The Case for PAS
About 3% of all the patients in the United States cannot have their pain or illnesses relieved, and this calls for an urgent measure to rescue them. The debate over physician-assisted suicide (PAS) has largely dwelt on the morality surrounding it and the advantages and disadvantages that may be achieved by legalizing it. The controversy surrounding PAS has revolved around the issue of the rights of physicians to terminate the life of individuals as well as having a personal decision on death rather than allowing natural causes. Some consequences accrue to legalizing such a controversial law. One of the reasons presented against the legalization of PAS is the negative consequences of such action. Elsewhere, the experience of legalizing PAS and its practice has shown that the occurrence of these consequences (whose occurrence is based on “predictions”) does not occur (Dieterle, 127). The particular case discussed in this paper is the Netherlands, which has participated in legal PAS since 1992. Dieterle has argued that the analysis of the possible negative consequences shows that the consequences are not valid, and therefore there is no reason why PAS should not be legalized (127). However, the analysis of the Netherlands case is not because the country has legalized both PAS and active euthanasia. Opioids, morphine as well as other chemicals have been utilized in the alleviation of symptoms with no “explicit intention” hastening of death (Maas et al; cited in Onwuteaka-Philipsen, 4).
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Arguments for PAS include the fact that patients who would benefit from it could be intensely suffering and yet their pain cannot be alleviated. Bearing physical or mental torment where there is no possibility of cure or alleviation of pain must be a genuine reason to legalize PAS to relieve the patient from intense pain and suffering.
Yet opponents of PAS would argue that only a few cases of all sicknesses and health complications involve the impossibility to alleviate pain. Therefore, only a few patients or none would have a genuine request for PAS. However, the possibility that there could be a genuine case for such a request must also be respected. In addition, there are so many issues relating to the attention of patients in terminal life. The availability or lack of a solution is not the only issue surrounding the attention and caring of patients. Other issues such as the affordability, availability of personnel, and medics should also be included. It should be considered that many patients (3%) do not have the pain relieved and thus would be assisted by the PAS. These issues have greatly impacted the provision of services in health care centers to the extent that the quality of services provided has been compromised, or that the competence is even lacking or not available at the time of need. This only prolongs the intensity of suffering and pain. Opponents could argue in this respect that the right to terminate life must not be based on any other reason than the availability or lack of possibility for a cure and/or alleviation of symptoms, but the danger to expose the patient with constant pain and suffering only seeks to shorten his life on a normal perspective, something they might have instigated earlier.
It is assumed that it would be reasonable for the patients to be left to have control over their death through the possibility of instigating death. This is not a major deviation from the current legal setting because patients still retain the right to refuse treatment and physicians who conduct such treatment or medical attention can be charged with assault in a court of law. Cases for PAS have touched on the rights and the freedom of the patient to terminate medical attention and treatment. The right to control their death would leave a psychological comfort that people may terminate their lives if they feel so and legally.
Opponents in this respect would argue that because pain is virtually controllable in almost all cases, few people would request to be put to death. It is possible, as experience has shown that the right to die becomes an obligation. Therefore, legalizing PAS based on having the patient control their death and the right to die may cause problems where the case turns to be an “obligation” for death (Life Circles Books). Leaving people to have control for their death may as well as cause many to give up too easily and resolve to kill themselves. It would only be reasonable if the discretion to die was tied to the availability or exclusive lack of other options. Allowing the patient to instigate death by themselves legalizes the possibility of a situation where a patient would not want all possibilities of evading the death tried. Mostly, patients who have given up on life would wish to die to get out of persistent pain and therefore the actual concern should be whether it is possible to alleviate the pain or not. But legalizing PAS could provide for a situation where such extent is not reached. It would only be reasonable if physicians firstly tried all the possibilities of alleviating the problem (pain) that would cause the patient to think of an alternative (instigating death). Opponents of PAS could also argue that this does not eliminate the possibility of having genuine cases of terminal illnesses where the patient is exhausted and has lost all hope after every possibility is tried. It would only be fair to allow these to instigate death.
