The debate over Physician-Assisted Suicide (PAS) is complex and contentious. Since ancient times, there have been arguments about the permissibility of suicide, assisted suicide, and physician-assisted suicide. (Kopelman, DeVille, pp 1). The discussions have covered the properly legal, ethical, or professional response of the people who feel that they are prepared to assist the terminally ill with suicide or euthanasia. During ancient times, there were Hippocratic writings that instructed the physicians on how they can help the patients who wanted to relieve their suffering through euthanasia or suicide.
On contrary, there is a Hippocratic Oath that again forbids the physicians from doing the same. For instance, Aristotle and Plato objected to suicide or killing even for merciful reasons, while philosophers like Stoics defended such policies in some instances (Cohen-Almagor pp 19). As a physician, you are entitled to advise the patient on the dangers of terminating life and encourage the patient to strive for the life that usually lies in the hands of God. Therefore the patient should be advised accordingly not to decide to take off his or her life by use of euthanasia. Thus why, in many countries, the government has imposed rules and regulations that do not allow such acts to be carried out. These usually protect one from making his or her own decision regarding his or her life.
These divisions are still visible in contemporary societies, where many states are sharply divided on whether to allow physician-assisted suicide in society or not. There are very few jurisdictions that allow for the carrying out assisted suicide, even in cases where there are no sanctions for attempting to commit suicide. Furthermore, clinicians have almost universally been prohibited from participating in euthanasia or assisting suicide. However, the Netherlands and the Oregon States have passed laws that allow for PAS under some conditions. According to these countries, an individual who is terminally ill has some benefits to enjoy when the governments legalize the act of assisted suicide by a physician. These benefits include:
- Respect for individual autonomy and freeness to make one’s decision.
- One can enjoy the liberty of doing what he or she wants.
- Rights to make one own choice on matters regarding personal life.
Different professionals have different ethics which have to be observed. On various occasions, this ethics might not be followed or observed by the practitioners. These codes of ethics set standards for the operation which the physicians must ensure that they follow them promptly. These ethics are also incorporated in government rules and regulation which certifies physicians and allow them to practice their profession.
In the field of medicine, one of the recurrent ethical problems experienced is the PAS issue. National and international medical societies have been drafting professional codes of ethics to curb this vice in the medical fields. These codes have always been based on the Greek oath for the physicians that declare, “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect,” (Emanuel 1994 pp 1895).
This was a means of making sure that physicians do not cause any harm or do anything that will result in harming their patients and ultimately leading to the death of the patient. The code of ethics protects the patient dignity and ensures that nothing unjust can be done to the patient since due to some reasons the doctor can administer euthanasia to a patient who is not willing and since the patient dies and there is no evidence that he or she was not willing, he or she can go Scot free having killed someone unjustly
In Greek, the physicians were poorly equipped to relieve the pain of patients. This made the patients consider committing suicide as a way of escaping the painful illness and suffering that accompanied the dying. The most common means of committing suicide was the use of poison, and the poison was found easily with the help of physicians. In essence, then oath was used by physicians who wanted to keep public trust and respect and well distance themselves from those who contributed to the death of seriously ill patients (Manning 1998 pp 48).
Physician-Assisted suicide has been an ethical and legal issue for a long time. Many people have been putting in their voices concerning the problem faced by people who care for it and those who are against it. The media has been following up on the PAS cases very keenly thus making the subject to be of substantial interest to the public. The issue has also attracted scholarly attention in an effort to evaluate whether the issues of assisted suicide need to be legalized or not.
There are different arguments in various states concerning the PAS. Some arguments have been for, while others against PAS. In the cases of Washington v. Glucksberg and Vacco v. Quill, in 1997, the Supreme Court of the United States passed a decision that assured constitutional protection for PAS (Battin, Rhodes & Silvers, 1998, pp1). The United States government to pass the ruling of allowing a physician to terminate one’s life, there must be visibility that the person can not survive again by any chance.
The court’s ruling brought about a dispute among states due to the (peoples’) differing values, historical circumstances, religious commitments, and the political and economic environments. These factors were to be considered while deciding on the ruling so as to have an equal ruling which does not affect anyone in any way. In the ruling, the court was limited to the question of determining whether PAS was unconstitutional. Because of this, the court realized the consequences such as those faced by a patient when he or she is for assisted suicide, like trauma or when the action fails, hence allowed the debate on the issue to continue in a democratic way. The PAS debate has so far gone beyond the legal debate into the political, social, moral, medical, and religious fields (Battin, Rhodes & Silvers 1998, pp 2).
1997, rulings have however been confused and misunderstood. In the court’s ruling, it was that the PAS was not unconstitutional. This did not make physician-assisted suicide to be a criminal act in every state but left it up to each state to whether or not to criminalize PAS (Lagay 2003 Para 1). Oregon has adopted the act that legalizes PAS. Forty-six states do not, however, agree with Oregon’s legalizing of the PAS, while North Carolina, Utah, and Wyoming are the states that have not criminalized nor legalized the PAS act. Those who are opposed to the act argue that legalizing such an act would put pressure on those who feel that their illness is a burden to their relatives.
