physician assisted suicide (pas)
Physically Assisted Suicide
Physician-assisted suicide has been and still one of the major issues in American society. Questions whether a physician can assist a terminally ill patient in committing suicide by prescribing him or her lethal medications and if the act is morally justifiable have split the population for a long time. Physically Assisted Suicide occurs a patient’s death is facilitated by a physician who provides the necessary means or information that enables the patient to carry out a life-ending act (Weir, 12).
For some people, the most powerful and persuasive argument that supports suicide concerns increasing people’s liberty. On this view, proper to the ancient disagreement about how to face suffering, pain and death are to allow people to choose the sort of assistance in dying that best suits them. Competent, rational, and informed individuals may decide that their lives are no longer worth living and want to plan the time and circumstance of their death. In their view, maximizing options for people defends their distinct interests and perspectives, protecting from social manipulation. People should decide how to end their lives when it is intolerable to them, on this view; their actions typically affect no one else, and usually this option allows an individual to avoid suffering or what is to them a humiliating or dishonorable existence. Allowing people to have a free choice about the sort of assistance in dying they choose acknowledges that this is a personal matter and shows respect for people’s autonomy or rights of self-determination. Consequently, the argument continues, we should respect people’s choices and allow them to exercise their freedom by permitting relevant options. Policy and research should try to enhance people’s choices regarding assistance in dying and include not only good advance care planning, palliative care and withdrawal of life-sustaining treatments, but, they conclude, also assisted suicide or physician-assisted suicides (Callahan and Margot, 124).
Some proponents carry the liberty further, saying that restrictions are unjustifiable infringements on people’s freedom. For example, they question why people must be terminally ill to obtain relief, pointing out that the claims of people with degenerative diseases may sometimes be at least as compelling. Anecdotal evidence indicates that people may seek physician-assisted suicide not only to avoid the last stages of terminal illness, but also to avoid mental and physical deterioration from long-term, chronic and progressive diseases such as Alzheimer’s and cancer. These are most anguishing to patients in the initial stages when they are relatively functional and most disturbing to the family when these diseases ravage patients. People in the early stages sometimes request assistance in dying from clinicians when they reach a particular stage of anticipated deterioration. While they do not want to die while they have some facilities, they fear waiting too long until they lack the capacity to kill themselves (Van der Maas et al, 1700).
Another argument that supports the permissibility of physician-assisted suicide concerns the duty to relieve suffering or the importance of treating others with compassion. An important goal of medicine is to relieve suffering, and in some cases it overrides the goal of prolonging life. One reason to give authority to doctors for assisted suicide, proponents argue, emanates from physicians’ long-standing duties to relief suffering. Many of the best-known accounts of physician-assisted suicide are cases where compassionate, knowledgeable, and understanding physicians believed their duty to assist in a suicide in order to relieve pain, anguish, or suffering was a higher duty than prolonging life (Thomson, 500-501).
Some proponents argue that it is unreasonable to allow passive euthanasia while prohibiting physician-assisted suicide because there is no genuine difference between them. Society and the courts now agree that competent people have a right to forgo life-saving treatment and get adequate pain medication even if that hastens their death. This ‘no moral difference argument’ takes two forms. First, some proponents argue that we cannot draw a bright line between those acts that have social approval and assisted suicide and there are practical difficulties in distinguishing them. If we cannot draw a bright line between those acts that have social approval and assisted suicide, then if the one is a morally permissible social policy, the other ought to be as well (Kamisar, 234). The second and more plausible version of the ‘no moral difference’ is that there is no moral difference between doctors’ acts and omissions in assisting someone to hasten death since both are actions that may be justifiable and not, depending upon the circumstances. The key moral difference between those that are and are not justifiable is unrelated to using passive or active means. Unless one defends a principled objection to assisted suicide, it is acknowledged that there are cases where assisted suicide would be justifiable (Thomson, 505).
On the hand, opponents of PAS attack the liberty argument by arguing that such policies are too extreme in focusing so exclusively upon liberty rights and individualism. On this view, such policies mistakenly detach people from the web of their social commitments, considering them as separate social units entirely free to make self-regarding behavior. Failing to appreciate the social context of people’s lives promotes the view that people ought to get what they want, despite social costs. Rather people should be seen as part of a network of relationships and necessarily members of communities. Personal interest alone might dictate that someone has an interest in wishing for assistance in suicide, but this does not settle whether their preferences should be honored or if it is a prudent social policy to offer these options (Kamisar, 236).
Many, perhaps most, people seeking physician-assisted suicide would want to live if their situation were improved. Defenders argue that we should not consider physician-assisted suicide while many options exist to improve the situation of those in need of help. This includes better social support, pain management, and palliative care. Good palliative care provides a compassionate response and, therefore, neutralizes at least one convincing argument for physician-assisted suicide concerning duties to relieve suffering or the importance of treating others with compassion. Arguably, some would still request assistance in dying through physician-assisted suicide even if they were not in pain, but most people would not want to die if the quality of their lives improved (Callahan and Margot, 128).
Psychological suffering and physical pain among the people who are critically ill and dying are great evils. The attempt to relieve them by introducing PAS is even greater evil. Those practices threaten the future security of the living. They no less threaten the dying themselves. Once a society allows one person to take the life of another based on their mutual private standards of a life worth living, there can be no safe or sure way to contain the deadly virus thus introduced. The belief that PAS can be safely regulated is a myth the confidentiality of the doctor-patient relationship makes it impossible to provide adequate oversight. Since we are not able to know what goes on in the privacy of the doctor-patient encounter, can we never know whether, and to what extent, laws regulating PAS will be violated or ignored. The lack of any correlation between suffering and a desire for death means that physicians will have enormous discretion in assisting in suicide but no way of knowing how o make a definitive evaluation of the extent of, or the legitimacy of, the suffering the patient reports (Bachman, 304).
In conclusion, if suicide is permissible, why should people be prohibited from assisting in a suicide? And if assisting suicide is permissible, why should physicians alone be authorized to assist people? Answering these questions raises fundamental issues about the value of live, the worth of an individual to his or her community, rights of self-determination, duties of some physicians to relieve suffering, and the meaning of life itself. Finally, some people are skeptical that these disputes can ever be solved rationally because the debate is so intertwined with choices about the nature of our rights, duties and of morality itself. Whether this creates, unbridgeable chasms among us remain to be seen. In my opinion, PAS should be available only to people who are eligible who wishes to end their suffering.
Bachman, Jerald G., et al. “Attitudes of Michigan physicians and the public toward legalizing
physician-assisted suicide and voluntary euthanasia.” New England Journal of Medicine 334.5 (1996): 303-309.
Callahan, Daniel, and Margot White. “Legalization of Physician-Assisted Suicide:
Creating a Regulatory Potemkin Village, The.” U. Rich. L. Rev. 30 (1996): 1.
Kamisar, Yale. “Physician-assisted suicide: The last bridge to active voluntary euthanasia.”
Euthanasia examined: Ethical, clinical and legal perspectives (1997): 225-60.
Thomson, Judith Jarvis. “Physician‐Assisted Suicide: Two Moral Arguments*.”
Ethics 109.3 (1999): 497-518.
Van der Maas, Paul J., et al. “Euthanasia, physician-assisted suicide, and other medical practices
involving the end of life in the Netherlands, 1990–1995.” New England Journal of Medicine 335.22 (1996): 1699-1705.
Weir, Robert F., ed. Physician-assisted suicide. Indiana University Press, 1997.