Introduction
The issue of the withdrawal of life support in Physician-Assisted Suicide (PAS) has been a significant controversy surrounding the biomedical ethics of the human service profession (MacKinnon & Fiala, 2014) . The role of the physician is to help a patient recover from their illness through medical care. Additionally, the American constitution prohibits and considers illegal the act of taking one's life, either as murder or suicide. The issue of medical care, however, faces another ugly truth, which is the reality of terminal illnesses, or serious accidents resulting into a state of come from which a patient has very minimal chances of survival and is therefore kept alive through the life support machine. Who gets to decide when a patient should be taken out of life support is a critical issue in healthcare providence that puts into the spot the role of the physician in encouraging and carrying out the act of subjecting the patient to the inevitable end through PAS.
PAS is the act of mercy killing in which the physician takes a patient off the life support machine thereby ending their chances of survival (Coleman, 2015) . Various factors contribute to a patient surviving on life support. These factors include organ failure such as heart failure in which the patient is unable to perform such functions as the pumping of blood through the body system on their own and therefore require the life support machine to facilitate these functions. Organ failure could result from terminal illnesses or fatal accidents. PAS can be conducted on such a patient when they show no signs of improvement and the medics are confident that the patient cannot survive on their own once they are taken out of life support (Coleman, 2015) . This can be done to save both the patient and their family prolonged agony through physical pain and financial burden.
Delegate your assignment to our experts and they will do the rest.
Related Human Subject Protections
In as much as the PAS act of taking a patient out of life support is considered an act of compassion by both the physician and the patient's family, there are implications of such an action as far as human rights protection is concerned. For instance, American law considers illegal the act of taking one's life. This law covers abortion, murder and attempted suicide in which the perpetrator is liable to serve a jail term of up to 20 years in prison (MacKinnon & Fiala, 2014) . Mercy killing, therefore, by virtue of falling under murder, or supported suicide is implicated in this law. For PAS to be considered lawful, there has to be irrefutable evidence that the patient does not have any chances of survival outside the life support. Apart from the law, there is the biomedical ethical conduct that holds physicians accountable for the wellbeing of the patient (MacKinnon & Fiala, 2014) . According to this professional conduct, the physician is expected to use all their knowledge and medical techniques to ensure that a patient recovers from the medical state they are in. By carrying out PAS, the physician, therefore, violates this code of ethical conduct, their reasons for doing so notwithstanding. Lastly, there is the religious aspect of mercy killing. Religions across the word condemn murder. The Bible, just like the Quran and other holy books warn against murder as being against the will of the Supreme Being, with the Bible classifying such an act as the breaking of one of the Ten Commandments. By carrying out PAS, therefore, the physician goes against religious beliefs and doctrines of not taking the life of another. Human rights activists arguing from this perspective would advocate for the retaining of the patient under life support until the time his health improves, though medically, this act could be quite expensive.
The Role of Informed Consent
Due to the complex nature of the removal of a patient from life support, informed consent plays a critical role in determining whether or not a patient should be removed from the life support and left at the mercy of hours, probably minutes before they draw their last breath (Coleman, 2015) . Even though the physician advises on the best available options medically in such a situation, the final decision lies in the hands of the close members of the patient who are expected to come to a conclusion that reflects the best interests of the patient, as well as theirs, at heart. In this scenario, it is essential that the informed consent is unanimous of all the family members. In case the family members fail to come to a consistent conclusion, or in case the patient does not have family members to make such a decision, the matter is referred to a court of law (Coleman, 2015) . It is the duty of the court at this point to access the medical history of the patient to ascertain the chances of survival, or the lack thereof, and the financial implications of continuing with such a medical treatment to determine whether or not the patient should be taken out of life support. In case the patient is admitted to a county hospital, has medical reports indicating very dismal chances of survival, and the cost of affording such treatment is taking a significant toll on the family's finances, then the court is most likely to give the consent of taking the patient out of life support. Informed consent, whether from the family or the court, is critical in protecting the biomedical ethics of the physician and the health institution (Coleman, 2015) , as well as ensuring that the physician and the institution are protected from potential lawsuits for taking the patient's life.
Recommendations for Ethical Choices
Since the decision to take the life of a patient by taking them out of life support is of great significance to the biomedical ethical standards, it is essential that the decision is arrived at following standard steps that ensure moral choices are made. The first step is consultations with the hospital board (MacKinnon & Fiala, 2014) . For a physician to conclude that a patient should be taken off life support, he must consult with the hospital's board of management through the department which in turn will access the patient's medical files to explore the other therapeutic options available for the patient. Only when the board is sure that there is nothing more to be done should the family be informed of the option, which leads to the second step. The second step is involving the family by asking for their consent. The family will be tasked with the responsibility of making the final decision. As a third step, the physician is expected to respect the conclusion of the family should it unanimously decide against the act. Hover, the institution has the option of contesting this decision in a court of law should it feel the need to, such as the need to create room for other patients requiring the same facilities. In case the patient has no family, the institution should involve the court as the fifth possible cause of action to determine the fate of the patient (MacKinnon & Fiala, 2014) . All of these recommendations are steps meant to take into consideration the ethical implication of PAS.
Conclusion
Due to the complex nature of carrying out Physician-Assisted Suicide (PAS), it is important that the physician and the institution at large follow through the basic steps of carrying out such a medical act. This step includes engaging with the board of directors to exhaust any possible intervention measures, actively engaging the family members and allowing them room to decide on the best course of action, and engaging the court of law to seek the clearance to go ahead with taking the patient of the life support. This process is critical in protecting the ethical integrity of the physician and the institution.
References
Coleman, L. (2015). Thou Shalt Not Kill; But Needst Not Strive Officiously to Keep Alive: A Study into the Debate Surrounding Euthanasia and Assisted Suicide. NEL Rev. , 3 , 113.
MacKinnon, B., & Fiala, A. (2014). Ethics: Theory and contemporary issues . Nelson Education.
