Specialisation: Euthanasia

Death, Dying, and Euthanasia

The issue of death and dying presents complex ethical questions for healthcare providers, patients, and families. Chapter 6 of Thomas’ text examines two very different patient cases that illustrate the dilemmas surrounding end-of-life care and patient autonomy. In Case 6.1, Thomas details the contrasting situations of Carole, an older woman reliant on life support, and John, a young man with a debilitating disease who wishes to be taken off life support. Comparing these cases highlights several key issues, including differing perspectives on the value of life versus quality of life, the role of patient interests and consent, distinctions between the dying and not yet dying, and ethical differences between active and passive measures that may hasten death.

The first case describes Carole, an 81-year-old woman who has paralysis of her breathing muscles due to multiple cardiorespiratory arrests. She requires a respirator to stay alive and has no prospect of recovering her ability to breathe independently. Carole has minimal consciousness and is unable to participate in decisions about her care (Thomas et al., 2014). Her son insists she must remain on life support and be transported back to her native Jamaica before she dies, based on their shared religious beliefs about the afterlife. In contrast, the second case details the situation of 26-year-old John, who has battled a disfiguring neurological disease called neurofibromatosis his entire life. Despite over 100 surgeries, John is almost entirely paralyzed, deaf, and partially blind. He is conscious and mentally competent but relies on a respirator to breathe. John clearly expresses a wish to be taken off life support and allowed to die naturally. His family initially objects but eventually comes to accept his decision after counseling.

These two very different cases raise several ethical questions around patient autonomy, the moral status of life versus quality of life, and distinctions between actively or passively allowing death. The first significant issue is the sanctity of life versus quality of life. An absolute view of the sanctity of life would prohibit any action that intentionally ends a human life, including withdrawing treatment. However, a competing view holds that only lives possessing certain human qualities like rationality, self-awareness, and autonomy have inherent moral worth (Thomas et al., 2014). From this perspective, quality of life factors may override mere biological existence. For Carole, a rigid sanctity of life approach would require preserving her life at all costs. But this may paradoxically disrespect her remaining autonomy to shape end-of-life care. With John, ending his miserable and limited existence could be seen as showing greater respect for the value of his life than forcing him to endure unwanted treatments. However, abandoning the sanctity of life as a guiding principle raises concerns about protecting vulnerable patients. Overall, while the sanctity of life initially seems authoritative, it may conflict with patient wishes and best interests in complex cases like these.

A second key issue is how to weigh patient interests and consent. For Carole, consent is straightforward – neither she nor her son consent to withdrawing life support. The core question is whether patients have an unlimited right to access any treatment available, regardless of its costs or benefits. ICU care is very scarce and expensive, and continuing Carole’s dying process indefinitely deprives other patients. However, unilaterally refusing care due to futility or resource constraints seems callous and disrespectful (Thomas et al., 2014). With John, he clearly articulates a wish to stop treatment, but his family initially disagrees. Navigating this conflict raises concerns about patient autonomy versus familial authority. Counselors must balance their role as patient advocates with duties to promote health interests and support families. While respecting patient wishes is ideal, real-world resource limits and competing interests create ethical grey areas.

A third key question is whether it is morally different to withdraw care from a dying patient like Carole versus a more stable patient like John. Since death is imminent for Carole regardless, merely allowing it to proceed by stopping treatment could be acceptable. But John is not actively dying, so actively ending his life requires more substantial justification (Thomas et al., 2014). However, this distinction rests on dubious assumptions that existing life has the same status regardless of prognosis. If human life warrants protection intrinsically, this applies equally to relatively stable patients like John. But factors like avoiding unnecessary suffering are also ethically relevant. In reality, the dying/non-dying distinction is a simplistic dichotomy that does not accurately reflect complex medical realities.

Finally, there are debates around whether ethical distinctions exist between active versus passive measures that may result in death. Not resuscitating Carole allows the natural process of dying to occur, whereas removing John’s ventilator directly intervenes to cause his death. Some argue that active interventions to end life, like stopping life support, are ethically equivalent to killing (Thomas et al., 2014). However, others dispute that passively allowing nature to take its course differs meaningfully from direct actions that hasten death. With Carole, not saving her life may not vary much morally from withdrawing her ventilator. Moreover, “passive” approaches seem to inflict more suffering. With John, declining to end his life proactively painlessly seems hypocritical, given the acceptance of stopping his ventilator. Overall, while some view actively causing death as incompatible with healthcare’s healing aims, moral judgments should rest more on consequences than questionable distinctions between action and inaction.

Beyond the issues raised directly by Thomas, Beauchamp and Childress’ principles of biomedical ethics provide a valuable framework to analyze these cases. The principle of nonmaleficence supports not harming patients. Removing John’s ventilator breaches this principle by directly causing his death (Thomas et al., 2014). However, nonmaleficence must be balanced against competing principles like patient autonomy. The principle of autonomy supports respecting patients’ right to make decisions about their care. From this view, respecting John’s wish to stop treatment may supersede nonmaleficence. The principle of beneficence requires acting in patients’ best interests. However, applying beneficence is complex when patients have different views on benefit versus harm. Lastly, the principle of justice demands equitable distribution of care. Giving Carole scarce ICU resources regardless of medical benefit may deprive other patients in need. Overall, contextual analysis using ethical principles is essential.

In conclusion, end-of-life cases highlight multifaceted tensions in the ethical foundations of healthcare. The situations of Carole and John present no easy answers. Moving forward thoughtfully requires a nuanced examination of the value of life, patient interests, and distinctions between action and inaction. Open-minded discussion and debate around these complex issues are critical for developing ethically sound policies in our healthcare system.

