirdly, a reliable system must be developed in reporting all cases of PAS, in order to effectively screen any chances of abuse. (viii) Even with these three safeguards to protect against the abuse of PAS, Arras believes that the abuse of it is still very possible. Regarding the first safeguard, voluntariness, it is extremely unlikely that a person will make a decision like this on a completely voluntary basis. Another risk of abuse behind this safeguard is the fact that a patient could mistakenly be deemed competent, when, in fact, they are depressed and not in their right mind to make such a decision.

            Risk of abuse lies, too, in the second safeguard of PAS. As previously mentioned, the healthcare system is nowhere near perfect, this would allow for abuse of the second safeguard, which requires a patient to explore all other options before PAS. However, because of the flawed healthcare system, poorer people may not be able to do so, and thus be pushed toward choosing PAS as a first resort, rather than last. Another risk with this safeguard is that physicians often under-treat or ignore their patients in an impersonal manner. With regard to the third safeguard, reporting the use of PAS, Arras believes that physicians would widely not report the use of physician-assisted suicide. He supports this with evidence from Dutch experience with the reporting of PAS. Many physicians did not want to report due to the fear of putting the public eye on a family who desperately needed their privacy at the time. Another problem arises with this third safeguard, and that is the problem of doctor-patient confidentiality, and whether reporting a PAS rests in that realm.

            (ix) Arras describes this as a “tragic situation” because no matter what decision is made, whether that is reinstating of present legal restraints or a policy of legitimization and regulation, there are bound to be victims. In the meantime, Arras recommends that physicians begin to truly listen to their patients, and truly understand where they are coming from in their request to an assisted suicide. Physicians must also learn how to deliver effective palliative care, and know their laws in dispensing pain relief. They also must learn to respect their patient’s wishes in whatever they may be.

            As for the social level of PAS, those who are against it must promote public and medical education of pain control, along with attempting to sensitize insurance companies as to quality of dying, and reform state laws to allow better and easier access to pain-relieving medicine when it is needed.

            (x) Arras does not consider the act of a doctor complying with a patient’s request cease treatment to be equal with a doctor prescribing a lethal dosage of medicine to hasten death. He believes this and backs this argument up with a few different reasons. Firstly, he believes the act of prescribing a lethal dose meant to kill to be morally reprehensible, as it is a basic moral and law to not kill. Secondly, he believes it to be completely and utterly against what it means to be a doctor, as they are meant to be healers, not killers. And thirdly, to prescribe a lethal dose would completely disrupt whatever moral and credible aspects there are left to the profession of medicine. Arras very much believes in a patients’ right to refuse treatment, but not in the prescribing of a lethal dose to a patient, as it goes against what being a doctor essentially is.

 

Part III

            (i) Two major points that both the Philosopher’s Brief and Arras can agree on is that, firstly, a patient who wishes to partake in a physician-assisted suicide must wish to do so on a completely voluntary basis, and be deemed mentally capable of making a well-informed decision after exploring all other options. Secondly both of the essays agree that there are inherent risks with the legalization of PAS, as there could possibly be abuse of the system. (ii) (a) Morally, these sides are divided. The Philosopher’s Brief believes there to be no difference, in regard to moral value, between refraining from treating a patient and a doctor prescribing a lethal dosage. Arras, however, believes it is morally wrong to prescribe a lethal dosage, whereas it is morally fine to refrain from treatment. (b) It also seems that an empirical, difference between these two essays is that Arras claims that the Netherlands’ healthcare system has the process of utilizing PAS much more under control than the US does, when The Philosopher’s Brief claims that the Netherlands allows for a much bigger group of people have access to PAS, which is what Arras is strongly against. In this lies a rift in factual information, which would skew either’s conclusion.

            There are many sides to factor in when debating whether or not physician-assisted suicide is morally acceptable, and as seen here, there is no clear-cut answer. The conclusion completely depends on the viewer’s beliefs and morals on death and the hastening of it. What remains to be seen is if it will ever be completely morally accepted, and considering the issue has been debated for about two thousand years, and probably longer, it seems it will be a while until a clear consensus is reached.

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