Physician assisted suicide
- Is physician assisted suicide ethical, should a patient be given the chance to decide. (Lagay, 2018)
- should people be allowed to decide their own destiny when it comes to living or dying? (Rehm, 2018)
- The general view of death, is it beneficial or harmful? Goligher et al. (2018)
Introduction
The interest on legislation and legalization of physician-assisted suicide have escalated in the recent past and the public domains’ scope in the subject has increased. Situations where the patient is terminally ill or is in constant excruciating pain and can only survive on machines and medication have prompted questions on the legalization of euthanasia. Patients in this situation who decides to consciously end their lives may not have many options. Mercy killing as is often referred is against the law in many states. Should physician-aided suicide be legalized?
What is Physician-Assisted Suicide and is it Ethical.
Physician assisted suicide (PAS) is essentially one of the most controversial topics being indulged in by the members of the society today. Owing to the animosity of the situation conferred on physicians regarding this by recent laws, it has become imperative to stringently examine the situations surrounding this by seeking psychiatrists’ views and other specialists who will be consulted regarding the execution of PAS on a patient’s request.
Support has been advocated for certain situations such as the possibility that mental disorders occur in patience requesting PAS, but not for other issues such as the practice can be misused by being carried out on the vulnerable section of society.
Basing on the ethics surrounding the practice, several questions that are associated with the moral dilemma are raised:
- Is it essentially right to terminate the life of a patient with an incurable disease or one who is in consistent pain?
- Which situations call for the execution of euthanasia and does it make it right?
- Is there a disparity between letting someone die naturally and helping them eliminate their life? (Rehm, 2018)
Physician-aided suicide is usually carried out at the person’s request, but a situation may arise where the patient is indisposed due to illness in which case the decision is left to the relatives, medical experts or, in some extreme cases, the courts.
An issue that has prompted constant debate about PAS is the different perceptions surrounding the meaning and value of human existence. The debate that is constantly raised is weather human beings in their mortality have the right to decide human life?
Difference between Physician Assisted Suicide and Euthanasia
In physician assisted suicide, the physician gives the patient the means to end his or her own life. In euthanasia, the physician directly and in a deliberate manner, intervenes to end the patient’s life.
Some factions of society have gone against euthanasia and are saying it should never be allowed even if it has moral authority because it can be abused in a large scale to cover for murder and deliberate killings. In this case involuntary killing is carried out and covered up with legislation associated with euthanasia. The greatest debate is that it will be difficult to govern all cases and rogue physicians and those involved may take advantage. The ethical argument surrounding this practice is that it could inevitably become a slippery slope. General consensus has it that involuntary euthanasia has no distinction from murder and it could prove to be an uphill task trying to bring murderers to justice when euthanasia is given the green light. There is also a plausible observation that medical practitioners could take upon themselves to kill patients without their prior consent, or in extreme cases they may start murdering patients to create space, or to save money. This goes a long way in showing the dangers that are associated with legalization of euthanasia that will ultimately lead to involuntary euthanasia.
The other point of view of the debate points to the fact that people in their own sense have the right to terminate their own lives, however, and whenever they deem it necessary. Many of those who advocate for the legalization of PAS have the perception that everybody has the right to do with their body and life as they will and should have the right to decide in which manner and at what time they will pass on. Their point of view on this is that unnecessary stringent measures placed against human rights should be done away with. They argue that because people have the right to life and in essence have the right not to be killed if they don’t want to, this then will help in alleviating the risk of euthanasia being abused and used inappropriately, this they say arguably that killing a person would be a violation of their fundamental human right. It can also be put in the aspect of death being a personal and therefore private matter, if there is no risk of violating other peoples’ personal right, there is no point in deny anyone their ingrained wish to die. Augmenters of this line of thought say that if euthanasia fulfills the desires of all those concerned and doesn’t go against any human rights then it is ethical and moral to accept euthanasia as a way of life.