Reference

Thomas, J. E., Waluchow, W. J., & Gedge, E. (Eds.). (2014). Well and Good-: A Case Study Approach to Health Care Ethics. Broadview Press.

Ethical Egoists and Social Contract Ethicists on Euthanasia

Euthanasia is a highly morally controversial topic that has been the subject of much debate and disagreement. The term refers to deliberately taking someone’s life to stop an enduring pain or suffering (Harris, 2006). The paper will look into the debate on euthanasia, which accompanies moral controversy, disagreements, and disputes among different social spectrums. According to Grassl (2020), on one side of the debate, proponents of euthanasia (pro-euthanasia or “death with dignity” advocates) argue that it is a moral right for individuals to have control over their bodies and to be able to end their suffering. They argue that euthanasia is a compassionate act that allows individuals to die with dignity and without prolonged pain. On the other side, opponents of euthanasia (anti-euthanasia or “right to life” advocates) argue that it is morally wrong to end a human life intentionally and undermines its sanctity. They argue that alternative methods, such as palliative care, should be used to alleviate suffering. In the ethical argument, each side’s perspective must be explained comprehensively, together with the moral justifications used to rationalize their position as the acceptable one.

When the two positions are evaluated using the studied moral theories that Harris (2006) highlights, an ethical egoist, who believes in self-interest guidance for moral decision-making (Grassl, 2020), would assert that the optimal course of action is to permit euthanasia since it is in the best interests of the person. The ethical egoist would advocate for the legalization of euthanasia and argue that it is in the patient’s best interest to choose when and how they end their suffering. They would also argue that the individual’s right to autonomy must be protected and that there is no need to prolong the individual’s suffering in any manner, according to Harris (2006). They recognize that the laws and institutions of society should not constrain a person’s ability to make choices in their best interest.

However, a social contract ethicist would take a nuanced position. Referring to Grassl (2020), in understanding the social contract ethicist, for a society to coexist peacefully, they must first agree to adhere to a preset set of ethical and political values. Some believe that if individuals adhere to the social contract, they can live moral lives of their free will instead of being compelled by a higher power. A social contract ethicist would argue that individuals have a moral imperative to respect the rights and well-being of others, in addition to societal norms and rules. They would argue that euthanasia should be authorized under certain circumstances, such as when a person has a terminal illness, and there is no chance of recovery (Grassl., 2020). On the other side, they would argue that it is the responsibility of society to prevent euthanasia from being abused or employed in a way that causes harm to others (Grassl, 2020). So, the social contract ethicist would only advocate for euthanasia on the condition of set society laws but should not be executed for any pain or suffering where an individual has a recovery option.

From a different perspective, according to the American Medical Association’s (AMA) code of ethics for medical professionals (n.d, p. 10), doctors “have a duty to alleviate pain and suffering and to protect the dignity and autonomy of their patients.” It also states that medical professionals “should not be a participant in a legally sanctioned execution.” However, they “may provide terminally ill patients the necessary tools to alleviate suffering and discomfort” (p. 8). In addition, it states that “physicians should not administer lethal medications with the intent to end a patient’s life” (pg. 8). This code of ethics is relevant to the topic of euthanasia because it recognizes the physician’s role in alleviating pain and suffering and promoting autonomy, but prohibits physicians from actively ending the life of a patient. This code of ethics presents a tension between professional and family obligations since it specifies that doctors should not engage in the termination of a patient’s life but also recognizes the importance of the patient’s autonomy and the alleviation of pain and suffering. This code of ethics creates tension between professional and family responsibilities by stating that doctors should not engage in a patient’s euthanasia.

Conclusion

In conclusion, euthanasia is a morally controversial topic that has been the subject of much debate, controversy, and conflict. Anti-euthanasia activists believe that euthanasia is immoral because it is a type of killing, that it devalues human life, and that it might result in the abuse and maltreatment of vulnerable persons. Proponents of euthanasia claim that people have the right to make choices over their bodies and to terminate their suffering whenever they are willing. This is an indication of a sparkling debate that is never-ending. However, many individuals within the social clique would advocate for euthanasia for one’s respect of self-interest and for society’s moral value of eliminating a person who seems to endure pain or suffering, with death as the only solution to an individual’s travail.

References

American Medical Association (AMA) (n.d). Code of Medical Ethics. Opinions on Caring for Patients at the End of Life. Chapter 5. https://www.ama-assn.org/system/files/2019-06/code-of-medical-ethics-chapter-5.pdf

Grassl, F. F. (2020). Book Review: Craig A. Boyd and Don Thorsen, Christian Ethics and Moral Philosophy: An Introduction to Issues and Approaches.

Harris, J. (2006). The value of life: an introduction to medical ethics. Routledge.

Euthanasia and Assisted Suicide Should Be Legal

Introduction

Euthanasia and assisted suicide are controversial issues central to doctors’ responsibilities. These procedures happen when physicians offer the required facts and methods to facilitate a patient’s choice in their life. Many people consider life preservation as the higher drive of humanity’s existence. Numerous physicians graduating every year vow to utilize their abilities to help clients in pain and lengthen their existence. However, survival becomes extra complicated when the patients are experiencing unimaginable pain. Some suggest that offering such folks legitimate and safe ways to end their suffering is rational and humane. However, others oppose legalizing this practice due to severe medical and lawful obstacles. Assisted suicide and euthanasia are vital additions to the standard end-of-life care practice; thus, the government should legalize these practices.

