Ethical Issues Related to The Right to Physician-assisted Suicide

Many patients are admitted to the hospital near the end of their life or due to circumstances that foreshadow the end of one’s life. How someone dies, lives, and is medically cared for at the end of their life is important. All of these things not only directly affect that individual, but also their families and the rest of society. The growing debate between physician assisted suicide/euthanasia (PAS-E) hold many ethical implications for those practicing in the health care field. The objective of this essay is to explore the fundamental ethical issues related to PAS-E from the prospective of the healthcare professional. The main issues of dispute that are emphasized in this essay are: the act of humanity, unalienable and natural rights, and preventing a terminally ill patient from ending their life through self-inflicting suicide.

The Right to Physician-Assisted Suicide

The right to die by physician-assisted suicide/euthanasia (PAS-E) is a highly controversial topic. Supporters of PAS-E believe that a terminally ill patient has the right to willingly end their life because allowing them to live with pain and suffering could be considered as inhumane. PAS-E allows a patient to end their life peacefully, quickly, and with compassion. Euthanasia is the act of ending a life painlessly and without suffering, which is usually administered directly by a medical practitioner. An example of this is when a lethal injection is administered to the patient by a medical practitioner. Physician-assisted suicide is when a patient is prescribed a lethal dose of medication, which is not performed by the medical practitioner but the patient themselves. Examples of this are by withholding/withdrawing life sustaining treatments, terminal sedation, or allowing a patient to take pain medication that may accelerate death. The Canadian Medical Association describes the process of PAS-E as follows, “the subject has an incurable illness; the agent knows about the person's condition; commits the act with the primary intention of ending the life of that person; and the act is undertaken with empathy and compassion and without personal gain”. PAS-E should absolutely be a legal right for any person because of the fact that it is a humane act, an unalienable and natural right, and prevents the need for a terminally ill patient to take ending their life into their own hands through self-inflicting suicide. A person has the right to decide what they want to do with their own life. If an individual has the right to refuse life-saving medical treatment, why should they not have the right to end their own pain and suffering?

Unalienable and natural rights are the rights that an individual has at birth. PAS-E is a right that certainly falls into this category. It is clearly stated in The Declaration of Independence that among these rights are “life, liberty, and the pursuit of happiness”. Seeing as how The Declaration of Independence is essentially a blueprint of our rights as American Citizens, it seems clear that the right to PAS-E should be legal throughout the United States of America. California is one state that has shown to accept the fact that PAS-E is an unalienable and natural right, “In 1992, members of the Californian's against Human Suffering created and proposed Proposition 161 which would allow terminal patients with less than six months to live the right to end their life with the assistance of a Physician. Currently California, Vermont, Oregon, and Washington are the only states in America that have legalized PAS-E, while Montana has legalized it only via court ruling. Other countries besides the United States have also been on board in legalizing the right to PAS-E such as, “Switzerland, The Netherlands, Japan, Mexico, Belgium, Columbia, and Albania”. Many people agree that the right to PAS-E should be completely legal. There are many organizations around the world that have been created for the sole purpose of supporting the right to PAS-E and spreading awareness as well as education about why it is an unalienable and natural right. Some of these organizations include: The Death with Dignity National Center, Euthanasia Research & Guidance Organization (ERGO), and Euthanasia Educational Council (EEC), to name a few. These organizations are important in educating individuals about the truths and positive aspects of PAS-E. Along with the issue of patient’s rights, autonomy also comes into play, “Ethical arguments in support of physician-assisted suicide highlight the principle of respect for patient autonomy and a broad interpretation of a physician's duty to relieve suffering”.

