Abstract
For a long time, the medical profession has subscribed to many ethical statements that have been developed primarily for patients’ benefits. As members of the medical profession, physicians should always recognize their actual responsibility of the patients, society, self, and other professionals. Adhering to the set principles of professional conduct is essential in acting ethically in the profession. The topic of physician-assisted suicide (PAS) is controversial in the American medial context. Physically assisted suicide and euthanasia are often used interchangeably. The ethics of these issues are squarely placed before the public eye. This paper focuses on the ethics surrounding physically assisted suicide. The paper does this by conducting a thorough article review to establish the major researches on the topic; the gaps left, and the main recommendations regarding the issue. The key findings in the paper reveal that controversy still continues to surround the issues of physician-assisted suicides and euthanasia, and this controversy rests on different views of practical morality and ethics.
Introduction
Physically aided suicide is a term used to describe a practice in which a professional provides competent prescription to a terminally ill patient with a lethal dose for medication, which is done upon the request of the patient. The patient intends to use the medication to end his or her life (Radbruch et al., 2015). Increasing media attention as well as the mounting concern regarding the control of one’s life have generated very serious considerations concerning the legalization of the practice (Tomlinson et al., 2015). Major public decisions have focused on the desire for the control of one's life, especially concerning the timing as well as the manner in which the death occurs. Such discussions have come at a time of increased warnings about a potential harm or abuse of overriding the societal prohibitions against directly being involved in causing one’s death or assisting in one’s suicide. This paper argues that PAS and Euthanasia are unethical, dangerous and against the basic Christian teachings.
Literature Review
According to Manetta and Wells (2001), physically assisted suicide occurs when a physician provides the means for ending patient's life and the patient administers it. Although the medial doctors provide the means of ending the patient’s death. Social workers can also become involved as they are instrumental in assisting the patients in making good end-of-life decisions. The involvement with physically assisted suicide presents a major ethical dilemma in the profession (Levy et al., 2013). It is due to social workers may think that they lack no clear guidelines regarding professional behavior, when the particular practice guidelines have not yet evolved to match the existing technology or when the values that govern the professional behaviors are in conflict.
Currently, PAS is among the most debated issues in the medical profession, especially in the American context. Many studies have indicated that Americans are divided concerning the issue. For instance, the debaters have put across issues like life preservation, self-determination of different individuals, and the use of expensive medical services by the older people in the society as well as autonomy (Radbruch et al., 2015). However, most people have reached a consensus that PAS should only be used in cases where people are dying from what can be termed as terminal illnesses. Those who support PAS always believe that people who are dying from terminal illnesses pass through immense pain and as such, they should be allowed to terminate their life to save them from the extreme pain. However, this has been opposed by many people. For instance, some opponents argue that the underutilization of narcotics used for pain control in medical procedures is responsible for leaving the terminally ill patients in pain. Additionally, some other scholars have argued that dying is not painful but rather what are painful are the illnesses (Tomlinson et al., 2015). As such, the opponents of PAS further argue that it is not necessarily true that people who pass through extreme pains have terminal illnesses. Very little research has focused on etiology cases of physically assisted suicide (Tomlinson et al., 2015). The majority of the research conducted has focused on suicide cases on individuals who acted on their will without the intervention of any other persons or professional. Research has developed many predictors of suicide cases. The most common predictors of suicide are the suicide of another family member, deep pain, serious psychiatric illness, and recent loss a close person. Depression has been found to be one of the most common features surrounding people who tent to contemplate about suicide or even those who complete suicides.
There have been several safeguards developed and implemented in the profession of social work that act as guided to the social workers while making ethical decisions concerning intervention with their clients. Ethically, a social worker is required to adhere to all state and federal laws and legislations as well as their professional code of conducts. For instance, the code of ethics to be followed by the social workers were developed by the National Association of Social Workers (NASW) (Manetta & Wells, 2001). The role of social workers in PAS has significantly advanced over the last few years.
According to Tomlinson et al. (2015), assisted dying describes two major situations; physician-assisted suicide and voluntary euthanasia. Significant debates occur in the context of social change, which entail expanding the elderly population, cutting budgets to the health care, and medical advances in treatments aimed at sustaining lives. Some studies have risen sharp concerns that people who have dementia may be perceived as having the ‘duty to die’ without becoming incompetent. Several research works have suggested that half of the total number of dementia care givers support assisted dying (Tomlinson et al., 2015). Ideally, the right to die is a very powerful argument when discussing the issue of assisted dying. The argument draws from the principle of autonomy. It is worth noting that the principle of autonomy is highly valued in democracy, and this has resulted to the overwhelming support of individual’s right to die. However, the issue of legalizing assisted deaths for dementia is quite complex (Tomlinson et al., 2015; Manetta & Wells, 2001). Major concerns surround the issue of whether the patients have stable mental capacities that can allow them to make a good decision concerning whether they want to die or not. Wider research has explored decision making for treatments that are life threatening to dementia patients. The research works have identified that the surrounding capacity issues, as well as the consequent involvement of the beloved ones in the decision making process, may make it very challenging for the people with dementia to make clear and autonomous decisions. As a result, decisions regarding assisted dying can only be clear for the other terminal illnesses which do not affect one’s capacity to make autonomous decisions.