The government should legalize euthanasia and assisted suicide as a relief of suffering. Validating euthanasia would help lessen the suffering of fatally ill individuals (Luzon). It would appear biased and inhuman for physicians to make clients undergo unbearable pain. Generally, medicine always aims to relieve patients suffering from diseases. Hippocrates’s ancient oath assured to utilize therapies to assist clients but never administer toxic substances to those who demanded such procedures. However, supporters of assisted suicide and euthanasia contend that relieving suffering using lethal ingestion is sympathetic and humane. This situation applies if the client is dying and suffering becomes refractory.

The privilege to die must remain a personal decision but never mandated by administrations. Individuals possess the right to select many life routes that may lead them in varying directions. Most of these choices receive minimal governmental interference. Generally, some spiritual opinions regarding suicide may influence this discussion and the personal challenges involved in helping somebody die (Luzon). However, terminally ill individuals may desire to pass independently (McKinnon and Orellana-Barrios 39). Integrating dignity and death laws can assist in making this option possible. The patient has the final decision rather than waiting for review boards. Also, the sick finally take fatal prescriptions instead of the physician. Therefore, the decision to apply euthanasia and assisted suicide remains in the patient’s control. This phenomenon shows that the government should legalize these practices, giving people the right to end life.

Assisted suicide and euthanasia offer extra control regarding the ultimate life choices. A person’s death begins the financial expedition for their esteemed ones (Dugdale et al.). People never forgive arrears after death. The family and society become responsible for paying off the remaining obligations. In this case, these people can take extended periods to resolve multifaceted financial problems. Thus, once these practices become a portion of the discussion for people with terminal diseases can help, individuals can plan to make such a transition straightforward for everybody. A disease’s physical and emotional toll can decrease for everyone involved by possessing extra control over the ultimate life decision (Dugdale et al.). Therefore, euthanasia and assisted suicide can relieve family members, caretakers, and the sick. This family can have peace by recognizing the time to end such a circumstance. The phenomenon shows the need to legalize the practices, giving everyone control over their life choices.

Assisted suicide and euthanasia can help patients evade caregiver culpability. The most substantial challenge that happens with a fatal diagnosis is the emotions of shame and guilt that patients have concerning their caregivers. In this case, the sick start feeling like a burden on their loved ones. This situation creates reactions resulting in association difficulties. Authorizing euthanasia and assisted suicide may not be widespread in various groups, but it may establish a plan for the brief period that everybody faces these circumstances (Dugdale et al.). Helping a person find needed physical peace allows the emotional healing procedure to assist everyone in pushing through their misery more consistently.

Assisted suicide and euthanasia are safe medical practices. Many advocates laud these procedures for being safe medical practices. In this case, physicians can ensure safe death in ways other suicide means can never guarantee (Piili et al.). Therefore, euthanasia and assisted suicide are vital options among numerous possibilities for the care of the dying (Piili et al.). Though individual state rules and regulations differ, most recommend various precautions to inhibit misuse and offer an arrangement for actions that folks will conduct, notwithstanding extra messily. Generally, precautions require patients electing these practices to remain informed of every end-of-life option. The law requires two witnesses to confirm that the client demands assisted suicide or euthanasia autonomously. It also ensures the patients are free of coercion and can ingest the toxic prescription themselves. These phenomena demonstrate that euthanasia and assisted suicide are safe clinical practices because the rules and regulations ensure that doctors and patients follow the correct process before carrying out the procedures.

These practices fulfill the doctor’s duty of beneficence. This principle requires a physician to act in ways that promote patients’ welfare. Still, controversy arises over what actions doctors should undertake to fulfill the obligation appropriately. Also, some people proclaim that beneficence needs physicians to preserve life no matter the cost (Vargić 56). Other individuals argue that patients’ interests get best served by doctors who respect the client’s autonomy. In this case, the physician is sensitive to the patient’s pain and ready to take the necessary steps to end such suffering. Thus, the most generous act in the case of terminally ill patients requesting an end to their life and suffering intractable pain would entail terminating the life using merciful methods. In these instances, death is imminent, and physicians have two choices remaining. For example, the doctors may end the patient’s life or let the illness take its course. The second option achieves nothing except prolonging patients’ suffering and permitting painful deaths. However, the second method accomplishes the physician’s obligation of beneficence by making patients’ inevitable death easier and acting to end their life (Mroz et al.). Therefore, euthanasia and assisted suicide should get legalized because they fulfill the physician’s beneficence duty.

Numerous medical experts whose views are highly relevant agree that assisted suicide and euthanasia are sometimes the only options when dealing with a terminally ill individual. Doctors sometimes lack other methods to help but medicate the person to ease the pain. The patient is hardly aware of their environment. Physicians should never inflict more suffering upon the person entrusted with the patient’s care. Therefore, legalizing assisted suicide and euthanasia would permit medical experts and patients to cooperate in developing an end-of-life care strategy (Mroz et al.). This situation will eliminate the pain of an extended death; therefore, the government should validate these practices.

Conclusion

Assisted suicide and euthanasia should become legalized and be fundamental privileges because they allow patients to make conscious choices regarding their fate. These practices help relieve suffering, are safe medical procedures, and assist physicians in fulfilling their beneficence obligation. They also assist patients in avoiding caregiver guilt and provide more control over final life decisions. Numerous terminally ill individuals desire to die with self-respect. Thus, regimes should never deny patients this choice. Thus, the government should legalize these practices and establish relevant legislations to inhibit abuses.

