Abstract
Reported cases of suicide because of terminal illnesses have been on the rise. At present, several terminal diseases plague our community. Key among these terminal diseases includes cancer and diabetes (Appel, 2004). Adult patients have always considered the option of terminating their lives to avert the suffering that comes with the disease. Some of the methods used by patients in performing suicide are either personally initiated or physician-assisted suicides. In all cases and laws according to most constitutions, it is against the law to terminate the life of a human being no matter the circumstances. Additionally, such conditions are extremely medically expensive to attend because they use sophisticated hospital equipment. Thus, both family and the patient suffer financial and physical torment before the patient dies. In such cases, if a willing adult patient is convinced that early death will go a long way in averting these problems, then such a decision will be best implemented by a physician. On the other hand, opponents of physician-assisted suicide argue that the constitution recognizes the sanctity of life; therefore, no one has the right to end the life of another person. They also argue that the times shared between the patient and family is treasured and cannot be taken away (Buiting, 2009). The debate surrounding the legalization of physician-assisted suicide has been raging on for several decades now. This research paper analyses the meaning of physician-assisted suicide and its implications. It also looks into the practicality of the process and arguments supporting its legality. This paper will prove that physician assisted suicide should be legalized to allow terminally ill patient manage their own fate. The paper has identified various arguments that can be used to legalize physician-assisted suicide including preservation of life, legal stances in support of physician-assisted suicide, honesty for proper legislation and utilitarian argument. In addition, the paper advocates for dignity in death and autonomy of the patient to engage in physician-assisted suicide.
Definition of Physician- Assisted Suicide
Physician-assisted suicide (PAS) is a case in which a qualified medical practitioner provides a competent terminally ill patient with a lethal dose of medication under the directive of the patient. In this case, the patient has expressly made the decision to end his/her own life due to the terminal disease (Breitbart, 2000). This is in contrast with the most common version of suicide referred to as ‘auto-killing’ or ‘self-killing’ in which a patient uses own means to take own life. Physician-assisted suicide is not a new trend in the United States; sufferings have always been present since the inception of medicine. Appel (2004) affirms that 57 percent of medical practitioners have received patient requests to engage in assisted life-ending acts. Legalization of physician-assisted suicide is a contentious subject, even when applied in cases of terminal illness. Some medical experts argue that terminal diseases expose patients to long years of pain and suffering before they eventually die, which is not avertable (Breitbart, 2000).
Implicit in the term suicide, is that life has been prematurely ended due to desperation and hopelessness. However, in most cases, Pearlman & Hsu (2005) argue that suicide is mostly performed under unstable mental conditions of the patient; therefore, any form of suicide must be stopped due to ethical reasons. In general, the medical fraternity assumes that persons who exhibit suicidal characteristics have their decision-making capacity compromised. As a result, physicians have the ethical responsibility of providing life-sustaining medications and therapy (Seale, 2009).
However, professional organizations and other bodies have differed when it comes to terminally ill patient and the ethical concerns pertaining to assisted suicide. Terminally ill patients exhibit normal character and are of sound mind when making such a life threatening decision (Burg, 1997). Several states and countries have not been able to reach a final verdict on the issue While several states argue that any form of suicide is illegal, other nations such as Germany argue that every person has the right to end owns life and thus assisted suicide is considered legal (Breitbart, 2000).
Three states in the United States have legalized physician-assisted suicide. They include the States of Oregon, Washington and Montana. Oregon was the first state to make legal physician-assisted dying through a general election in 1994 (Pearlman & Hsu, 2005). The Act, referred to as Death with Dignity Act legalized the process of physician-assisted suicide, but under strict conditions. Likewise, the state of Washington passed a similar Act legalizing physician-assisted dying with the same strict conditions. However, in the case of Montana, a Supreme Court ruling provided a precedence that allows physician-assisted dying.
According to Pearlman & Hsu, (2005), the Acts and the landmark ruling of the Supreme Court of Montana implied that ending life is not constitutional; therefore, for the sake of legality in the physician assisted killing, several conditions must be met. The first condition is that the patient should be mentally eligible to make such a decision. Secondly, the patient must be prescribed with a terminally ill condition resulting in a life expectancy of six months or less. Such a patient must also provide the request for terminating own life in writing for the physician. Finally, the patient should also be a resident of the said state and of adult age, 18 years and above (Breitbart, 2000).
Physicians have the responsibility of ascertaining that the patient appreciates those relevant facts after the physician explains all the relevant aspects of the procedure. Such facts should include the medical diagnosis and prognosis of the condition of the patient. The patient should also understand the risk of the taking medication due to terminal illness. Physicians are also expected to explain to the patient other alternative means of care such as comfort care, hospice care and other pain relieving medications. After all these, the Act allows the patient to make the ultimate decision about the direction to take (Hayden, 1999).
