Phyician Assisted suicide ethical issues - Essay Example

? THEORY Physician Assisted Suicide Ethical Issues Introduction The purpose of this paper is to examine whether various ethical and moral theories offer appropriate guides or frameworks for physicians to consider when deciding whether to assist patients who have expressed a desire to end their own life. Theses conditions are separate from the legalities involved. First of all, I think it is important to establish parameters for this discussion. This study does not relate to the question whether it is moral or ethical for the patient to commit suicide or to ask a doctor to help him do so. It deals solely with whether there are situations in which arguments can be made that a doctor is acting ethically or morally in helping the process. Obviously if one takes the position that suicide is always unethical, immoral or illegal, no matter what the circumstances, then it follows that a doctor’s participation in the process must attract the same judgment as it would have to be considered as aiding and abetting a criminal, immoral, unethical act. However if one considers suicide ethical and/or moral (even if illegal) at least in certain circumstances, then if a physicians assistance is sought by the patient, one can argue that these are separate considerations that should govern the possible help provided by the doctor. When most people think of suicide, they visualize overt acts performed by people intending to end their own life, for example, such as by shooting oneself or by deliberately ingesting poison. However, I would argue that the concept of suicide should be broadened. It should also include failure to do what is required to sustain life, for example stop eating. Furthermore, it should include possible future acts where a patient has expressed a desire to end his own life under certain circumstances even if that desire is not expressed at the time of the life ending act or the patient does not participate in or is unaware of the act at the time. For example, if a patient of sound mind states in writing or orally that if he becomes brain dead, he wants life support systems to be disconnected , he is effectively committing suicide even though he does not personally disconnect the machine because his death is his own intention, not that of others including the physician. However, the desire must be communicated to others either at the time of life support connection or in advance if he is in a coma and unable to make the request. Even if the patient has that intention, but does not communicate it, I would argue that the act of ending his life by turning of the respirator would have to be considered as murder by the doctor, even if done with the best of intentions such as ending pain for a terminally ill patient, as the person/s intentions cannot be assumed and I would argue this is the most important factor distinguishing suicide from murder by others. I now turn to the various ethical frameworks for analyzing a physician’s approach to the use of his moral and ethical obligations to participate in doctor assisted suicide regardless of the legalities. Utilitarianism This theory initially postulated that a person’s actions should be judged on whether they generally produce significantly more widespread pleasure or pain, and later whether overall good or bad outcomes prevailed. (West Encyclopedia Britannica) In other words, the end of a good outcome could justify the means. I would argue that the application of this theory as a guide for physician assisted suicide has problems both quantitatively and qualitatively. How does one measure units of good and bad outcomes? More importantly, what constitutes a good outcome and for whom? For example, terminally ill patients suffering constant severe pain may argue hat they have nothing to lose, for nothing could be worse, and liberation from their agony is the best possible outcome. On the other hand, society at large, especially Western culture which values the preservation of life above all else, would consider allowing physician assisted suicide as undermining the sanctity of life and therefore a bad outcome. They would feel that it would encourage people to kill themselves as a copout rather than try to overcome life’s problems, whatever the cause. They would argue that terminally ill patients should “hang in” because the good outcome of a cure or at least an effective pain reliever may be “just around the corner”. I think what society regards as a good outcome is largely determined by its’ value hierarchy. For example, Muslims place a higher value on honor than life, resulting in them performing more suicide bomb attacks and honor killings. Therefore, because the are no objective standards to measure good and bad outcomes, either quantitatively or qualitatively, I would reject utilitarianism as a basis for assessing ethical and moral physician assisted suicide considerations. Deontology In contrast to Utilitarianism, deontology argues that ethics and moral decisions should be based on one’s duty rather than expected outcomes.