Works Cited

Dugdale, Lydia S et al. “Pros and Cons of Physician Aid in Dying.” The Yale journal of biology and medicine vol. 92, 4 747-750. 20 Dec. 2019

Luzon, Golan. “The Practice of Euthanasia and Assisted Suicide Meets the Concept of Legalization.” Criminal Law and Philosophy, vol. 13, no. 2, 5 July 2018, pp. 329–345, 10.1007/s11572-018-9474-9.

McKinnon, Brandi, and Menfil Orellana-Barrios. “Ethics in Physician-Assisted Dying and Euthanasia.” The Southwest Respiratory and Critical Care Chronicles, vol. 7, no. 30, 19 July 2019, pp. 36–42, 10.12746/swrccc.v7i30.561.

Mroz, Sarah, et al. “Assisted Dying around the World: A Status Question.” Annals of Palliative Medicine, vol. 9, no. 6, Sept. 2020, pp. 57–57, apm.amegroups.com/article/view/50986/html, 10.21037/apm-20-637.

Piili, Reetta P., et al. “Ambivalence toward Euthanasia and Physician-Assisted Suicide Has Decreased among Physicians in Finland.” BMC Medical Ethics, vol. 23, no. 1, 11 July 2022, 10.1186/s12910-022-00810-y. Accessed 30 July 2022.

Vargić, Hrvoje. “Should Euthanasia and Assisted Suicide Be Legal?” Disputatio Philosophica, vol. 20, no. 1, 7 Feb. 2019, pp. 45–75, 10.32701/dp.20.1.3. Accessed 14 Jan. 2020.

Physician-Assisted Suicide Versus Euthanasia

Physician-assisted suicide is defined as death that occurs when a doctor assists a patient get rid or their life by providing them with the necessary tools or expertise. For instance, the doctor may give sleeping medications and knowledge regarding the deadly dose to a patient likely to commit suicide. Euthanasia, also known as mercy killing, refers to any simple and painless death or the deliberate cessation of a human’s life at their desire who is struggling with an irreversible or agonizing sickness. Several things differentiate euthanasia from physician-assisted suicide since euthanasia is legally allowed as long the patient and their family agree about it. In contrast, in physician-assisted suicide, the patient requests help and expertise to terminate their life. (Herx, 2015).

Euthanasia can be classified into different types depending on how it happens when done with the patient’s agreement; it is called voluntary euthanasia. Non-voluntary euthanasia is when euthanasia is done on a patient who cannot consent because of their health condition. In this instance, based on the accuracy of pain and health, another appropriate person takes the ultimate choice on behalf of the patient. Involuntary euthanasia occurs when a competent person to give valid consent refuses to do so, maybe because they do not want to die or since they were not asked. Because it is frequently done against the person’s will, this is referred to as murder. Two major known procedures are followed during euthanasia: passive euthanasia is the first procedure is that is performed by doctors withholding life-sustaining activities to the suffering patient, and the second procedure is known as active euthanasia, which involves using fatal drugs or any other painless processes to end the life of a patient, whether the patient or someone else is doing it.

Assisted suicide and euthanasia are becoming increasingly controversial. The push to legalize PAS and VAE is gaining traction in the United States. In recent times when the Supreme Court of the United States first addressed the issue in 1997, the Supreme Court upheld legislation prohibiting assisted suicide. (Masterstdt, 2003)Assisted suicide was legal. PAS is now allowed in California, Hawaii, Colorado, Montana, Oregon, Vermont, Washington, Maine, New Jersey, and 15 other Districts. International patterns have also changed. PAS and VAE have gained a ground course of events that have not been linear. Lately, some countries have made efforts to legalize assisted suicide or enhance laws that have been rejected—prohibiting assisted suicide. Assisted suicide has been outlawed in some nations. However, there is a subtle but steady movement in favor of legalization. (Rosenfeld, 2004).

Furthermore, following a lengthy time of increased stability on the subject, public opinion appears to be shifting in support of assisted suicide in recent years. However, in the United States, this shift toward legalization has not been prompted by court rulings. The courts in the United States have mostly been examples of judicial restraint regarding assisted suicide. Various lower courts struck down statutes prohibiting assisted suicide in the mid-1990s. These judges used the infamous phrase from Planned Parenthood. “The heart of liberty is the right to define one’s own sense of existence, of meaning, of the world, and of the mystery of human life,” the joint decision stated in Casey.

These lower courts overlooked the resistance to assisted suicide in our state. Casey’s abstract discourse was used to appeal to history and tradition. The wide phrasing was seen as “very informative” and “nearly prescriptive” in settling the assisted suicide problem in these rulings. However, when the subject reached the United States Supreme Court in 1997, the Court dismissed constitutional arguments to state statutes prohibiting assisted suicide in Washington v. Glucksberg and Vacco v. Quill. The Court dismissed the notion that assisted suicide is a fundamental constitutional right in doing just that. Instead of relying on Casey’s broad interpretation, the Court examined if there was any evidence that a right to assisted suicide was deeply ingrained in the nation’s history and tradition.

One advantage of this act of judicial modesty is that it allows the continuing discussion to be influenced by the practice of jurisdictions that have allowed assisted suicide. States are being used as testbeds for new ideas. Regarding the legislation on assisted suicide, prior knowledge in other jurisdictions is crucial. However, there are numerous perceptions of what the evidence indicates and the consequences. Numerous courts, for instance, have addressed the notion that laws prohibiting assisted suicide are essential due to the potential for misuse if assisted suicide were permitted in a limited manner. Several courts have cited this concern in rejecting constitutional arguments against assisted suicide laws. A recent major decision from New York’s highest Court assessed empirical proof almost the same way. Judge Fahey’s concurrence opinion was very forceful on this point. “Independently to expand on specific hazards that would be linked with adopting PAS in New York and that necessitate its ban,” he wrote.

