Physician Assisted Suicide
By definition, Physician-Assisted Suicide (PAS) means terminating one’s life willingly by use of a lethal substance.
A physician may assist in this process either indirectly or directly. During this process, the physician prescribes certain medication to a competent patient with the prime aim of putting an end to patient’s life. (MedicineNet.com, 2004)The issue of Physician-Assisted Suicide is widely debated and has opponents and proponents both. Opponents say that PAS contradicts the fundamental beliefs and principles of medicine.
Moreover, they also consider PAS as contradicting with a doctor’s job as a healer. (MedicineNet.com, 2004)The term ‘Euthanasia’ is used for “the intentional killing by act or omission of a dependent human being for his or her alleged benefit”. ‘Voluntary euthanasia’ is “when the person who is killed has requested to be killed”. ‘Non-voluntary euthanasia’ is “when the person who is killed made no request and gave no consent”.
‘Involuntary euthanasia’ is “when the person who is killed made an expressed wish to the contrary”. ‘Assisted suicide’ is when “someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose”. ‘Euthanasia by Action’ is “intentionally causing a person’s death by performing an action such as by giving a lethal injection”. ‘Euthanasia by Omission’ is “intentionally causing death by not providing necessary and ordinary (usual and customary) care or food and water”. (Euthanasia.com, 2010)It is important to understand that only when death is an intended result of a particular action may it be referred to as euthanasia.
A situation, where there is absence of the intention of taking one’s life, cannot be regarded as euthanasia. Examples of such acts are withdrawal of a treatment that was found to be not desirable, ineffective, or too troublesome. Refraining from commencement of a treatment that is not going to be beneficial for the patient, and giving high dosages of painkillers when needed but dangerous for the patient’s life, are also examples of such a situation. These are rather authorized by law and considered as good medical care when carried out in a proper manner. (Euthanasia.com, 2010)Proponents of PAS argue that it is not same as euthanasia because the physician or the doctor only provides the means for death, usually in form of a prescription. The lethal medication, however, is ultimately administered by the patient him or herself rather than the physician. They also argue that PAS needs to be distinguished from some other practices, such as pain medication, terminal sedation, and withdrawal of life-sustaining treatments. A patient who is terminally ill sometimes requires doses of pain medication, which is used for impairment of the respiratory system and thus may hasten death. Court decisions and professional societies regard this as justifiable when done with the primary aim of relieving the patient from suffering. (University of Washington School of Medicine, April 11, 2008)Terminal sedation is when a terminally ill patient is sedated such that he/she becomes unconscious and then allowed to die of starvation, disease, or dehydration.
Withdrawal of life-sustaining treatments is when a competent patient refuses a life-sustaining treatment and takes an informed decision regarding this. Virtual unanimity about respecting this wish is seen in the medical profession as well as the law. (University of Washington School of Medicine, April 11, 2008)The proponents of PAS also argue that it is rational for a person who chooses death over life when faced with unbearable suffering. They also suggest that a physician has the responsibility of alleviating suffering. They may also do this by assisting in suicide.
It is important to understand that these arguments are based on the idea of individual autonomy and recognition of an individual’s right to choose the course of his or her life. This also means the right over how his or her life will end. (University of Washington School of Medicine, April 11, 2008)It is argued that a competent person has the right to choose his or her death as he or she wants. These decisions regarding the circumstances and time of death are personal and must be given respect to. Hence, respect for autonomy is a major supporting argument for the issue of PAS.
Proponents of PAS also suggest that at times refusal of treatment does not hasten death and there is no other option to relieve suffering but suicide. Justice systems are based on the notion that different cases should be treated alike; therefore, such patients should be allowed assisted death. (University of Washington School of Medicine, April 11, 2008)Some people say that suffering does not only mean pain but also includes different psychological and physical burden. Sometimes a possible way of relieving the patient from suffering is not present and hence PAS is justified in these cases. People holding such views regard PAS as a compassionate way of putting an end to unbearable suffering.
(University of Washington School of Medicine, April 11, 2008)Even though it is in society’s interest to preserve life, in case of a terminally ill person with a strong desire to die, this interest reduces. People argue that a complete ban on PAS means excessive limitations on rights of personal freedom and choice. People with these views believe that PAS should be permitted in peculiar cases. Others also say that PAS already occurs secretly, even though law may not permit it. For instance, apparent use of morphine drips for pain relief can be seen as a clandestine way of euthanasia or PAS.
If PAS gets legalized, physicians and patients can discuss these issues openly instead of secretly. (University of Washington School of Medicine, April 11, 2008)PAS is unethicalPeople against PAS consider it unethical and immoral. Their views are based on the notion that PAS conflicts with a physician’s traditional role as a preserver of life. Others also show concern about the possible abuses of PAS in case it gets legalized. For instance, the elderly and people who cannot afford costly and complex palliative treatments may indirectly be pressurized into opting for PAS.
(University of Washington School of Medicine, April 11, 2008)Opponents of PAS argue that sanctity of life must be respected. Most secular and religious traditions forbid taking of an individual’s life. People with these views consider PAS to be morally improper as it conflicts with these beliefs. Some people also focus on the distinction between passive and active PAS. They point out that actively killing someone is different from passively letting someone die.
They say that passive PAS is justifiable but active PAS is not. (University of Washington School of Medicine, April 11, 2008)Opponents of PAS also maintain that if legalized, particular groups of people who cannot afford proper support and care may be forced into PAS. They also suggest that PAS could come to be seen as a cost-containment way. At times, burdened health-care providers and family members may also support PAS. In order to avoid and prevent such abuses, PAS should not be legalized.
