There are two central and distinct moral issues about physician-assisted suicide. First, is physician-assisted suicide morally justified in any individual cases? Second, would it be ethically justified for public and legal policy to permit physician-assisted suicide? In some cases, assisted suicide has seemed to be endorsed ahead of euthanasia; indeed, most policy proposals brought to legislatures or to the public in state referenda in the last few years have applied only to assisted suicide and not euthanasia.
The main difference between assisted suicide and euthanasia is that, despite both being aided by a physician, the former is implemented by the patient him/herself while the latter is carried out by the physician due to incapacity of the patient to do so. In each, the physician plays an active and necessary role, for instance, of providing the lethal dose to be used in the process of ending the patient’s death. In both cases, the patient has the full choice of deciding what to be done on him or her. Given that both acts tend to provide an ethical issue/dilemma, it becomes unrealistic as to why the legal policy should allow the application of either. However, some people argue that because in assisted suicide the patient must take the final physical act that results in his or her death, there is greater certainty of the patient’s voluntary resolve to die than when the physician performs that act.
Ethical Argument for Assisted Suicide and Euthanasia
Acceptance of assisted suicide and euthanasia is not as radical as moral departure from the current consensus and practice giving patients the right to decide to forgo life support. Since both are voluntary, Brock (1992, Para. 8) claims that self-determination in both assisted suicide and euthanasia involves “people’s interest in making important decisions about their lives for themselves according to their own values or conceptions of a good life, and in being left free to act on those decisions.” In this case, an individual is bound to live as he/she wishes as well as make decision on time and manner of his/her death, given that he/she has total control of his/her life so long as such control does not override the limits of justice. However, “a central aspect of human dignity and the moral worth of persons lie in people’s capacity to direct their lives in this way” (Brock, 1992). Moreover, self-determination provides an individual the right to make valuation of his/her life and make decision as to whether it is worth living or not, and at any time, he may apply the self-determination solution he/she feels is necessary.
Individual well-being also significantly influences assisted suicide in that, despite life being considered critical to a person, there are instances when the individual feels that it is not worth the pain and long-term suffering especially when the individual is terminally ill. In addition, poor health that has persisted for quite some time may be perceived by a patient as valueless, thus prompting the patient to seek termination of life as the desired solution to the burden of suffering. This is more likely to be observed when the patient’s health has deteriorated so much that all the efforts of life-sustaining treatment seem to be burdensome to the patient and the caregivers, thus as per the patients judgment and perception, such continued treatment has less value that no life at all.
However, despite patients having the value or right of self-determination, physicians are bound by moral or professional values/ethics that they have to adhere to at all times; therefore they will only approve any action of assisted suicide when their personal judgment explicitly determines that such action is morally justifiable. Physicians are moral and professional agents whose own self-determination or integrity should be respected as well. If performing assisted suicide becomes legally permissible but conflicts with a particular physician’s reasonable understanding of his or her moral or professional responsibilities, the care of a patient who requests assisted suicide should be transferred to another (Weir, 1997, p. 91). Therefore, even where the legal policy has provided that it is legitimate for a patient to decide the end of his/her life, the physician has the moral obligation to seek alternative solution, and will only abide by the action of assisted suicide as the last option, that is, when all other alternatives have failed to provide adequate solution.
The United Supreme Court ruled that there is no constitutional right to assisted suicide. Most states explicitly criminalize it. However, Oregon has chosen to legalize physician-assisted suicide in certain circumstances under detailed procedures. Some view the ability to control the manner and timing of death in this way as a right. Inadequacies in end-of-life care continue to make legalization an appealing option, or at least an option many view as worth having, and well organized efforts to legalize physician-assisted suicide continue. The physician-assisted suicide has been kept on the national policy and legislative agenda as the Pain Relief Promotion Act of 1999 and other bills are being considered. Physician-assisted suicide is one of a spectrum of end-of-life issues in medical context, ranging from withholding or withdrawing life-sustaining treatment when patients refuse such treatment, to prescribing high doses of pain-relieving medication that risk hastening death, to active euthanasia in which a physician brings about death directly by administering a lethal injection at the request of a patient. Legal and ethical commentators often cite a difference of causation to account for the distinction between withdrawing life-sustaining treatment and assisted suicide (Snyder and Caplan, 2002, p. 20).
Euthanasia and Self-determination
The self-determination or autonomy argument in favor of euthanasia reaches back to classical antiquity. Autonomy is the right of a person to control his or her body and life decisions. The ones who stick to this argument suggest that our liberty should include the freedom to choose our final exit in as far as we do not interfere with or harm other people’s lives. If there is legal prohibition of euthanasia, the law would fail to respect the freedom of those who want the physician to assist them in dying. According to the proponents of self-determination, the patient who either consents to being killed or asks assistance in suicide presumably harms no other person, thus from this perspective, laws restricting assisted suicide or euthanasia seem paternalistic, unjustified, and arbitrary. Many Americans seem to agree that the value of self determination extends to choosing the time and manner of one’s death based on the value his/her life at any given time. Indeed, if self determination is a value, then it is important that each individual be allowed to control the manner, circumstance and time of death.
The Catholic Church has no quarrel with a properly contextualized understanding of autonomy. The church defends the inviolability of a properly formed individual conscience. It similarly defends the right of the individual to refuse burdensome medical treatments. But the church holds that there are divine limits on the autonomy not only of individuals, but of nations and states as well. Some pro-choice advocates however place no such limits. Choice and control become important for their own sakes. Individuals have a right to make important decisions about their lives and lifestyles in pursuit of what they deem to be the good life. They should be free to act on these decisions without interference. Within the bounds of justice and so long as others are not harmed or their freedom interfered with, society ought not to interfere with life-ending decisions.