“The practice of physician-assisted suicide and euthanasia in the Netherlands offers us with a terrible glimpse of what we should expect upon legalization,” Judge Fahey said. In Carter v. Canada, the Supreme Court of Canada, on the other hand, deviated from this type of argument. The Carter Court depended heavily on the trial court judge’s conclusions. “A lenient regime with well-designed and implemented protections was competent for safeguarding vulnerable individuals from misuse and error,” the trial judge decided. The trial judge dismissed the proposal that judicial prudence should be based on previous occurrences in other jurisdictions. “The fate of Canada’s legislation on this hugely important cultural and ethical matter hinged on a single trial court judge’s determination of fact, a conclusion that was, however, incorrect,” Keown said. Second, there are several prudential objections to legalization (Emanuel et al. 2016). The premise is that certain techniques must be prohibited to prevent abuse, especially among vulnerable communities, including the poor, old, and crippled. Although these activities are justified in limited circumstances, the restriction must be maintained to avoid practical and realistic pitfalls. The limited range of the right to die that the right to die advocacy intended at the outset would not be preserved. These activities would vastly extend beyond the specific instances that have garnered universal acceptance.

In regards to this topic, in my opinion, I would advocate for the legalization of physician-assisted suicide and euthanasia for patients who desired it and were diagnosed with a terminal condition, were suffering greatly, and had the mental capacity to make the decision. (Dugdale, Lerner, Callahan, 2019). According to doctors, “terminal sickness” refers to an unavoidably incurable condition that cannot be cured and is expected to result in the patient’s death within a few months. Euthanasia might free up resources that could be put to better use in helping those who are still alive. Relatives and close friends would spare the misery of watching a loved one die slowly and painfully. When other species are in pain, society permits euthanasia as a humane gesture; the same approach should be applied to humans.

To me, physician-assisted suicide is still a massive no-no. Suicidal behavior contagion, a harmful precedent, and the mortality of those suffering from mental illnesses could all have unintended repercussions. On the other hand, physician AID remains a contentious subject that has an impact on patient care. The Hippocratic approach controlled clinical processes for millennia. Just after the emergence of euthanasia in Europe in the second decade of the twentieth century, several doctors began to reassess their positions, yet accelerating the death of patients remains upsetting to many. Even though several health organizations have started to reassess their viewpoints, there are strong reasons both in favor and against the procedure, and physicians have an ethical obligation to be updated on this topical issue.

References

Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Focus: Death: Pros and Cons of Physician Aid in Dying. The Yale journal of biology and medicine, 92(4), 747.

Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Jama, 316(1), 79-90.

Herx, L. (2015). Physician-assisted death is not palliative care. Current Oncology, 22(2), 82-83.

Materstvedt, Lars Johan, David Clark, John Ellershaw, Reidun Førde, Anne-Marie Boeck Gravgaard, H. Christof Müller-Busch, Josep Porta i Sales, and Charles-Henri Rapin. “Euthanasia and physician-assisted suicide: a view from an EAPC Ethics Task Force.” Palliative medicine 17, no. 2 (2003): 97-101.

Rosenfeld, B. (2004). Assisted suicide and the right to die: The interface of social science, public policy, and medical ethics. American Psychological Association.

Physician-Assisted Suicide

Proponents and opponents

Physician-assisted suicide is a long-discussed issue that has raised significant ethical concerns. The issue has in the past elicited more negative reactions that have significantly depressed efforts to review its pros and give it a deserving legal standing. The religious condemnation this issue receives whenever it is mentioned has traditionally strengthened the rigid approach to and negative attitude towards physician-assisted suicide (Gopal, 2015). Cases of physician-assisted suicide in the early twentieth century were discussed. Patients could hardly be accorded the quality of life they needed if the quality of life involved taking the patient’s life. In 1976, a New Jersey Superior Court denied Karen Ann Quinlan’s parents a request to have the patient removed from a ventilator even though the patient had stayed on the ventilator for months without hope of recovery (Ann, n.d). The Supreme Court later reversed the ruling with the argument that the patient had a right to privacy which also involved removing her from the ventilator.

Analytically, the Supreme Court did not vividly term physician-assisted suicide legal. Instead, the Supreme Court cushioned it under the privacy aspect, indirectly legalizing it without drawing too many critiques to its decision. Open discussions around physician-assisted suicide in the United States started in 1967 with the inception of the right-to-die movement (Gopal, 2015). Such movements opened room for a positive lens from which different critiques and scholars have addressed the ethical concern. In the United States, at least four states have legalized physician-assisted suicide-Oregon, Vermont, Montana, and Washington. The sluggish inception of Physician-assisted suicide across the United States raises significant questions about its pros and cons. This analysis digs into physician-assisted suicide’s pros and cons, its proponents and opponents, and its facts.

Facts around PAS

The global prevalence of chronic health conditions has significantly escalated in the past decades. Despite the massive technological growth and innovation in healthcare, most healthcare settings still face the devastating impacts of chronic diseases (Simmons, 2018). Patients with chronic diseases endure chronic pain that sometimes drives them to opt out the easiest way. Despite the global knowledge of the devastating impact of chronic diseases on patients, only 18 jurisdictions worldwide have legalized physician-assisted suicide (Mroz, Dierickx, Deliens, & Cohen, 2020). However, this number might increase in the coming years because of the heightening public discourse on the constituents of a good death, quality of life, patient autonomy, and end-of-life care. Physician-assisted dying involves physicians knowingly and willingly prescribing a patient a drug that ends their life at the patient’s request.