All these acts are quite clear and precise in terms of all the steps necessary before any assisted suicide is performed. In fact, these Acts are keen to ensure that the physician does not perform any procedure if due process is not followed (Appel, 2004). However, just like any other life concerning legislation, these Acts attracted a lot of controversy. Medical experts have expressed ethical reasons why physician-assisted suicide should not be legalized. Legal experts also argue that physician-assisted suicide contravenes provisions of the constitution. However, I will argue that physician-assisted suicide is ethically acceptable and that the legal provisions of the constitution are not breeched.
Ethical Arguments for Physician-Assisted Suicide
1. Autonomy of the Patient
The main argument in support of physician-assisted Suicide is that every capable human being has the right to make a decision on the manner in which to live life. That autonomy should also be extended to persons suffering from terminal conditions in order to control the timing and the manner of death they wish to face (Buiting, 2009). Every person has the option to live a quality life, and avert any suffering and pain; therefore, they should be allowed to do so in a dignified manner. Thus, terminally ill patients should be allowed to die in dignity without the need to face any anguish. As a result, this autonomy must not be taken away from them.
Proponents of physician-assisted suicide further argue that the sanctity of life is dramatically reduced when an individual is diagnosed with a terminal disease (Pearlman & Hsu, 2005). Such a life will be characterized by endless visits to the hospital and long hours of medical treatment and surgeries. The life of the patient will be reduced to a bed ridden life facing sympathies from friends and family. This anguish and pain is not worth going through while the end of the journey is certain, death (Breitbart, 2000).
However, several scholars have argued that any person suffering for a terminal disease is not in a position to make a rational decision reading his life. Thus, it is not in good argument to say that the patient is competent and of sound mind in demanding physician-assisted suicide. To counter this argument, it is safe to say that a majority of terminally ill patients are senior citizens of the society. Therefore, death is not a matter of concern as they have lived the entire lives to the fullest. Such persons are said to make competent and rational decisions even when life is in danger. Therefore, no one is in a position to decide the manner in which a person lives life or ends it for that purpose (Breitbart, 2000).
2. Dignity in Death
Terminal conditions have the tendency of reducing able individuals from strong, versatile and respected persons to frail suffering individuals who depend on others for food, personal hygiene and other dehumanizing aspects of life. Terminally ill patients also suffer mental deterioration declining vision, mobility and hearing capabilities. This worsening state of life has to be witnessed by close friends and family. Thus, when the patient eventually dies, the only memories left with the family are the sorry state of their loved one who died a sorry death. Proponents of physician-assisted suicide assert that a person who has lived a dignified life should not be left to die in such a sorry state.
Additionally, Pearlman & Hsu (2005) illustrate that terminally ill patients are susceptible to depressions. In fact, nearly one third of all terminally ill patients suffer depression and other emotional associated problems such as stress. Therefore, these patients are known to resort to self-suicides, which are usually carried out in a crude and disturbing manner. To avoid such undignified manner of death, physician-assisted suicide for terminally ill patients ought to be legalized.
3. Utilitarian Argument
It has been argued that the benefits gained from Physician assisted suicide are more than the cost involved. In general, the benefits gained from assisted suicide include a dignified death, the patient is able to control the manner and timing of death and the patient averts immense pain and suffering. As a result, the patient is able to manage the final days of life and be in a good position to do his final acts. Moreover, the economics of treating a terminally ill patient is normally at an astronomical cost, and the problem is that the patient will eventually die. According to (Breitbart, 2000), this is not economical and other means of saving cost with dignity preserved may be considered. On the other hand, the cost involved in ending a patient’s life is mainly the feeling of guilt and the pressure that comes with killing a patient. Some family members or caregivers may have pressured the physician to end the life of the patient, thus this may not rest well with the physician.
When comparing the costs and benefits of physician-assisted suicide, it is acceptable to say that the benefits far outweigh the costs. In order to mitigate the emotional cost and stress to the practicing physician, proper legislation guidelines, education and counseling would help physician overcome emotional problems associated with the procedure.
Such cost/benefit analysis has been used in past to make economical decision. However, using the same idea in making life concerning decision always creates controversy. John Stuart Mill, a renowned philosopher, proposed the idea of thorough decision-making by reducing all matter to make economic sense and resolute decisions (Pearlman & Hsu, 2005). In his assertion, an act is justifiable for good decision if the condition allow for equitable cost benefit analysis. Such decision attains the goals of bringing the greatest happiness to people and the society.
