According to the Institute of Medicine (2015), death is a deeply personal human experience that elicits different emotions, reactions, as well as perceptions from families, individuals and communities throughout the lifecycle. On the same note, perceptions about death vary in childhood, prime adulthood and in later life stages. However, death remains a personal issue regardless of when it occurs in the life stage. Death is also affected by social, cultural and religious perceptions, which most of the time hinder many people from expressing their views on how they will die. As a consequence, no one knows exactly whether the death of a loved one occurred with the dignity that is deserved or the process was marred by fear, pain, discomfort and emotional or physical struggle. Usually, many people envision their death as a peaceful rapid transition. Nevertheless, with the exception of accidents or short illnesses death sometimes comes at the end of a prolonged chronic illness or as a consequence of old age. That implies that people may take months, years or even decades suffering from conditions that will ultimately cause their death. While healthcare workers may be aware that the patient will finally die, the existing legal and ethical structures may hinder them from discussing the death process or suggesting how to end the patient’s life to alleviate suffering. This paper argues for assisted suicide in cases where there is prolonged suffering and thereafter justify the position using utilitarian ethics.
Background
It is not yet clear when discussions about euthanasia or assisted suicide emerged. However, debates on the subject have been on-going in developed countries such as the United States and the United Kingdom. For example in 1906, Ohio attempted to pass legislation to legalize assisted suicide but the process elicited a lot of controversy (Banović, Turanjanin, & Miloradović, 2017). However, in the recent past, a few states in the United States have decriminalized euthanasia as a milder method of deprivation of life. The Supreme Court has, nevertheless, held that there is no constitutional right to physician assisted suicide nor the ban on the practice. This position by the Supreme Court leaves the public in dilemma.
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One recent prominent case concerning death is that of Noel Conway, a United Kingdom citizen who feared being entombed in his body as a consequence of suffering from motor neuron disease (Rawlinson, 2017). Conway presented his case to a UK high court arguing that the country’s suicide act was incompatible with the European convention on human rights, which advocates for respect for private and family life. Conway, who was 67 years old and a retired lecturer, wanted the court to grant him a peaceful and dignified death. However, the high court rejected the case and ruled that the country’s suicide act outlaws euthanasia and that it was compatible with the right to a private life as conferred in the European convention on human rights. According to the high court, the only option left for Conway was to suffocate to death by choosing to remove the ventilator that he had become dependent on to breathe for up to 22 hours a day. Conway argued that the option was cruelty because he would not know how long it would take for him to die. The high court’s decision on the Conway case was reversed in 2018 by the Supreme Court. Eventually, Conway was allowed to die a peaceful and dignified death through physician assisted suicide. Before his death, Conway had the opportunity to meet and talk to his family members and friends and knew exactly when he would die and end his suffering.
Criticism of Assisted Suicide
According to Sulmasy & Mueller (2017), the role of medicine and healthcare in the society is to address wellness. That means that the duties of physicians should be to provide care that conforms to clinical judgment, evidence, and ethics. The society expects physicians to focus on addressing efforts that alleviate suffering to patients and foster the needs of patients and families. Summarily, the role of a physician according to the society needs to be improving access to effective hospital and palliative care. From these expectations, it appears odd for physicians to suggest to patients or families that physician assisted suicide be implemented in certain cases. For patients and loved ones, healthcare workers are supposed to do everything they can to restore the health status of their loved ones. Perhaps the greatest impediment to physician assisted suicide has been the universal law of the right to life. In light of this law, people are not expected to end their own lives or have other people end their lives. In the United Kingdom for instance, physician assisted suicide attracts a sentence of up to 14 years in prison (Rawlinson, 2017). In many countries in the world, the practice remains illegal.