Not allowing PAS-E is inhumane based on a variety of aspects. Allowing an individual to slowly die while suffering and experiencing excruciating pain can comparatively be considered as torture. Why should it be widely accepted for an animal, who has emotions, cognitive thinking skills, and can feel pain, to be put out of its misery by lethal injection; but a human should not have that same right? Due to the fact that animals are not granted the same rights as people, it would only seem appropriate that they should not be granted rights that people are denied of. Not only does PAS-E facilitate in ending the pain and suffering of a terminally ill individual, it allows for anyone who is emotionally involved in his or her life to experience less pain and be granted peace. Seeing a loved one endure a horrendous death can cause emotional and physical distress. Allowing PAS-E to be the choice of an individual who is left with no quality of life, allows that individual to end their life with dignity rather than dying as someone whom they are ashamed or embarrassed of. When quality of life is compromised, an individual could feel as if they are living as a shadow of their former self. This is also difficult for family and loved ones, to see a life fall apart right in front of their very eyes. According to Ezekiel Emanuel from the University of Pennsylvania, “In the states of Oregon and Washington, the reasons for wanting PAS were: 90% of patients reported loss of autonomy, 90% were less able to engage in activities that make life enjoyable and 70% declared loss of dignity”. All of these reasons strongly highlight what an ethical disservice it is to deny a patient the right to die.

Seeing family members and loved ones suffering because of the pain and suffering a person is dealing with can cause a range of psychological issues for a terminally ill patient. Medical literature proposes that, “The incidence of major depression in terminally ill patients ranges from 25% to 77%. Depression is both associated with intense suffering and is a cause of intense suffering”. Not only does depression cause additional suffering for a patient who is already experiencing pain, it can eventually lead to suicide. Prolonging the life of a person who no longer wants to live can drive that person to take matters into their own hands. It is absolutely horrifying that terminally ill patients would feel the need to take their own life, as if dealing with a terminal illness is not difficult enough. Not only is it horrifying for the patient, it can cause more harm directly to the patient if the self-inflicted suicide is unsuccessful. Also, knowing that a family member or loved one suffered even more so by committing suicide can be extremely traumatic. PAS-E allows a patient to die painlessly and peacefully without the need for a patient to attempt to take things into their own hands, creating a possibly messier and more horrific situation than is already taking place. Where the is a will, there is a way. Now this does not mean that all willful acts should be made legal; however, when it comes to the issue of someone taking their own life by whatever means they can, there should be a safe and painless option made available.

PAS-E is in the best interest of the patient and everyone involved in the patient’s life. Prolonging an inevitable death of a patient against their will only supports pain and suffering. It is inhumane to keep suffering people alive, against their own will. Spending each day in misery is no way to live and offers absolutely no quality of life. Merely existing is not living and can lead a patient towards depression. Depression is a form of suffering within itself and can cause a patient to develop suicidal thoughts, which can unfortunately be followed by trying to end their own life in a horrifying manner. Allowing a patient to merely exist is undoubtedly merciless and strips the dignity from that person. People have the right to give life, marry who they choose, voluntary abortion, and refusal of life-saving medical treatment. It only seems right that people should also have the right to decide whether or not they want to continue their life in pain or end it peacefully, in a compassionate manner. No one has the right to say how much is too much or not enough for someone else. PAS-E is not devaluing human life; in fact, it does just the opposite. PAS-E allows an individual to decide how much value their life has left and is essentially a way into a better life; for those who are in terrible pain, suffering, and have completely lost all quality of life. People should be allowed to make that choice freely and legally.

References

1. Emanuel, E. (2017). Euthanasia and Physician-Assisted Suicide: Focus on the Data. Retrieved from https://www.mja.com.au/system/files/issues/206_08/10.5694mja16.00132.pdf
2. Euthanasia (2015). Euthanasia. Retrieved from http://euthanasia.procon.org/view.resource.php?resourceID=000132
3. Euthanasia and assisted suicide (2007). Canadian Medical Association. Retrieved from https://web.archive.org/web/20111219230512/http://policybase.cma.ca/dbtw- wpd/Policypdf/PD07-01.pdf
4. Fine, R (2001). Depression, Anxiety, and Delirium in the Terminally Ill Patient. National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291326/
5. Important ideas (2013). Constitutional Rights Foundation. Retrieved from http://www.crfcelebrateamerica.org/index.php/ideas/53-unalienable-and-natural-rights
6. Physician assisted suicide (n.d.). Physician Assisted Suicide. Retrieved from http://physician-assisted-suicide.weebly.com/pros-and-cons.html
7. Sulmasy, L.S., Mueller, P.S, (2017). Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Retrieved from https://annals.org/aim/fullarticle/2654458/ethics-legalization-physician-assisted-suicide-american-college-physicians-position-paper?searchresult=1