Another proponent on advocacy against euthanasia that is perceptively practical is that PAS is not necessary if palliative measures are being administered. Patients who are terminally sick are put on drugs to alleviate the physical pain and discomfiture, which will better the patients’ quality of life. This however does not do away with all the pain as it is not the physical pain alone that may be ailing the person, psychological trauma experienced by someone waiting to die can be inevitably detrimental, even though the stressful trauma experienced by the patient can be lessened by the palliative care and can go a long way in giving the patient a more comfortable existence. The care provided when palliative measures are effected successfully will provide the patient with quality time to spend with family and loved ones, this will allow the terminally ill patient to live the remainder of their lives with some pain removed and less distress as possible. However an argument has been raised in the past that due to the expensive nature of palliative care, with the legalization of euthanasia, much focus will be shifted to it to possibly eliminate the cost than to prolong life and incur further expenditure. This will also invariably lead to scanty availability of palliative care. This will also inevitably lead to diminished care for patients who do not wish to be euthanized. But there always arises a situation where the patient is too terminally disposed that palliative care will do less to lessen the trauma, could this mean that administration of euthanasia could be the better option? Rourke and Hudson (2018)
Proponents for the advocacy of euthanasia have come up with another plausible argument they reiterate that if people could do away with the premonition that death can be in no way positive then, it can be accepted that it is a better option than sustaining a terminally sick patient in discomfiture and consistent pain on the verge of inevitable death. Perhaps if death wasn’t viewed as the worst possible scenario, then the negative opposition against euthanasia will be eliminated, for they stem from the notion that death is not good. People actually avoid death because of the feeling of fulfillment and enjoyment that comes with being alive, this may not be the case with terminally sick who often at times cannot have the fulfillment and therefore cannot enjoy life. This can unalterably lead to the patient suffering mental anguish and can devalue their life and wish to be euthanized, this can accrue negatively on the family of the patient. Those who favor this line of thought and advocate for euthanasia argue that in this case the patients’ death may be a less painful option than prolonging their life then their wishes should be respected. Goligher et al (2018)
In this day and era of decayed morality and justice and a decline in both, there is an argument by those who are for the abolishment of euthanasia that, relatives and family members may misuse the practice and deliberately apply it against the patient’s wishes to gain property. These cases have been observed in court and have been a subject of much debate with the catch phrase ‘mercy killing’ should not be misplaced for ‘killing mercy’ in the esteemed medical profession. So to avoid situations of such nature from occurring then there should be constant revision of conduct and ethics among the medical elite. It is also imperative to come up with laws that protect the terminally ill and also practitioners from unnecessary and avoidable lawsuits. (Lagay, 2018)
Latest research has revealed that a great number of those terminally sick patients that ask to be euthanized, suffer from depression, and their desire for death is related to the mental disorder. Psychiatrists however argue that if care and palliative treatment is given, and counselling administered then those suicidal thoughts can be put to rest. However in cases where major depression has escalated to the point where counselling cannot be effectively used and physical pain is unavoidable then the advocates for euthanasia deem it a necessity to obey the wishes of the patient and the concerned faction.
The assumption that legalizing euthanasia will lead to its abuse has another angle to it in that not providing regulation for it will lead to it being secretly carried out. Coming up with laws which will regulate the practice and physicians will lead to better monitoring of facilities and prosecuting those who engage in it illegally. Arguably the government has no right to infringe on decisions that involve the self, they should rather oversee that it’s done in the stipulated way. This will allow the terminally ill to die with their dignity intact, and to prevent suffering over long periods waiting for the inevitable death. The expenses that can be accrued medically should also be a case in point, the family of the patient will suffer trauma related with having a patient suffer for a long period of time that may lead to the ultimate elimination of the family.
Another concern that has been raised by those opposed to the advocacy of euthanasia is that the mentally incompetent will be abused. There is a huge disparity when explaining the terminally ill and mental incompetence. Mental incompetence will be construed to mean the party in question is not aware of the consequences that have been arrayed against their life and are incapable of making sound judgement, this therefore calls for a heightened sense of safety of those people.
Conclusion
The ultimate result of physician-assisted suicide has a different sense to different factions, others may see it as homicide and others see it as mercy. Those who are against the practice have sought ways to show that it will be abused and has detrimental consequences whereas those of the contrary opinion maintain that it’s the right of a person to decide if they want to live or die or at least the family in cases where the subject is indisposed.