Physician-assisted suicide is often used as a synonym for euthanasia. However, a thin line distinguishes the two acts of assisted dying in that in euthanasia; the physician actively administers a drug that ends the patient’s life. Contrarily, in physician-assisted suicide, the physician prescribes the drug, and the patient ends their own life by willingly taking it (Mroz, Dierickx, Deliens, & Cohen, 2020). In the United States, only four States-Oregon, Vermont, Washington, and Montana have legalized physician-assisted suicide. The population of people going for PAS is still small, but steady growth is witnessed across states that have so far legalized the act. Research shows that most people going for physician-assisted suicide are more educated and wealthy (Sulmasy, 2019). Whites are more likely to opt for PAS compared to other races.

Proponents of physician-assisted suicide have often highlighted the need to end excruciating pain and death with dignity as some of the primary reasons people opt for physician-assisted suicide. However, the depth of literature on the issue reveals that most patients opting for PAS do so because they have lost control, patient autonomy, and independence (Mroz, Dierickx, Deliens, & Cohen, 2020; Jones & Paton, 2015). This evidence suggests that patients’ families or primary caregivers are rapidly requesting PAS on their patient’s behalf. A patient without autonomy, independence, and control lacks the capacity to seek PAS. However, it is also possible that these patients request PAS when they still have autonomy. Most states that have legalized PAS have also placed legal safeguards to ensure that a patient is worthy of physician-assisted suicide. Essentially, these laws mandate that patients seeking PAS undergo a thorough psychiatric evaluation to ascertain that mental and psychological health problems do not influence their requests. However, a state like Oregon enacted a new law that allows a patient to bypass the waiting period that involved waiting for a psychiatric evaluation.

Patients in Oregon can now take a prescribed pill to end life in less than two days under the Oregon Senate Bill 579. Oregon Senate Bill 2217, recently passed, allows physicians to inject patients with lethal drugs (Sulmasy, 2019). Analytically, states that have signed PAS into law gradually deviate from the original perception of PAS into euthanasia. As discussed earlier in this analysis, the only difference between euthanasia and PAS is that in the latter case, the patient takes the drug alone while the physician’s role is only to prescribe it. The physician’s administration of a lethal drug is only a hair’s breadth away from euthanasia. Legalizing PAS in various jurisdictions has had tremendous implications on psychiatric healthcare. Psychiatrists deal with several psychiatric challenges, some of which involve suicide.

Psychiatrists are responsible for relieving patients of psychiatric symptoms such as suicidal ideation. On the other hand, the dilemma caused by legalized PAS allows patients to fulfill such symptoms as suicidal ideation (Gopal, 2015). The legalization of PAS has somehow reduced the validity of psychiatric treatment by going against the same health problem psychiatrists are supposed to avert. Scientific knowledge on suicide has often claimed that psychological and social problems mostly cause suicide. These problems are often perceived as beyond human control but can be managed by psychiatric intervention. Physician-assisted suicide has come as a solution to mental health problems manifesting their symptoms in suicidal ideation. On the other hand, PAS poses a threat to psychiatric intervention and invalidates the need to assess patients for mental health problems before they can take the prescribed drugs. Physician-assisted continues to raise controversies as the proponents strongly argue for its benefits while the opponents view the issue from a negative lens.

The Proponents of PAS

The proponents of PAS often highlight various benefits linked to medical practice. Death with dignity is a common synonym the proponents of PAS use to refer to the term. In this context, PAS supporters argue that patients with chronic and end-stage diseases often experience excruciating pain (Dugdale, Lerner, & Callahan, 2019). The pain can be extreme for healthcare interventions to manage. Most patients are drawn into a state of despair that reduces them to children. It is not uncommon to witness an adult patient groaning and crying out of pain. Physician-assisted suicide helps patients experiencing pain and despair to have a dignified end. Patients can experience psychological or physical pain. Cluster headaches, commonly referred to as suicide headaches, can also be quite excruciating to patients driving them to commit suicide. Instead of painful suicides, physicians help such patients to go through a painless death that helps them restore their dignity. When Oregon legalized PAS, the state adopted Death with Dignity as the preferred name.

Regaining Control

Loss of independence and control of one’s life can devastate individuals. Research shows that as opposed to the majority perception that most patients opt for PAS to reduce pain, most patients opt for physician-assisted suicide because they have lost autonomy, independence, and control of their lives (Dugdale, Lerner, & Callahan, 2019). Patients still need to have control over the circumstances that define their death. The gained control may not come in the original form where the patient actively participates in the decisions regarding their treatments. Patients with debilitating health conditions resort to PAS. A patient may envision a future of suffering and opt to escape this future to have control over their life.

Quality of Care

The proponents of PAS have widely argued that PAS is a safe medical practice as it involves a physician prescribing medication that relieves patients of pain and helps them restore their lost dignity. PAS is one of the most preferred end-of-life care because it provides patients with the peace they desire (Dugdale, Lerner, & Callahan, 2019). States that have legalized PAS have put in place certain safeguards that protect patients against abuse by physicians. The safeguards also mandate that only qualified and registered physicians can take part in assisting the patient through the merciful ending of life.

Relieving Patients and Families of Suffering

The primary aim of medical interventions is to relieve patients of suffering. Suffering may manifest in different forms ranging from psychological to physical. Suffering extends beyond physical pain. Psychological suffering can be more devastating because some patients may not understand or know how to express this pain (Dugdale, Lerner, & Callahan, 2019). The economic and social burden of suffering inflicted on families can be devastating. Chronic and end-stage diseases often leave huge financial impacts on family resources. A patient may opt for physician-assisted suicide to save the family resources and are themselves from suffering.

