Should physician assisted suicide be legalized
Should Physician-Assisted Suicide be Legalized?
Physician-assisted suicide (PAS) is a word synonymous with a heinous death sentence for some group of people while, for others, it epitomizes the act of love for ending the agony of a loved one suffering from a life-threatening illness. PAS refers to the intentional act of ending a patient’s life by a physician after providing the patient with the counseling or required knowledge for the procedure. The legalization debate for PAS predominantly centers on compassionately relieving a patient of the suffering and pain, curtailing accrued medical costs, and protecting doctors. This medical procedure has erupted dire public concern from different groups such as the clergy, the human rights agencies, political class, the medical fraternity, and citizens. This point of disagreement cuts across the moral, ethic, and legal dimensions. The clergy, for instance, bases their argument from a moral perspective, as they believe that ending an individual’s life is tantamount to killing and goes against the sacred nature of life, which is given or taken way by only God, but not man (Carr 66). The ethical argument involved the medical practice of physicians with organizations such as American Medical Association maintaining that the practice is inconsistent with ethical obligations of physicians.
The legal discontentment for PAS arises from the fact the request to have an individual’s life taken contravenes the natural law of the U.S. This reasoning is based on the premise that it contravenes the foundations of the Universal Declaration of Human Rights, Declaration of Independence, and Bills of Rights, specifically, the right to life, privacy, and liberty of citizens. The legal concern of PAS elicits powerful emotions because it questions the fabric of the U.S., a civilized democracy with a history anchored on the protection of human rights. Further, adversaries of PAS front the criminality aspect of the medical procedure because it supports ending an individual’s life that does not threaten the well-being of another individual. It should be apparent, however, that the removal of pain, in the case of a terminally ill patient, is of profound benefit (Battin 31). Nonetheless, as much as the removal of pain is a moral obligation even to a physician, serious concern arises when suicide is used to achieve this goal. This is the hallmark of the arguments and counterarguments on PAS. In such a situation, even the concept of liberty, as enshrined by the founding fathers of this great nation, goes against the value of life.
Life and liberty are special and important rights, but sometimes it is impossible to pursue both. The most challenging aspect regarding PAS is the conflict between an individual’s autonomy to end his or her life and preservation of life (Kopelman 52). In different terms, PAS is like a battle for supremacy between which one of the two dimensions should be favored over the other. PAS draws equal concern from adversaries and proponent because it pits personal autonomy and individual liberty against preservation of life, which is a societal value. This conflict is reminiscent of Vacco v. Quill and Wahington v. Glucksberg cases of 1997 where the Supreme Court made ground-breaking decisions concerning PAS. In the ruling, the court emphasized that the government’s role in preventing a physician’s intentional killing and preserving citizens’ life is more important than an individual’s liberty to choose death over life, devoid of the medical situation. These divided opinions are some of the concerns characteristic of PAS debate. For this reason, it is essential to give a critical analysis of PAS. There are many organizations across the U.S. that are opposed to PAS such as the American Medical Association (AMA), National Council on Disability, the American College of Physicians, and the American Association of People with Disabilities (AAPD), among other advocacy groups.
The majority of the aforementioned groups hold similar arguments against PAS. The arguments of disability advocates are founded on the reality of the experiences these groups of people face. According to these advocates, the legalization of PAS would have a negative impact especially on disabled individuals with a history of unresolved psychiatric problems and trauma. This fact implies that the imminent option of PAS would make these groups of people vulnerable and lose hope since most of them struggle with personal adjustments problems during such episodes (Jeffrey 70). This factor cuts-off an individual’s life who, in the long-term, may lead contributing and good lives. PAS also contravenes the traditional values and roles of physicians as healers (Law 312). AMA vehemently fronts this argument as they argue rather than ending a patient’s life, such requests from patients implies there is a need for more research and advancement towards finding other alternative methods for treating pain and other discomforts either psychological or physical. The reason AMA is at the center stage to advocating against such medical practices is because they are the organization tasked with higher education training of physicians in the U.S. about pain management strategies and techniques to combat the need for PAS in their practice.
Another argument against PAS involves the potential risk of creating a slippery slope about involuntary euthanasia. This aspect implies that the acceptability of PAS for sympathetic reasons will lead many individuals to use it as a tool of eliminating patients who they perceive have been incapacitated by illness (Young 181). This factor will create a situation where PAS is applied even if the patients have not contemplated death and are self-determined to fight through the illness. According to this argument, the most affected individuals will be the poor, elderly, and disabled as uninformed judgment will be made regarding when their life is of value or not. The proponents of this argument usually use Netherlands as a case study in which several reports emerged in the mid-1990s that revealed several instances where involuntary euthanasia was performed on patients without their consent. This case was also similar to the one in Michigan where the infamous Dr. Jack Kevorkian used PAS that led to several deaths among patients. Further, adversaries of PAS argue there is no need for this medical procedure as states such as New York, and Washington does not incriminate terminally ill patients who obtain pain-relieving medication to the extent of causing unconsciousness and catalyzing death. This notion is known as the double effect in which heavy doses of painkillers are administered to relieve pain and hasten death simultaneously (Battin 305).