Both methods have advantages and disadvantages and it remains the duty of the regulators to see that if legislated they are not abused and in the case where it is not then it should be ensured they are not carried out.
References
Dianne Rehm. (2018). Let Dying People End Their Suffering, https://www.nytimes.com/2018/06/07/opinion/california-end-of-life-aid-in-dying.html?rref=collection%2Ftimestopic%2FAssisted%20Suicide&action=click&contentCollection=timestopics®ion=stream&module=stream_unit&version=latest&contentPlacement=10&pgtype=collection
Discussions on the site were based on weather patients should be given the choice of deciding if the wanted to continue living or if they should be allowed to choose either PAS or euthanasia considering that some terminal illnesses caused prolonged suffering for instance chemotherapy. The article questioned the laws that were in place and against these practices. The article also argued that in the case of terminal illness, death was inevitable and would cause n harm if carried out prior. It argues that physical pain is far worse than the actual death and advocated for its speedy legislation. Terminal illness can also prove to be a burden to the family in many aspects including financial, and mental detriment. PAS and euthanasia should be allowed where death is inevitable and prolonging it causes more harm than good. The article argues that it should be up to the person in the situation to decide and not legislation.
Ewan C. Goligher., Daniel P Sulmasy., John Raphael., Annmarie Hosie., Larry Churchill., Wesley E. Elly.,…. Douglas B White. (2018) Physician-Assisted Suicide and Euthanasia in the Intensive Care Unit: A Dialogue on Core Ethical Issues, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5245170/
In dealing with physician assisted suicides, four key issues were identified that clearly brought out the views of the argument at hand these were: the morality surrounding physicians knowingly administering death, the correct methods to manage conscientious issues and views against PAS and euthanasia, the relation between PAS and euthanasia and the choice of keeping the patient on life support and withdrawing it, and the positivity and negativity surrounding death, different conclusions were reached regarding the ethical issues surrounding PAS and euthanasia with several issues being raised including weather it is a violation of human rights to fully legislate PAS and euthanasia or denying it being carried out, there were objections raised against involuntary euthanasia, which basically means death of the patient without their consent, voluntary euthanasia on the other hand was lauded because it involves consent of the patient in cases where a terminally ill patient is given the chance to decide weather to live or die.
Faith Lagay. (2018). Physician-Assisted Suicide: The Law and Professional Ethics, https://journalofethics.ama-assn.org/article/physician-assisted-suicide-law-and-professional-ethics/2003-01
Several issues were raised regarding the legality of PAS and euthanasia and the relationship between law and professional ethics, reasons were given as to why some physicians actually carry out euthanasia and PAS, patients with terminal sicknesses were seen to be more deserving of the PAS due to the psychological and physical drama involved. Dignity for self and others was also discussed with PAS being encouraged due to the medical expenses that may be incurred by the family in cases where the illness is prolonged. PAS was also seen as a way of ensuring a clean death when administered to patients’ as opposed to when the patient does it alone, it was also observed that the physical trauma and mental anguish from which the patient will not possibly recover do not in any way violate the ethics of the medical profession.
Mark A. O’Rouke., M. Colleen O’Rouke, & Matthew F. Hudson. (2018). Reasons to Reject Physician Assisted Suicide/Physician Aid in Dying, http://ascopubs.org/doi/full/10.1200/JOP.2017.021840
The piece argues that in cases where proper care is administered then there is no need for PAS or euthanasia. The argument is that in the case where medical help is withdrawn then the cause of death is natural but when a patient is given medication to end their life then the cause of death is inflicted and should not be encouraged. The proposers of this line of thinking argue that physicians are primarily there to offer protection to the patient against external intervention. It argues that palliative treatment should be a priority. The article goes on to state that palliative treatment is available and at an advanced level and can comfortably cove terminally ill patients’ making the remainder of their stay as comfortable as possible. PAS goes against the ethical mandate of physicians whose primary focus should be to provide care for the patient.