Therefore, in case this act should by any chance be legalized the ultimate decision should come from those who are determined to be terminally ill but not from the relatives or the physician. Secondly, such legality would go against the highly followed medical ethics that have been widely adhered to for centuries. The role of a physician is to act as a healer and therefore being involved in the assisted suicide would be incompatible with that role. The issue of whether this act should be legalized or not should be left ultimately to the government to decide but the leaders who are deciding should be governed by the principle which justifies the illegal act of assisting suicide.
Since some states have legalized PAS while others have not, PAS brings about conflicting issues on the legal and ethical matters, and what the state allows her resident to do, and what members of the medical profession feel that they ought to do. Therefore, even though the state can legalize this act, it might not be easy for it to force the medical professions to carry out this duty. This is because they feel that the acts are not within their professional ethics (Boyd N.d, para 10).
For example, a very fatal accident accrued in the United States which left a man under very critical condition. He had no limbs and was in a coma for quite some time, Therefore when he gained his consciousness and realized that he will be disabled for the rest of his life, he opted for a PAS, The doctors were not willing to do it since they were aware that disability is not inability so they tried to encourage the man while in hospital. After he was discharged he committed suicide since he could not bear with his statures. Therefore it should be left to individuals to decide what they want with their lives but under strict counseling.
In many cases, terminally ill patients would like to commit suicide in a non-violent form which gives respect to themselves and others. It is, however, not just an easy task to administer the assisted suicide and if in the event the activity fails, then the practice can cause a big trauma than death itself to both the patient and the caregiver. The patients might still request the caregiver to complete the failed attempts. These are some of the circumstances that have convinced some physicians to feel that by helping the patients who are really determined to end their lives might prevent greater harm than what it causes (McHugh Para 6 ).
It is also due to the belief that helping a patient to end his/her life due to the pain or anguish he/she might not recover violates the spirit or goals of medical ethics. In this case, the physician is alleged to advise the patient on the dangers he or she can face due to attempted and failed suicide since it can even cause a lifetime of disableness. Therefore in those countries where the act is legalized, a physician needs to put into consideration many factors that can affect the patient in case the action fails.
The arguments about the legalizing of physician-assisted suicide have been with time taking different angles. The initial argument has been whether to permit physician-assisted suicide at all. However, in recent cases, there have cases of how to go about physician-assisted suicide and not conceptualizing whether to permit it. This is because the issue is seen to be taking an angle that was taken by the arguments concerning abortion which have seen the practice being undertaken underground. With the legalization, it is argued it would enable the states to be in a position to control the condition in which the practice is carried and thus suppress the situation in which the physician and the patients make the private arrangements, thus breaking the law.
The patients’ interested groups have also contributed to the debate of legalizing the PAS act and its potential consequences to the patients. These groups mostly have been focusing on those groups they feel are more vulnerable due to their specific features of physical or social characteristics. For instance, those people with disabilities, the racial minority groups, the elderly women, and patients who are not competent.
Those arguing in defense of such groups are worried about abuse that can be directed towards them since these vulnerable groups might receive assistance at the time when they least or do not require it at all. The vulnerable interested group’s concern is rooted in the economics of medicine in the US whereby the medical policies have been unable to provide medical cover to all citizens. This has created a cut-throat competition among the institutions offering medical services in the United States (Kopelman & de Ville 2002 pp 54).
An individual who is mentally incompetent, when he or she requests for PAS it should not be granted to them since they can be under the influence of their mental statures which may not be their will to commit such an act.
The degree of physician-assisted suicide and euthanasia has led to many researchers being conducted to receive a public opinion on the issue. In a research carried out in 1989, twenty percent of the interviewed physicians felt that patients who had the incurable terminal illness should have an option of euthanasia. Forty percent said that they could personally carry out the exercise while thirty-five percent were opposed to the exercise (Newfield N.d. para 6).
In another public poll contacted in 1994, sixty-three percent of lay respondents were pro the legalizing of physician-assisted suicide & euthanasia. Eighty-one percent supported the passage of laws that would allow physicians to carry out patients’ advance directives that include euthanasia. Those who supported the withdrawal of life support from hopelessly ill patients were seventy-six percent. Fifty-six percent also felt that they can consider the option of ending their lives if they had a terminal illness (New field N.d Para 7). Although in this research there were ranging responses. It is evident that the majority of the people were pro-euthanasia in some form 1996
In many aspects, religion plays a big role in the debate concerning whether to legalize PAS or not. Most people who are staunch Christians consider this act as murder since it involves taking one’s life without the will of God. Christians believe that God works in miraculous ways and can heal an individual even when one has lost hope for good. Many people who are considered to be more religious have always shown reluctance to accept the legalization of assisted suicides whether as physicians who provide the exercise or as the requestors of the exercise to be administered to them. This is however much different from those people who do not take religion to be so important.
