Moral Ethics of Physician Assissted Suicide

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Physician assisted suicide is the most common form of euthanasia. In cases of euthanasia, the physician provides the method of death, usually through a lethal drug. In physician assisted suicide, it is required that a person of full mental capacity willingly expresses the wish to die and requests some kind of medication that will end their life. The difference between the two is that physician assisted suicide requires the patient to take the medication himself. Physician assisted suicide has its opponents and its proponents. Among the opponents are some physicians who believe it violates the main goal of the profession and believe that healthcare providers should not assist in suicides because to do so is incompatible with their role as therapists. This is mostly prohibited in the United States, although euthanasia is lawful, with specific limitations, at the Netherlands, Belgium, and Luxembourg where it is legal to perform. According to the Hippocratic oath, all doctors are supposed to “refrain from doing harm” as their main purpose is to do healing but it is a matter of debate as to whether the physician assisted suicide would violate the Hippocratic oath quoted above or if exception should be made in case it is a part of ending suffering. Bellow I will be analyzing the historical aspects of physician assisted suicide and then I will be moving into the analysis of the ethical dilemma whether it is ethical to help patients end their suffering through a Physician Assisted suicide center or if it is for the greatest good to suppress the right of the autonomy of the patient for this matter.

As physician assisted suicide is a type of assisted suicide that involves the use of a lethal drug that the patient has to administer himself to end his or her life. This creates a debatable issue arising whether physician assisted suicide is morally right or wrong. The debate over physician assisted suicide is not new, but it has been around for many years. The first recorded case of physician assisted suicide was in 1865 by Thomas Jefferson. Thomas Jefferson believed that doctors should be allowed to perform their own medical decisions without interference from the government. In 1803, Thomas Jefferson wrote: 'I have no doubt that physicians are capable of making the best decision for the patient and may even make it better than what they had before.' The second major controversy arises when the supreme court ruled that physician assisted suicide was unconstitutional. The court stated that physician assisted suicide was a violation of the fourth amendment's prohibition against cruel and unusual punishment. This is because the court held that “physician assisted suicide was not an act of murder and therefore could not be considered murder”. The court also said 'that physician assisted suicide was a violation of the fifth amendment's prohibition on cruel and unusual punishment.' This decision was based on the fact that physicians were not allowed to perform any medical procedure without consent from the patient. The court concluded that physician assisted suicide was unconstitutional because it violated the eighth amendment's prohibition on cruel and unusual punishment. The court stated “that physician assisted suicide was unconstitutional because the patient had no right to terminate his or her life”.

As of the most updated version of the American Medical Association’s Code of practice clearly says “that physician assisted suicide is prohibited”. It forbids physician assisted suicide because it is essentially inconsistent with the doctor’s character as therapist and because it could be challenging or impossible to operate, and would pose serious societal risks. But Switzerland has an odd point on assisted suicide: “It is legally allowed and will be executed by non-physicians”. Euthanasia constitutes prohibited, but there is a discussion about decriminalization that likewise talks about engagement by non-physicians with patients who are terminally ill. The World Medical Association's position is: 'Physicians-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However, the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.” (Adopted by the 44th World Medical Assembly, Marbella, Spain, September 1992 and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005)

The statement to legalize physician assisted suicide was rejected by the UK legislature's second chamber, the House of Lords, after the period of intense discussion. This personal part's statement, brought to the table by this crossbench individual Joel Joffe, was turned down when equals voted 148 to 100 to change it for six months. This seldom used statement to change this bill was tabled by the progressive Democrat individual attorney Alex Carlile QC, who identified this statement as “morally indefensible” that Assisted suicide for the Terminally Ill bill, which would allow assisted suicide. In the last year, California has also legalized physician assisted suicide, Also Canada legalized both physician assisted suicide and euthanasia, and at Colombia the first legal euthanasia was performed, John Urwin, a study author from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia said, “In order to inform current debates, it’s imperative to understand current laws and practices.”

In March 2003, a vote to legalise assisted suicide was lost by a single vote (at the time, assisted suicide was not illegal, as suicide was permitted under the criminal code, but a person assisting someone to take their own life could face prosecution). After that Luxembourg's parliament at December 2008 amended the country's constitution to take the power away from the monarch. And finally euthanasia and assisted suicide became legalized in April, 2009 as announced by Tehran Times on article 'Luxembourg becomes third EU country to legalize euthanasia”. Also in China, Physician Assisted suicide is illegal under Articles “232” and “233” of the Criminal Law of the Republic of China. Up to now, five states have legalized physician assisted suicide: Oregon, Vermont, WA, CA, and Mt (via court opinion). California’s Government recently united at legalizing physician assisted suicide, with the ending of time choice Act returning through the California construction and government legislature at September and Governor Jerry Brown signing the bill into law in early October. The proposed statement in New York also tried to legalize physician assisted suicide.

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Now that we have some data to analyze about the legal and social aspects of this matter. The patients side is stating that it is there right and their autonomy is breached if they do not have the right to decide when to die and how, with dignity and autonomy. On the other hand, how can a patient take an informed and legally correct decision if they don’t know the exact prospects of their disease and how the future and the therapies that will become available will affect their situation and suffering. You can state that you cannot wait and stay in suffering anymore so this is why you are asking to be euthanized in a legal and not an ignoble way but on the other side we can say and state that speaking from the healthcare professional side we would not do something that we consider immoral and in contrast with the Hippocratic oath even though some of the proponents will say that the oath need updating and differentiation since is ancient and outdated with today standards. Even though the physician has the right to decline he is also responsible to let the patient know and refer him to someone that would be able to execute his wishes in an autonomic way.

