Due to the consistently improving quality of life in developed countries, the average life expectancy has increased over the past decades. The growing aging population means that the rate of disease occurrence later on in life has also augmented. For the incurable and terminal conditions, medical care usually focuses on providing a pain-free state for the patient until death. If the patient is suffering from a debilitating condition and recovery becomes unattainable, a debate arises regarding whether he or she should be allowed to undergo voluntary suicide. Many physicians argue in favor of assisted suicide, feeling entitled to alleviate the patient’s suffering despite the life-shortening. Others are concerned with the ethics of consciously euthanatizing a patient. Thereby, the debate stems from the following unanswered question: should the patient be the sole party legally responsible for the decisions regarding his or her medical treatment? This paper discusses the ethical arguments for and against assisted dying (AD). The author believes that the patients should be the sole decision-makers regarding their medical treatment and voluntary suicide, although the legalization of assisted suicide requires careful and nuanced regulation.
AD refers to both physician-assisted suicide and voluntary active euthanasia. Voluntary active euthanasia involves “a physician (or third person) intentionally ending a person’s life normally through the administration of drugs, at that person’s voluntary and competent request” (Fontalis et al. 2). Physician-assisted suicide refers to a doctor helping with the provision of drugs to assist the patient with voluntary death. The two fundamentally differ in who administrates the drugs – the medic or the patient. While involuntary euthanasia leaves no question regarding its unethicality, all forms of voluntary euthanasia are subjects of controversy. Currently, only several jurisdictions have legalized some form of active euthanasia, including are the Netherlands, Luxemburg, Belgium, Switzerland, Canada, and several states of the United States of America (Preston 1). In other countries, assisting with suicide, even by a trained physician, is a criminal offense (Fontalis et al. 3). Many patients, notably Diane Pretty and Dax Cowart, have protested such legislations, claiming they violate the person’s civil rights (Preston 2). As a result, the AD legislation continues to be a topical issue in the medical and legal communities.
Bioethics describes the patient’s right to autonomy, which is the freedom to make decisions regarding his or her medical treatment. Most notably, this right manifests in refusal of treatment or intervention, despite the possibility of severe harm or death to the patient. Under Article 8 of the European Convention on Human Rights, the medic cannot interfere with the patient’s decision (Fontalis et al. 6). By the extension of this right, terminally or chronically ill individuals should reserve the right to decide whether to continue living. For many patients, the emotional costs of living with a debilitating illness outweigh the desire to live. They fear further deterioration and the progressive loss of mobility or mental functioning and wish to die while preserving some dignity (Fontalis et al. 6). Therefore, AD could serve as an act of compassion by minimizing the patient’s subsequent suffering while respecting their right to autonomy.
The biggest concern regarding AD is accurately evaluating whether the patient is competent to make the decision. A study by Bolt et al. (597) found that less than 50% of the surveyed physicians (n=1456) would agree to AD in patients suffering from mental disorders or dementia. If the cited reason for the request was “tired of living,” only 27% of physicians agreed to grant the request (Bolt et al. 597). Clinical depression falls under the category of mental disorders, meaning that many reported physicians would not deem the patient competent. However, depressive moods often accompany terminal illnesses, making it especially challenging to set a mental competency threshold. Additionally, many patients report feeling like a “burden” and wish to end their life to prevent further financial and emotional suffering to their families (Fontalis et al. 9). These factors present significant challenges in assessing what constitutes a threshold of mental competency.
Another concern is the inaccurate estimation of the patient’s life expectancy. Typically, medics would only consider AD if the patient’s diagnosis is progressive and incurable, and the prognosis does not exceed six months. However, frequently, such prediction proves to be erroneous, as the physicians base them on previous clinical experience (Trevino et al. 1908). Undoubtedly, no clinical factors can predict the exact timeframe within which the patient will definitively die. History shows that many patients exceeded their initial prognosis by years and even decades. Since life expectancy is likely to affect the patient’s decision on voluntary suicide, the frequent inaccuracies are of significant concern. Experiencing debilitating pain for years rather than months, as initially predicted, can prove to be the deciding factor in the request for AD.
