Physician-assisted suicide is a highly controversial topic which tends to polarize people’s views. Around the world, there is much debate in governments about laws regulating physician-assisted suicide, and several countries now allow the practice. There are many strong arguments on both side of the debate and taking all of these arguments into account is helpful when assessing the topic. Against this type of euthanasia, the slippery slope argument asserts that legalizing assisted suicide could lead to desensitization around killing, which could in turn lead to involuntary euthanasia being legalized. Perhaps the most important to a physician, the medical ethics argument points out the discrepancy between the moral code and oath of physicians, and the idea of killing patients. On the other side of the debate, the ethical argument asserts that people have the right to choose what happens to their own bodies, including around death, and the pragmatic argument argues that practices are already taking place which closely resemble euthanasia, so it may as well be legalized and regulated properly. While complex to regulate to avoid loopholes, it seems that most physicians are likely to agree that, in appropriate circumstances, patients have a right to decide when and how they die, and that physician-assisted suicide should therefore be legalized.
According to Radbruch et al (2015), over the last few decades, significant changes regarding euthanasia and physician-assisted suicide have been occurring. They report that: “In 1996, for the first time in history, a democratic government enacted a law that made both euthanasia and PAS legal acts, under certain conditions as described in the Rights of the Terminally Ill Amendment Act 1996, Northern Territory, Australia” (Rabruch, 2015, 1). However, this new law was countered and made useless by the “Euthanasia Laws Bill of the Parliament of Australia in 1997” (Radbruch, 2015, 1). This is one of many countries in which laws around physician-assisted suicide have been debated and laws altered.
The slippery slope argument centres on the notion that once the government allows a physician to actively helping to kill one of their patients, a boundary has been crossed and could easily lead to a society which is desensitized to killing people, and more euthanasia could then be permitted, perhaps with questionable reasoning (Keown, 1997, 261). The worry here is that a government who permits voluntary euthanasia may slowly adapt its outlooks generally, allowing non-voluntary and then even involuntary euthanasia. There are plenty of examples of how voluntary physician-assisted suicide could lead to unexpected end results. A severely unwell person requiring a high degree of care may feel under pressure to ask their physician to help them die, so as to avoid being a burden on their next of kin. Also, legalizing such suicide could lead to a reduction into palliative care research, and research into cures for serious life-threatening illness. Patients could end up requesting euthanasia when, in fact, a cure could have been found for them.
Similar to the slippery slope argument is the medical ethics argument. Obviously, this is the most important argument to most physicians. It argues that legalizing physician assisted suicide would breach one of the key medical ethics: “A physician shall always bear in mind the obligation to respect human life” (Sarin, 2007, 188). Instructing physicians to go against this oath to preserve human life could lead confusion for them, or even mental health issues. Furthermore, it might be difficult for a physician to waver one fundamental principle and still preserve respect for others. Also, the words of the Hippocratic Oath directly oppose physician-assisted suicide: “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan” (Capone, 2016, 1). Going against the preserving life oath could prove detrimental to the relationship between physician and patient. Routinely assisting in patients’ suicides could result in uncompassionate treatment towards the elderly or patients who are terminally ill. Problems could also arise in the relationship from the patient’s point of view. Very old patients or those with severe care needs may begin to mistrust physicians, believing that the physician may rather kill them than help with their complicated needs.
Of course, the arguments against physician-assisted suicide have counter-arguments. The ethical argument takes the position that humans should have free choice, and that they ought to have a right to decide what happens to their own body. According to this argument, the government should not be able to control people to a degree that their human rights are compromised; this includes disallowing people to make decisions about their own deaths. The ethical argument focuses a lot on dignity, and this is where it resonates with many physicians. The medical profession are taught to treat every person with respect and dignity and most physicians would agree that disallowing a person their right to dignity is fundamentally wrong. A bedridden patient who can no longer move, needing help with all elements of their personal care, may see their life as undignified, and wish for a physician to help them end before their dignity is compromised any further. Another factor which may make a physician inclined to support assisted-suicide is quality of life. The ethical argument holds this at its heart; that life should only continue if it is worthwhile for the person living it.
A further point of view in favour of physician-assisted suicide, known as the pragmatic argument, is based on the idea that numerous palliative care treatments are actually a masked version of assisted suicide. For example, some patients opt to not be resuscitated, should they fall into cardiac arrest or their breathing stops. For the physician to follow this instruction is arguably passively assisting in that person’s suicide, as they could have perhaps intervened and prolonged their life. A further example is the use of palliative sedation. This controversial practice is used for a patient who has an incurable illness and is suffering a great deal. It involves administering a substantial quantity of sedatives in order to send them to sleep and alleviate their suffering. Palliative sedation is not administered in order to euthanize patients, but it can cause the patient do die sooner than they otherwise may have done. The pragmatic argument asserts that as such practices are already taking place, euthanasia should be lawful and then the practices would be monitored more stringently.
On balance, it seems that most physicians would support the legalization of physician-assisted suicide, providing that the laws were carefully put in place and regulated, to avoid any abuse of the system. While a highly controversial topic, physician-assisted suicide would provide terminally ill and suffering patients to end their lives with dignity and alleviate their suffering. Having a physician-assisted suicide would ensure that patients passed away in a controlled manner and without pain. On the other hand, if a patient attempted suicide alone or asked a family member to help them, without medical knowledge they could easily worsen their own situation. They could experience a long and painful death, or they could survive the suicide attempt but be in a worse state of health than before. There are many valid arguments on both for and against such assisted suicide and addressing all arguments is useful when deciding the best stance on the issue. While the medical ethics argument and the slippery slope argument are both valid, the ethical argument that people have a right to dignity and quality of life, is much more solid and convincing. Physicians have the expertise and knowledge to address governments and put their opinions forward. Undoubtedly, the medical profession is split in opinion on this controversial subject in the same way that the general public is. However, it seems that over the coming years, the world could see some changes regarding laws on physician-assisted suicide.
References
Capone, R. (2016.) AMA Reconsiders Opposition to Physician-Assisted Suicide. Ethics and Medics. Retrieved from: http://www.ncbcenter.org/files/9014/7387/2511/NCBC_EthicsMedics_October2016.pdf
Keone, J. (1997.) Euthanasia Examined: Ethical, Clinical and Legal Perspectives. Google Books. Retrieved from: https://books.google.co.uk/books?id=1KcVOUhGDkoC&dq=ethics+physician+assisted+death+slippery+slope&lr=&source=gbs_navlinks_s
Radbruch, L. et al. (2015.) Euthanasia and physician-assisted suicide: A white paper from the European Association for Palliative Care. Palliative Medicine. Retrieved from: http://www.eapcnet.eu/LinkClick.aspx?fileticket=28Vb6OIn9SQ%3D
Sarin, D. et al. (2007.) Ethics for Surgeons: The Role of Trainees, Surgical Innovations and the Informed Consent. Research Gate. Retrived from: https://www.researchgate.net/publication/236586149_ETHICS_FOR_SURGEONS_THE_ROLE_OF_TRAINEES_SURGICAL_INNOVATIONS_AND_THE_INFORMED_CONSENT
