Introduction
Assisted suicide or euthanasia used to be allowed only in some European countries, but today residents of several US states are eligible for AS. The essence of the idea of AS is to allow a person who suffers from an incurable disease and experiences severe pain symptoms to die with the help of doctors to end the suffering. Modern society has divided views on euthanasia: some professional doctors and experts defend the human right to AS, and another part of society presents critical arguments against such a practice. This paper aims to debate the pros and cons of assisted suicide and its morality or immorality.
Assisted Suicide in the US
The first clandestine practice of euthanasia in the US began in the early 1900s. These practices gained popularity under the influence of the eugenics movement, which defined the discourse on this issue as a confrontation between practical and religious-moral positions. However, attempts to legalize euthanasia were unsuccessful, and this issue was not officially raised for a long time (Dugdale et al. 747). In the 1980s, AS was first introduced in the Netherlands to allow patients to self-administer lethal drugs. In particular, Dr. Jacob Kevorkian presented help with assisted suicide to 130 patients from 1990 to 1998 (Dugdale et al. 748). However, in 1999, when Kevorkian tried to appeal to the public to legalize euthanasia, he was sent to prison on murder charges, as his practice was seen as deeply immoral.
Kevorkian’s activism resonated with the international scientific community, and New York State doctors filed a lawsuit against the state’s ban on physician-assisted suicide, which resulted in the Supreme Court ruling “that there is no constitutionally protected right to die” and leaving decisions to the states (Dugdale et al., 749). Subsequently, several states decriminalized AS, including Washington (2008), Montana (2009), Vermont (2013), California (2015), Colorado (2016), Columbia (2017), Hawaii (2018), New Jersey ( 2018), and Maine (2019) (Dugdale et al. 749). Therefore, today euthanasia is adopted in 9 states, the most populous of which is California.
Several definitions of euthanasia are related to the type classification of the AS. One classification divides AS into three categories, where the first type is assistance to die without suffering. The second type is the accelerated death of the patient due to disability, insanity, or severe forms of other diseases (Ming et al. 91). The third type is mercy killing, which can be carried out at the request of the patient, his family, or the state. Therefore, the scholars introduce the classification aiming for productive dialogue on the practice’s morality within the determined contexts.
Another type of classification includes the division into active and passive euthanasia. Active euthanasia is the termination of life by some action, such as a lethal injection, while passive euthanasia is when a patient is left to die, such as by withholding medical care (Ming et al. 92). Euthanasia is also divided into voluntary, involuntary, and forced, depending on the consent of the patient in the first case, or the impossibility of voicing consent in the second case. Notably, forced euthanasia can be performed within the framework of the practices of penitentiary institutions.
AS and Healthcare Practitioners: Ethical and Legal Aspects
Proponents of euthanasia view this issue from a variety of perspectives, including the involvement of physicians in the AS process. For example, Hatherley notes that doctors should have a clear position related to protecting the rights of their patients (817). In particular, the scientist argues against AS provided for mentally ill patients, because of their distorted decision-making ability, in contrast to somatic patients. Equally important, so far there is no sufficient scientific basis for the incurability of mental illness. Finally, the institutionalization of patient-assisted suicide (PAS) raises many moral and ethical issues that require detailed discussion (Hatherley 818). Therefore, most experts, including proponents of euthanasia, oppose the provision of AS services for mentally ill patients and perceive it as immoral.
Scholars also believe that legal discussions about whether a physician has the right to perform AS should be based on ethical law reasoning. On the one hand, many doctors refuse to help a patient with AS, because as long as the person is alive, there is still hope for recovery. Equally important, often the euthanasia decision is made by the relatives of the patient, who may be in a coma and not be able to influence the situation (Dugdale et al. 750). The pretext may be to end prolonged suffering, but most physicians are not prepared to risk their oath and comply with such a request, taking the patient’s life. Therefore, physicians tend to take the position condemning the AS, and their participation may have serious legal repercussions.
The medical authorities should have a clear position on AS. Vogelstein cites the American Nurses Association’s statement on euthanasia, which is based primarily on the organization’s code of ethics, providing for an injunction against nurses practicing AS for patients (124). This document specifically addresses the risks of maltreatment in the provision of euthanasia services, the ethical debatability of the social contract between the nurse providing the service and society, the oath of no harm, the sanctity of life, traditions of care, and the basic goals of nursing. According to the document, which is the main guide for US nurses, the practice of AS goes against all of the listed norms and requirements for the work of nurses. Despite this, nine states have decriminalized the practice of euthanasia, which, however, does not guarantee that patients will receive it since the final decision is usually made by each doctor or nurse personally.
Scholars note that there has been a softening of stances in medical circles regarding AS practices. Sulmasy et al. emphasize that since the 1990s there has been an ethical shift “from opposition to neutrality” or “from forbidden to optional” concerning PAS practice (1394). According to Sulmasy et al., arguments in favor of PAS include patient autonomy and compassion for those who are suffering greatly, as well as distinguishing between the concepts of killing and assisted dying (1395). At the same time, arguments against AS and PAS include limiting autonomy and distorting the relationship between patient and healthcare practitioner, as well as the goal of healing, the search for alternatives, and the social nature of suicide. In other words, the arguments against the practice of euthanasia focus on the impossibility of overturning the decision and the hope of a cure, while the arguments in favor are related to the patient’s right to determine their future.
