Should Physician-Assisted Suicide Be Legalized - Essay Example

Should Physician-assisted suicide be legalized? and number submitted Should Physician-assisted Suicide Be Legalized? Introduction In the current age of modern medicine, there are various advancements which have been introduced into the practice. These advancements have made it possible to treat many of the diseases afflicting the general population. These advancements however have not completely eradicated or treated many other diseases, including most forms of cancer and the different forms of cardiovascular and organ-failure diseases. Consequently, many of these diseases cause the eventual deaths of those afflicted. The symptoms of these diseases also cannot be relieved by available medical remedies, and so many patients suffering from these diseases are made to endure severe and chronic pain, vomiting, difficulty in breathing, and other similar discomforts. They are often also made to endure such symptoms for days and even months before they eventually die. In the interim, they often reach the point of wanting to end their suffering and pain by ending their life. Lacking the strength and the means to end it, these patients turn to their physicians to assist them in ending their life. But legalizing physician-assisted suicide (PAS) is a dangerous step which is very much against the basic principles of the medical practice. With such a premise, this paper shall discuss and support the thesis that physician-assisted suicide should not be made legal. Argument An important consideration in the assisted suicide discussion is the fact that committing it is against the basic principle of non-maleficence or of not doing any harm to one’s patient. The Hippocratic Oath which serves as the basic ethical mandate of the medical practice expressly prohibits physician-assisted suicide and euthanasia (Finlay, 2005). This oath declares that a physician should not “administer a poison to anybody when asked to do so, nor will [the physician] suggest such a course” (as cited by Demy and Stewart, 1998, p. 249). In the time of Hippocrates, assisted suicide and euthanasia were very much against the principles of medicine. In the current context however, assisted suicide and euthanasia are ideas which are new and different from the concepts of medicine and care (Walker, 2001). Those who support physician-assisted suicide and euthanasia also have different ideas on what it is to be a physician and what the moral boundaries of the practice are. “It is also telling that the current public interest in PAS comes at a time when the palliative powers of American medicine are greater than they have ever been in the past” (Walker, 2001, p. 27). All in all, it can be deduced that the public is not aware of the various technological advancements in palliative and hospice care. In effect, this implies that palliative care is not fully utilized in the practice as an essential part of medical care. In a medical practice where assisted suicide is available as a legal remedy, the focus of care becomes skewed towards the easier option. Between palliative care and assisted suicide, assisted suicide is the less costly, less painful, and less burdensome option. Instead of further developing palliative care practice, its progress in the medical field can potentially be reduced to a slower pace (Walker, 2001). Faced with reduced quality of palliative care and the option of assisted suicide dangling over their heads, patients suffering the overwhelming symptoms of their terminal illness may find that there is no other choice for them but to opt for death and assisted suicide. In effect, although they do opt for assisted suicide, the circumstances which have led them to that decision are less than ideal; in other words, their choice was made because they had no other option but to just give in and choose death (Ardelt, 2003). In the medical practice, legalizing assisted suicide grants more legitimacy to its incorporation into the medical practice. It becomes another legally sanctioned intervention or medical remedy. But unlike other remedies which usually evolve or improve, there is no other goal or improvement to this remedy, because the nature of its application ends all possibilities for improvement. This cannot bode well for the practice and for improvements in the medical practice – that of seeking better lives and better interventions for patients, regardless of the hopelessness of their situation. Physician-assisted suicide should not be made legal because it will likely lead to a slippery slope, one which leads towards voluntary euthanasia and even beyond (Churchill and King, 1997). There is a close-link between euthanasia and physician-assisted suicide. First of all, they are based on the same principle – that of ending the life of a chronically ill patient, in order to end his pain and suffering from his illness. Euthanasia may be active or passive with the active kind implying an active act by the physician to end the life of the patient; or it may be passive, as in not rendering resuscitation when the patient’s heart has stopped. Very close to the above act is that of physician-assisted suicide where the physician would, with the consent of the patient, assists the latter to commit suicide (Battin and Lipman, 1996). The assistance may come in the form of a drug which would be fatal to the patient. With the closeness and similarity of these acts, there is a danger of one thing leading to another – that the legalization of one would eventually lead to the legalization of the other. The close relationship between physician-assisted suicide and voluntary euthanasia is in harmony with the concept of patient choice which is the strong basis for these acts (Larson, 1995). To