(University of Washington School of Medicine, April 11, 2008)Historical ethical teachings and traditions of medicine are strongly against the idea of taking an individual’s life. The Hippocratic oath says,I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.” (The Hippocratic Oath, January, 1999)Moreover, The American Geriatrics Society (AGS), American Medical Association (AMA), and other such major professional groups also disapprove PAS. If PAS is legalized, the public image of medical profession may be damaged. (University of Washington School of Medicine, April 11, 2008)There is also debate regarding the fallibility or misjudgment of the medical profession, which is indeed a possibility. Sometimes physicians may make mistakes.
Physicians may not be sure about their prognosis or diagnosis. There are possibilities of inadequate pain treatments and erroneous depression treatments. Therefore, it is obligatory on the State to provide protection to the citizens against such inevitable errors. (University of Washington School of Medicine, April 11, 2008)According to a news report by Kenneth R. Stevens Jr.
, published on March 10, 2010, neither of the 59 people who sought PAS had a psychiatric evaluation. The report also states that only 1% of all the people who sought PAS have had a psychiatric evaluation, that is only 2 out of 168 people, in the span of last three years in the state of Oregon where PAS is legalized. Oregon Health Department has shown concern about the reduction in requests regarding formal psychiatric evaluation of patients. These patients receive prescriptions in compliance with the Death with Dignity Act (DWDA) but any possibilities of depression stay undiagnosed. An OHSU report stated that in the year 2008, 25% of the patients who had requested PAS were suffering from depression.
It should be seen why then only 1% of the patients are advised for psychiatric evaluation. (Kenneth R. Stevens Jr., March 10, 2010)The same report also goes on to say that the pro-assisted suicide organization Compassion & Choices is found to be involved in most of the PAS cases in the state of Oregon. They were involved in 78% of the PAS cases during last 12 years since it was legalized.
With its involvement in 88% of the PAS cases in 2008 and 97% of the cases in 2009, Compassion & Choices is drawing a lot of attention. According to this news report, the members of Compassion & Choices authored the PAS law. It is therefore evident that they would not want to report anything against it for the sake of their reputation. (Kenneth R. Stevens Jr.
, March 10, 2010)Elaborating on this issue, the report pointed out that according to OHD, during a period of 7 years, starting from 2001 up till 2009, out of an approximate 10,000 physicians in the state of Oregon, only 109 wrote one or more of the 271 PAS prescriptions. A small proportion of physicians wrote most of these prescriptions. It is surprising that 20 physicians wrote 61% of the total 271 PAS prescriptions. It is even more surprising that 23% of the total 271 prescriptions were written by 3 physicians only! These statistics also fail to satisfy us and lead us to conclude that PAS should not be legalized. (Kenneth R. Stevens Jr.
, March 10, 2010)After having gone through both, the opposing and the supporting arguments, I have come to conclude that PAS should not be made legal. When a patient is provided with means to alleviate his or her suffering, physicians may prescribe a drug that may be necessary but potentially lethal. This would mean indirectly assisting the suicide in an unavoidable situation. The laws should distinguish these situations from intentional PAS.It is also important to understand that allowing PAS might result in undermining the relationship of trust that prevails between a patient and his or her physician. Moreover, historically speaking, the principle aim of a physician should be providing cure and comfort to the patient.
If a physician’s role were altered such that provision of comfort also means the intentional termination of the patient’s life, the fundamental alliance would be challenged.The possibilities of abuse of the economically underprivileged, disabled, and frail, cannot be neglected. If PAS gets legalized, people would indeed be encouraged to welcome premature death due to psychological and social pressures. They would want to relieve their families and society of a burden if they come to see themselves as a burden.It has also been observed that most people, who willingly opt for PAS, do it because of the fear of death itself.
There are already many legal ways of relieving a patient from his or her suffering, for instance sedation that provides comfort. It is also legal for a person to do without life-sustaining treatments. With all these options available to a patient, PAS should not be legalized. If PSA is made lawful, the masses might resolve to hinder the expansion of resources and services that are used for the purpose of providing care to the terminally ill patients who would eventually die.We should also try to look into the reasons that a patient presents when asking for a PAS. There is a possibility of under treated physical symptoms.
Clinical depression may also make a patient ask for PAS. Hence, we need to make sure that patients are provided with a hopeful and lively environment such that they do no think about giving up on a blessing as great as their life. Patients may also be faced with spiritual or psychosocial crisis. The medical assistance should also focus on dealing with this issue.When debating the issue of PSA, we must also look into the consequences of PSA being legalized and not being legalized. A comparison should be done in order to see if the supporting arguments outweigh the opposing arguments or vice versa.
When PSA is prohibited, the patient’s autonomy is limited as far as choosing the mode of his or her death is concerned. A person with a limited life span and intractable suffering is legally authorized to forego sedation. By prohibiting PSA, physicians can maintain a reasonable balance of their obligation and commitment of provision of safe and proper care to the patients. IF PSA gets legalized, these patients may be faced with the risk of shortened life span.Even though some people may still want assisted suicide and get in trouble if not provided physician’s involvement, it should be obligatory on physicians to disengage themselves from any possibilities of this kind.
It should also be ensured that necessary medical treatment is provided to all patients.IF PAS becomes legal, there are increased chances of euthanasia becoming legal as well. It may mean that anyone who is deemed to be ‘useless’ by the society, be it physically handicapped, homeless, demented, mentally ill, or an elderly person, could be ‘killed’ without his or her consent.