Advocates against PAS also challenge the fact that patients cause a financial burden to their families in accrued medical costs. These advocates support the need for serious amendments such as in Medicaid insurance to cover more families and individuals. One of the major cases in the right to die issue came was the Washington v. Glucksberg in 1997. This case has begun in 1994 at a Federal District Court in Washington and involved a lawsuit filed by a group named Compassion in Dying, four doctors, and three dying patients. The case was aimed at challenging the ban on PAS in Washington, which according to previous rulings by the District Court, claimed that PAS was unconstitutional on the basis of Fourteen Amendment’s Equal Protection Clause and Due Process Clause (Jackson 13). However, in 1996, this ruling was overruled with the Court of Appeal stating that the jurisdiction to institute a constitutional right to PAS does not rest with the federal judiciary. This ruling was later reversed the same year by the same court to the original decision that affirmed the abolishment of PAS by the District Court. It is not until 1997 that a groundbreaking decision that lifted the ban on PAS was made. The Supreme Court took a keen interest at the Due Process claim and upheld that rulings based on the substantive due process can only suffice and be protected under law, as regards the rights and liberties that are so fundamental to the extent that neither justice nor liberty would be eminent if they were overlooked. Therefore, in the case’s situation, the PAS was not fundamental.
Another point of concern in the case was the stake of Washington’s state that included protection of suffering and depressed persons, the belief in the equal worth of everyone’s life, and the avoidance of involuntary euthanasia. Other interests included the protection of individuals who are prone to be abused for the purpose of minimizing medical costs, preservation of human life, and protection of the ethics of the medical fraternity. Even though the Court found these stakes were legitimate, and the prior ban on PAS promoted the stakes, the final ruling held that the Due Process Clause was not in any way violated by the Washington law as applied to terminally ill adults whose desire was to fasten their death using drugs authorized by their physicians. Another remarkable case was Vacco v Quill, which apparently, was decided upon by the Supreme Court on the same day as the Washington case. The case involved Quill and several physicians who challenged the New York’s law that incriminated PAS as they claimed it violated the Fourteenth Amendment and Equal Protection Clause. They argued that during the final stages of a terminal illness, patients can fasten the death process by authorizing the physician to remove the life-supporting machine.
On the other hand, they upheld that in a situation where patients were not supported by life-supporting machines, it would be difficult to fasten their deaths by administering prescribed drugs. According to Quill, the fact that some patients in their final stages of terminal illness lacked life-supporting machines such as feeding tubes and ventilators was discriminatory against them. Concerning the Equal Protection Clause, the US Supreme Court held that the clause does not hold ground when basing it on substantive rights. The Court noted there were distinctions between switching-off a life-supporting machine in a situation where death is imminent from the underlying disease and PAS where the direct cause of death is the lethal medication. These differences implied that the Clause was adhered to. The fact that medical treatment could be denied by every patient and there was no guarantee for any patient to receive PAS ruled out the discrimination argument (Jackson 15). The final ruling of the Court supported the constitutionality of the New York law against PAS.
As much as PAS has elicited strong emotions from different organizations, there is a need to address an appropriate plan for action to counter the arguments against this medical procedure. One of the arguments against PAS by adversaries such as the AMA is that it contravenes the role of physicians as healers. Even though the physicians’ role is to relieve suffering and preserve life, this argument fails to consider a situation where both aspects are unattainable. In such a situation, the importance of a patient’s autonomy outweighs the physician’s role. When considering a patient’s right to life, it is important to note that the patient has the choice to waive or claim it (Dworkin 7). Of course, such a decision is arrived at after the patient and the physician have conclusively assessed the situation, thus the aspect of the physician being a healer should extend to the patient’s decision and help him or her to carry it out. Additionally, opponents of PAS list reasons such as inadequate pain control and depression as catalysts for suicide. This, however, is a narrow way of justifying suicide cases as there are many other motives that may lead an individual to commit suicide. For instance, interviews with family members and physicians of patients who had undergone PAS revealed that pain control concerns were not factors considered by the patients.
Most of the patients from Oregon, who chose PAS, cited factors such as losing autonomy, being unable to control their body functions, and the inability to participate in enjoyable activities (Jackson 28). Concerning the slippery slope debate, there exist weaknesses evident in this argument. It is extremely difficult to conduct heinously an involuntary euthanasia because of the stringent requirements for such a procedure to take place as evident in the Death With Dignity Act in Oregon. As a standard procedure, the Oregon Act requires that PAS is carried under the supervision of a professional physician who walks through the procedure with the patient and his or her family (The Economist 1). Even so, terminally ill patients are of sound mind and cannot be compared to patients in vegetative states who are unable to make informed decisions. Moreover, PAS does not does not constitute murder as it is a voluntary request that is not forced upon or done maliciously to hurt the patient. Regarding persons with disability, it is inaccurate to condemn PAS as a catalyst to persons with a history of trauma. This reasoning is biased because the actual problem lies in mending the social fabric and social structure that in most cases socially and economically marginalizes the disable individuals.
