Introduction
Physician-assisted suicide has been subject to much global public debate. As the topic on human rights continues to gain momentum and make waves across the consciousness of people all over the world, humanity also continues to expand the scope and coverage of their rights. The right to death, as best manifested by physician-assisted suicide, is one such right. Highly controversial, this particular right brings forth some important questions. Firstly, when does one’s right to death begin? Secondly, to what extent should the physician take responsibility for the person who requested for death? Finally, on a personal note, can the practice of physician-assisted suicide in today’s society be considered moral and just and should its practice be authorized? Consequently, this paper seeks to answer such questions by exploring the moral dimensions of physician-assisted suicide through the theory of utilitarianism in contrast with ethical egoist perspectives.
Physician-Assisted Suicide Defined
If people have the right to life, then why should they not have the right to death as well? This is the central question plaguing several moralists and humanists. If by living a person continues to suffer in his every waking hour, would it not be better to just let him surrender to death if he so chooses? Besides the usual moral dilemma, there are economic considerations at play. Not only will death spare him from excruciating pain, his family need not be burdened with overwhelming hospital fees and maintenance medicines.
A specific definition of physician-assisted suicide would first and foremost be appropriate. There is a tendency to mistake this situation with euthanasia, which revolves around a different though relative ethical issue. In euthanasia, other another person or group ends the life of an invalid subject out of mercy. Physician-assisted suicide is a different case altogether. Not only is the subject able to retain much of his consciousness, he intentionally and voluntarily seeks approval and practical assistance from medical professionals in line with his right to death. Free will is what separates euthanasia from physician-assisted suicide. While the former is decided by persons close to the subject such as direct family, relatives or guardians and may not necessarily require the assistance of professionals in the medical field, the latter is decided by the person himself but with the participation of a medical expert. Most often than not, such assistance is administered by a physician (Lo, 2013, pp.149-150).
The yearning for medically sanctioned death is triggered by several factors. One of the most compelling reasons for exerting one’s right to death is severe pain and suffering. In most cases, the person seeking to end his life is either an elderly or someone suffering from a grave congenital, acquired or undetected illness. Many old people suffer from deteriorating organs and are prone to various life-threatening health conditions. There are times when state-of-the-art therapeutic or palliative techniques in medicine and nursing are not enough to relieve them of their suffering (Lo, 2013, p.156). As such, death appears to be a welcome solution.
Likewise, those who suffer from a terminal illness go through the same predicament as geriatric patients. Treatment of a terminal illness often requires the patient to undergo painful procedures that diminish his motivation for living, day by day. Along with rising costs (incurred in the treatment process and purchase of medicines) and especially when chances of survival are slim, the patient feels the necessity to die. Through the assistance of a physician, death would be a little less painful and more cost-efficient for the patient.
Other reasons for choosing physician-assisted death include severe depression and other psychological issues that cause severe mental or physical pain or suffering to the patient, to the point of obstructing the quality of his life and that of his family’s.
The Right to Death and the Two Paths of Utilitarianism
Defining physician-assisted suicide using the lens of utilitarianism is a double-edged sword. There are no clear-cut dimensions as far as morality is concerned. Considering the many schools under its wing, the utilitarian perspective supports as well as rejects a person’s right to death, depending on the argument being used. For that reason, some paradigms will be explored to present the two sides of the coin in the context of utilitarianism.
Utilitarianism has two paths. The first path is geared toward the individual and the action he undertakes. Called act utilitarianism, this particular facet of utilitarianism deems an act moral only if the individual performs an action that results in the most good (Smart & Williams, 1973, p.9). This is the confusing part: what constitutes goodness? There are different standards of goodness that people adhere to. What may be good for one may not always be good for another. Therefore, specific criteria must be met in order for an act to be considered as good.
The paradigm now shifts to the aspect of beneficiality or as the classical utilitarians would have defined it, utility. Setting the parameter on beneficiality provides a clearer insight into this moral issue. Is physician-assisted suicide beneficial to the majority? How beneficial is it? In the context of utilitarianism, unless these questions are answered, this particular act remains in the grey area of morality.
Jeremy Bentham (1879) defines utility as:
That principle which approves or disapproves of every action whatsoever, according to the tendency it appears to have to augment or diminish the happiness of the party whose interest is in question: or, what is the same thing in other words to promote or to oppose that happiness. I say of every action whatsoever, and therefore not only of every action of a private individual, but of every measure of government. (p.5)
In accordance with the utilitarian viewpoint, a patient can exert his right to die by way of physician-assisted suicide if doing so can best benefit the majority. Because the common good is at the heart of the utilitarian mindset, physician-assisted suicide becomes moral only when its occurrence can give maximum benefit or the highest balance of happiness to the greatest number of people. It is moral to voluntarily terminate one’s life if by doing so the majority will not be burdened or inconvenienced.
