One of the most difficult subjects for people to talk about is death. People may joke about it; for example, making outrageous predictions for their own deaths saying things like, “My death will be caused by being eaten by a great white shark!” However, people tend to avoid serious discussions about death with others such as family; people even avoid an introspective self-dialogue about death, neglecting creating documents such as wills and advance directives. When imminent death or a lengthy terminal illness arrive on the horizon, it may come as a surprise even to those who have lived a long and rewarding life. Hospice and palliative care exist to make sure that such patients have the least amount of pain and suffering possible during the last days or months of their lives. Yet, there are some patients whose terminal conditions are violently excruciating, patients who realize that soon their condition will reach that point, and they know the standards of hospice and palliative care will not ease pain or suffering through their last days of life. It is a social injustice to force these patients to be forced to soldier on, to endure torture which could be defined as cruel and unusual punishment, and to refuse to honor their wish for physician assisted suicide.
Only two states currently allow assisted suicide; Oregon has the Death With Dignity Act and Washington has the Washington Death With Dignity Act (“Assisted”). While assisted suicide in Montana is not recognized as legal, it is not considered to be a crime (“Assisted”). Other states, such as New Jersey, are considering bills based on Oregon’s Act that would permit physicians to administer a lethal dose of drugs if a patient’s life expectancy is less than six months (Farrell). Terminal cancer patient Claudia Dowling Burzichelli the thoughts of the anxiety her illness causes to her family makes her wish there were better, more compassionate ways for die rather than the unpleasant measures people are forced to take now such as self-starvation or some violent method; she would like a better way that would not hurt her family (Farrell). Suicide is often believed to be the selfish act of an individual, one that causes terrible trauma to friends and relatives (Markus 265). Contrary to this general belief concerning suicide, it is obvious that in Burzichelli’s case, thoughts of loved ones are foremost on her mind. From Burzichelli’s and many physician assisted suicide (PAS) advocates, the justice issue is one that applies not only to the terminally ill patient, but also to his or her family.
The debate over PAS is ongoing. One of the most vocal opponents of PAS is Susan M. Wolf; scholar Diane Christine Raymond presents an analysis of Wolf’s arguments in her 1999 paper, “‘Fatal Practices’: A Feminist Analysis of Physician-Assisted Suicide and Euthanasia.” Although Raymond’s analysis presents a feminist view of PAS, her paper brings up important issues of social justice and end of life care. Concerning Wolf’s views, she believes that feminism rightly points out the misbalance of power where the physician has more and the patient has less, and therefore Wolf is correct to be distrustful concerning involving doctors in PAS situations. (9). Although Raymond presents the view that PAS is complicated by patriarchal dynamics and she may be correct, more importantly she illustrates the imbalance of power that make PAS problematical. Raymond mentions the imbalance between patients and providers, the well and the sick, ethical questions about resource allocations, and ethical questions about competence, choices, and life quality (4). However, Raymond argues that the most important point is not whether PAS should be legal or not, but that America’s health care system neglects the needs of millions of people (21). In other words, because America’s health care system is broken, even if PAS were to be determined to be legal and compassionate, it would not be available to many people who need it. This highlights the social injustice surrounding PAS because many may not be able to afford it, insurance may decline to cover the cost, patients may be unable to go to a state where it is legal, a physician may be biased against PAS and decline to offer the option, and so on.
Interestingly, nearly 10 years after Raymond’s article about Wolf’s PAS opposing views, Wolf wrote a very personal article about how the death of her father caused her to reconsider all the writing she had done in opposition of PAS (23). Although Wolf ultimately does not change her views that oppose PAS, her article supports Raymond’s view that the healthcare system is broken. For example, when her father decided that he no longer wanted the life-sustaining feeding tube he relied on, the hospital staff told them that her father needed to leave the hospital and that their view was that with continued treatment, he could be well again, although Wolf and her father both knew that was not the case (Wolf 24). It appears that the hospital staff was in denial about Wolf’s father’s condition. Andrew Markus offers some views about why some health care professionals may be in this kind of denial. For example, he writes that although the Judeo-Christian view is that people have free will and that God has granted us this life and free will, it is willful suicide is always sinful and wrong (Markus 267). A British scholar, Markus also adds that one of the reasons that people believe that physicians should have nothing to do with assistance in death is because there is a fear about it due to remaining repercussions of the Nazi doctors’ involvement in appalling medical and eugenic experiments (269). Certainly, Markus’s statement about Nazi Germany is an argument in favor of the social stigma against PAS because social injustice was a prime aspect of the Nazi doctors’ involvement in death-causing procedures. However, this argument may not stand for younger generations for whom the horrors of the Holocaust have faded.
