Issue of Physician-Assisted Suicide

CloseThe issue of physician-assisted suicide (PAS) is a hotly contested one in the field of medical ethics. There are two main positions held on this issue; one contends that in the appropriate situation, suicide should be considered an acceptable solution in the case of terminally ill patients, and furthermore, that it is within the role of the physician to provide the patient with the means to kill themselves. The other argument generally argues against one or both of the aforementioned reasons in favor of PAS, maintaining that the physician should not be allowed to aid in the death of the patient. In an article by Yale Kamisar, the author argues against PAS, giving several key points as to why the practice should not be decriminalized. Although there are numerous arguments against the practice of physician-assisted suicide, ultimately, in consideration of the bioethical principles of autonomy, justice, beneficence, and nonmaleficence, PAS can and should be legalized.

Looking at the entire lifespan, if someone has lived a complete, full, and generally healthy life, have they not achieved the 'standard of health' that should be accorded to every individual? Similar to the debate with respect to universal healthcare, it is certainly reasonable to say that maybe not receiving treatment would be most fair to equalize the level of health among different people. Considering the principle of justice, is it unjust to use heroic measures to save someone who is dying when there are others who have a better prognosis/longer expected lifespan if they receive treatment? In general, heroic measures usually only prolong life but do not reverse debilitating terminal illnesses. Thus, it is reasonable to assume that the cost-benefit ratio of heroic measures to prolong life is relatively low, and that the funding directed toward this would have a more measurable positive effect in other areas of healthcare. Although this interpretation of standard of health is certainly not universally accepted, it provides a plausible and cohesive argument for why physician-assisted suicide should be legalized with respect to justice.

In addition to the principle of justice, respect for patient autonomy also lends to the argument for PAS. There are many situations in which, from an ethical standpoint, we could consider a person's request for death as a reasonable solution, especially in cases of extreme patient pain and a grim outlook for the rest of life. What if the person wants to die but is incapable of killing themselves or wants the medical expertise of a doctor to ensure as smooth and painless a transition into death as possible? In cases where the patient can give informed consent (they know that they want, are cognizant of their actions and themselves, and have been provided with adequate information that has clearly been processed) and wants to die, their request should be acknowledged, or at least considered, out of respect for patient autonomy.

In certain cases, it is the doctor or patient's family that raises objections to the practice of assisted suicide. With respect to consideration of the medical provider, the situation seems very similar to that of abortion; every physician is not obligated to perform abortions, but rather it is limited to those who do not raise personal ethical objections to the practice of abortion. Similar to abortion, the case of PAS need not mandate that every doctor be obligated to assist in patient suicide - doctors could decide whether or not they would be willing to help based on their own internal ethical considerations. On a similar note, although family members are allotted a role in the decision making process of the patient, valuing the consideration of the family over the patient with respect to suicide would be a violation of the patient's right to autonomy.

Furthermore, this consideration still holds when applied to certain situations of patients who are not capable of consciously making their own informed decisions. In the case of patients who are not currently cognizant but have made an end-of-life plan, then the patient's choice should be honored and respected. Regardless of the state of mind of a patient in this situation, if the person specified their wishes at the end of life at a time when they were cogent, then their decision should be followed out of respect for their autonomy. The considerations of the family should only be considered when the patient is incapable of giving informed consent and their end of life plans are unknown or unclear. Barring situations in which the desires of the patient is unknown, considering the wishes of the family over those of the patient is a clear violation of a person's right to autonomy.

Moreover, there are also considerations for PAS that should be made with respect to the principle of beneficence. It is certainly appropriate to say that one of the primary concerns of healthcare providers should be to extend the lifespan of those they are responsible for treating. However, this is not the sole consideration of healthcare providers. They should also consider the quality of care they are able to provide and the quality of life the patient is experiencing. In many cases, it is true that extending the lifespan and augmenting quality of life can occur simultaneously, and are in the patient's best interests. However, there are also cases in which prolonging the lifespan comes at the expense of improving the quality of life of the individual. It is also equally possible that, with consideration to both of the aforementioned standards of are, a patient's deteriorating condition would suggest that death would be kinder to them than using heroic measures to keep them alive with an increasingly debilitating quality of life.

On another note, the argument for PAS is also very similar with respect for the principle of nonmaleficence. The principle of nonmaleficence maintains