Issues such as the short supply of affordable houses, inadequate community programs that support and fund the disabled should be top agenda for policy makers at both the local and national level, and even advocacy groups, rather than diverting the attention towards the symptoms while they case a blind eye to the diagnosis. PAS has the potential of reducing cases of abuses compared to when treatment is withdrawn and in a situation where individuals are given massive doses of painkillers. The fact that the double effect is unregulated and allowed, creates room for legalizing PAS under tight regulatory measures to increase the surveillance and have an accurate reporting of deaths caused by overdosing of painkillers to initiate preventive measures (Young 46). I support PAS because it saves the patient and the family from psychological and financial burnout. I support the idea that the right to end an individual’s life should rest on him or her when a terminal illness devours their ability to enjoy life or confines their lives to being supported by equipment such as ventilators. This situation is hurting because it reduces the patients’ to mere objects and death becomes a painful psychological process. One of the interesting things worth noting about PAS is the fact that it is based on the suffering of the patient rather than the illness itself.
When considering the extent of an individual’s suffering from a life-threatening chronic illness, it is enough reason to relieve him or her of the pain as a moral duty for a loved one (Somerville 32). Further, the advancement of medical technology has enabled such a procedure to be painless. When a patient is denied the opportunity for PAS implies a subjective application of the Declaration of Independence. The patients are denied their liberty by the effects of the terminal illness while their pursuit of happiness, including their family’s sake, is achieved through ending the physical and psychological torture through PAS. Even so, PAS is a criminal offense in the majority of the states in the U.S., with only California, Oregon, Montana, Washington, and Vermont states legalizing it. In Oregon, for instance, the famous Death with Dignity Act allows doctors to prescribe lethal medication in a situation where the patients have less than six months to live (The Economist 1). To ensure prevention of involuntary euthanasia, Oregon’s law emphasize on the self-administering of the lethal medication. It should, however, be noted that the law applies only to patients suffering from terminal conditions. Another observation is that this law only applies to adults and not children.
In the case of children, the PAS decision is left until in their adulthood. If, however, the terminal illness exposes them to death, the decision for PAS is left for their parents. On the other hand, however, PAS is treated as a crime in other states such as New York. If a physician is found guilty of PAS in New York, he or she may face a second-degree manslaughter charge. Further, the Public Health Law has a section that is primarily designed to support the state’s policy of preventing PAS. However, amidst all the policies and laws against PAS, New York, and many other states, allows switching-off life-supporting machines. In this context, the aspect of life-support refers to medications, procedures, or treatments that control the normal functioning of the body. It should be apparent that PAS helps patients suffering from a terminal medical condition to evade pain and misery in a peaceful way. Even so, such advancements in the medical field are prone to receive harsh critics from groups such as the clergy, advocacy groups, and members of the public. This opposition is evident as only a handful of states have legalized PAS with the majority of the states either locked in court battles or totally disowning it. This discontentment is proof that every revolutionary idea or truth must be ridiculed and violently rejected to be self-evident. Even though the opponents of PAS raise valid concerns, most of their arguments fail to address the structural and policy concerns of such laws. More importantly, there is a need for informed public discourses about the significance of PAS now, and in the future.
Battin, M P, Rosamond Rhodes, and Anita Silvers. Physician Assisted Suicide: Expanding the Debate. New York: Routledge, 1998. Print.
Carr, Mark F. Physician-assisted Suicide: Religious Perspectives on Death with Dignity. Tucson, Ariz: Wheatmark, 2009. Print.
Dworkin, Gerald, R G. Frey, and Sissela Bok. Euthanasia and Physician-Assisted Suicide. Cambridge: Cambridge University Press, 1998. Print.
Jackson, Julia Amanda, “The Ethics and Legality of Euthanasia and Physician Assisted Suicide” (2003). University of Tennessee Honors Thesis Projects. Print.
Jeffrey, David. Against Physician Assisted Suicide: A Palliative Care Perspective. Oxford: Radcliffe Pub, 2009. Print.
Kopelman, Loretta M, and Ville K. A. De. Physician-assisted Suicide: What Are the Issues? Dordrecht: Kluwer Academic Publishers, 2001. Print.
Law, SA. “Physician-assisted Death: an Essay on Constitutional Rights and Remedies.”Maryland Law Review (baltimore, Md. : 1936). 55.2 (1996): 292-342. Print.
Somerville, Margaret A. Death Talk: The Case against Euthanasia and Physician-Assisted Suicide. Montreal: McGill-Queen’s University Press, 2001. Print.
The Economist. ‘‘The Right to Die.” . The Economist Newspaper Limited, 2015. Web. 22 Dec. 2015. <http://www.economist.com/news/leaders/21656182-doctors-should-be-allowed-help-suffering-and-terminally-ill-die-when-they-choose>.
Young, Robert. Medically Assisted Death. Cambridge; New York: Cambridge University Press, 2007. Print.