Opponents of PAS would further argue that the patient must not be allowed to have control over their death because they may either be non-competent (either medically or mentally). In addition, there may be other factors that could cause them to make decisions to terminate their own lives, rather than the illness, but use the illness as the reason to instigate death. In case the government and stakeholders capitalize on control of PAS, the benefits only go to a few people and are very high cost. However, it must be considered that the possibility of having so many factors influencing the decision of patients to have control over death does not eliminate the possibility of controlling and discovering such abuse of the legal provision.
The Case against P.A.S
Many consequences have been brought forward against PAS. Legalizing PAS has been seen as a “slippery slope” to endorsing involuntary euthanasia (128). Physician-assisted suicide is where the patient himself is the instigator of death unlike in active euthanasia where the physician is the instigator. Because patients will have legality to think about and instigate their death, the case of involuntary euthanasia may occur.
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The argument by critics of PAS on the possibility of the occurrence of involuntary euthanasia is weak because the law would seal this possibility. As observed in the Oregon example, the patient (qualified) must make the request himself (twice orally and once via written notice) with a period of 15 days in-between, and no delegation of such responsibility is provided by the law. The criticism of PAS on the basis that people may call for the legalization of involuntary euthanasia is invalid since the case of Oregon has exemplified this, now that no such steps have followed the original legalization of voluntary euthanasia (Dieterle, 129). Therefore experience has indicated that the proposed negative consequences against PAS based on the possibility of involuntary euthanasia are based on a fallacy. Passive euthanasia where the patients make decisions for non-treatment (130) has been practiced in some scenarios. There is the possibility of physicians instigating the death of a patient at the end of life even without the explicit request from the patient (Onwuteaka-Philipsen, 2). Non-voluntary euthanasia has been reported in countries like Belgium, Denmark, and Switzerland even in times when PAS was not legalized, indicating that non-voluntary euthanasia is not a consequence of PAS legalization.
Another criticism against the legalization of PAS is based on the argument that the patients may be pressured by insurance companies and family members to instigate their deaths. Critics may have been misleading in that they were not willing to consider the details in this respect. While it is imperative that patients would meet family members and share with them, it does not eliminate the possibility of ensuring that the decision is personal and not influenced. In practice, Oregon has scrutinized the requests on assisted suicide and, for example, cases, where victims would consider themselves as a burden to others, would not be granted the request. In addition, the psychiatric examination is possible to determine whether the decisions are “personal” or influenced by other people (Dieterle, 131). In addition, the current legal framework allows the patients to refuse treatments and be allowed to die. There are more loopholes for abuse of this passive euthanasia than would for PAS. For example, a family member could pressure the patient to refuse treatment or medical attention. Therefore the argument for refusal of legalization of PAS on the basis that family members may influence the decision to instigate death, is not substantial and exclusive at all. Although critics may consider the comparison between the possibility of abusing passive euthanasia and the likelihood of abuse of PAS as unfair, it must be considered that the right to PAS is a “positive right” (Dieterle, 132).
Proponents of anti-PAS have also argued that there could be the marginalization of the poor and minority groups such as the elderly. The abuse would result because the practice will tend to favor the rich and the decisions to favor the powerful in the society. The poor and the marginalized groups will not have a say to either control the practice of the rules governing the practice. The poor and the marginalized groups may be victimized because they may be forced to go for the option. Marginalization based on age is misguided because analysis of the Oregon example indicates that only 8% of the patients aged above 85 years chose to die in respect to the provision of Oregon’s Death with Dignity Act between 1998 and 2004, while young people were “more likely” to use PAS than the elderly. The age of those choosing to die in respect to the provision was 25 to 94. The group with high social-economic status was more likely to receive euthanasia in the Netherlands than those with low socio-economic ratings. The depressed people may choose the PAS option not on their own because their mental condition is not normal, and this means that the option would be undesirable. Given an option of normal condition, they would choose not to have the PAS. These may quickly choose PAS yet their conditions could improve after a short while.
Dieterle, J. M. “Physician assisted suicide: a new look at the arguments”. Bioethics, Vol. 21 (3), 2007: 127–139.
Maas, van der et al. “Euthanasia, Physician Assisted Suicide, and Other Medical Practices Involving the End of Life in the Netherlands, 1990–1995”. N Engl J Med 335, 1996: 1699–1706.
Onwuteaka-Philipsen, Bregje et al. “Euthanasia and Other End-of-Life Decisions in the Netherlands in 1990, 1995, and 2001”. Lancet. 2003. Web.