One of the central aspects of human personhood and dignity is the ability to direct one’s life without undue interference. Essential to this dignity is the sound mental capacity of the individual concerned: organic dementia and psychological or psychiatric factors limiting mental competence would prevent the individual from making significant end of life decisions.
American courts have tended to extend civil rights enjoyed by the competent and able-bodied to the physically and mentally handicapped by surrogates. Some argue that the right to death must be extended to all, even the mentally incompetent. Providing an administrative mechanism for exercising these rights on behalf of the handicapped may lead to evolutionary euthanasia or surrogate euthanasia by judicial fiat. Physician’s right to self determination should also be respected under all circumstances. Most who view euthanasia as a right would permit the transfer of patient care to another physician in a case where a patient wishes euthanasia but the physician disagrees with or cannot honor the decision due to personal belief.
Opponents of euthanasia argue that there is a naïve expectation of the degree of freedom involved in making the choice to end one’s life. Those who practice clinical medicine or care for the elderly have seen many instances of elderly patients being subtly, and sometimes not subtly, pressured by loved ones or relatives. Even if the family does not exert psychological force, the decision to request euthanasia is hardly free if the consequences of living are financial ruin or psychological or medical mistreatment. Unequal access to health care, along with economic pressure to contain costs, may create an unhealthy pressure for euthanasia as an easy solution. Socio-economic factors are not the only pressures that may influence inappropriate choices for euthanasia or physician-assisted suicide (Manning, 1998, p. 31).
The Controversy in Euthanasia and Assisted Suicide
The legal forms of assisted suicide and euthanasia have provoked moral arguments. People opposed to euthanasia and assisted suicide make the following arguments:
- Individual freedom does not include the right to kill oneself or anyone else.
- A good society will care for vulnerable people, such as the disabled, those who are near death and the elderly.
- The job of a doctor is to protect and prolong life, not to end it.
- On the contrary, those that support assisted suicide and euthanasia argue that:
- Life no longer counts as human life when its quality and meaning are gone.
- Personal autonomy includes the right to chose one’s own death.
- A humane society will allow its members to choose dignified and painless deaths.
Ethical and Religious Viewpoint on Assisted Suicide
Ethicists study whether certain ideas or behaviours are right or wrong. Generally, ethicists take two sides on the question of euthanasia – the traditional side and the libertarian side. Traditionalists strongly disapprove of assisted suicide. They accept passive euthanasia under certain, very strict conditions. They believe that life is worth living even when it involves extreme suffering.
Libertarians approve of euthanasia as long as the doctor’s intention is to relieve the patient from unavoidable pain. Libertarians make no distinction between doctor-assisted suicide and passive euthanasia. They feel that the quality of a life determines its value. If a person is permanently incapable of responding to his or her surroundings, they believe that individual is not alive in any meaningful sense of the world. These differing ethical principles sometimes combine with religious beliefs. Religious opponents of euthanasia claim that life is a gift from God. People must continue their life journey through happiness and sorrow, pleasure and pain. They must have faith that all their experiences, even pain and illness will help them to develop spiritually. Religious proponents of euthanasia argue that when God takes a person’s consciousness, He has taken the person’s life. Without consciousness, no one can develop either intellectually or spiritually (Forman, 2008, p. 14).
The Oregon Law
Most states make assisted suicide a crime. However, in Oregon a ‘death with dignity law’ was enacted and became effective in November 1997. This is the first law of its kind in United States. For this law to apply for a patient, the patient must be terminally ill and is likely to die in the few months, that is, within half a year. The patients must have the mental capacity to fully understand the situation that confronts them. There is a fifteen day waiting period after the patient applies and is found to have qualified for physician-assisted suicide. An Oregon physician may then prescribe drugs to end the patient’s life, but the physician does not administer the drugs (Gardner, 2008, p.253).
Although assisted suicide is legal in certain parts of the world, in most places the debate about whether it should be legal continues. Despite these considerations, some people feel that they have a right to choose what they consider a dignified death rather than enduring a long and painful one. Many U.S citizens argue that the Constitution, which protects their liberty and privacy, gives them the right to choose passive euthanasia or assisted suicide. Physicians routinely do what would be criminal for non-physicians to do. Neither homicide laws, nor the criminal’s law’s construction of intent generally, contain exceptive clauses for physicians. Yet, no physician acting within his capacity as a licensed, medical fiduciary for hiss patient, has ever been convicted of homicide or for assisted suicide
Public policy, as expressed in the law, gives competent patients the right to refuse any treatment, including life-sustaining treatment, and thereby gives greater weight to respecting the patient’s right of control or self-determination regarding his or her own life. In this case, the person decides whether his/her life is worth living at any particular time and may make decisions that he/she feels have more value.
Brock, D. W. (1992). Voluntary active euthanasia: Dying Well? A Colloquy on Euthanasia and Assisted Suicide. Web.
Forman, L. (2008). Assisted Suicide. Minnesota, ABDO Group. Web.
Gardner, T. J. and Anderson, T. M. (2008). Criminal Law. CA, Cengage Learning. Web.
Manning, M. and Manning, D. (1998). Euthanasia and physician-assisted suicide: killing or caring? NJ, Paulist Press. Web.
Snyder, L and Caplan, A. L. (2002). Assisted suicide: finding common ground. IN, Indiana University Press. Web.
Weir, R. F. (1997). Physician-assisted suicide. IN, Indiana University Press. Web.