Over the years, there has been significant debate on ethics of Physician-Assisted Suicide (PAS) or euthanasia in terminally ill patients. Individuals have come with various arguments that favoring the morality of euthanasia in the public consensus. Others have counter-arguments in favor against euthanasia ranging from the importance of preserving the sanctity of human life to other ethics related to the medical profession. This paper will focus on various prominent arguments in favor of euthanasia such as autonomy, beneficence and the importance of alleviating suffering. It will also delve into arguments against euthanasia taking into considering the ethics that guide physicians, the importance of palliative care and misuse of PAS.
Physician-Assisted Suicide (PAS) involves a physician assisting the patient in dying by administering or prescribing a drug that is lethal. Euthanasia, on the other hand, refers to the killing of the patient regardless of the intent or the patient's circumstances ( International Anti-Euthanasia Task Force, 2000) . Euthanasia, however, may be classified depending on whether the patient has informed consent. The first type of Euthanasia is the voluntary euthanasia. This type of Euthanasia, the patient, approves his or her death with the assistance of the doctor. It is mostly referred to as assisted suicide and legalized in countries such as Switzerland, Washington and US states of Oregon. Non-voluntary euthanasia the consent of the patient is not required. This happens especially in child euthanasia and is carried in specific circumstances. In involuntary euthanasia, the approval of the patient is not required. Passive and active euthanasia is under voluntary, involuntary and non –voluntary euthanasia. Passive euthanasia entails the physician withholding the treatment of the patient later leading to death. This type is practiced mainly if it was the directive of the patient from his living wills as well as the powers of the Attorney. In most cases, this is not often regarded as criminal as the physician is acting in the best interests of the patient. Active euthanasia involves the use of lethal injection or drugs hastening the process of dying without much pain.
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Legalization of PAS
Debates about the ethics of euthanasia and physician-assisted suicide date back from the ancient Greece and Rome. As early as 1870, physicians had started advocating for the user of anesthetics to reduce the pains of death. Samuel Williams, one of the physicians, proposed the use of drugs such as morphine to terminate the life of patients. For more than 20 years, debates about the ethical implications of euthanasia have sparked a lot of mixed feeling across the United States and Britain (Radbruch et al., 2016). This has resulted to the legislation of bills in some states, some of which have also been defeated. In the United States, there is no federal policy regarding the practice of assisted suicide is in existence. During President Clinton tenure, a ban was instituted to prevent any federal funds including Medicaid or Medicare from paying hospital bills that were associated with assisted suicide. The state of Oregon, however, passed a law in the year 1994 through the Oregon Death and Dignity Act allowing physicians to help their patients to die under some circumstances ( Frey, Cordon & Waun, 2015). To comply with the law, physicians must ensure that all prescriptions given to the patient are submitted in the form of a report to the Oregon Health Division (OHD). Similarly, the death certificate of the patient is also screened through the OHD records so that they can match with the earlier physician report.
Similar legislation has taken place in other states such as Washington, Vermont, and California. As compared to other countries in European countries, the rules require that patients must have suffered from terminally illnesses to quality for PAS.
Switzerland is also another country that has had a long history of assisted suicide. The law does not only apply to Swiss citizens but also to foreigners. The legislation laws that were passed as early as 1942 are not only related to terminal illnesses as it is in other countries. The physician prescribes lethal drugs as per the request of the patient without necessarily being with the patient. This is in contrast with other European countries such as the Netherlands and Belgium that have specific regulations.
The Netherland in 2001 legalized the Termination of Life on Request and Assisted suicide law. Before the law was passed, individuals would be prosecuted for attempting to practice euthanasia. However, after the law was passed, the prosecution was suspended, and PAS would only happen under certain conditions. One, the patient must be terminally ill, and there are minimal chances of improvement even after treatment. The patient also should show a full understanding of his condition including the prognosis of the disease. Moreover, the patient show has requested for more PAS for more than three times persistently. After the approval of the condition, a second independent physician conducts various tests and confirms the status of the patient. After all the above is approved, PAS is performed in the most medically appropriate way (Radbruch et al.,2016). After the death of the patient, the physician is required to write and submit a report to the Regional Euthanasia Review Committee (RERCs) for them to assess and determine whether the condition for PAS have been met. PAS is only performed in adults and children over the age of 16 years. In children below 16 years, the consent of the parent is required in the written form.
