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Physician Assisted Suicide
Erick Loss
PHI 208 Ethics and Moral Reasoning
Professor: John Wise
April 15, 2019
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Physician Assisted Suicide
Throughout time and in most cultures, most people hope for a painless death with dignity.
Doctors desired this for their patients as well. As Robert Weir (1997) explains in the opening of
his book, Physician-Assisted Suicide, in ancient Greece physicians unable to cure many of the
illnesses they faced offered poisons to relive the suffering. A small group of physicians wrestled
with the medical ethics of aiding in suicide and created the Hippocratic Oath with the
overarching theme to do no harm to the patient. One directive, “I will neither give a deadly drug
to anybody if asked for it, nor will I make a suggestion to this effect” has maintained influence in
Western medicine and culture since the 5th century. But now that modern medicine is capable of
prolonging life and sustaining life even in extreme cases, some people with fatal, potentially
painful maladies would like to have a swift dignified death with the aid of their physician.
Governments are drafting and passing legislation to give patients end of life options and medical
directives. The medical community is conflicted on this issue since it goes against the
Hippocratic Oath they swore to uphold, while they empathize with the patients they serve. The
doctor should not abdicate patient care decisions to the government. Even incurable cases
deserve to have the full attendance of care to make them comfortable, assuage mental anguish
and ease the worries of loved ones. No one and nothing should come between the doctor and
patient, especially when the doctor is asked to abandon his moral and ethical duty to preserve
and respect all human life. Physician Assisted Suicide (PAS) should not be legalized at the State
or Federal level.
The Judeo-Christian commandment of “Thou shalt not kill” applies whether one commits
self-homicide or volunteers for death at someone else’s hand. Suicide is not illegal because you
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cannot put a dead body in jail or exact a punishment, but it is considered to be immoral because
it is an act of taking a life. Attempted suicides are illegal in many jurisdictions but are rarely
charged or prosecuted with a crime but because we value life, they are given counsel and
medical aid to help the person with the mental distress and keep them from trying again. Assisted
suicide is defined as: the act of intentionally killing yourself with the aid of someone who
provides the knowledge of means to do so (Rosner, 1996). Culturally, the immorality of the act
of suicide is conferred upon the one who helps in this act too. Ethically it is the same as placing a
loaded gun in someone’s hands but not pulling the trigger to kill them. Active euthanasia is when
someone administers the means of suicide, which is also considered immoral and is illegal in the
United States, akin to murder. While passive euthanasia is the act of doing nothing to prevent a
death it is still illegal and immoral (Rachels, 1975).
The American College of Physicians-American Society of Internal Medicine (ACP-ASIM)
does not support the legalization of physician-assisted suicide.
“The routine practice of physician-assisted suicide raises serious ethical and other
concerns. Legalization would undermine the patient-physician relationship and the trust
necessary to sustain it; alter the medical profession's role in society; and endanger the
value our society places on life, especially on the lives of disabled, incompetent, and
vulnerable individuals. The ACP-ASIM remains thoroughly committed to improving care
for patients at the end of life.” American College of Physicians (2003)
Concerns are that society will start down a slippery slope, beginning with competent doctors and
patients making informed decisions about ending one’s life and leading to PAS offered to less
competent patients or those who are distressed but not terminally ill. Eventually decisions to
terminate life could be made by hospital administrators or insurers concerned more about cost
than life. We already see instances of medical procedures and drugs being withheld for treating
terminally ill due to costs and inability to predict positive results. Abortion is used to end
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pregnancies when the child is diagnosed with an abnormality. How soon will it be before
people’s lives are ended because of a disability or the stress that they place on a family? Doctors
specialize in every field of healthcare now. One can imagine that PAS clinics will compete for
patients by offering better end-of-life services. Insurers will likely calculate the cost of continued
care versus PAS and offer incentives to terminate the life now. Doctors, patients and loved ones
will be paid to “pull the plug.” The original narrow scope of defined parameters for PAS is likely
to widen and more than just the terminally ill and suffering will be euthanized.