Dementia care givers may at times feel unable to make a decision for others due to the uncertainty that surrounds different factors, such as the ability to reliably and effectively administer the assisted death medications, surrounding anxiety about possible prosecution, as well as concerns about commotional burden which follows the process. The majority of dementia caregivers decide to withdraw treatments that are life supporting by implying that the acts of omission are quite different from the acts of commission (Manetta & Wells, 2001). Patients with dementia will often change their opinions concerning their end of life treatments during their sickness. Ideally, this presents a huge ethical challenge to the care givers because the capacity of the patients may be impaired grossly over their illness period. A person with capacity during the initial states may fail to have capacity during the later stages of the illness.
Levy et al. (2013) found out that physicians who were affiliated to religious orthodox portrayed more conservative views concerning euthanasia as compared to physicians who considered themselves as being secular. Additionally, the female physicians portrayed more conservative views on euthanasia in comparison to the male physicians. However, all these associations were not related to other factors, such as marital status, age or seniority of the physicians.
According to Radbruch et al (2015), the world has witnessed some critical changes concerning PAS and euthanasia. For instance, in 1991, a debate that took place at the European Parliament that focused on euthanasia stimulated serious discussions at all levels in Europe. It resulted in the issue of the first statements by the European Association for Palliative Care (EAPC). It was done in a bid to clarify the organization’s position towards the issue of euthanasia. Patients who request lethal medication to end their lives as a way of ending their suffering are a major challenge in a palliative care setting. Such patients not only deserve the best kind of treatment for systems control, but they also need spiritual as well as psychological counseling. It should depend on individual’s understanding as well as respect in situations of despair and misery (Manetta & Wells, 2001). Therefore, palliative care is based on the understanding that even in situations that cannot be changed, sensitive communication that is based on partnership and trust can play a big role in improving the situations.
Current study
Purpose of the study
Ethics in the medical profession is very instrumental in determining the kind of services that are offered to the patients by the medical care professionals. Health care providers should understand all the ethical issues that surround the profession. PAS and euthanasia have become a hot debate in the past considering the ethical issues which surround it (Tomlinson et al., 2015). In some countries, the practice has not yet been legalized while in other countries is legal. However, in other countries, debates are still ongoing on whether the practice should be legalized or not. The purpose of this study is to establish the ethical issues surrounding the issue of PAS and euthanasia by establishing the truths in the sentiments proposed by different opponents and proponents of the practice.
Hypothesis
The study aims at testing the following explicit hypothesis;
H0: PAS and Euthanasia are not ethical practices in the medical profession
H1: PAS and Euthanasia are ethical practices in the medical profession
Participants
Considering the fact that the medical profession is one that impacts a large part of the society, the practices of the profession are likely to illicit sharp debates and reactions from a large number of people (Radbruch et al., 2015). The main participants in the study will be drawn from there major categories of people and which include; medical professionals, patients, and the society. It will give a good representation of the views elicited by different stakeholders in the medical profession.
Materials
The study utilized different articles on the topic as well as previous research works on the topic. The study also makes use of the professional code of ethics as advanced by Medical Association.
Methods
The data utilized in the study is both quantitative and qualitative. The qualitative data will entail the data related to different views and opinions of different medical health stakeholders concerning ethical practices on PAS and Euthanasia (Manetta & Wells, 2001). On the other hand, the quantitative data will include data collected in the number of medical caregivers who have preferred PAS and those who do not support the practice. Therefore, the study takes a mixed approach to conducting the research. In obtaining the qualitative data, qualitative methods will be used while quantitative data will be used to obtain quantitative data.
Discussion
Often, the terms physically assisted suicide and euthanasia are used interchangeably. In respect to the law, the two terms are however treated differently. Euthanasia is defined as knowingly, directly, and intentionally acting in any manner that causes the death of another person through different means, such as giving a lethal medication. On the other hand, assisted suicide is defined as intentionally, directly and knowingly providing the means of death to a person so that this person may use the mean to commit suicide. A good example of assisted suicide is providing a prescription for a lethal medication. Although the two terms have different treatments in the eyes of the law, they are often surrounded by similar ethical debates. Activists have used different reasons to promote changes in the laws surrounding the issues (Tomlinson et al., 2015). The responses to the different philosophical arguments as well as various components of physically assisted suicide have been undertaken by many theologians, policy theorists, and bioethics. However, there is a very little resolution on the competing claims of social consequences and autonomous views both against and for the practice. The compromise figures have primarily seemed to focus on the ways of improving pain control in patients, entailing accelerated research, and broadly training and educating patients. Others include rejecting outdated concerns that are associated with different opiate drugs and the induction of permanent unconsciousness if everything else seems to fail (Manetta & Wells, 2001). All these efforts assume that if it is possible to alleviate pain in any given terminal illness, then request for the assistance in suicide should no longer arise. Additionally, compromise views are of the idea that assistance in death should remain a last resort and only in the most recalcitrant cases.
