Physician-assisted suicide (PAS) is defined as a voluntary end of a patient’s life through the administration of a lethal substance with either the direct or indirect intervention of the physician. It can further be described as a practice that involves giving a competent patient a prescription for use with the aim of terminating their life. There is a section of people that support PAS while there are others who view it as an unethical practice. Opponents believe that the practice violates the primary role of medicine which stipulates that physicians should not play a role in suicide because it contradicts their position as a healer. In the United States, PAS is currently legal in five states including Vermont, Oregon, California, Washington, and Montana. For a patient to qualify for this process, they must be having a terminal disease whose prognosis is six months or less remaining to live (“Physician-Assisted Suicide Fast Facts,’’ 2017). Additionally, physicians cannot be prosecuted for prescribing the medication that ultimately results in death. The arguments for or against PAS emanate from the ethical provisions of patients' autonomy and the physician's primary role of protecting life.
Ethical Dilemma
Advocates of the PAS mainly refer to the patients' power of autonomy. Autonomy allows the patients to choose what the physicians do with their health. Since it is their life, proponents of PAS feel that they have an inherent right to take away their lives when it is the best thing to do. Therefore, the argument centers on respecting an individual's autonomy and the capacity to make decisions based on what they want best for their life. However, the principle of autonomy might be in conflict with other critical ethical tenets such as non-maleficence and beneficence. The main aim of a physician is to do good and desists from any practice that causes harm to the patients. However, autonomy tends to allow people to have the freedom of making judgments and critical decisions that act on them. Therefore, physicians are compelled to respect a patient’s autonomous choice, respecting not only how they decide to live but also how they want to die. In studying history, one would realize that the ethical dilemma surrounding the PAS started in the ancient Greek and Rome societies. Gostin and Roberts (2016) noted that the physicians at this time were allowed to carry out the assisted suicide and many regarded it as their role. Patients would have to convince the senate that there was a good reason to terminate their life, and the physician would proceed to offer a lethal drug to complete the process. However, the rise in religion saw the rejection of the practice, with opponents citing sanctity of life and the fact that only God takes away life.
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PAS in the United States
As earlier intimated, PAS is defined as a voluntary end of a patient’s life through the administration of a lethal substance with either the direct or indirect intervention of the physician. The US allows the practice in five states including Oregon, Washington, Vermont, and California where the option is given to the individuals by the state. However, in Montana, the power to conduct the PAS is accorded through a court decision. The specific method used in each state varies, but the commonality is that a prescription from a registered physician approved by the state where the patient lives. In Oregon, there are certain considerations with regards to the qualification of the medical practitioner. The physician must either be a Doctor of Osteopathy or a Doctor of Medicine licensed by the Board of Medical Examiners for the State of Oregon. Most fundamentally, the physician must show a willingness to participate in the act. The law in Vermont makes it clear that a doctor of osteopathy or medicine based in Washington will be allowed to conduct the process with strict restrictions put on a physician, pharmacist, or the nurse. Similar requirements cut across in Washington. To oral requests that are 15 days apart are required in California and the District of Columbia to attain the medication (“Physician-Assisted Suicide Fast Facts,’’ 2017)
A majority of the states do not allow patients to play a role in ending their death either through their help of a doctor or by themselves. However, it is also vital to take cognizance of the 1990 Supreme Court decision that asserted that patients or their healthcare providers have the power to refuse life-preserving medical treatment such as the use of tubes.
Health Providers’ Dilemma
The physician required to perform the PAS is always surrounding with a plethora of ethical considerations that can influence their decision and define them within the context of morality. Gostin and Roberts (2016) illustrated that healthcare providers are supposed to respect the autonomy of the patient and respect their decision regarding life and death. However, in virtue ethics, there is what is referred to as the sanctity of life where PAS is regarded as a deviation to the respect of human position to live. Secondly, healthcare providers are also called upon by their ethical guidelines to practice justice where they treat like cases alike. Competent and terminally ill patients have a legal right to reject any form of treatment that would act to prolong their deaths. Therefore, physicians must treat patients equitably, which involves allowing deaths as an option in terminally ill patients who would want to hasten their deaths. However, health professionals understand that with such actions, they can negatively impact the society because the practice is prone to abuse. Yang and Curlin (2016) asserted that vulnerable populations without access to quality care and support could contemplate engaging in assisted death. Others might also utilize it as a cost-containment strategy. Also, historical, ethical provisions tend to go against any potential involvement of the physician in taking away the life of a patient. The Hippocratic Oath, for instance, asserts that “I will not administer poison to anyone where asked,’’ and that the doctor will “be of benefit, or at least do no harm’’ (Yang, & Curlin, 2016).
Religious Dilemma
One of the most significant arguments made by the religious body with regards to suicide is that there should be the sanctity of life. Furthermore, tow important arguments are made by Christians that advice against suicide for any reason whatsoever. First, life is regarded as a gift from God meaning that only God can start a life and as such, he should be the one allowed to end it. Any person committing suicide potentially commits sin. Secondly, religious principles believe that God does not send people any experience that is beyond their handling. Therefore, God supports people during their suffering times and therefore, ending one’s life would be tantamount to showing lack of trust in God (Jacobs, 2016). However, there is growing discontent among some religious factions that such as Agonists, Humanists, and Atheists among others who believe that each has autonomy over their life. Therefore, any person whose quality of life is nonexistence should solely have the decision to commit suicide in an attempt to achieve peace. Secondly, Jacobs (2016) noted that another argument made that counters the religious assertions is that illness terminal illness can be very painful that it causes an unbearable burden to the patient. Therefore, death could turn out to be the only source of relief to the intolerable suffering. Thus, the dilemma sets in when individuals contemplate whether to follow theological provisions of the sanctity of life or rather stick to the ethical power of autonomy and the realities surrounding terminal illness.
Understanding the dilemma that comes with religious beliefs on PAS would require deeper insights into individual faith’s assessment. Many Christians, Jews, and Muslims believe that God is the giver of life and as such, suicide is a rejection of God’s sovereignty and plan to love his people. However, the nominally religious people of North America with liberal religious views hold that PAS can be a morally desirable option in certain circumstances. In their defense, religious groups have attempted to understand the meaning of suffering and how it is relevant for Christians in pursuing the life of Christ.
Critique of the Reviewed Articles
First and foremost, physician-assisted death is still a controversial issue that continues to divide opinions. In the US, the practice is largely unacceptable given that only five states have authorized it. The CNN news article on ‘’Physician-Assisted Suicide Fast Facts’’ outlines the dynamics of the practice in the US including the minimums set aside by each state as requirements to engage in the process. The author concisely uses data to explain how various states have approached the issue. Gostin and Roberts (2016) in their assessment of physician-assisted dying as a turning point highlight various ethical tenets such as autonomy that could give the physician an impetus to perform PAS. Jacobs (2016) explains using religious evidence why human dignity should be upheld in his debunking of this practice. Using ethical arguments, Yang and Curlin (2016) explains why physicians should oppose PAS because it goes against their ethical considerations in the Hippocratic Oath and also their moral responsibility to the society.
References
Gostin, L. O., & Roberts, A. E. (2016). Physician-assisted dying: a turning point? Jama , 315 (3), 249-250.
Jacobs, B. B. (2016). Respect for human dignity in nursing: Philosophical and practical perspectives. Canadian Journal of Nursing Research Archive , 32 (2).
Physician-Assisted Suicide Fast Facts, CNN Library, June 10, 2017 . https://edition.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/index.html
Yang, Y. T., & Curlin, F. A. (2016). Why physicians should oppose assisted suicide. Jama , 315 (3), 247-248.
