Abstract
This paper discusses the ethical issues related to the legalization or forbiddance of physician-assisted suicide (PAS). It identifies various stakeholders that are involved and presents their arguments in support of or in opposition to medically aid suicide. The author argues that patients should have the freedom of choice concerning his/her end-of-life decision and better if they die under the control of the professionals to avoid additional suffering. Next, it is stated that physicians facing ethical issues which forbid them to assist patients in dying should prioritize patients’ well-being over instructions. Finally, the author maintains that the legalization of PAS may not affect the development of alternative end-life care methods such as palliative care.
Introduction
The claims that physician-assisted suicide (PAS) should be legalized have intensified in recent years due to increasing public attention. The famous and controversial case of Brittany Maynard’s death of dignity has caused many people to contemplate this problem and decide what their ethical standpoint is. As a result, public opinion has divided into two opposing groups: those who support medical aid in dying and those who oppose it. The former party mostly consists of the common public; the latter generally includes professional medical associations. The fact that both sides are able to present valid justifications to strengthen their position proves that resolving this issue is not a trivial task and necessitates multifaceted analysis. Therefore, this paper, firstly, seeks to discuss different perspectives on ethical issues that arise around the topic of PAS, and, secondly, presents the arguments in support of Brittany Maynard’s decision to die with medical assistance.
The Definition of Physician-Assisted Suicide
According to Snyder Sulmasy & Mueller (2017), assisted suicide is “physician participation in advising or providing, but not directly administering, the means or information enabling a person to intentionally end his or her life” (p. 578). PAS, thus, refers to the aid that physicians provide to terminally ill patients who seek to die with dignity through prescription for a lethal dose of medication. That method differs from euthanasia, as the latter includes direct actions of the medical workers to end the suffering person’s life. For instance, that can be lethal injections made by physicians.
States with Legal Protection of Physician-Assisted Suicide
Currently, eleven jurisdictions in the United States legally allow the practice of PAS. They include California, Colorado, District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington (Death with Dignity, 2021). Among them, ten of the administrative units have the laws that safeguard PAS, except Montana. On the other hand, the latter’s government found none of the existing laws to contradict or prohibit the right of the terminally ill patients to pursue or for physicians to provide medical aid in dying.
Ethical Issues Related to PAS
Either allowing PAS or forbidding it can raise ethical problems related to the rights and duties of various stakeholders. If PAS is not legal, then one of the basic human rights, namely, the freedom to choose, is violated. Conversely, the legalization of physician-assisted death contradicts the medical professionals’ ethical norms, which have existed since ancient times. It is argued that by agreeing to prescribe lethal doses of medication, physicians breach the Hippocratic Oath. Particularly, it contradicts the line that states: “neither will I administer a poison to anybody when asked to do so nor will I suggest such a course” (Ahlzen, 2020, p. 353). Therefore, medical workers are faced with an unpleasant decision between two options. If physicians refuse to assist terminally ill people, they doom the latter to suffering or trying risky “self-administered” or unprofessionally-assisted suicide attempts, which eventually can cause greater damage. Conversely, if doctors decide to aid patients in dying, they break the professional norms.
Moreover, legally allowed PAS raises concerns about the nature of a human being from a philosophical perspective. Some argue that seeking suicide may devalue the meaning of human existence when a person avoids pain and suffering by being unable to embrace them. Hence, a patient who seeks medical aid in death cheapens individuals’ lives (Butts & Rich, 2019). However, others criticize that notion as lacking compassion and being inhumane, especially when patient’s sufferings are unbearable.
The Author’s Position on the Subject
Despite the complexity of the topic and the existence of equally valuable pros and cons of PAS, it is necessary for everyone concerned to solve the ethical dilemma. For that reason, the author of the paper intends to elaborate on the arguments supporting medical aid in dying. Firstly, it is argued that a patient has a personal right to choose how to end one’s life. One who decides to die with dignity should be able to do that under the supervision of professionals instead of trying other methods of suicide, which may cause more harm to the person.
Secondly, Gallup’s nationwide poll shows that 72% of Americans support doctor-assisted suicide (Brenan, 2018). Therefore, it is evident that medical aid dying is not the caprice of a certain group of people but the will of the democratic society. Even though that desire may contradict the Hippocratic Oath, the doctors have to serve the well-being of the patients. Otherwise, the former is led by the instructions rather than by feelings of compassion towards patients. However, it is important to note that those medical workers who do not support PAS due to personal or religious views should not be forced to participate in the process.
Finally, although it is the belief that PAS can reduce the development of alternative methods such as palliative care, those views may be wrong. For instance, Oregon, where assist in dying exists more than two decades, is considered as one of the best jurisdictions in providing palliative care. Moreover, PAS may be used until other treatment approaches are not sufficiently developed to effectively reduce patients’ suffering.
The Position of American Nurses Association
Many official medical unions participated in the debate around PAS by publishing official positions, including American Nurses Association (ANA). The association’s arguments against aid in dying include the sacredness of life, contradiction to professional values, and devaluation of human experience (American Nurses Association, 2019). ANA states that any participation of nurses in PAS is ethically and professionally prohibited but emphasizes that the latter should be able to have discussions concerning end-of-life with their patients. Medical assistants should encourage terminally ill people to choose palliative and hospice care. Furthermore, ANA contends that nurses should contemplate their ethical foundations about the issue and reach a clear understanding of their position on the matter.
Conclusion
In summary, this paper presented the analysis of the ethical questions that arise around the problem of PAS. Firstly, the definition of the term was provided, and eleven jurisdictions where PAS is legalized were identified. Secondly, the main ethical issues of medically assisted death were analyzed, presenting arguments of various stakeholders. Moreover, the author’s personal arguments in favor of PAS were presented. They included the patient’s freedom of choice in the questions concerning his/her end-of-life and the necessity to concentrate on the patient’s well-being, not on the instructions that do not reflect public opinion. Additionally, the counterargument against the notion that the legalization of PAS may harm the development of alternative care methods was presented. Finally, the position of the American Nurses Association concerning the matter was analyzed.
References
Ahlzen, R. (2020). Suffering, authenticity, and physician assisted suicide. Medicine, Health Care and Philosophy, 23(3), 353-359.
American Nurses Association (2019). The nurse’s role when a patient requests medical aid in dying. Web.
Brenan M. (2018). Americans’ strong support for euthanasia persists. Gallup. Web.
Butts, J. B., & Rich, K. L. (2019). Nursing ethics: Across the curriculum and into practice (7th ed.). Jones & Bartlett Learning.
Death with Dignity (2021). In your state. Web.
Snyder Sulmasy, L., & Mueller, P. S. (2017). Ethics and the legalization of physician-assisted suicide: An American College of Physicians position paper. Annals of Internal Medicine, 167(8), 576-578.