(Deontology Ethical Theory) Therefore, those that argue that the sanctity of life is the highest value would likely claim that a physician’s duty is to prolong life as long as they can regardless of the quality of a particular life or the wishes of the liver of that life. They would say that everyone has a duty not to commit suicide with or without the assistance of a doctor. Also they would argue that everyone must follow this precept regardless of an individual’s particular circumstances. However some deontologists recognize this can impose conflicting duties on a doctor, that is, to preserve life and end needless suffering, To resolve this dilemma they have invented the notion of catastrophe, so that the duty the allege that should be performed is the one that results in a lesser catastrophe. Thus a physician may participate in assisted suicide if this is considered a lesser catastrophe than allowing the patient to suffer a very painful inevitable lingering death against his will. It is interesting to note that modern Hippocratic Oaths sworn by most graduating doctors today is equivocal on a physician’s duty with respect to assisted suicide.( Tyson 2001). It states “but it may also be within my power to take a life. This awesome responsibility must be faced with great humbleness and awareness of my own frailty”. It does not say a physician is duty bound to try to prolong life no matter what quality and under any circumstances., but that he consider each case very seriously and thoughtfully before making a decision. Thus the medical profession’s own oath of what they consider as their responsibility conflicts with the notion that aiding and abetting the suicide of a patient is automatically committing murder even if requested by him. Because of these conflicting notions of a physician’s duty, I would argue this is not an appropriate framework for him to use as a moral and ethical compass Virtue Ethics A third yardstick to asses whether doctor assisted suicide is moral and ethical is virtue ethics.( Cline Virtue Ethics) Instead of placing emphasis on outcomes or duties, this theory emphasizes good character traits such as wisdom, courage, temperance and justice and hypothesizes that if a doctor develops these characteristics he will have good character and naturally make the right decision whether to accede to a patient’s request for assisted suicide. But good character is not enough. The doctor must use his knowledge, thinking and reasoning skills to ascertain if there are alternative ways to help the patient. For example, are there medical and/or psychological therapies available that could help him? Could his life circumstances be improved to diminish the desire for suicide? Is there any indication of new cures, treatment, and/or pain killers soon becoming available? Even if assisted suicide is considered it should be only as a last resort, when there appears to be no real prospects of a productive life. Finally, I would argue that virtue ethics is not an appropriate guide for physicians to use to make decisions about assisted suicide as virtues vary from culture to culture and from doctor to doctor. Some may regard illegal assisted suicide as courageous and just, to the patient, but others consider it as foolhardy and law breaking. Relativism This theory postulates that culture determines ethical values. (Velasquez et al 1992) For example in some cultures suicide may be considered a light matter, the recourse of someone who has some slight rebuff. In such a society suicide occurs frequently. The disadvantage of this theory is that there is no common framework for resolving moral disputes between societies. Under this theory societies may differ in application of fundamental purposes but agree on principles. For example, while a society may kill relatively young and vigorous parents, this is based on the assumption that in the afterlife they will remain I that condition rather than grow old and frail. Thus they maintain the underlying moral principle of a duty to care for parents. Another weakness is that people are expected to conform to the norms of society and there is no moral improvement. This theory also ignores the fact that people may differ within a society, for example, the pro choice and pro life debate. I would argue that in multi cultural societies physicians must still deal with the overarching core value of the prolonging of life which takes precedence over different cultural value in assisted suicide issues. Emotivism This theory declares that moral statements are meaningless, only express speakers’ feelings about an issue and may influence another person’s thought and conduct.(BBC Ethics Guide 2002) Emotivism differs from subjectivism in that when subjectivists say “lying is bad” they are merely expressing an opinion. However, when emotivists do something similar they are implying if not actually saying “don’t tell lies”. This theory has fallen out of favor because even philosophers think they should be moral statements, not just expressions of feeling. Obviously a physician cannot use mere feelings which will differ from doctor to doctor as a basis for decisions about providing assisted suicide. Ethical Egoism Ethical egoism postulates that one’s moral obligation is only to serve and promote one’s own interests (Ethical Egoism Philosophy 302) It theorizes that if one does that everyone’s interest is served. In economic terms it finds expression in the Republican Party’s doctrine that lower taxes on the rich will stimulate employment because it is assumed they will invest the added money in new business employing more workers, who in turn will spend