The ethics of physician-assisted suicide and euthanasia have continued to illicit sharp debates and responses from different members of the society. Some people believe that PAS is ethically permitted while others believe that that PAS is not ethical. Often, those who view the practice as ethically permissible do this because PAS may remain as the most rational choice for a person dying from terminal illness. It is done to ensure that these terminally ill patients escape from unbearable suffering at the end of the patient’s life (Jecker, Jonsen & Pearlman, 2007). Further, the duty of the physicians to alleviate patient’s suffering may sometimes be seen as a genuine reason for conducting physically aided suicide. These arguments majorly rely on the respect for patient’s autonomy in making rational and major decisions in his life. Further, this recognizes the rights of a competent person to choose the manner and the timing of death in the case of a terminal illness.
On the other hand, those who argue that PAS is not ethically permitted do this on different grounds. For instance, they argue that PAS and euthanasia practices directly counter the traditional duty of a medical professional to preserve the life of the patients and not to cause any harm to the patients (Manetta & Wells, 2001). Additionally, this stand is surrounded by the opinion that if PAS were legalized, then abuses would frequently occur due to the slippery nature of social forces that tend to condone the practice.
The ongoing and vigorous debate concerning physician-assisted suicide has appeared to overlap with concerns about suicide as well as assisted deaths, which are assisted with old age. The debate surrounding PAS have extensively focused on patients who are terminally ill. In this context, terminally ill patients are determined as those who expect to die within the next six months. However, death is not seen as imminent as in the case for older people. For instance, all old people end up dying at some point in time (Tomlinson et al., 2015). Issues about suicide in the older people focus mainly on the debility of the old person, loss of function, and not nearness to death. As a result, public debate has not been keen on discussing the issue of suicide among the elderly people- suicide for the sole reason of age (Depts.washington.edu, 2016). There is also no adequate research on other circumstances surrounding suicide, which have often been discussed in the historical literature, such as poverty, disgrace, symbolic protest and martyrdom. The topic of suicide in old age has very rich history, both in the non-western and western cultures.
Biblical perspective
Ideally, physician-assisted suicide and euthanasia tend to contradict biblical teachings; hence, inconsistent with the Christian views. For instance, God created human beings in His image and the fact that the society has tended to euthanize animals does not always justify euthanizing of human beings (Genesis 1: 27).Additionally, the Bible records that death and human life are in God’s domain. (Deuteronomy 32: 39). In the Ten Commandments, God said that people should not kill (Exodus 20: 13). However, God has allowed individuals to kill others in only three circumstances; during a just war, death penalty and self-defense (Exodus 22: 2).
Conclusion
The American health care provision is undergoing some critical changes and shows no major signs of straining. Physician-assisted suicide and euthanasia are legal in some states in the US such as Washington, Vermont, and Oregon. In some other states that lack specific court decision and legislative authority, PAS would most likely be considered as an illegal thing while in some other states, the practice is completely illegal. Some arguments which favor PAS practice include respect for an individual's autonomy, Justice, transparency, and honesty, State interest versus individual liberty and compassion. On the other hand, arguments which are against the practice include potential for being abused, professional integrity, and active versus passive distinction, the sanctity of life and fallibility of the medical profession. The issue of PAS and euthanasia is also argued from the biblical perspective. Despite the different perspectives on the topic, this paper argues that PAS and Euthanasia are dangerous and unethical.
References
Depts.washington.edu (2016), "Physician Aid-In-Dying: Ethical Topic In Medicine". Depts.washington.edu. Retrieved on 29 Apr. 2016 Available at https://depts.washington.edu/bioethx/topics/pad.html
Jecker, N. A. S., Jonsen, A. R., & Pearlman, R. A. (2007). Bioethics: An introduction to the history, methods, and practice. New York: Jones & Bartlett Learning.
Levy, T. B., Azar, S., Huberfeld, R., Siegel, A. M., & Strous, R. D. (2013). Attitudes towards euthanasia and assisted suicide: a comparison between psychiatrists and other physicians. Bioethics, 27(7), 402-408.
Manetta, A. A., & Wells, J. G. (2001). Ethical issues in the social worker's role in physician-assisted suicide. Health & Social work, 26(3), 160-166.
Radbruch, L., Leget, C., Bahr, P., Müller-Busch, C., Ellershaw, J., de Conno, F., & Berghe, P. V. (2015). Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliative medicine, 0269216315616524.
The Holy Bible. New International version (NIV)
Tomlinson, E., Spector, A., Nurock, S., & Stott, J. (2015). Euthanasia and physician-assisted suicide in dementia: A qualitative study of the views of former dementia carers. Palliative medicine, 29(8), 720-726.
