Physician-assisted suicide
Physician-assisted suicide (PAS) as part of euthanasia is one of the oldest points of contention in medical ethics. The original Hippocratic Oath forbids it, and many religions and societal traditions have rejected it since antiquity. In physician-assisted suicide, a suffering or terminally ill patient is aided by a certified health practitioner to get access to a lethal dose that the patient then administers on themselves. If the patient is incapable of doing so, they can request the physician to administer the lethal substance to end the patient’s life. The practice of physician-assisted suicide continues to raise debate as only five American states, a handful of European Countries and Colombia permit some form of doctor-assisted suicide. Even though many governments and organizations do not formally accept physician-assisted suicide as a standard medical practice due to ethical concerns, they should adopt it because it is a show of respect to individual civil liberties as provided by the right of every individual to choose what is best for them without government or societal interference.
Although physician-assisted suicide can be regarded as a sound practice, there are valid arguments against its application. According to Margaret Sommerville in her book “Death Talk, Second Edition: The Case Against Euthanasia and Physician-Assisted Suicide”, she claims that the constitution recognizes the right to life, and when life and death are compared, life will take precedence. Allowing physician-assisted dying is a contradiction of the first liberty. In a literature review by Nicole Steck and Matthias Egger “Euthanasia and assisted suicide in selected European countries and US states: systematic literature review”, they conclude that it is also possible that legislating doctor-assisted suicide will be the first step on a slippery slope that will involve threats to the vulnerable as premature death is enacted as a cheap alternative for palliative care. This is true when one considers that a dose of euthanasia costs an upward of $50 and kidney failure treatment may cost an upward of $89,000 per year in the US. Also, Sommerville points out that, unproductive and poor citizens will be targeted and this, again, goes against the right of every American to access quality healthcare. For some people, the contention is absolute and moral. Life is sacred and the suffering that comes with it till one dies confers its dignity and consequently, deliberately ending a human life is wrong. Finally, how long will it take before physician-assisted suicide becomes involuntary? When relatives approach a 92-year old man on life support and request them to sign the physician-assisted suicide forms, is that not indirectly violating their rights as they have no choice?
According to Bradley Denton and his partner Dr. William Bradley in their “Australian Nursing and Midwifery” journal , the views that physician-assisted dying is immoral and strips human dignity deserves some seriousness but, is not autonomy and liberty critical sources of human dignity as well? The right to choose certainly adds value to human life and people should not take a myopic view of ethics without analyzing the laws that make these ethics possible. In the society we live in where the state and religion are separated, it is queer to support the sanctity of life abstractly by exposing particular individuals to unbearable pain, suffering and indignity that comes from some terminal conditions .Furthermore, evidence from countries and states where physician-assisted suicide has been enacted shows that the slippery slope contention with regard to widespread physician-assisted suicide is a myth. In the Netherlands for example, Gopal in his “Journal of the American Academy of Psychiatry and the Law”, says that the process of doctor-assisted dying is bureaucratic and highly complex meaning that most applicants are rejected until it is established beyond reasonable doubt that the request is voluntary and will do more good than good. The Netherlands treats physician-assisted suicide as a criminal act if not carried out in the presence of an ethics expert, a legal expert, and the doctor. This implies that strict controls are needed, not blatant rejection, to ensure that this right is protected and not abused.
In the article” Academic Journal of Interdisciplinary Studies” by MSC. Suela Hoxhaj, the argument that life should take precedence over death does not hold water when analyzed from an individual’s rights perspective. Just as people have the right to live with dignity, they also have a right to die with dignity. Medical practice is supposed to alleviate pain and unnecessary suffering in patients. Take the example of a single mother of teenage children having stage four cancer. Undergoing chemotherapy means that her hair falls off even as she consistently vomits while enduring the extreme pain that her children are supposed to watch as they take care of her. Presently, the medical technology we have cannot do any better than chemotherapy and radiotherapy to treat cancer (which generally cannot restore health in stage four cancer) and in the case of this mother, the continuing suffering only robs her of her dignity and those of her children. With physician-assisted suicide, such patients and their families get a right to a dignified end.
According to Sommerville, anti-physician assisted suicide proponents argue that death is a natural process that should not be interfered with. However, doctors have and continue to implicitly exercise the right of dying on the patient’ behalf. Physician-assisted suicide fixes this by recognizing the individual civil liberty of the patient to choose and administer PAS. Doctors normally exercise this right by giving pain-relief in lethal doses or withdrawing treatment. As Steck, Egger, Maessen, Reisch, & Zwahlen notes, this is usually after talking to relatives, and even though doctors are normally investigated for overstepping this mark, they are rarely charged. Numerous people welcome this fudge given that it lays limits to PAS albeit with no need to articulate the contentious moral choices involved. This is unethical and unworkable given that the explicit choice to die that should be in the hands of a patient is left in the doctor’s hands. It is hypocritical and goes against the individual civil liberties as society pretends to shun PAS while tacitly and subtly allowing it without safeguards. Physician-assisted dying in its openness will fix this practice of deaths through nods and winks that contravenes individual rights.
Gopal also suggests that, the fear that physician-assisted suicide will be foisted on vulnerable individuals, bullied by rogue doctors, cash-strapped states, panicking relatives, and parsimonious insurers is unfounded. The Oregon experience, where a law allowing PAS has existed since 1997, points to the enhanced recognition of civil liberties. Individuals who choose doctor-assisted dying are in fact insured, well-educated and getting the best palliative care. These individuals are motivated by the desire to maintain their own dignity, pleasure in life, autonomy, and the pain that comes with some conditions. These are factors that embody the civil liberties promise of most governments around the world.
In conclusion, physician-assisted dying is the ultimate protection of individual civil liberties in the ongoing euthanasia debate. Just as people have the right to life, they have a right to autonomy, happiness, and pleasure in life; elements that are guaranteed through the right to choose a dignified death that alleviates unnecessary suffering. Anti-PAS proponents suggest that it will open the doors to a slippery slope of forced death on vulnerable patients, but evidence from Netherlands and Oregon show that this is a myth if strict controls are in place. After all, the right to die for patients has for long been practiced by physicians and relatives on behalf of patients through the withdrawal of medication or prescription of pain medication. Physician-assisted suicide is fixing this subtle illegal practice by placing the right to die in the patient’s hands hence protecting civil liberties.
References
Denton, A., Levett, C., Bradley, S., & Thoma, L. (2016). Death and dignity: Why voluntary euthanasia is a question of choice. Australian Nursing and Midwifery Journal, 24(6), 18-23.
Gopal, A. A. (2015). Physician-Assisted Suicide: Considering the Evidence, Existential Distress, and an Emerging Role for Psychiatry. Journal of the American Academy of Psychiatry and the Law, 43(2), 183-190. Retrieved from http://jaapl.org/content/43/2/183
Hoxhaj, O. (2014). Euthanasia – The Choice between the Right to Life and Human Dignity. Academic Journal of Interdisciplinary Studies, 3(6), 279-284. doi:10.5901/ajis.2014.v3n6p279
Sommerville, M. A. (2014). Death talk: The case against euthanasia and physician-assisted Suicide (2nd Ed.). Sydney, Australia: McGill-Queen’s Press-MQUP.
Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and Assisted Suicide in Selected European Countries and US States. Medical Care, 51(10), 938-944. doi:10.1097/mlr.0b013e3182a0f427
Counterintuitive 