Physician Assisted Suicide, Is it Ethical?
In our society today, we often face ethical dilemmas in our everyday life. In the world of healthcare, many in the workforce, particularly physicians and nurses, face ethical dilemmas, which are more confusing and challenging than before. These dilemmas are sometimes intricate by the advancement in medical technology because it prolongs life; thus, comes with ethical and legal problems over patients’ autonomy, quality of life and death. Physicians, and nurses, are not just healthcare provider that provides medical and health services to people, but they are also part of a profession with moral and ethical responsibilities to the public and their respected professions. According American Medical Association, “By assisting in killing patients, or person, contradicts with competent medical service of preserving life (Davis, 1995).”
The term “Physician-assisted suicide” is an alternative end-of-life decision in which physicians provide individuals with the means to end their life (Johnson, Cramer, Gardner, & Nobles, 2015). The term “Physician-assisted suicide” was coined to accurately reflect the physician and patient relationship to denote the etymological root as “self-killing.” The ethical concern arises from physician-assisted suicide involve patient autonomy, worth of life, and meaning of death. The involvement of healthcare professionals may vary depending on the situation. The physician may instruct a patient for a fatal dose of medicine that a patient can get, or readily available. For example, a physician might tell a patient to take ten times the dose of barbiturates he/she normally take for pain, crush it and mix it in a drink. Any healthcare professional, like nurse, may assist patient by administering or providing means of passing away in his or her professional expertise.
The controversy around physician-assisted suicide centers on the decision of terminating a human life to ease physical and emotional pain. For a long time, issues related to physician assisted suicide have been intensely debated by those who opposes it and advocates for it, and both sides have been gaining grounds. Those who favor, and advocates, for physician-assisted suicide view the method as painless and peaceful death. However, those who opposes argued that there are many consequences with killing a person, or even help kill a person, which includes ethical and legal problems. The International Association of Hospice and Palliative Care also argued, “it[PAS] is unacceptable to argue that the desire to relieve the burden onto others constitutes a legitimate reason for euthanasia or PAS” (De Lima et al., 2017). With the advancement of modern medicine and technology, life and death decision have been more complex and complicated. As a result, controversy in healthcare profession regarding life and death have been on the rise, and healthcare professionals are obligated to tackle the dilemma forcibly.
In my point of view, physician-assisted suicide is a very controversial topic and should be taken lightly. I believe that a person has the right to life and death, however, choosing death means that the patient has taken all possible treatments, has irreversible condition, pain and suffering cannot be alleviated by any means, and must undergo psychiatric and cognitive evaluation to rule out depression. With this point of view, I am by no means advocating for physician-assisted suicide but advocating for the patient. I do not think it is ethical to keep a patient alive if none of the treatments work and they are suffering from a tremendous amount of pain.
Advocate for physician-assisted suicide argue that each individual should have the right to life and the right to die, and live or die in a dignified way. This means that each individual has the right to choose their own dignified quality of life and death, it is a personal choice. If so, then the value and significance of human life is based entirely on subjective decisions based on criteria or standards. This affects the whole society and not just those who are thinking of physician-assisted suicide because we are now putting value on each individual’s life. Patient’s pain and suffering does not justify taking away the value and worth of a human life (O’Rourke, M.A., O’Rourke, M.C., and Hudson, 2017). For society to survive and flourish, our society has to recognize that all lives are important.
Those who oppose physician-assisted suicide claimed that ethical and legal consequences should be considered. According to Davis (1995), medical professionals are dedicated in saving and preserving human life (p. 3). By assisting with patient’s, or person, suicide, it contradicts with competent medical service that the healthcare professionals uphold, which is to preserve life. The Hippocratic Oath’s, “First, Do No Harm,” is an essential duty and obligation that many physicians take. Physician-assisted suicide is not, by any means, a form of medical care whatsoever. Allowing physician-assisted suicide destroys the core value of our healthcare system and the physician-patient bond that we form with our patient and the public.
Applying Kant’s Categorical Imperative in this dilemma agrees with the opposition of physician-assisted suicide. According to Kant, “Duty is the necessity of an action done out of respect for the law” (Howard, n.d.a). I think this means that physician should not hasten a person’s death because their duty is to preserve and save lives. It is unethical and against the law to purposely kill someone or provide the means to do it. It is against the American Medical Association Principles of Medical Ethics to assist in killing patient, or person, because it does not follow their ethical principles. Providing or helping someone end their life is considered against the law even if the physician is doing it for the patient because killing someone is murder, therefore, any kind of killing whether it has good intention is still murder.
