Ethics: physician assisted suicide article
The idea of physician assisted suicide (PAS) is an ongoing conversation in modern America. Since the US has achieved its status in the industrialized world, the question of voluntary euthanasia has been frequently asked and discussed in the social and political arena. There are many reasons to agree with assisted suicide, and many reasons to oppose it.
One of the primary arguments in favor of PAS is medical autonomy. Medical rights to our own bodies have been a fundamental principle since equal rights have been defined. The decision to end one’s own life should be one’s own, it’s that simple.
A secondary factor in favor of voluntary euthanasia is that it is a compassionate act. This is generally the most commonly discussed angle in favor of PAS. If you have ever had a loved one that is terminally ill and is at the end of their life, then this might be something you have thought about. If you have ever had a relative wasting away due to an incurable degenerative disease and they are wasting away, then PAS might have been discussed. Due to the raw emotions associated with PAS, this might be the most commonly thought of justification for PAS.
There are just as many arguments against the use of PAS as there are in favor of it. The primary argument being, PAS goes directly against God’s will and it is unethical to defy God and His will for mankind. People who have strong beliefs in this regard tend to feel strongly that PAS is a sin and not permissible in society.
The Hippocratic Oath is often cited as a reason against PAS. The philosophy of “first do no harm” prevents physicians from engaging in any activity that causes harm or intentional death to their patients. This is a direct contradiction to PAS, which raises the question of whether or not PAS is an ethical practice. Permitting physicians to assist their patients to end their lives is often considered an intentional violation of the oath doctors have taken.
Another argument against PAS is the question of abuse if it is permitted. Often times we hear about scandals in which the medical companies refuse treatment because it is too costly and a positive outcome is unlikely. We all have heard about the family member that makes a decision for a family member that results in the death of a relative. The concern of abuse if PAS is permitted is one that raises the questions of how to regulate such an event that is as subjective as PAS is.
Some people believe that legalizing PAS opens Pandora’s Box. The question of “if PAS is permitted, what next” comes to the minds of many. The social implications that arise as a result of PAS, some opposors believe, can pave the way to permitting “nonvoluntary” cases of legalized suicide. This is a path that many people fear is highly possible and one that they do not wish to go down.
The US is not the only industrialized nation that struggles with the idea of PAS. Many eastern and western European countries also have regulations and laws either in favor of PAS with set regulations, or have a clear stance against PAS. The Netherlands, Germany, England, France, and Spain have all addressed the issue of PAS.
The Netherlands, for example, has the DNR (do not resuscitate) option as well as PAS to address end-of-life situations. There are specified guidelines that dictate how PAS is executed in the Netherlands. The first provision is the patient is to request the act and it must be “voluntary and well considered” (p. 266). The second provision is that the patient must be either about to or already experiencing intolerable suffering. The third provision involves the investigation of all other potential alternatives. All other options must be explored and considered in order for PAS to be instituted. The patient must give informed consent about all aspects of the situation, which makes up the fourth provision. The fifth provision dictates that two physicians must consult regarding each specific case to ensure that independent judgment regarding whether PAS in each case is appropriate. And the sixth provision demands that the professional who carries out the suicide do so with the utmost care.
Another example that has openly dealt with the issue of PAS is Germany. Likely due to the historical implications, Germany is less in favor of PAS than the Netherlands, or even the US. Voluntary euthanasia has long since been discounted in German society and has only recently been accepted amongst some when the Dutch way of PAS is discussed. Germany distinguishes between active direct and active indirect euthanasia. Active direct euthanasia, which occurs when there is direct assistance to a person who is committing suicide, is illegal. Active indirect euthanasia, which is defined as assistance in suicide and not during it, is legal.
In regards to the US, some people consider society not a suitable candidate for PAS in its current state. “The United States is in many respects an untrustworthy candidate for practicing active euthanasia” (p. 276). The implications that led to this assessment include: “sustained contact with a personal physician has been decreasing; the risk of malpractice action is perceived as substantial; much medical care is not insured; many medical decisions are financial decisions as well, racism remains high; and the public has not experienced direct contact with Nazism or similar totalitarian movements” (p. 276). These cultural differences lead people to believe that the US is not “experienced” enough to understand the ins and outs of PAS and its implications to individuals and society as a whole.
Oregon is the only state in the US, since 1997, that has permitted PAS up until recently. On 11/4/08 Washington State passed the “Death with Dignity” law that permits PAS. The law took effect on 3/4/09. In 2009, there were 64 requests for permission to be granted for PAS. So far in 2010, there have been 36 requests. There are specifications in place that permit only a select few to actually participate in the Death with Dignity law resulting in PAS. Safeguards, such as informed consent, multiple physician examinations, psychiatrist evaluation and verification, and other requirements are necessary in order to ensure the individual is of sound mind and body to make a decision such as PAS. The individual must also be suffering from an incurable illness that cannot be managed due to medical insufficiencies to minimize pain or suffering. In regards to the argument about the Hippocratic Oath, Washington does not require any medical professional to participate in the implementation of Death with Dignity unless they chose to do so. As current law stands, no medical professional is required to participate in the assisted suicide of a patient if they do not wish to. It must be an active choice to participate.
There are many pros and cons regarding PAS. There are many valid arguments in favor of PAS as well as many legitimate arguments against it. The idea of PAS is definitely something that is very subjective. People have varying opinions regarding voluntary euthanasia and the motivations for their support either for or against it.
References:
Waller, Bruce N. Consider Ethics: Theory, Readings, and Contemporary Issues.
Custom Publishing: New York, 2005.
Washington State Department of Health. “Washington Death with Dignity Act.”
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