4. Honesty for Proper Legislation
Some experts and medical practitioners acknowledge that physician-suicide is widely practiced in the United States albeit in secret (Seale, 2009). The illegality of the practice puts any discussion of the issue in disarray and thus several legislative arms of leadership avoid the topic in totality. Legalizing the procedure would bring patients and physician to a common debate on the matter.
Furthermore, legislation of physician-assisted suicide would bring forth public awareness and direction on how to handle physician-assisted suicide. It would also improve the national outlook in the manner which citizens view the dignity of life. According to Burg (1997), a life full of anguish and pain with no better is not worth living. Even though such a life is not worth living, it should be ended in dignity and respect.
5. Legal Stances in Support of Physician-Assisted Suicide
The matter of physician-assisted suicide has been discussed and debated upon in the legal domain in the United States of America. Several courts and other judicial bodies have heard cases regarding physician-assisted suicide; however, the outcomes have been quite varied. One such a debate has been on the Liberty Interest of the individual on the manner and time that a competent terminally ill patient may choose to end life (Hayden, 1999).
The United States Supreme Court and the Ninth Circuit have also expressed their opinions with regard to the same matter. The Ninth Circuit has expressed its view on the matter admitting that the personal dignity and autonomy is central to the every individual in the society (Pearlman & Hsu, 2005). That one should be able to make a decision on how to live life. The court further appreciates that a terminally ill adult who has lived life to the fullest has a strong liberty in deciding how to end life on earth. From this viewpoint, any respected person of the society who does not wish to live the twilight days of his life in a childlike state of helplessness and despair has the liberty of making a decision to terminate his/her life.
The Ninth Court, in expressing its opinion, looked to precedence in the United State Supreme Court in the 1990 cases of Cruzan v. Director, Missouri Dept. of Health in which the court held that a person had the right to refuse any life prolonging medication (Seale, 2009). In a separate case, the Supreme Court also held that a person has the right to determine the meaning and existence of life. These cases point to the idea that in as much as a court may value the sanctity of life, it is beyond the court to determine the course of an individual personal decision. It is also upon the court to respect the personal decision of sound competent persons with regard to their state of life.
6. Preservation of Life
The Ninth Circuit has expressed an opinion as to the responsibility of the court to preserve life. While the courts and other state organs have a responsibility of preserving life, such need is drastically diminished in cases where the patient is terminally ill without any slight hope for cure (Burg, 1997). In its opinion, the court is not in a compelling position to force a person who cannot pursue happiness to continue living.
In general, courts are at a hard place when it comes making ruling in cases involving terminally ill patients. While the constitution requires that every life be preserved, it is not in good ideals that a man should live his last days in embarrassment and pain. Courts have simply provided direction on how to look at the matter physician-assisted suicide but do not commit directly to give an asserting precedence.
Conclusion
Terminally ill patients face a huge predicament in how to live their last days. While some are willing to brave nature and face a slow death, others wish for faster and less painful methods. Physicians may assist such persons to end their lives by administering life-ending medication to these patients.
There are many ethical reasons that are opposed to any physician-assisted suicides. Similarly, there are several ethical reasons that support this procedure. Some of these ethical reasons include liberty interest, dignity in death, cost benefit analysis and proper legislation to guide the already prevalent practices. Additionally courts have not expressly decided that it is illegal simply providing guidelines on the matter. In conclusion, legalizing physician-assisted suicide will go far in maintaining the dignity of the patient and other ethical aspects as discussed in this paper. In support for the legalization of physician-assisted suicide, the paper has argued for the preservation of life, legal stances in support of physician-assisted suicide, honesty for proper legislation and utilitarian argument. In addition, the paper has advocated for dignity in death and autonomy of the patient to engage in physician-assisted suicide.
References
Appel, J. (2004). A Duty to Kill? A Duty to Die? Rethinking the Euthanasia Controversy of 1906. Bulletin of the History of Medicine , 78 (3), 610-634.
Breitbart, W. (2000). Depression, Hopelessness, and Desire for Hastened Death in Terminally Ill Patients with Cancer. Journal of the American Medical Association, 284(22), 2907-2911.
Buiting, H. (2009). Reporting of Euthanasia and Physician-Assisted Suicide in the Netherlands: Descriptive Study. BMC Medical Ethics , 102.
Burg, W. (1997). The Slippery-Slope Argument. Journal of Clinical Ethics , 256-268.
Hayden, L. (1999). Helping Patients with End-Of-Life Decisions. The American Journal of Nursing, 99.
Pearlman, A., & Hsu, C. (2005). Motivations for Physician-Assisted Suicide. J Gen Intern Med , 20 (3), 234-239.
Seale, C. (2009). Legalisation of Euthanasia or Physician-Assisted Suicide: Survey of Doctors’ Attitudes. Palliat Med , 25 (3), 205-212.
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