Analyzing the issue, I came upon a lot of different definitions and procedures on how Physician Assisted Suicide works and upon all of them I found out the patient should be mentally capable to take the decision to end his or her life. But how can a person with severe Depression and suicidal ideation be capable of taking such an important and well thought decision? On the other hand, isn’t this person suffering? Isn’t he or she allowed to end his suffering? And finally isn’t he going to take his life eventually if he is in a suffering state? And my dilemma is should we allow suicidal and mentally ill patients take such a decision? Are they capable of weighting the facts equally and objectively? And here I would like to say that sometimes mental suffering is worse than any suffering but by commercializing suicides are we encouraging them at the same time to take their life? And here I believe there is a role for a special committee which would ideally examine the patient and give their opinion about their suffering. But then another dilemma arises and it is the one of “Are the physician going to play gods?”.

Here I would like to disclose the case of Magda who lived a long and fulfilling life and she was healthy throughout her life and even thought she broke her 2 hip at the age of 90, nothing could stop her from taking care of herself and cooking till 101 year of age. Although she was relatively healthy her organ began to let her down as macular degradation took away her vision and much of her hearing was lost. Her mind was so clear that she was suffering from thinking that life was closing down for her. To summarize things up, a vibrant woman who loved life and enjoyed her activities now is felling that she is resisting of her “closing hour”. Because she thought of this beforehand she had a stash of sleeping pills in case she needed to commit suicide, but in the chaos of the apartment she could not move and get them so she decided to stop eating and drinking until she would die. This leads us to the question: is it acceptable to provide her with the help of ending her life rather than letting her shriek in pain and live disgusted with her condition living like that for months or years even until death would come?

Another case is this of Mr. Perry. Mr. Perry an 83 years old man who had several problems. He had spent the past several months in and out of hospitals and rehab. Before he lived independently in a small town. Widowed many years ago, he subsequently enjoyed the company of a lovely lady friend who lived down the street from the Perry’s home. He had five adult children and numerous grandchildren. Life should have been relatively good for this guy. But life was not good at all. “My body is all worn out. I’m worn out. Don’t want to do this anymore, Doc. They say I can’t go home and be safe. And I’m NOT going to a nursing home. No way! Just stop that little gadget that shocks me and the part that keeps my heart going. I want them stopped. Yes, the pacemaker, too. A magnet will stop it, right? Just do it. Please.” That was his request. Deactivating an internal defibrillator is one thing. The patient’s cardiologist didn’t need an ethics consultation for that decision. “If he doesn’t want to be shocked again, that’s his decision. And if it went off again after he’d requested it stopped, that could be a kind of torture,” she reasoned. Deactivation happened quickly after admission from the Emergency Department. A “Do Not Attempt Resuscitation” order was placed in the chart. But the pacemaker, also? He wanted it stopped. Ought we do so? Would that be ethically respectful of this patient’s autonomy? The doctor said to Mr. Perry, “If we stop the pacemaker, Mr. Perry, you will die within a few minutes.” And he replied, “Yes, I know. I’m tired of fighting. Please.”

A similar case would be Jennie’s. Jennie was a forty-eight-year-old woman when she found the first breast lump. Her doctor had been hopeful, but the pathology report showed that her cancer was an aggressive one and had already spread to the lymph nodes around the area. Radiation and chemotherapy were completed praying for the best outcome for her. Sadly, it wasn’t long till Jennie developed back pain. The cause was the spread of her breast cancer to her spine. The disease seemed to spread through her bones, liver, and lungs. She lost weight very fast and became depressed requiring large doses of morphine. This medication only partially relieved her suffering. Eventually her husband, Sam asked the doctor, “Doctor, it’s probably wrong to ask you this, but could you possibly give Jennie one large injection of morphine so that she won’t suffer anymore? She’s been in so much pain for so long. She just wants to get it over with.” The ethical dilemmas created here are very complex.

Analyzing the ethical dilemma of physician assisted suicide, it is clear that there are many ethical issues involved. The issue of physician assisted suicide is a controversial one. What if the patient has been suffering from terminal illness for years? What if he or she has suffered from severe depression and anxiety? Is it morally right to end life? Should doctors be allowed to perform such an action without any medical supervision? Is it morally wrong to allow someone with terminal illness to die? These was my questions but after analysis and thought I came up with two main points:

  1. Physician assisted suicide is morally wrong, but the patient has every right to request it as long as they option is available.
  2. The patient's right to refuse treatment it is not being violated by the doctor, but rather the patient’s wishes are respected. In the same context, he or she is also eligible for end of life treatment options. As the promotion of physician assisted suicide has fired a debate throughout the world. From my view, Physician assisted suicide is when doctors assist patients who could not tolerate the pain of their diseases and are voluntarily given lethal drugs resulting in death. However, physician assisted suicide might be considered to be divergent in many countries currently due to the religions, the laws and the negative image which is created around this matter.

At this point, it remains possible that physician assisted suicide under specific conditions is having a different meaning from physician assisted suicide under the previous conditions. Maybe physician assisted suicide is now acceptable because of some legal changes that have been made and it makes it possible for physicians to respect patients’ requests for death in a more humane way. Physician assisted-suicide is a personal decision which gives the opportunity to a suffering person to end his life. Physician assisted-suicide can affect the patient's family in many aspects. When a person is suffering from some kind of illness and they are already suffering, they should have the right to decide how they want to die. Even though Physician assisted suicide is illegal in most parts of the world by law, exceptions should be made to make it legal for the people who are already suffering from terminal illnesses, as they should not have to suffer anymore. Physician assisted suicide is needed in order to put human rights in place and respect patients’ autonomy.

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