Introduction
Following the controversy surrounding its execution, physician-assisted suicide (PAS) has sparked a never-ending discussion. Assisted suicide occurs when a patient expresses a desire to die and asks a doctor to assist him or her in doing so. The latest advancements in mechanical devices and life-saving measures resulting from medical technology have resulted in a protracted dying process, necessitating end-of-life care. Patients with terminal conditions like cancer face severe and unremitting pain despite effective pain control and advanced palliative care facilitated by medical technology (Pence, 2021). Although only a few nations have legalized PAS, the practice has been going on, albeit hidden. Medical practitioners, human life activists, and the general public have shown diverse views regarding the ethical and moral position of PAS in society. While proponents feel that PAS eliminates human suffering and maintains an individual’s freedom of choice, opponents cite the moral and religious perspectives against the practice, and the debate continues.
Technical Aspects
The morality and ethical nature of PAS can be evaluated based on its technical aspects, including mode of execution, knowledge sharing, and personal concerns. While active PAS entails directly terminating life by the use of a lethal drug, passive PAS has been characterized by indirect actions, such as withholding medication, that lead to life termination (O’Rourke, 2019). In many cases, passive euthanasia has been criticized as unethical, while some nations support active euthanasia. This point leads to the concepts of voluntary, involuntary, and non-voluntary PAS, all of which have elicited different reactions from stakeholders in the medical field.
The most crucial technical aspect of PAS is the patient’s role in directing their medical intervention. While the doctor directs the process in euthanasia, the patient makes a personal request to a medical practitioner to end their life in active PAS. Pence (2021) notes that active PAS is a voluntary process initiated by a mentally capable patient. The second vital aspect is the medical practitioner’s knowledge of the patient’s intention. In this case, the physician understands what the patient wants and furnishes them will all the necessary information to enable them to come to a logical conclusion. In essence, the doctor is actively involved in providing the drugs needed to end a person’s life.
Technical features of PAS include the physician’s moral and legal positions. A doctor is required to support a patient’s health and maintain their life, but they are morally bound to obey a patient’s request as far as it complies with informed consent. According to Sulmasey and Mueller (2017), the most prominent contributors to PAS are suffering and despair. Although some terminally ill individuals wait for their mental health to degrade before making a decision, others want to end their suffering while they still have the mental capability to do so. In this situation, a physician must follow their professional ethical guidelines and aid the patient, as their mission is to alleviate patient suffering. On a global scale, PAS has led to diverse opinions on its legal, ethical, and moral implications in society.
Policy Debates
The issue regarding the moral implications of PAS is not new in public policy circles. For several years, PAS has been embroiled in contentious arguments that show no signs of abating anytime soon. The goal of the public discourse on PAS is for every patient to reach the end of life free of ceaseless afflictions that do not satisfy the patient’s fundamental self-defining beliefs (O’Rourke, 2019). Oregon, Hawaii, Nevada, Maine, and Washington DC are among the states that have legalized PAS. Sulmasey and Mueller (2017) record that Canada made it lawful across the board in 2015. Both supporters and opponents of PAS have a responsibility to principles such as care, honor, dignity, and empathy (Dugdale et al., 2019). They differ in their moral conclusions drawn from the same fundamental values in good faith.
Arguments
Arguments for PAS
Respect for patient autonomy and a broad understanding of a doctor’s obligation to ease a patient’s suffering is the most popular argument in favor of PAS legalization (Sulmasy & Mueller, 2017). Supporters of the PAS claim that relieving people of their afflictions by lethal ingesting is compassionate and humanitarian (Dugdale et al., 2019). Patients with terminal diseases provide some of the most compelling arguments in favor of PAS. The utilitarian model provides a basis within which the assertions for PAS can be viewed. According to Pence (2021), utilitarianism is applicable for striking a balance between the good and negative implications of a situation or method by ensuring that individuals derive the greatest benefit from it. Since medical officers are responsible for ensuring a patient lives as painlessly as possible, then it is logical to end their suffering by all means possible, including PAS.
In many states, patient autonomy is respected as they are permitted to decide the type of treatment they would like to take. It follows that since they can refuse a given medical procedure, patients should also freely choose their time and method of death (Dugdale et al., 2019). Legalizing PAS can also be analyzed based on benefits to the patient. Notably, patients suffering from terminal illnesses undergo mental, physical, and emotional torture, with no hope of recovery. Arguing from the utilitarian view, forcing a person to remain in that state does not amount to any good since they will still die. Even in a state of extreme pain, patients can choose not to undergo procedures such as chemotherapy. It would therefore be logical to allow them to make an informed decision about their health regarding death and suffering.