Opponents of Physician-Assisted Suicide

Arguments against physician-assisted suicide continue to prevail over the proponents’ ideals. Only eighteen states globally have legalized physician-assisted suicide. Opponents of the medical action have laid down several claims ranging from organ donation to advanced depression in chronic illnesses.

Depression

Depression is a prevalent mental health problem. Most chronic diseases today present with depression as one of the major symptoms. In their study, Dugdale, Lerner, and Callahan (2019) established that 70% of elderly patients diagnosed with cancer suffer from depression. Depression instills in patients the feeling of hopelessness where they detach from reality and cannot envision a better future. Depression somatically manifests, calling for thorough psychiatric evaluation to provide patients with the most effective interventions. However, in states like Oregon, where a patient is allowed to take the prescribed lethal injection or drug within two days, it reduces the duration required for an effective psychiatric assessment of patients. Most patients caged in this situation may be seeking suicide because of the constant suicidal ideation manifesting as a symptom of depression. In essence, the opponents of PAS argue that it takes away the opportunity for patients to live a better life when they could be admitted to psychiatric hospitals to restore their will to live.

Organ Donation

The issue of organ donation has elicited debate across different states. Sulmasy (2019) established that euthanasia and physician-assisted suicide have become major sources of organ donation. While the United States has been reluctant to follow this trend of using PAS as a source of organ donation, the future may take a different trajectory that will see several people in the United States undertaking PAS for organ donation. Organ donation is a lucrative business that can attract the illegal killing of patients in the presence of physician-assisted suicide.

The Slippery Slope

Doctors take a commitment oath that holds them responsible for saving lives. Physician-assisted suicide allows physicians to hasten a patient’s death. Once a doctor takes this path, they slip from the oath, increasing their susceptibility to making slippery decisions. Physicians present patients with information that should guide their decisions in choosing or forgoing physician-assisted suicide. Opponents of PAS have pointed to the growing cases of PAS as an outcome of increased physician coercion of patients to take the PAS alternative among the existing. The opponents of PAS also claim that the rising call to legalize euthanasia in the United States is steered by physicians who have embraced physician-assisted suicide as a quick fix to health cases they find challenging.

Suicide Contagion

One single suicide case in a family may create a thread of suicides. Research highlights that a spike often follows high-profile suicide cases in suicide cases. Family members of patients who opt for suicide become highly susceptible to suicide because they begin to perceive it as an easy alternative (Dugdale, Lerner, & Callahan, 2019). For instance, in 2014, Oregon witnessed high-profile death cases followed by increased suicide cases from lethal injection. States that legalized assisted suicide have witnessed more cases of suicide than states which still hold the act illegal.

Conclusion

Physician-assisted suicide is an ethical issue that has raised discussion across states. Globally, only eighteen states have legalized physician-assisted suicide. In the United States, at least four states have legalized PAS. The proponents of PAS continue to support and call for the legalization of PAS across the United States. The proponents argue that PAS relieves patients of suffering, restores patients’ autonomy, independence, and control, and ensures quality care to patients in their end-stage life. Contrarily, opponents of physician-assisted suicide describe the action as a slippery slope for physicians, suicide contagion, increased depression among patients, and suicide contagion. The arguments from both viewpoints continue to elicit more reaction as the benefits seem worth exploring while the cons present significant implications to public health and policymakers. Perceptively, PAS should remain illegal due to its overwhelming cons.

References

American Psychiatric Association. (2017). APA Resource Document on Physician-Assisted Death. Retrieved from https://www.psychiatry.org/file%20library/psychiatrists/directories/library-and-archive/resource_documents/2017-resource-document-on-physician-assisted-death.pdf

Ann, K. (n.d). The Story of Karen Ann Quinlan Made Headlines! Quinlan Hospice. Retrieved from https://karenannquinlanhospice.org/about/history/

Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Pros and Cons of Physician Aid in Dying. Yale Journal of Biological Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913818/

Gopal, A. A. (2015). Physician-Assisted Suicide: Considering the Evidence, Existential Distress, and an Emerging Role for Psychiatry. Journal of Amerian Academy of Psychiatry Law. Retrieved from http://jaapl.org/content/jaapl/43/2/183.full.pdf

Jones, D. A., & Paton , D. (2015). How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide? South Medicine Journal. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26437189/#:~:text=Results%3A%20Controlling%20for%20various%

20socioeconomic,suicides%20(including%20assisted%20suicides).

Mroz, S., Dierickx, S., Deliens, L., & Cohen, J. (2020). Assisted dying around the world: A status quaestionis. Annals of Palliative Medicine. doi:10.21037/apm-20-637

Simmons, K. M. (2018). Suicide and Death with Dignity. Journal of Law and the Biosciences, pp. 436–439. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121057/

Sulmasy, D. P. (2019). Physician-Assisted Suicide and the Perils of Empirical Ethical Research. JAMA Network Open. Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2747689

Ethics of Euthanasia

Euthanasia has been an emotive issue regarding ethics and moral grounds in the medical field since its conception. Some physicians argue that patients have the right to decide their care (Barsness et al. 90). Therefore, these physicians support euthanasia. On the other hand, other physicians argue against euthanasia on ethics and moral grounds that no one has the right to take a life. As a result, the argument against euthanasia views it as murder. My ethics and morals align with the idea of euthanasia. Physicians have a responsibility to respect a patient’s autonomy. Therefore, physicians should respect patients’ wishes when they intend to have the pain stop in terminal illness. As a physician, I value the freedom of choice for everyone. Morally, every individual should die with dignity. Diseases that warrant euthanasia are often causing turmoil to the patient without a tangible medical solution in sight. Subjecting a patient to treatments and additional therapies that do not produce a good enough outcome to reduce the severity of the disease is cruel and denies patients a dignified death.