Dr. Cari Levy explains that we already have treatment options in place to treat the terminally
ill. The goal of Palliative care is to provide the best quality of life for the patient at the end of
their lives but not to pursue curative goals. Palliative care can also be expensive since the care is
mainly pain relief to give quality to the last few days or months of a person’s life. Feeding and
treatments continue. It is not like Hospice which provides care up to the end but will not
resuscitate or continue feeding unless a living will directs them to try. There is not a compelling
need to hasten one own death when Palliative care can relieve patients pain and aid families in
the decisions they need to make (2013). The United States Constitution is written to protect the
rights of it citizens. The right to life should not be infringed upon with euthanasia laws enacted
by the states.
“Death with Dignity” or “Right to Die” legislation is presented as a directive for health care
providers treating chronically ill patients. Some believe that terminally ill patients should be
given the choice when they are faced with a painful end to their life. They should have the right
to choose how and when they die (Weir, 1997). In conversation with these supporters, PAS is
replaced with Physician Aid in Dying to avoid the negative connotation of the word suicide.
Colorado joined 5 other states in approving Physician Assisted Suicide with the vote on
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November 8th. The law provides that a patient must have a terminal prognosis with six months or
less to live as verified by two doctors. They must be over 18 and judged to be competent to make
this decision. The physician is permitted to provide medicines or other means and instructions to
the patient or caregiver about how to carry out the use. The patient must be given options other
than suicide and likely outcomes as well as information about the consequences if the suicide
does not work as planned. Doctors are permitted to opt out and not participate in PAS for any
reason. Robert Weir (1997) believes another provision should be included.
“If in the opinion of the attending physician or the consulting physician a patient may be suffering
from a psychiatric or psychological disorder or depression causing impaired judgment, either
physician shall refer the patient for counseling. No medication to end a patient's life in a humane
and dignified manner shall be prescribed until the person performing the counseling determines
that the patient is not suffering from a psychiatric or psychological disorder or depression causing
impaired judgment.”
James Rachels remarks that physicians perceive death to be a failure and work to preserve
their patients’ lives. This can drive up costs as cures and surgeries are offered toward that end.
Some think that the cost of end of life care is so expensive that the patient should have the option
of Physician Aid in Dying to save the expense and pass more money on to surviving loved ones
(1975). In some cases these heroic efforts not only extend life but pain and suffering too.
Euthanasia can be seen two ways. As a mercy killing to prevent a painful death or as a sin for
taking a life. Since it is a “Right to life” issue it could be judged unconstitutional. The Supreme
Court will likely be called upon to rule on the constitutionality of a physician or anyone else
ending a life or assisting to end a life. A careful examination of the complexities of end-of-life
care should be done by the medical community. The physicians, nurses and caretakers should
drive the discussions to determine what care is prudent in each case. Those with a financial stake
in health care, the insurance claims or inheritance should not be seated at that table. Emotions
and politics need to be left out these discussions too. Logic and a focus on the care and comfort
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of the patient should be the primary concerns. The way that we address Physician Assisted
Suicide will demonstrate our values, ethics and morality to everyone in every socioeconomic
condition and every background. Any policy made that devalues a life or divorces the doctor
from his vow to care for his patient will put a monetary price tag on everyone. When you exceed
your worth your number is up. We can’t afford to get this wrong.
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References
Weir, R. F. (1997). Physician-assisted suicide. Bloomington: Indiana University Press. Berkeley
Wellness Retrieved on 3/8/17 from http://www.berkeleywellness.com/healthycommunity/health-care-policy/article/physician-assisted-suicide-ethical
American College of Physicians (2003)., Snyder, L., & American College of Physicians (2003).
(2005). Ethics manual. Philadelphia: American College of Physicians.
Rosner, F., & Bennett, A. J. (January 01, 1996). Physician-assisted suicide. Archives of Internal
Medicine, 156, 10.)
Snyder, L., & Caplan, A. L. (2002). Assisted suicide: Finding common ground. Bloomington:
Indiana University Press.
Rachels, J. (1975). Active and passive euthanasia. Boston, Mass: Massachusetts Medical
Society.
Levy, A. E. C. (March 01, 2013). Isn't That Just Good Medical Care?. Journal of Palliative
Medicine, 16, 3, 218-219.
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