most people, choice is the most important consideration, and allowing physician-assisted death to be carried out without the patient’s choice is a clear evil which is not to be contemplated in any shape or form. Those who support physician-assisted suicide and voluntary euthanasia are indeed clear in pointing out that the application of these acts must be on patients who are able to choose. Miller, et.al., (1994) argues that only adults who have the decision-making capacity are allowed to be considered for physician-assisted suicide. In following the concept and logic of ‘choice,’ there is “little to stop a slide from PAS to voluntary euthanasia” (Walker, 2001, p. 27). And by strictly applying the choice element of the acts, it is possible to prevent the acts from being pushed further into non-voluntary euthanasia. This is the danger being pointed out by those who argue against assisted suicide, that it might lead down to a slippery slope which we cannot pull back from. A stronger basis for the argument against assisted suicide is that it is tantamount to playing God (Feldman, 1998). Plato, Aquinas, and Kant set forth their argument against assisted suicide in different ways. Aquinas claims that suicide is wrong because life is a gift of God to man, and therefore it is a gift subject to God’s whims. In effect, a person who commits suicide also commits a sin against God. Plato also argues that according to Socrates, the gods are the guardians and people are the properties of these guardians. Man must therefore wait until these gods call on him (Feldman, 1998). Kant’s arguments against suicide also involve God when he sets forth that humans are placed in this world for specific purposes; suicide is akin to deserting one’s post and is an opposition of God’s purpose for man. Moreover, Kant claims that we are God’s possessions and he is our master. In further supporting the argument of ‘playing God,’ Plato and Kant point out that we are God’s property and in the act of committing assisted suicide, we are also destroying someone else’s property (Feldman, 1998). Since the act of destroying someone else’s property is always a wrong act, it follows that suicide is always wrong. In continuing this argument to assisted suicide, since suicide is similar to playing God with our lives, it follows that helping someone to commit suicide is also playing God. This makes the act a sin, and therefore basically wrong and immoral (Feldman, 1998). Counter-thesis and counter-argument One of the ethical principles in the medical practice is that of autonomy and self-determination. In applying such principle to the assisted suicide concept, the sense of positive freedom can be specifically utilized. In this sense, positive freedom refers to “the property of the will of all adult human beings insofar as they are viewed as moral legislators, prescribing general principles to themselves rationally, free from causal determinism, and not motivated by sensuous desires” (Hill, 1991, p. 44). In effect, autonomy applies as a normative principle which lies naturally in all people. Autonomy encompasses all logical human beings in perceiving humanity, on its own, as an end (Charalambous, 2007). For assisted suicide, autonomy is a binding reason, so far as it seeks to preserve and protect human dignity. The reliability in being able to maintain one’s practical identity is a crucial element in a person’s life. Such reliability ensures that a person also secures his moral values. In effect, as a person attests to have meaning in his life, he expresses such meaning in his action (Charalambous, 2007). Consequently, he endows himself with his practical identity – one which distinguishes him from other people. The essence of respecting someone’s preference in maintaining his identity is especially important in assisted suicide. It is important because a person can be made to understand that maintaining an identity is a crucial condition from where obligations may arise (Korsgaard, 1996). Therefore, in relation to assisted suicide, there is a need to recognize the normal wishes of a person in maintaining his identity and values. Moreover based on personal dignity or the maintenance of one’s moral choices, the decisions of terminally ill individuals must be accepted. Respecting other people, especially the terminally ill does not necessarily require keeping these people alive; “it just obligates us to treat them with respect in any way that is required by their personhood. The recognition of the value of human life does not imply, as it is often argued, that somebody is obligated to live” (Charalambous, 2007, p. 129). In other words, the respect for human life is not diminished by death or by choosing death, especially when the alternative is a life of pain and extreme suffering. The application of assisted suicide has also to be emphasized as a voluntary choice, and one which is the last resort for patients who have no hope of recovering or being relieved from symptoms regardless of the medical interventions administered (Salem, 1999). It is not a remedy which is being implemented without considering other possible choices and possibilities. At a point in the patient’s life when their life involves much pain to the point that their life revolves around such pain, these patients start to see their life as one without dignity (Charalambous, 2007). Although pain is the determinant which seems to make assisted suicide morally acceptable, the other consequences of pain on a person are equally, or even more so, compelling reasons for accepting assisted suicide. The right to choose is one which is tied in with a person’s right to die and to die with dignity. One has the right to choose whether or not a medical intervention would be carried out