The latest NPR-Truven Health Analytics poll showed that most US citizens favoured the idea of physician-assisted suicides for patients who are terminally ill and who have less than just 6 months to live.1
Physician –assisted suicide (PAS) was a major development in the United States in the 1990s, but it also became a significant ethical and legal issue. The physician’s role in assisting the patient to terminate his life is always with a good intention and is to always comfort the patient when hopes from further treatments have faded. When a pain - wracked patient begs for his death, his physician or other caregivers will likely pay heed to the ailing patient solely from a humanitarian instinct.2
The Hippocratic Oath that a physician takes before beginning to start his profession as a doctor, forbids him from administering a deadly drug to his patient even when requested by the patient or simply for the noble reason of giving him a pain relief.2
PAS occurs when the physician offers the means and medical device that aids someone to end his life by suicide. The death is good in such case since it is intended to be pain free.3
During the past few decades, attempts were made to legalize PAS. Oregon was the only state in US, 3 which legalized a form of PAS in 1997 followed by Washington and Montana.4 Besides these three states of the USA, Netherlands and Belgium has passed laws permitting PAS.4 In 1994, Oregon, under the Death with Dignity act, approved an initiative to enact PAS and it became available for terminally ill patients in late 1997. 3 The Washington Death with Dignity Act was approved in 2008; in Montana, it was made legal in 2009.4 Still, about forty five states5 have condemned PAS whereas it is considered to be a crime in thirty six states.6 This seems to be inconsistent with results of few polls, including the latest NPR-Truven Health Analytics poll, showing that many US citizens favour PAS.1,7
Though against the Hippocratic Oath, a physician feels forced to assist patients who beg for termination of life, but this may also lead to a situation wherein it becomes normal to kill people who are of no use to the society anymore.8
In the literature and in public opinion, there always has been a debate over this issue. Decision regarding life and death of an individual should be up to the concerned individual. Therefore, in many countries suicide is morally and legally recognised. So, if they can be allowed to kill themselves, one can always argue why they should not be given the rights to demand for death when they cannot perform the act themselves. Besides, many terminally ill patients are afraid that if the disease progresses, it will steal them of their dignity and they would not want to become dependent on others for day-to-day life activities. In such a case, they would like to prefer to terminate their life rather than witnessing their own terminal days and a loss of self.8
Several other arguments consider the job of the physician in alleviating pain and suffering. If there is no option left with regards to the treatment, then the physician should be allowed to actively end the patient’s life. For a terminally ill patient, not only death is certain, but so is physical pain and mental suffering. However, a big drawback of legalising PAS will be that, patients will not be able to trust their doctors completely if doctors are given the rights to take their lives particularly in an environment where physicians are offered cost-saving incentives. Besides, it may also place undue moral and ethical burden on patient’s family and friends e.g., consider in a case where physician is absent at the time of suicide attempt and the patient has to ask for a family member’s help in the administration of lethal drug. Therefore, most religions also have condemned this act.9
The discussion and arguments regarding medical ethics and medical law in physician-assisted suicides stick to very general ideas and lack reference to specific social and historical goals.
In 1995, Markson described in his review the American Hospital Association’s recognition that, as many as six thousand deaths in the US per day are planned in some way or the other, either by the patients or their families or their physicians. Besides the physical pain and mental agony, there is also considerable medical cost to the patient and his family. Therefore, the decision to terminate a life can prove to be beneficial to all considering the economic costs, whereas in a decision to not prolong life, there is a direct and considerable economic cost. Pain and suffering are considered to be negative cash flows; the benefit of PAS is to avoid the realization of negative cash flows. To address this, improvement in medical research, medical technologies, and drug therapies is required which may lead to treatments that can cure the illness, thus making PAS less attractive. This indicates that if a society wants to reduce the demand for PAS, then more medical research needs to be done dedicated to the goal of alleviating pain and suffering. In recent years, the Hospice and Palliative Care division of Medicine is aiming at this goal. Apart from this, the value of PAS is nil if there is a chance that a diagnosis of terminal illness is wrong or if there is a major medical breakthrough that can save the life of a patient or that can at least prolong his life.10
For numerous reasons, the issue of legalisation of PAS will always be in debate and will always be controversial. In any case, before focusing on the individual’s right to choose a PAS, the field of medicine as well as the society should make sure that every individual has access to adequate healthcare facilities and long-term care that includes emotional, mental, physical, and spiritual care at the end of their lives.
References:
- Americans Support Physician-Assisted Suicide For Terminally Ill. Health news from NPR. Available at: http://www.npr.org/blogs/health/2012/12/27/168150886/americans-support-physician-assisted-suicide-for-terminally-ill
- Nova Online, Hippocratic Oath—Classical Version, at www.pbs.org/wgbh/nova/doctors/oath_classical.html
- U.S. Takes Oregon Assisted-Suicide Law to High Court, Waah. Post, Nov. 10, 2004, at A04 [hereinafter U.S. Takes Oregon].
- Norman, GV. The Ethics of Ending Life: Euthanasia and Assisted Suicide, Part 1. CSA Bulletin. Available at: http://www.csahq.org/pdf/bulletin/end_of_life_61_1.pdf
- News Release, Judiciary Comm., Statement of Sen. Orin Hatch, Senate Judiciary Committee, Hearing on Drugs, Dignity and Death: Physician Assisted Suicide (July 31, 1998), Available at http://judiciary.senate.gov/oldsite/ogh73198.htm.
- Eryn, RA., Krischer VM. (1999) Avoiding the Dangers of Assisted Suicide, 32 Akron L. Rev. 723, 728.
- Charles, HB. (1999) Assisted Dying, trial, 44, 50.
- Widdershoven, G. The Moral Basis of Euthanasia in the Netherlands. Beyond Autonomy and Beneficence. Available at: http://www.ethical-perspectives.be/viewpic.php?LAN=E&TABLE=EP&ID=52
- Ardelt, M. (2003) Physician-Assisted Death. CD Bryant et al Handbook of Death and Dying. Thousand Oaks, CA: Sage.
- Chan, L., and Lien, D. Physician-assisted Suicide as a Real Option. Utah Valley University. JEL Classifications: I12, I18, D81. Available at: http://www.uvu.edu/woodbury/faculty/WorkingPaper2.pdf