Although PAS is prohibited in many nations, patients have been taking away their lives in various ways. Notably, suicide and abuse of prescription drugs have been used for many years, in ways that are extremely dangerous to the patient. Essentially, an individual willing to die will follow any means available to them. O’Rourke (2019) asserts that PAS is a safe medical procedure that requires the assistance of a healthcare expert. Physicians may be able to assure death in a way that other methods of suicide cannot. Arguably, legalizing PAS would make it safer and easier to die, limiting the negative implications associated with suicide and other illegal methods.
Arguments against PAS
PAS critics have made several arguments highlighting the unethical nature of the practice, ranging from philosophical to pragmatic points. Opponents claim that PAS violates several professional and ethical values. To begin with, palliative care should be focused on saving patients and prolonging their healthy lives, as opposed to ending them (O’Rourke, 2019). Nurses are expected to abide by their professional ethics and do everything in their power to offer end-of-life care. Holding PAS as an illegal act would motivate nurses to think critically and brainstorm on new solutions that could minimize suffering. Notably, if the focus is laid on improving palliative care in such a way that a patient only dies when every possible rote has been exhausted would be more beneficial in the long run than legalizing PAS. The debate would even lose meaning as all stakeholders are determined to avert death by all means.
As technology application in the medical field continues expanding, medical practitioners can now apply their knowledge and expertise for breakthroughs in new treatment regimens that could prolong the lives of terminally-ill patients. Pain and depression are the main reasons for patients to request medical assistance to end their misery. In many cases, depressed individuals view death as the only way out, while there may be other viable solutions. Opponents fear that expanding PAS may result in unintended consequences such as suicide contagion, and fatalities of depressed individuals (Sulmasy & Mueller, 2017). If nations do not regulate the practice, it may turn into a crisis, leading to uncountable deaths of individuals who would have been saved.
The accuracy and implications of medical diagnoses are other critical points raised by PAS opponents. In many cases, prognoses have indicated that patients are on the verge of death, although they end up recovering and leading healthy lives. Wrong diagnoses induce fear and depression in patients and may contribute to their need for PAS. Dugdale et al. (2019) comment that physicians play a vital role in influencing patients’ decisions regarding their health and death. In many cases, people have according to what they are told, in this case by qualified medical officers. Notably, new developments are made occasionally in the medical field whereby originally terminal illnesses are now curable. Legalizing PAS may limit research and innovation in line with developing new solutions to medical problems.
Religious views and quality of human life are also viable points against PAS. One of the ethical standards of palliative care entails respecting patients’ religious views. In many religions, human life is highly valued and should not be lowered to the point of legalizing PAS. This criticism is derived from the interpretation of the practice as taking someone’s life (O’Rourke, 2019). Holding other factors constant, PAS destroys the moral fabric of society. Opponents of PAS claim that over 70% of patients who choose PAS have cancer and are elderly (Dugdale et al., 2019). Despite this, only about 5% of people are referred to a psychologist or psychiatrist to rule out the possibility of medical depression (Dugdale et al., 2019). Therefore, legalizing PAS would lower the quality of life and change people’s perspectives of suffering and recovery, putting the elderly at risk of untimely death.
Personal Opinions and Conclusion
The arguments for and against PAS are largely based on a personal interpretation of the medical practice and its implications on individual patients and the entire society. The debate has been ongoing for decades and nations have started legalizing it. Although there are negative implications of the practice, legalizing and regulating it would provide a safe way for terminally ill patients to die. From a humanistic point of view, there is no glory in suffering. My opinion is that PAS is ethical, moral, and necessary in society. Even before it was legalized, patients have been committing suicide in extremely dangerous ways. I believe that since patients can decide what type of medication to take, they should also decide when to end their lives.
References
Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Pros and cons of physician aid in dying. The Yale Journal of Biology and Medicine, 92(4), 747–750. Web.
O’Rourke, M. A. (2019). Physician-assisted suicide (PAS)/Physician aid in dying (PAD) at the end of the day. Practical Radiation Oncology, 9(6), 384-386. Web.
Pence, G. (2021). Medical ethics: Accounts of ground-breaking cases (9th ed.). McGraw Hill Education.
Sulmasey, L.S. & Mueller, P.S. (2017). Ethics and the legalization of physician-assisted suicide: An American college of physicians position paper. Annals of Internal Medicine, 167(8), 576-578. Web.