Physician assisted suicide (PAS) has been one of the most controversial and sensitive issues facing the healthcare industry in most countries today (Burt 567). PAS normally occur when a physician gets involved in helping a patient take their own life through the writing of a prescription, advice, lethal medication, or giving a patient crucial information that can enable them to take their own life. Someone can describe it as a doctor providing a gun to a patient, and the patient pulling the trigger (Manning 248). PAS tends to have a similar moral goal with euthanasia, which is normally premature death of a patient.
Most ethicists have described PAS as having the same morals as euthanasia and the two should not be distinguished for the sake of understanding their moral vision. Some medical ethicists have noted that euthanasia and withdrawing medication do not require patient participation (Burt 568). PAS is normally guided by natural law, which can be described as reason reflecting on experience of humans discovering the moral value (Weir 117). Natural law theory, the force of law is the force of reason in the sense of right reason, which is grasping reality and settling to moral truth. Natural law tends to have four convictions.
- Independently of one’s religious background, it is accessible to everyone with right reason
- It's knowledge can be universalized
- There exists an objective moral order
- Humans do not actualize their ability of knowing the objective moral order.
Based on the laws, I am for the idea of PAS. Relieving a patient's psychosocial and other forms of suffering can be as vital as relieving them of their pain. When the goal of treatment for a given patient in the final stages of terminal illness, changes from curative efforts to comfort care, the physician involved, should be continual to the very end (Council on Ethical and Judicial Affairs 48). Such patients should be able to be carefully managed, and be put in a position where they can make their own choices to save them from burdensome symptoms and pain, accompanied by optimal spiritual and psychological support from close family and friends (Manning 243).
My chief moral argument in support of PAS is respect for autonomy, mercy, compassion and relief of pain. Based on these circumstances, I feel the physician becomes ethically obligated to assist any suffering patient to end their life (Margaret P. Battin 132). Though, it has to be the physician since he is the only qualified and plausible personnel that should provide such assistance. This is due to the fact that, the physician tends to have specialized knowledge concerning the appropriate drugs that can be administered, how to prevent certain side effects like vomiting and nausea and he has access to drugs. It is, therefore, the right of the suffering patient to receive such assistance from a physician (Peter John 1700).
Majorly, I consider autonomy as my primary justification for assisted suicide. It is usually the moral right for any individual to live their lives as they so wish, subject to a constraint that living their lives in whichever manner they prefer, does not cause harm to other individuals (Thomas Qull 553). In this sense, the freedom to live should incorporate the ability to decide how one can end his/her life whenever they feel it is appropriate. Basically, choosing how one dies is an integral part of choosing how they live. If such a right is denied, such individuals should never be considered as having lived a happy life (Dworkin 78). In my opinion, if an individual’s death is characterized by a lot of suffering or pain which is unavoidable without help to end their lives, they should not be considered to have lived a happy life. The choosing ability will always give patients a choice of writing the final chapter of their lives in whichever manner they prefer (Council on Ethical and Judicial Affairs 49).
Therefore, positions favoring legalization of PAS should emphasize patient autonomy in law and bioethics. The decision to end one’s life is intensely private and personal, and it does not cause any harm to others. Therefore, it should not be prohibited by medical professionals or governments as it is evident in most countries in the world (Margaret P. Battin 134).
The second argument for PAS is based on the obligation to do good (mercy and non-maleficence) and avoid harm. This can be referred to as the principle of patient welfare or ‘principal of mercy’ as it is referred to by some medical practitioners (Weir 117). This principle clearly states that any individual should refrain from suffering or pain in any form or shape and should act to relieve it. This is in accordance with the natural law, which stipulates that humans should exist, and failure to act on a pain implies that a person fails to exist; therefore, they can as well take their own lives. The law is universally recognized and determined by nature (Emmanuel Johnson 1900).
In addition, physicians have the duty of reducing human suffering by not causing any harm. In certain circumstances, assisting patients with suicide can be viewed as more humane, instead of forcing such patients to live in agony and getting over treated at their life end (Thomas Qull 556). The inherent right of dying which an individual can exercise when life becomes unsatisfactory is the rational for PAS, in this case. The main consideration is; if anyway an individual is going to die from a devastating and painful illness, then they should choose how they want to die (Emmanue Johnson 1891).
The suffering of patients during their life’s end can be immense. It normally includes suffering characterized by nausea and pain, somatic symptoms, or even anxiety and depression which are psychological conditions (Dworkin 79). It includes interpersonal suffering, due to dependency or as a result of personal conflicts with other persons. It can even be existential suffering. In various clinical situations, some sufferings are uncontrollable using standard surgical or pharmacological interventions (Peter John 1700). Trust can be eroded when PAS is not an option, or is an option under discussion in such circumstances. In this view, PAS is an act of compassion, which fulfills a non-abandonment obligation and respects a patient’s choice (Weir 118).
Though I support patient assisted suicide, in my opinion, it should be guided and constrained by these conditions:
- The patient’s condition should be incurable, characterized by severe suffering.
- The physician must confirm that a suicide request does not result from inadequate pain control.
- The patient's request to die must be clear and repeated.
- The physician must confirm the patient's judgment is right
- PAS should only be conducted under long meaningful patient doctor relationship
- A physician should not be forced into performing a PAS if they feel it is unethical
- There should be consultation with other physicians to ensure the request is sincere
- All the crucial steps should be properly documented.
This is the only way to ensure this process does not get abused because there is always a chance of abuse.
There are other additional reasons that I support the need for PAS if given by patients. These reasons support PAS as a rational response to unbearable suffering. These include:
- Readiness of death
- If a patient wanted to control the circumstance of their death
- Unable to take care of oneself
- Physical pain
While the ethical and moral debate continues to rage in the world today, physicians should ensure they deal with these circumstances every day. Respecting the patient’s opinion is crucial in the medical world, and PAS should be adopted to save patients from severe suffering experienced by most patients in the world today. Though, whichever path society decides to choose concerning PAS, moral and ethical objections should always come first. The public, on the other hand, there is a need for proper education on different legal options.
Burt, Richard. "The Supreme Court Speaks: Not Assisted Suicide." American Journal of Medicine (1998): 565-568.
Council on Ethical and Judicial Affairs, American Medical Association. "Code of Medical Ethics: Reports, Vol 1. Chicago." American Medical Association (2011): 45-59.
Dworkin, Gerald. Euthanasia and Physician-Assisted Suicide. Manchester: Cambridge University Press, 2000. Print.
Emmanue Johnson. "Ethical, and Empiric Perspectives. ." Archives of Internal Medicine (1994): 1890-1901.
Manning, Michael. Euthanasia and Physician-Assisted Suicide: Killing Or Caring? New York: Paulist Press, 1998.Print.
Margaret P. Battin, Rosamond Rhodes, Anita Silvers. Physician assisted suicide: expanding the debate. New York: Routledge, 2001. Print.
Peter John, Van De Mass. "Euthanasia, Physician-Assisted Suicide, and other Medical Practices Involving the End of Life." New England Journal of Medicine (2007): 1699-1705.
Thomas Qull, Deidre Meier. "The Debate Over Physician-Assisted Suicide: Empirical Data and Convergent Views." Annals of Internal Medicine (1998): 552-558.
Weir, Ronald. "The morality of physician-assisted suicide." Law Medicine Health Care (2009): 116-126.