On the other hand, Kant’s Categorical Imperative doesn’t always apply in all situation. What if a patient is truly suffering and have used all possible resources to alleviate pain, has an irreversible condition and have made peace with his/her family and friends, and the only way to alleviate pain is to die? Using Kant’s Categorical Imperative, murder is murder. But when is it not murder, or okay to end life? Kant did mention that there is an exception to the rule, immorality. Immorality is defined as conflicting with generally or traditionally held moral principles, judgement of right or wrong (Merriam Webster Dictionary, n.d.). If a patient has received all possible treatment to alleviate pain and to improve quality of life, and a physician is prolonging his/her life, wouldn’t it be immoral and unethical to et someone live with that amount of pain? It is immoral to let someone live like that knowing what they’re going through.
Kant believes that we should respect people and their rights. “Act in such a way that you treat humanity, whether in your own person or in the person of another, always at the same time as an end and never simply as a means” (Howard, n.d.a). We should respect people’s right of autonomy and freedom. To deny someone of freedom and free will is treating them as a mere means to an end, thus, undermines Kant’s Categorical Imperative. Everyday we use people as means to an end. For example, we use people to order drinks at coffee shops, when we use uber, and when we go to salons. But the main point is that we don’t use people as merely a means to end.
One other principle I really liked that we discussed in class was Rand’s Objectivism. Rand’s Objectivism surrounds the principle of self-interest, and that selfishness should be a virtue. Her philosophy revolves around a person’s happiness is his/her moral purpose in life and reason as his/her absolute (Ayn Rand’s Atlas Shrugged, 2010). There is no greater goal in life than achieving one’s happiness. Applying this concept to physician-assisted suicide, Ayn Rand’s Objectivism advocates for physician-assisted suicide because it promotes the patient’s, or person, self-interest.
On the other hand, using the physician’s point of view on this matter it is the opposite than from the patient. Rand’s Objectivism does not promote their own self-interest as well as others in a cooperative way, avoid helping others, and balance his or her own interest with the interest of others, but it promotes any decision becomes right by virtue of one’s advantage and nothing else (Howard, n.d.b). Thus, by helping patients to commit suicide do physicians feel good about themselves or because they helped someone. Most would probably not feel good by helping someone commit suicide, therefore, it is not self-centered and does not agree with Rand’s Objectivism philosophy.
The method that I prefer between Kant’s Categorical Imperative and Ayn Rand’s Objectivism is Kant’s Categorical Imperative. I prefer Kant’s because it focuses on the physician’s duty, the promise they took that they will save and preserve lives. Any form of killing, whether it’s requested by the patient, is still a murder. I also like that there is a bit of an exception with Kant’s philosophy which is immorality. I do believe it is immoral and unethical to let someone suffer knowing that they have done everything there is to do to alleviate pain and end suffering but no avail. I think that physician-assisted suicide should depend on the patient’s situation, ruling out depression and cognitive function is intact.
I think that each physician-assisted case should be evaluated intricately and meticulously. I do not fully agree with physician-assisted suicide, however, there are some instances that warrant it, mainly to relieve someone of endless pain and suffering when everything has been done because I fully believe that it is unethical and immoral to let someone live in great amount of pain. Imagine yourself feeling burning and stabbing pain every second of your life and the only way out is to end your life? We should respect people’s request to end their life and also meet their physical, emotional, and spiritual needs—a holistic care, and intense communication to better understand the underlying attitudes and motivation.
- Ayn Rand’s Atlas Shrugged. (2010, June 11). Retrieved from https://atlassociety.org/commentary/commentary-blog/3347-ayn-rand-s-atlas-shrugged
- Davis, M. (1995). The state’s Dr. Death: What’s unethical about physicians helping at executions?
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- De Lima, L., Woodruff, R., Pettus, K., Downing, J., Buitrago, R., Munyoro, E., … Radbruch, L. (2017). International Association for Hospice and Palliative Care Position Statement: Euthanasia and Physician-Assisted Suicide.
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- Howard, D. (n.d.a). Philosopher Lecturette. Retrieved June 23, 2019, from https://lms.courselearn.net/lms/CourseExport/files/ce8821c9-17d6-4342-a8e2-0c5f5a506216/documents–Kant.pdf
- Howard, D. (n.d.b). Week 6 Lesson: Ethics within Human Relationships. Retrieved from https://chamberlain.instructure.com/courses/42288/pages/week-6-lesson-ethics-within-human-relationships?module_item_id=5246715
- Johnson, S. M., Cramer, R. J., Gardner, B. O., & Nobles, M. R. (2015). What Patient and Psychologist Characteristics Are Important in Competency for Physician-Assisted Suicide Evaluations?
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- Merriam Webster Dictionary. (n.d.). Immoral. Retrieved from https://www.merriam-webster.com/dictionary/immoral
- O’Rourke, M. A., O’Rourke, M. C., & Hudson, M. F. (2017). Reasons to Reject Physician Assisted Suicide/Physician Aid in Dying.
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- Rohlf, Michael, “Immanuel Kant”, The Stanford Encyclopedia of Philosophy (Summer 2018 Edition), Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/sum2018/entries/kant/>.