Following the legalization of PAS in the Netherlands, Belgium also enacted similar legislation in 2002. Physicians in the country would no longer be prosecuted for administering PAS to patients within the legal age, which is 18 years. Patients suffering from excruciating and irreversible mental and physical medical conditions were allowed to PAS as detailed in the law. The requests, in this case, had to be expressed in writing. In 2014, individual clauses were added into the code. The provisions incorporated stated that no legal age limit was required for patients to request for PAS. Despite having extended PAS to children, psychiatrist illnesses were excluded in PAS. Across Europe as a whole, there is little evidence to legalize PAS through parliamentary processes. Apart from the above countries, many professional bodies including doctors, teachers, and nurses have opposed the legalization of PAS. Lexemburg also legalized PAS in 2009. The criterion for PAS was that patients must be suffering from terminal illnesses with no signs of improvement. Just like Netherland, the patient to undergo PAS must request it in the form of writing but must also be of legal age.
Outside Europe, PAS has extended to Canada. The Supreme Court ruled that individuals or patients have a constitutional right to make their own decisions. The court, therefore, has no right to prohibit a sane person from consenting to decisions related to PAS. The patient must have irreversible medical conditions that cause enduring suffering intolerable to the patient.
Views in Favor of Euthanasia and PAS
In the recent years, many professionals including physicians, philosophers, and religious leaders have conceptualized the debate on Euthanasia and PAS. The Proponents of physician-assisted suicide argues that it is essential to respect the autonomy of an individual. It is generally accepted that an adult has a right to make independent decisions without any external influences. This means that a competent person should be allowed to choose his or her destiny concerning death. To avoid unbearable suffering, patients should be given the right to control the way they are going to die. Forcing any individual to make a contrary decision may be seen to allowing them to live against their wishes hence violating their personal choices as well rights ( Patient rights. 2013). Several arguments have been passed to such as the patient should be given another agent such as palliative care to alleviate suffering; however, the pain sometimes cannot be avoided. It is therefore essential to respect the patient’s right to self-determination.
According to Emmanuel (1999) assisted suicide also alleviates the suffering of individuals. Most terminally sick patients live with a lot of pain, sometimes with no hope of ever recovering. Proponents of Euthanasia argue that it is essential to allow people to die with dignity. For the dying patient, suffering may sometimes go beyond the pain. The patient may be immobile making him or her be in a state of helplessness hence depending on others for support. Besides, physical discomforts may also be prevalent such as the inability to talk, dementia, incontinence and general body weakness. At this point, life may suffer losses it a means to an end of death becoming the preferable option. Dying with dignity becomes the only way the patient can die without pain. The society, therefore, should allow such people to practice assisted suicide if they wish. It is immoral and inconsiderate to compel people to live with such kind of pain and suffering. It is therefore imprudent to implement legislation that would regulate assisted suicide (Emmanuel et al.,2016).
Physicians in favor of euthanasia and PAS use the principle of beneficence. The law requires that the physicians should act in the best way to promote the welfare of the patient. This principle is very controversial as some argue that a physician should preserve the life of a patient no matter the cost. Others argue that the physician should respect the patient autonomy and should be sensitive to the suffering. He should, therefore, take actions that are supposed to end the suffering and pain. This happens mostly in terminally ill patients who experience uncontrollable pain during treatment. In such as a situation, proponents of PAS argue that the doctor has the choice of fulfilling his obligation of ensuring that the patient is free from any pain. This is because the first option achieves nothing except by prolonging the suffering of the patient, which in turn leads to a painful death.
In the recent years, the public stigma related to suicide has drastically reduced. In most countries, suicide is considered as a legal act especially in situations in describing temporary mental illness, especially depression ( Marker, 2009). A person who is terminally ill in most cases may not be able to exercise suicide due to certain physical limitations. The rational suicide decision in the case of PAS is therefore applicable to shorten the process of dying as well as to terminate suffering.
Arguments against Suicide
Opponents against physician-assisted suicide argue that legalizing it would make it easier to commit suicide or to legalize murder. They believe that legalizing PAS might open the door for relaxation in the application of the law. This means that patients will no longer have to seek consent but will use the other means to an end their life. In the Netherlands, various amendments have been made extending the criteria to non-terminal illness patients. The legal age limit has also been reduced to apply also to minor, patients with mental illness and other conditions. This show that the respect for human life would be diminished with time. Individuals who would feel pressurized with life without necessarily suffering from any illness would be forced to subscribing to the ideology of euthanasia.
The Hippocratic Oath governs physicians operating in the hospital. The oath obliges doctors to preserve life at all costs. This is by observing the principle of beneficence as well as non-maleficence (Emanuel et al., 2016). The principle requires them to act to the best of their abilities in prolonging the life of a patient using the best treatment. Statements like this demonstrate that physicians are not to give any deadly drug to a patient or to make any suggestion likely to assist the patient is dying. Besides, the doctor is not supposed to harm the patient but is required to improve his or her life. By legalizing assisted suicide, it implies that the physician is going against the code that needs him or her not to help a patient die.