in his behalf. This is an inherent right, and the right to choose medical care also carries with it the right to refuse medical care (Charalambous, 2007). This is when assisted suicide can find justification. The right to refuse treatment which may lead to a patient gradually losing his life can find support under this principle. The right to self-determination includes the right to live and the right to die – to determine the direction of his life (Rosenfeld, 2000). It therefore includes the right to opt for the remedy which would end his life and his suffering. Respect for such choice allows the patient to have control over his body, as well as the care and interventions applied by medical professionals. Response to counter-thesis The right to self-determination is not an absolute right. There are exceptions to this right. The principles set forth that this right does not apply in instances when it causes harm to oneself and to others (Matthews, 2000). Such harm can definitely be seen in instances of assisted suicide. Assisted suicide is a decision which ultimately seeks to end a person’s life, it does not benefit him or alleviate his pain and suffering. But it brings him the ultimate type of harm – which is death. The right to choose death taken as a part of the right to autonomy and self-determination cannot therefore be used to justify assisted suicide (Rousseau, 2000). The right to choose pertains to preventive, curative, even rehabilitative types of care, but not to the type of care which brings a patient harm. It is also prudent to consider yet another ethical principle in the medical practice, the principle of beneficence (Jonsen, 1995). This principle mandates that a medical practitioner’s actions must be based on what is beneficial to the patient. Assisted suicide is hardly beneficial to the patient. In the case of the terminally ill patient, what is beneficial for the patient actually includes palliative or hospice care – care which is meant to relieve his pain, and make the last days of his life more comfortable. Most patients who opt for suicide as a means of ending their pain and suffering are afflicted with depression and anxiety (Rosenfeld, 2000). They are going through these feelings as a response to their pain, their suffering, and their terminal illness. As an immediate response to such symptoms, some of them think about ways to end their suffering. And since medicines and other medical remedies cannot end these, they think about death. In any case, these individuals opting for suicide are not making their decision based on logical and sound judgment (Rosenfeld, 2000). They are influenced by their inability to bodies’ inability to handle their pain and suffering. A decision made under such conditions is based on one’s emotions, not on logic and cold rationality. Therefore, such a decision must not be considered final and not be perceived as rational. The right to self-determination does not provide strong support for physician-assisted suicide because it makes the right or principle superior to other rights and principles in the medical care and practice. Even granting that a person has the right to control his body and to determine his actions and the direction of his life, such right cannot be imposed at the expense of public interest, including the interests of the physician who would be asked to assist the patient. Other principles and rights also have to be considered, including the principles of non-maleficence, beneficence, and even justice (Brazier, 2005). The principle of justice is focused on giving a person his due. In medical care, it involves the process of rendering medical and health services based on one’s skills and training as a medical professional. In effect, all patients deserve quality medical care, it is their due; and they should therefore receive it to the very end of their life. In one of the cases decided in the UK, Lord Kay put it succinctly when he commented that “it would seem to me a matter of deep regret if the law has developed to a point in this area where the rights of a patient count for everything and other ethical values and institutional integrity count for nothing” (as cited by Brazier, 2005, p. 420). A more holistic consideration of assisted suicide sets forth that it does not indicate sufficient logical support for its legalization. Conclusion Physician-suicide must not be made legal because it is against the basic medical principles of doing no harm to the patient. Based on the slippery slope argument, it also can lead dangerously to the subsequent legalization of voluntary euthanasia. Although a patient indeed has a right to self determination, such right is not absolute, and it is subject to public interest and cannot be carried out in instances of self-harm. Moreover, even as the patient has the right to die, such right cannot be supported because the decision of death over life is being made under symptoms of pain, anxiety, and depression. A decision made under such circumstances is not based on cold logic and rationality. Works Cited Ardelt, M. (2003). Physician-assisted death. In CD Bryant, et.al., (eds) Handbook of death and dying. California: Sage Battin, M. & Lipman, A. (1996). Drug use in assisted suicide and euthanasia. New York: Routledge. Brazier, M. (2006). Do no harm – do patients have responsibilities too? The Cambridge Law Journal, vol. 65: pp. 397-422 Charalambous, G. (2007). Physician assisted death. Review of Bioethics, vol. 1(1), pp. 1-6 Churchill, L. (1997). Physician assisted suicide, euthanasia, or withdrawal of treatment: Distinguishing between them clarifies moral, legal, and practical positions. British Medical Journal, vol. 315(7101); p. 137 Feldman, F. 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