Physician-Assisted Suicide: Compassionate Murder - Research Paper Example

Elizabeth Zubczynski of “Physician-Assisted Suicide: Compassionate Murder?” Since the mid-1970s, countless arguments over whether physician-assisted suicides are ethical or not, have raged within the medical field as well as among the general public and popular media. Though the arguments weigh more or less evenly against each other, it is the contention of this paper that physician-assisted suicide can often amount to killing a patient. 1. The Definition of Physician-Assisted Suicide (PAS) and Patient Autonomy: Using the definition given by Herbert Hendin, M.D.: Euthanasia is a word coined from Greek in the 17th century to refer to an easy, painless, happy death. In modern times, however, it has come to mean a physicians causing a patients death by injection of a lethal dose of medication. In physician-assisted suicide, the physician prescribes the lethal dose, knowing the patient intends to end their life. Giving medicine to relieve suffering, even if it risks or causes death, is not assisted suicide or euthanasia; nor is withdrawing treatments that only prolong a painful dying process. The argument in favor of euthanasia usually justifies itself by citing compassion for the pain and suffering of terminally ill or respect for “patient autonomy.” (Hendin, 2004). The online Medical Dictionary defines “patient autonomy” as: “Patient Autonomy: The right of patients to make decisions about their medical care without their health care provider trying to influence the decision. Patient autonomy does allow for health care providers to educate the patient but does not allow the health care provider to make the decision for the patient.” (MedicineNet.com, 2000) These two bases are often made ineffective. The physician may have the best intentions in their heart for the patient and yet harm the patient unknowingly. And on the other side, patient autonomy is useless if the patients are not made aware of the options available to them by a physician who is trained to do so. 2. The Two Arguments For PAS: a. The Compassionate Physician Argument: Although it might be true that the concerned physician is indeed compassionate to his or her patient’s needs, it is also possible that the physician does not know best. It has often been seen that due to lack of experience or skill, the physician has misdiagnosed the patient’s illness and perhaps sent someone who could have been cured to his or her death. This argument is meant to be an assertion of the patient’s right to choose death over life. But can any member of society, one who is inextricably connected to other members of the society, really be allowed to exercise their freedom of choice in any manner they choose? If that was true, it would be completely acceptable for us to say, murder our neighbor just because we chose to. In its favor, Peter Rogatz in “The Positive Virtues of Physician-Assisted Suicide” states that human dignity is often at stake for patients. Even if they are not terminally ill or are not suffering from great pain, actions like vomiting uncontrollably, losing control of bowel movements, paralysis, and immobility discount a human being’s inherent dignity. We as compassionate individuals should allow them to choose a more dignified option of ending their own lives. Although this holds weight, one can never ensure perfectly that the choice the patient is making is not under misconceptions, which brings us to the next argument in favor of sanctioning PAS. b. The Patient Autonomy Argument: Those who favor the practice of euthanasia or physician-aided suicide usually base their argument on the human right to freedom of choice. The claim made is that since human beings have the right to lead their lives in any fit way they choose to, they should also have the right to terminate that very life. If the patient who is suffering asks the physician, without any coercion from any party, to end his or her life, then the physician ought to accept the demand. The primary objections to this argument lie on the term “autonomy.” A patient who is on his or her deathbed is unlikely to be in a rational, detached “autonomous” state of being. The decision may be influenced by a temporary phase of depression. Furthermore, the options to PAS are often not suitably expressed to the patient. The physician often hurries through the alternatives and does not take the time required to explain to the patient the exact options available. Hendin elaborates on this in his commentary: “A cursory, dismissive presentation of alternatives precludes any autonomous decision by the patient. Autonomy is further compromised by the failure to mandate psychiatric evaluation. Such an evaluation is the standard of care for patients who are suicidal, but the Oregon law does not require it in cases of assisted suicide.” Using Netherlands and the state of Oregon as examples, Hendin discusses real incidents of where negligence or simply lack of ability on part of the physician has led to the sanction of physician-assisted suicide, in cases where it may have been possible to cure them. If the patient is thus misguided then there decision is not autonomous, in the strictest sense of the word. 3. The Arguments Against PAS: a. The Catholic Perspective: The Catholics deem birth and death as divine functions. Giving life and taking life are attributed to god who forbids us to kill. “Thou Shalt Not Kill” as a commandment is often cited against the legalizing of physician-assisted suicide. Who are we as mere mortals ourselves to play god with other people’s lives? If we are not responsible for bringing a person to life, what right do we have to take the same life away? David F. Kelly in his book Medical Care at the End of Life: a Catholic Perspective suggests two alternatives to euthanasia: There are two humane and morally proper alternatives to PAS that are supported by the present consensus […] first, the ethically right and legal forgoing of life-sustaining treatment and second, proper pain management. Palliative care or pain management has been suggested by Hendin too. Hendin claims that lack of development in palliative care in Netherlands is a major reason for such high euthanasia rates there. b. Integrity of the Medical Profession: The Hippocratic Oath, which all physicians are required to take at the commencement of their profession, binds them to preserve life and not take it. They are professionally liable for their patient’s life. However, one must not overlook the fact that the Hippocratic Oath originally also forbade taking fees for treating patients, operating on patients and so on (Battin, 2005). These practices are nonetheless everyday routine now. The fact remains though, that the question of human life far outweighs less significant issues of