The medical ethics state that the principles of beneficence and non-maleficence should guide the doctor’s decisions. The beneficence commands that all actions represent the patient’s best interest, while non-maleficence instructs not to do any harm (Fontalis et al. 10). The dilemma then arises whether AD is an act of beneficence or malice. On the one hand, AD leads to the relief of the patient’s suffering and the right to autonomy. Prolonging one’s life as his or her condition rapidly deteriorates not only does not improve the patient’s quality of life but worsens it. On the other hand, each medical practitioner interprets the principle of non-maleficence based on their own ethical beliefs or religious views. The doctor might argue that all life is inherently valuable despite the suffering and equate euthanasia to killing. In this case, active euthanasia would be an act of malevolence and go against the bioethical principles.
The consequences of AD legalization extend beyond the individual’s life. Vulnerable groups, such as people with disabilities, might feel compelled to request AD to alleviate their families’ financial and emotional pressures (Fontalis et al. 7). It might become impossible to evaluate to what extent the decision is genuinely voluntary. Furthermore, eradicating the legal responsibility could result in AD cases that fall outside of the established frameworks, such as in patients who are not fully competent (Fontalis et al. 9). Additionally, sustaining terminally-ill patients in palliative care proves costly, raising the question of whether a part of the funds should go towards individuals with better chances of survival. The legalization of AD could result in patients mistrusting their doctor’s real intent due to the sudden conflict of interest (Fontalis et al. 14). Ironically, withdrawing treatment and allowing the patient to die from the underlying condition is acceptable and legal in most countries. Whether “letting to die” is more ethical than “assisting in dying” is questionable, given that they ensure the same result and with potentially more suffering during the former.
Despite the concerns regarding the potential exploitation of the practice, the current situation argues in favor of AD legalization. The increasingly liberal views place a higher value on the patient’s needs and desires above all else (Fontalis et al. 15). Continuing the individual’s suffering, especially against one’s wishes, appears more unethical than a controlled and peaceful death. Each person should hold the authority to make informed decisions regarding their bodies and lives. The medical practitioners might not fully understand the full scope of the patient’s suffering or ethical believes. Therefore, they should not be the ones making executive decisions for the patient. Providing that the choice only affects the mentally-competent person in question, patients should reserve a right to die on their terms.
One way to ensure that AD cases do not escalate is by introducing standardized and rigorous evaluation protocols. The medical staff should provide the patients with full disclosure regarding prognosis and its potential inaccuracy, and the alternatives to AD. The medical staff should undergo sufficient training to prepare them for the possibility of assisted suicide. It might be beneficial to appoint a regulatory committee to assess the nuances of each separate case. Together, the doctors’ and the committee’s evaluation could form the necessary oversight to prevent AD misuse.
Assisted suicide remains a controversial and heavily debated topic, raising several ethical concerns. Its legalization would grant patients the right to autonomy and uphold their fundamental civil liberties. Ultimately, the patient should be the sole decision-maker as he or she holds a better understanding of their position. The challenges remain to establish the competency threshold of such individuals and prevent the overexploitation of the practice. To achieve this, the governments need to offer federal support, establish relevant regulatory committees, and provide medical staff with sufficient training. The topic of voluntary suicide largely remains taboo in most cultures. It might be time to reevaluate the societal attitudes to prevent continual suffering, especially when the affected individuals themselves are asking the society for compassion.
Works Cited
Bolt, Eva Elizabeth, et al. “Can Physicians Conceive of Performing Euthanasia in Case of Psychiatric Disease, Dementia or Being Tired of Living?” Journal of Medical Ethics, vol. 41, no. 8, 2015, pp. 592–98. Crossref.
Fontalis, Andreas, et al. “Euthanasia and Assisted Dying: What Is the Current Position and What Are the Key Arguments Informing the Debate?” Journal of the Royal Society of Medicine, vol. 111, no. 11, 2018, pp. 407–13. Crossref.
Trevino, Kelly M., et al. “Accuracy of Advanced Cancer Patients’ Life Expectancy Estimates: The Role of Race and Source of Life Expectancy Information.” Cancer, vol. 122, no. 12, 2016, pp. 1905–12. Crossref.