Proponents of the legalization of Euthanasia and PAS believe that the dignity and worth of human life are dependent on physical and, mental wellness of an individual, rather than the value of human life itself. This means that individuals with chronic illnesses such as Cancer who depend on others are likely to consider their lives are worthless. Consequently, they might be obliged to choose euthanasia to end their suffering as they may deem their experience less valuable. Teaching people to make choices as to whether their life is worth living or not goes against the ethos that governs the medical field. This could also prevent people from disclosing their health or psychological status as they may be forced to end their life. Opponents argue that the state should not implement legislation of assisted dying, as it would become difficult to regulate it. Research shows that most terminally ill patient has traveled to some countries in the United States to access assisted suicide services even when their health has not deteriorated very much.
Opponents of PAS believe that human life is sacred and PAS is a form of killing and is morally wrong. Sometimes, they ignore the various issues that happen in the body of an individual when sick. When a patient reaches a point of considering death than suffering, it means that he or she no longer derive pleasure from anything in life. The patient has evaluated his breath and noticed that he gains nothing by continuing to live and suffering. Death is not an evil that should be avoided, and life is not too good to be preserved at all costs. Understanding this concept shows that individual human life should not be subjected to suffering to wait for the psychological death. However, opponents still believe that God is the only one who can exercise power over life.
Assisted suicide has the potential to affect the relationship between the patient and the doctor. Existing laws protect patients by restricting doctors from intentionally ending or helping a patient die. This is because their duties lie in acting to the best of patient’s lives until their natural death occurs. Legalizing euthanasia and assisted suicide means the doctors will always give patients the options of dying even if there are signs of recovery. Such actions, therefore, are bound to cause fears in some patients who would feel that the physician has some interest in hastening their death.
In this world, we are dependent on others not only for existence but also when making individual choices. This kind of dependence is integral when it comes to human dignity. Patient dignity is often threatened when the proponent of assisted suicide equate it to choice and autonomy. Assisted death would be painful to discuss especially behind the curtains with the rest of the patients listening. This would affect the rest of the patients who might have gained trust in the doctors for recovery. This would also change the therapeutic dynamic that helps terminally ill or mentally unstable patients get in hospice and rehabilitation centers. Hospice /palliative care in the society helps in improving the quality of life for patients suffering from terminal illnesses through prevention of pain ( Frey, Cordon, & Waun, 2015). Instead of legalizing assisted dying, more resources should be channeled to palliative care to support people to die with dignity.
While mostly Euthanasia is associated with terminal illnesses, there have been suggestions that assisted dying may also apply to the elderly who are likely to suffer from degenerative diseases and the mentally ill patients. Research conducted shows that suicide rate to people over the age of 85 years have increased over the past years. Moreover, extremely premature babies should also be included. The parents of the children should be given the responsibility of making the decisions, as their chances of survival are usually meager. Those who may survive may have increased likelihood of getting immune-related illnesses that would make them suffer for the rest of their lives.
There is no doubt that human beings are mortal, and everyone wishes for a death that is associated with dignity. However, there are various huge controversies about the meaning of pride and its implication. For the proponents, death with dignity involves legalizing euthanasia and PAS in response to the patient demands. For the opponents, death with dignity implies that physicians should amalgamate other options including palliative care, hospice as well as spiritual care at the request of euthanasia. These options will help to alleviate the pain and suffering of the patient, hence not undermining human dignity. On the issue of euthanasia, my standing is that human dignity may depend on the meaning attached to it by the patient. The patient choices should therefore not be limited to legal constraints. Physicians should, therefore, comply with a patient's request for PAS, failure to which it might result in violation his autonomy. In most countries, there is limited palliative care hence the patient is limited to the choices he makes concerning his death.
Conclusion
Current research indicates that the emergence of terminal illnesses has had a devastating impact on the life of the patient losing their senses of control and independence. Additionally, due to the high costs of treatment used to treat the illnesses; patients have a fear of passing the burden to their families. This has resulted in many patients seeking to practice euthanasia to put an end to their suffering. However, the sanctity of human life should be respected. By focusing on central elements in the moral justification against or for assisted death, the essay supports euthanasia in a bid to end suffering and pain. Also, patient autonomy without interference is very critical as a right to self-determination. However, therefore, social policies should be introduced to protect the vulnerable population from seeking PAS without seeking opinions from other sectors. Physicians, on the other hand, should play an active role in evaluating the patient's illness to determine how urgent PAS is to the patient.
References
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