fees and surgery. As Diane Meier, MD points out, nearly 25% in New York do not have medical insurance. Under such pressures added to shortage of time, the treatment being expensive and so on, physicians may feel more inclined to taking the PAS solution. Their decision to take the patient’s life may not be free from bias, and hence, unprofessional. c. The Slippery-Slope Argument: The slippery-slope argument explores the possibility of abuse of the power that patients invest in their physicians. Physicians are at the end of the day human beings, and as likely to fall prey to greed and laziness as any other. There are also the added pressures of expenses and time. Some physicians may just be insensitive to the patient as an individual and think of him or her as just another bed to empty. Although, it is true that institutions can make laws to prevent this abuse, laws hardly ever get enforced correctly, as we shall see in Section 4 (The Inconsistencies in Enforcing Laws Regarding PAS) of this paper. Many of the slippery-slope arguments deal with very grey areas, as most of the arguments are hypotheses. But even in these hypotheses, there are grains of truth. One such hypothetical prediction is that vulnerable groups of patients would suffer the brunt of this more than the others. As Susan M. Wolf points out in her essay “Gender, Feminism and Death: Physician-Assisted Suicide and Euthanasia” women may be more vulnerable. She also predicts the possible outcomes of legalizing PAS on women: What sort of gender effects might we expect? There are four different possibilities. First, we might anticipate a higher incidence of women than men dying by physician-assisted suicide. […] There may, however, be a second gender effect. […] difficulty getting good medical care generally, poor pain relief, a higher incidence of depression, and a higher rate of poverty – may figure more prominently in women’s motivations. […] historical valorization of women’s self sacrifice […] may also affect physicians’ responses. […] Finally, gender may affect the broad public debate. (Wolf, 1996) Others like Adrienne Asch and Leslie Francis have raised concerns over the effect of this legalization on people with disabilities and the elderly, respectively (Battin, 2005). John Hardwig in his essay “Is there a Duty to Die?” weighs and counter-weighs the theory that the aged have a responsibility to their family to take the choice of PAS. He concludes by supporting the duty-to-die theory stating that it asserts moral agency of the patient as well as reaffirms the patient’s relationship with his or her family. It is this logic (that the elderly ought to die to relieve their families) that might influence them in deciding. Institutions or families that have something to gain from the patient’s death might also influence them to opt for physician-assisted suicide. Inheritances are often seen to be major factors in the pressure that the family exerts on the patient to choose the quicker option. This kind of abuse can never be completely wiped out, as they work in invisible ways, beyond the purview of the state law. We see therefore that although one might argue for euthanasia based on principles of human dignity and a person’s right to choose, there are ways in which these can be abused. A physician’s conscience cannot be held above question, neither can one ensure that the patient’s “autonomous” decision to die has not been influenced, and on a more philosophical but not necessarily less vital note, if we do not own the power of giving life how can we claim the power to take it away? The following section is an explanation of how in the two case-studies (Netherlands and Oregon) where euthanasia was legalized, the conditions of the law failed to hold up in reality. 4. The Inconsistencies in Enforcing Laws Regarding PAS: Hendin in his commentary on The Case against Physician-Assisted Suicide: For the Right to End-of-Life Care, mentions two cases in point where physician-assisted suicide is legal. Netherlands and Oregon in the U.S. are both places where euthanasia has become a feasible option for the terminally ill and patients in great pain. He brings out how the legal requirements of both the nation and the state in question are inadequate. And even these inadequate laws are often flouted. His findings include: “[…]in the Netherlands when 50% of Dutch cases of assisted suicide and euthanasia are not reported, more than 50% of Dutch doctors feel free to suggest euthanasia to their patients, and 25% admit to ending patients lives without their consent.” If this is how the states, where physician-assisted suicide is sanctioned legally, function –the prospect of legalizing it everywhere does not seem too favorable. The power that legalizing assisted-suicide invests in physicians may not be used honorably at all times. 5. Conclusion: In having to decide between the two options, I found myself unsure at first. On the one hand, taking away a person’s life deliberately seems like an act of murder. On the other, forcing a person to undergo suffering and humiliation when the option to end it exists does not seem kind either. But after weighing through the arguments, I concluded that although the dignity of the patient is important, it cannot be at the cost of human life. Accidentally sending patients to their death, influencing them to choose suicide, killing people without their consent to empty hospital wards – all these are unsavory possibilities of legalizing suicide. Till the time we can enforce the necessary machinery that will find a way of locating and correcting each of the possible abuses of the law, euthanasia or physician-assisted suicide should not be legalized. Works Cited Battin, Pabst M. Ending Life: Ethics and the Way we Die. New York: Oxford University Press, 2005. Print. Dieterle, J.M. "Physician assisted Suicide: A New look at the Arguments." Bioethics 21.3 (2007): 127-139. Print. Hardwig, John. “Is there a Duty to Die?”. Hastings Center Report 27. 2 (1997): 34-42. Print. Hendin, Herbert. “Commentary: The Case Against Physician-Assisted Suicide: For the Right to End-of-Life Care.” Psychiatric Times 21.2 (2004): 1-5. Print. Foley, Kathleen M. and Hendin, Herbert. The Case Against Physician-Assisted Suicide: For the Right to End-of-Life Care. Baltimore: The John Hopkins University Press, 2002. Kelly, David F. Medical Care at the End of Life: A Catholic Perspective. Washington DC: Georgetown University Press, 2006. Print. “Patient Autonomy Definition.” MedicineNet.com. 14 Jun 2000. Web. 13 Nov 2009. Rogatz, Peter. “The Virtues of Physician-Assisted Suicide.” The Humanist Nov./Dec. 2001. Print. Wolf, Susan M. “Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia.” Feminism and Bioethics: Beyond Reproduction. New York: Oxford University Press, 1996. Print. Read More