Arguments for Assisted Suicid e
The first argument highlights the patient’s autonomy as well as the physician’s duty to relieve pain and suffering. The resolve to end one’s life is regarded as highly private and should not be prohibited. Sulmasy & Mueller (2017) state that in Oregon, a state that has had the most experiences of physician assisted suicide, approximately 1327 people have obtained legal consent for lethal injections since 1997. Of that number, a significant proportion has comprised of elderly people and people suffering from chronic illnesses such as cancer. In these instances, there seems to be justifications for physician assisted suicide. In the case of chronic illnesses such as cancer, the death process usually takes a long time amid pain and suffering. It ought to be understood that physician assisted suicide does not occur because of benign conditions, rather, it occurs in critical cases.
For a country such as the United States, which does not have a comprehensive medical cover for all citizens, taking care of a patient with a chronic condition can be an agonizing moment. Even when physicians know that the patient will ultimately die regardless of the medical attention, it can be too costly for loved ones to insist on caring for the patient (Institute of Medicine, 2015). The first cost is emotional. It can be heartbreaking for family members to witness the pain and suffering of their loved ones each time they visit them in hospitals. The experience becomes even worse when physicians cannot alleviate the condition and the law does not allow dignified termination of the patient’s life. The patient, therefore, has to endure a painful process towards the end of his or her life. Sometimes it can be argued that the legal structures and environment do not understand the real experiences that physicians, patients and family members go through in cases of chronic illnesses or conditions associated with old age.
In regard to the financial constraints, treatment and care of patients who are in either way bound to die can be too costly, especially in the United States. Because of the lack of a comprehensive medical cover, patients and family members are compelled to draw out all their finances to care for the patient. Eventually, when the patient dies, families become impoverished and may experience trauma. Family members spend too much money on treatment, witness the pain and suffering of their loved ones, and ultimately witness them die. While critics of physician assisted suicide oppose the practice, perhaps it is also important to ask them whether it is ethical to subject people to suffering (both emotionally and financially) when there is something that can be done. Proponents of physician assisted suicide also posit that it is an act of compassion, which respects patients’ choices and fulfills a sense of non-abandonment (Sulmasy & Mueller, 2017). Suffering and pain may translate into being abandoned and cruelty. It is even worse when the ventilator is withdrawn and the patient is left to suffocate. Such an action may trigger questions concerning why the patient was put on the ventilator in the first place.
Utilitarian Ethics
Utilitarianism judges an action as either right or wrong depending on the outcome (Hayry, 2013). In this case, the decision may not be the best but the consequences may justify it. Normally, assisted suicide does not sound morally right, but the circumstances that compel the practice may be justified. For example, assisted suicide in cases where patients suffer from chronic or terminal illnesses alleviates pain and suffering to patients and family members. Besides, family members are cushioned from unnecessary costs when it is known that the patient will eventually die. Even in assisted suicide, patients are not forced to undergo the process, rather, they make their own choices.
Conclusion
The process of dying has seemingly been affected by cultural, spiritual, and religious factors. It is almost uncommon for families to discuss about death because of these factors. While death has always been perceived as a peaceful and rapid transition, there are cases when there process can be marred by pain and suffering. Sometimes the experience can take several months, years or even decades. As a consequence, it is always prudent for personal decision to be respected in light of these painful experiences. Assisted suicide can alleviate all this pain and suffering both to the patient and family members. From the perspective of utilitarian ethics, assisted suicide is right in such instances because it prevents suffering, emotional pain and financial costs to patients and family members.
References
Banović, B., Turanjanin, V., & Miloradović, A. (2017). An Ethical Review of Euthanasia and Physician-assisted Suicide. Iranian journal of public health , 46 (2), 173.
Hayry, M. (2013). Liberal utilitarianism and applied ethics . Routledge .
Institute of Medicine (US). Committee on Approaching Death: Addressing Key End-of-Life Issues. (2015). Dying in America: Improving quality and honoring individual preferences near the end of life . National Academies Press.
Rawlinson, K. (2017). Terminally ill man loses high court fight to end his life . The Guardian . Retrieved 23 October 2018, from https://www.theguardian.com/society/2017/oct/05/entombed-man-noel-conway-loses-high-court-fight-end-life
Sulmasy, L. S., & 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.