Regardless of age or generation, many doctors and other health care professionals interpret the Hippocratic Oath, the document upon which they vow to practice medicine with honesty and ethically, to mean that life must be fought for at all costs. However, an interesting aspect of the Oath is that it has evolved from the classical version into a number of different documents. For example, in a survey of American and Canadian medical schools, only a small percentage of students swear on versions of the oath that includes dictums considered sacred to its classic version, including prohibition of euthanasia, following religious laws, prohibitions against abortion, and foreswearing sexual contact with patients (Tyson). Although Oaths differ from school to school today, in Nova’s example, two statements could support the idea that PAS should be prohibited. The first of these is a physician will benefit ill patients everything they can do to help while avoiding the snares of overtreating a patient and its opposite, failing to see how the patient can be helped and not doing enough (Tyson). In other words, a physician should find the appropriate balance in treatment; therapeutic nihilism could be interpreted to mean the cessation of all medical treatment leading to death. Another statement within this Oath is that the physician may not act as God (Tyson). Reflecting Markus’s statement on Judeo-Christian views about suicide, for some physicians this statement effectively prohibits PAS. Tyson writes about the current debate of the relevance of the Hippocratic Oath, questioning whether doctors have the moral obligation to treat people who have deadly diseases like Ebola or AIDS. The same question could be asked of doctors whose patients suffer from other terminal conditions, such as cancer patient Claudia Dowling Burzichelli. The debate concerning the modern versions of the Hippocratic oath continue because many people are unsure that this document properly addresses many current social justice issues.
As Coral Levett, President of the Australian Nursing Journal writes, technological developments of the past century mean that life can be sustained almost indefinitely (48). To Levett, this means that life-sustaining technology can mean unnecessarily prolonged suffering and pain for dying patients. In other words, a society that prohibits PAS is a society that shows no empathy or mercy for the pain of the dying; in essence, it is a society that is so blinded by the idea that life is precious that it does not see it is promoting torture. Levett argues in favor of PAS because she believes that the suffering dying patients endure is not simply physical; additionally, she cites evidence that in places where PAS is legal, many patients do not choose it but find the availability of that option to be a psychological comfort (48).
As Virginia Woolf writes in her essay, “The Death of the Moth,” the helplessness of the moth enduring his death throes provoked her interest and sympathy (653). She picks up a pencil, thinking to make the moth’s efforts to struggle to his feet easier, but realizes that the struggles of the moth were signs that its death was imminent (653). She puts the pencil down. Many of the arguments for PAS include the idea that people have the right to die in dignity. Woolf describes the moth as triumphant, superb, and decent in his death (653). Woolf’s essay provides an observation about the moment between full life and death; however, for people, the issue is not so simple as the death of the moth. Woolf’s decision not to assist the moth has fewer consequences than a doctor who cannot or will not provide PAS. There is no social injustice when Woolf lays down her pencil; yet, when PAS is not an option because it is illegal or unaffordable to people, social injustice not only for the patient, but also for the patient’s loved ones prevails.
Assisted Suicide. Answers.USA.gov, n.d. Web.
Farrell, Joelle. N.J. Committee Hears About Right-to-Die Bill. Philly.com (9 Feb. 2013). Web.
Levett, Coral. Dying With Dignity -- The Case For End Of Life Choices. Australian Nursing Journal 18.8 (2011): 48. Print.
Markus, Andrew C. Life or Death, Mad or Sane--Who Decides? Perspectives in Biology and Medicine 45.2 (Spring 2002): 264-271. Print. DOI: 10.1353/pbm.2002.0034
Raymond, Diane Christine. "Fatal Practices": A Feminist Analysis of Physician-Assisted Suicide and Euthanasia. Hypatia 14.2 (Spring 1999): 1-25. Print. DOI: 10.1353/hyp.2005.0049
Tyson, Peter. The Hippocratic Oath Today. Nova (27 Mar. 2001). Web. http://www.pbs.org/
Wolf, Susan M. Confronting Physician Assisted Suicide and Euthanasia: My Father's Death. Hastings Center Report 38.5 (Sep./Oct. 2008): 23-26. Print. DOI: 10.1353/hcr.0.0054
Woolf, Virginia. The Death of the Moth (1942). Classic and Contemporary Reading for Composition. Ed. Igor Webb. Boston: McGraw Hill, 2008. 650-653. Print.