Additionally, euthanasia is ethically and morally sane because it provides medical resources to patients who need them. Ethically, physicians are required to prioritize patient care for all their patients. Therefore, all patients have a right to have quality resources to help fight their conditions. Euthanasia helps physicians channel resources to those who want to continue living rather than leaving them with patients who have expressed no desire to continue living. Resources such as skilled medical staff, equipment, hospital beds, medication, and therapies can be directed to other patients. Lastly, euthanasia is humane and helps shorten the grief of family members and friends watching their loved ones die a slow, excruciating pain. Medical professionals who care for animals carry out euthanasia on terminally ill animals or are deemed as dangerous to others (Keown 90). This ethical principle should be transferred to humans to allow them the right to choose between life and death when the option of life does not guarantee a long, pain-free life.

Professional ethics and morals on euthanasia present arguments supporting and providing circumstances for euthanasia. As a result, the professional ethics and morals for euthanasia do not support its execution in some cases (Halloran, 34). Medical professionals use professional ethics and morals on euthanasia to navigate the issues regardless of personal ethics and morals. First, medical professionals are required to respect and uphold the human rights of a patient while administering care. Additionally, patients have autonomy over what happens to their lives. Unless incapacitated, patients have a right to make decisions about their medical plans. Medical proxies make decisions for incapacitated patients. Therefore, if a patient decides to discontinue treatment and prefers death, medical professionals are ethically required to uphold the patient wishes. Medical professionals are morally responsible for informing a patient about euthanasia, its impact, and the alternative options available for the patient. Morally, medical professionals are not required to influence patient decisions based on personal beliefs. Instead, they are tasked with presenting unbiased information objectively and obtaining informed consent (Pesut et al. 67). Obtaining informed consent requires a physician to evaluate the patient’s mental state to ensure that the permission was obtained from someone with a sound mind.

Secondly, professional ethics and morals on euthanasia dictate medical professionals practice beneficence. Beneficence dictates that medical professionals make decisions that provide more harm than good to the people involved (Halloran, 89). The morals that support beneficence include mercy and compassion. Therefore, medical professionals are morally required not to prolong the pain and suffering of a patient when they have decided on euthanasia. Professionally, euthanasia can either be active or passive. Passive euthanasia is common among medical professionals as they are ethically obligated to comply if a patient refuses to continue medication and let the disease attack the body to death. On the other hand, active euthanasia differs from the professional ethics and morals that require physicians to protect and preserve life. Physicians take an oath to protect and safeguard the lives of their patients by advocating for treatment options that prolong their lives the patients.

My ethics and morals on euthanasia provide a foundation for upholding professional ethics and morals regarding this issue. Having personal ethics and morals that guide translates to acknowledging professional ethics and morals regardless of personal beliefs. My personal ethics and morals on euthanasia side with the arguments in support of it. Therefore, they will impact how I interpret and enforce professional ethics. My personal beliefs will enable me to identify professional ethics and morals that align with my personal views and uphold them.

Additionally, having personal ethics will ensure I identify contrary professional ethics easily and ensure that they are enforced. Approaches to responding to this issue require to be handled professionally without compromising one’s integrity. I can use a strategy for such a dilemma by prioritizing a patient’s needs. Medical professionals are responsible for ensuring they care for all aspects of patient needs. Therefore, I would objectively listen to the patient’s needs, inform the patient of his options without bias and take his decision without coercing the patient to a conclusion that aligns with my personal beliefs. Lastly, I would ensure to make a decision that aligns with professional ethics and morals. Suppose the right decision for this dilemma infringes on my integrity. In that case, I will ensure to consult with other physicians or remove myself from the patient’s medical team for possible conflict of interest and bias. Although some of my personal ethics and morals on euthanasia differ from those of professional ethics, I plan to reconcile the two to ensure I effectively perform my medical obligations. My plan involves ensuring that I strictly uphold professional standards on this issue. My responsibility to the patient is professional and not personal. Therefore, in a dilemma where my professional and personal beliefs differ, decision-making will use professional ethics and morals on the issue. Remaining objective and unbiased throughout the professional decision-making process and carrying out my obligations will benefit my patients and career.

Works Cited

Barsness, Joseph G., et al. “US medical and surgical society position statements on physician-assisted suicide and euthanasia: a review.” BMC medical ethics 21.1, 2020: 1-7. www://doi.org/10.1186/s12910-020-00556-5.

Halloran, Kathryn. “Ethics of Euthanasia and Physician-Assisted Suicide.”, 2022. www://scholarworks.merrimack.edu/cgi/viewcontent.cgi?article=1061&context=honors_capstones.

Keown, John. Euthanasia, ethics and public policy: an argument against legalisation. Cambridge University Press, 2018. www://books.google.co.ke/books?hl=en&lr=&id=2r9tDwAAQBAJ&oi=fnd&pg=PR9&dq=ethics+of+euthanasia&ots=_gMOVcjGrA&sig=VDNq

TcqO0_7oHv4gAPRAPLuCUdw&redir_esc=y#v=onepage&q=ethics%20of%20euthanasia&f=false.

Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., … & Janke, R., 2020. Nursing and euthanasia: A narrative review of the nursing ethics literature. Nursing ethics27(1), 152-167. www://doi.org/10.1177%2F0969733019845127.