Even though the most argumentative idea about physician-assisted suicide has been about moral issues, there are questions that have also risen from it. For instance, does mortal life belong to an individual, and is one sovereign over their bodies, or they belong to the society or family in which they are embedded. The other question that arises due to moral consideration is that will the legalization of the assisted suicide give the terminally ill a sense of control over their circumstances or will it weaken respect for life? In this respect, it is right to say that since individuals have sovereignty over their lives, then it is prudent to argue that a terminally ill person should be able to choose death over life. This is due to the fact that the terminally ill are the people feeling the pain and suffering as a result of the disease and not anybody else, i.e. the relatives, friends, or even the state.
On the other hand, terminally ill patients can have a sense of control over their lives when they feel that it is enough for them to end their lives with the assistance of physicians. The sick are capable of deciding the course of life rather than having to wait for the disease to dictate the course of life. The diseases at some point, especially towards the last stages do overtake the life and dignity of the patient. Hence with the aid of the legally aided suicide, the patients can be able to end their lines in a more dignified manner (Cohen-Almagor 2001 pp 78).
The lack of a legal framework in the United States that governs euthanasia clinics has left many patients with incurable diseases (e.g. Cancer, Aids & multiple sclerosis) to be in the hands of the hospital indefinitely. Passive euthanasia is legally accepted in the United States. However, this step might increase suffering and more pain. In this respect, many have agreed that active euthanasia with mentally competent patients’ full consent should be made legal (Behuniak & Svenson 2004 pp 112).
Those opposed to euthanasia argue that doctors should follow the Hippocratic Oath. In this argument, it is felt that if any part of the oath is disregarded, then the doctors won’t be in any way compelled to maintain any of the oath’s parts. However, the oath has undergone so many alterations as time goes by, with doctors sometimes seeing it necessary to take life.
Many people who are terminally ill have opted for different ways of ending their lives due to the fact that there lacks a legal framework for them to end their lives. These options include strangling, drowning, and overdosing. This can however be averted by allowing a more humane alternative of physician-assisted suicide (Newfield N.d para 8).
“In Europe, a patient in just the first stages of Alzheimer’s can choose active euthanasia; qualifying for this procedure in the United States should be far more difficult,” (McHugh 2005, para 8). Those who are terminally competent hopefully suffering patients are voluntarily eligible to do it out of their own will.
It is therefore important to allow for the physician’s assisted suicide to take place within certain limitations. For instance, the patient should be within the proximity of death and this should be documented by a licensed physician that nothing more can be done to sustain the life of this individual and therefore the physician has to honor the request to terminate the patients’ life. The physician can only agree on it when the government is not against this act and it’s legalized. In case the act is the illegal physician can not agree on it since he or she will have broken the law. The patient can be in unbearable pain which makes it reasonable to continue with the procedure.
The decision by the patient to end their lives should not be taken lightly (McHugh, 2005). To help such patients, there should be counseling services to help them to weigh the options of suicide and to decide for themselves whether to go on with the act or not. Therefore the act should first be legalized by the government and it should be patient-centered for it to be conducted. Therefore those issues which need to be taken into consideration by the government before allowing PAS should be taken into consideration to ensure all the parties affected in this case are taken care of before the act is passed.
References
Battin M.P, Rhodes R & Silver A, (1998), Physician Assisted Suicide: Expanding the Debate,Routledge: New York pg. 20-30.
Behuniak S.M, Svenson A.G, (2004),.Physician-Assisted Suicide: The Anatomy of a Constitutional Law Issue, Rowman & Littlefield: New York, pg. 19-22.
Boyd D.A. Physician-Assisted Suicide: For and Against. Web.
Cohen-Almagor R., (2001), The Right to Die With Dignity: An Argument in Ethics, Medicine, and Law, Rutgers University Press: New Jersey, pg. 27-33.
Emanuel E J, (1994), Euthanasia: historical, ethical, and empiric perspectives. Archives of Internal Medicine; 154:1890-1901.
Lagay F. Physician-Assisted Suicide: The Law and Professional Ethics, Virtual Mentor (2003), Volume 5, Number 1. Web.
Manning M. (1998),Physician-Assisted Suicide and Euthenasia, Paulist Press: New York, pg. 45-50.
McHugh M. Physician-Assisted Suicide is the More Humane Option, Salem Statesman Journal, 2005. Web.
Newfield P. Euthanasia, Physician Assisted Suicide and the Dying Patient: Medical Status, N.d. Web.
Quill T.E, Death and Dignity: a case of individualized decision making. New England Journal of Medicine 1991; 324:691-694.