the money and stimulate the economy in a trickle down effect. However, the Bush tax cuts have shown this model doesn’t work if the rich don’t invest their increased wealth. The opposite of the ethical egoism theory is the altruistic claiming the ethical thing to do is to serve others’ interests over ones’ own. However, if one serves others’ interests in the expectation it will lead to reciprocal treatment this can be considered a variation of ethical egoism. If one applies this theory to physician assisted suicide a doctor will always opt to prolong life as this is the legal safe thing to do and in line with Hippocratic Oath perspectives. My Choice Finally, while I believe all the discussed theories have valid perspectives, none of them in my view should be used solely as the basis for decisions about allowing physician assisted suicide. However, if I have to chose, I would pick ethical egoism with one caveat. The moral obligation served should not be the interest of the doctor but that of the patient in certain specified circumstances. I would explain as follows. First of all, I would suggest that life be considered both as individual and communal property. It may appear by taking this position I am demeaning life to some kind of inanimate object.. I simply mean that our life belongs to each one of us as individuals. Also at the same time, especially in a society which rightly in my view, places a high value on life and therefore in a sense owns it and is responsible for doing all it can to protect it. Thus we have 2 interests which can conflict. I regard life as a most important property because without it we can have no other property. Yet while other property such as a house, car etc. we can use freely or dispose of it as we see fit, ( with specified exceptions deemed harmful to society) we cannot control our own lives at least in terms of keeping or disposing of it. On the other hand, given the obvious finality of death, I recognize society must protect us from ourselves, that is, in prematurely ending our lives because of problems we may feel are insurmountable but which can in fact be resolved. I therefore propose the following. If a person of sound mind feels their condition is such that they are highly unlikely to return to at least a minimum standard of being able to function independently in a meaningful way and at least 2 doctors certify that they agree. They can apply for legalized physician assisted suicide. The government would be bound to accept the application based on the patient’s written application and the written opinions of 2 independent doctors. The performing doctor would be granted immunity from murder charges and from malpractice allegations providing the procedure was done according to prevailing medical standards and as humanely as possible. If lucid the patient could make the formal request at time of diagnosis or prior. If the patient does not make any such request it must be assumed that he wants his life prolonged as long as possible regardless of his condition. I would suggest that the threshold for consideration of physicians assisted suicide be analogous to that of criminal law, that is, beyond a reasonable doubt. The patient will die within a foreseeable time frame because of his condition and will not have a minimal quality of life even if he survives. If the system works well, perhaps the threshold could be lowered to “ a balance of probabilities” similar to civil law but no further. I would argue that neither physicians nor government are qualified or comfortable with making assisted suicide decisions based on nebulous and contradictory philosophical theories open to biased and inconsistent interpretations. Also while I recognize societies’ right and duty to protect life in most instances, after all the individual’s life belongs to him and therefore that person should have the right to make decisions about its’ preservation or termination if prospects for return to a productive life appear bleak. Conclusion While the various philosophical theories offer useful frameworks for consideration of the morality and ethics of physician assisted suicide, I believe the ultimate decision at least in severe cases should be that of the patient. I submit this offers a reasonable compromise between a patients’ right to some control over their own life and societies’ right and duty to protect the value of life in general. References 1). Cline, Austin “Virtue Ethics Morality and Character” About.com Agnosticism/Atheism retrieved from atheism.about.com/od/ethicalsystems/a/virtueethics.htm 2). Tyson, Peter “The Hippocratic Oath Today Mar. 27, 2001” Nova.beta retrieved from www.pbs.org/wgbh/nova/body/Hippocratic-oath-today-html. 3). Velasquez, Manuel-Andre, Claire-Shanks, Thomas-Meyer, Michael J. “Ethical Relativism . Markula Center for Applied Ethics Santa Clara University 1992 retrieved from www.scu.edu/ethics/practicing/ethicalrelativism.html-united-states. 4) West, Henry K. “Utilitarianism” Encyclopedia Britannica retrieved from www.utilitarianism.com/utilitarianism.html. 5)”Emotivism” BBC Ethics Guide 2002 retrieved from www.bbc.uk/ethics/introduction/emotivism/html. 6)”Ethical Theory- Deontology” retrieved from www.3”sympatico.ca/cogito/Gr11/demotology.html. 7) “Ethical Egoism” Philosophy 392. Ethics retrieved from http:/philosophy/lander.edu/ethical-ego-html. Read More