The scientists also separately consider some categories of patients who are supposedly more eligible for AS according to public opinion. For example, Elliot denounces the eugenic approach, which implies that some lives are more important than others (352). In particular, the scientist notes the tendency to view the lives of disabled people as less valuable and more prone to receive AS. However, according to the scientist, suicide has a social nature, and therefore the tendency to view disabled people as more deserving of the practice of AS is unnecessarily cruel. On the contrary, physicians and the public must fight to ensure a normal life for the disabled and to relieve them of physical and social suffering, including the suffering of loneliness and exclusion from social relationships.
Religious Perspective
Christians, including members of various small Christian communities, have supporters and opponents of AS. On the one hand, Christianity opposes suicide, as it is a self-destructive act. On the other hand, Christianity allows martyrdom, and there is a discourse among theosophical scholars about whether the crucifixion of Christ was a form of suicide. Therefore, Christians in general are considered to waive the “absolute prohibition against suicide” (Cooley 10). Therefore, scholars admit that Christians can justify “pure” suicides, which are carried out for self-sacrifice, as exemplified by the lives of many Christian martyrs. In general, Christianity leaves more questions than answers for people who face the terrible life choice of assisted suicide.
Interestingly, researchers note lower rates of suicide decisions, including AS, among residents of countries where a large number of people practice any of the religions, which probably indicates the healing potential of faith. Remarkably, from an ethical standpoint, believers cannot take an example from their God, since he is an omniscient being who is the source of morality and independently determines right and wrong actions (Cooley 11). In general, most religions prohibit or actively discourage self-harm, including suicide. At the same time, the pro-positions assume that if one of the religious role models, such as a martyr, commits suicide, then this may be ethically correct for other believers.
Suicide Tourism
One of the unexpected aspects of the issue is the phenomenon of suicide tourism. The very existence of this trend justifies the practice of AS to some extent, although such logic may seem dubious on closer examination. Notably, there is a niche sector of tourism named associated suicide tourism, where a travel agency helps a client get to their destination and meet with a doctor who will help them “commit suicide with dignity” (Mondal and Bhowmik 35). Because euthanasia is legalized only in a small number of countries, this type of tourism is quite popular. The very fact of the existence of suicide tourism, therefore, proves the demand for the service among a part of the members of society. At the same time, people who wish to receive medical assistance in AS may experience economic difficulties associated with additional costs due to the need to travel to another country.
Conclusion
Thus, the pros and cons of the practice of assisted suicide were analyzed in terms of its morality. Most experts stand for the con position, emphasizing the immorality of the AS practice. For PAS, in particular, arguments include an oath of no harm, personal legal liability for doctors and nurses, and a focus on healing. Moreover, ethical positions condemning AS are associated with the belief in the healing and the sanctity of life. Very few experts advocate for the provision of a PAS service seeing it as a morally acceptable practice justified by the freedom of choice.
Works Cited
Cooley, Dennis R. “Was Jesus an Assisted Suicide?” Ethics, Medicine and Public Health, vol. 14, no. 1, 2020, pp. 1-14.
Dugdale, Lydia S., Barron H. Lerner, and Daniel Callahan. “Focus: Death: Pros and Cons of Physician Aid in Dying.” The Yale Journal of Biology and Medicine, vol. 92, no. 4, 2019, pp. 747-758.
Elliot, David. “Anthropologies of Hope and Despair: Disability and the Assisted-Suicide Debate.” Journal of Disability & Religion, vol. 22, no. 3, 2018, pp. 352-367.
Hatherley, Joshua James. “Is the Exclusion of Psychiatric Patients from Access to Physician-Assisted Suicide Discriminatory?” Journal of Medical Ethics, vol. 45, no. 12, 2019, pp. 817-820.
Ming, David, Benjamin Metekohy, and Novita Loma Sahertian. “Euthanasia in Christian Ethic-Theological Context: Pros and Cons.” Jurnal Theologia, vol. 32, no. 1, 2021, pp. 89-108.
Mondal, Atish Prosad, and Puja Bhowmik. “Physician-Assisted Suicide Tourism – A Future Global Business Phenomenon.” The Business & Management Review, vol. 10, no. 1, 2018, pp. 35-43.
Sulmasy, Daniel P., et al. “Physician-assisted suicide: why neutrality by organized medicine is neither neutral nor appropriate.” Journal of General Internal Medicine, vol. 33, no. 8, 2018, pp. 1394-1399.
Vogelstein, Eric. “Evaluating the American Nurses Association’s Arguments against Nurse Participation in Assisted Suicide.” Nursing Ethics, vol. 26, no. 1, 2019, pp. 124-133.