If the person suffers from an incurable ailment and the purpose of treatment is only to prolong his life, then there is no utility in this situation. If he chooses to commit assisted suicide, then he should be allowed to do so. For one, the person is no longer of good health and his continual suffering lessens his productivity to a significant degree compared to the usual productivity of an average working person. In such cases, the patient feels socially incompetent and tends to isolate himself from society. Depending on the gravity of his illness, he can either do mild to zero labor.
A second point to consider is that it is more economical to opt for assisted suicide. The medical fees will continue to surge along with the pain. If the financial burden was once shouldered by the patient alone, in the long run, the burden extends itself to his family, to relatives, to friends and to social institutions and/or the government. Because the majority begins to undertake the problem of another, their productivity as functioning members of society may one way or another be compromised. When costs outweigh benefits, there is no equilibrium. The absence of balance and order between costs and benefits incurred in treating the patient does not support principles of utility. Surging costs promote disorder and in this position, the patient can therefore exert his right to death.
The second notion of utilitarianism, rule utilitarianism, asserts that “the rightness or wrongness of a particular action is a function of the correctness of the rule of which it is an instance” (Garner & Rosen, 1967, p.70). Taking this assertion into account, an act of assisted suicide becomes unjust and immoral the moment it breaks the rules established for the benefit the common good. If the act contradicts the rules put up by and for the majority, then it is ultimately deemed wrong. However, the moral dimensions of physician-assisted suicide grow more and more complex when the subject of human rights and various legislations on a country-per-country basis are brought to the fore.
The Physician’s Responsibility
If the patient’s decision to exert his right to die can either be just or unjust, depending on which side of the utilitarian coin one is looking at, when can the act of assisting a person commit suicide, even with the intention of relieving his suffering, be considered an immoral act? To what extent is the physician liable for the patient’s death?
Peter Rogatz (2001) in his article The Positive Virtues of Physician-Assisted Suicide argues that when patient’s death is already on the cards, “when cure is impossible and palliation has failed to achieve its objectives,” suicide assistance is but a duty sine qua non to being a physician. After all, doctors exist to provide their patients with the utmost care. Prolonging a patient’s agony against his wishes would be contrary to the physician’s obligations he had sworn to perform under oath. The physician always has “a residual obligation to relieve [a patient’s pain]” and should he leave “a desperate patient to unbearable suffering,” not only does he commit the greatest harm but he also defies the recognized responsibilities attached to or expected of the medical profession (Rogatz, 2001, p.31).
In the act utilitarian perspective, if the physician’s actions result to the greatest good or a highly beneficial situation to a great number of people, then assisting the patient in committing suicide is not an unjust act. The physician is in fact contributing to the balance of society, whereby the common good reigns supreme.
However, as stipulated by the principles of rule utilitarianism, should there be established laws or legal customs against suicide of all forms including physician-assisted suicide or if physician’s code of ethics expressly forbids physician-assisted suicide, then the physician’s actions veer towards the unjust in this particular situation. Countries such as India, Singapore, Norway, New Zealand and North Korea prohibit any voluntary act of suicide and sanctions are imposed on whosoever assists or encourages a person to commit suicide. Although as more and more suffering patients assert their right to die, more and more countries have legalized or are drafting laws and statutes in support of physician-assisted.
The Ethical Egoist Dimension of Physician-Assisted Suicide
Serving as an anti-thesis to the “common good” and “greatest good to the greatest number of people” paradigm of utilitarianism, ethical egoism opposes utilitarian principles by lobbying for the person’s self-interest instead. While John Stuart Mills’ utilitarian morality concerns itself with the majority’s welfare, ethical egoism’s main proponent Ayn Rand argues that society flourishes not by sacrificing oneself for the common good but by pursuing rational self-interests. It is a misperception to think that “one person’s gain is necessarily another person’s loss” (Rand, 1964, p.28).
Using this way of thinking, one can claim that every suffering patient can assert his right to die as long as they are genuinely interested in doing so. Whether this decision can benefit his family or bring about the greatest good is of no consequence. The important thing is that the patient is interested in dying, so it is his right to pursue this course of action. Self-directed actions are but natural in the egoist context. In order for society to move forward, persons who assert their right to die by way of physician-assisted suicide must be left alone. It is their prerogative and such is contributing to society one way or another.
As for doctors caught up in the moral dilemma of physician-assisted suicide, the egoist perspective supports them through and through. Whatever their real motives are for assisting the patient – whether money, mercy or genuine care – they can all be justified if done in accordance with one’s self-interest. Ideally, however:
The highest ethical imperative of doctors should be to provide care in whatever way best serves patients’ interests, in accord with each patient’s wishes, not with a theoretical commitment to preserve life no matter what the cost in suffering. (Angell, 2006, p.86)
A Personal Take on the Issue
The view supported in this paper is the utilitarian perspective, particularly the paradigms revolving around the common good and the greatest good. Although there are many factors to consider before actually considering the act as moral, there are cases when assisted suicide is a better recourse as it brings more justice, “a more paramount obligation,” to the suffering person (Mill, 2011, p.99).
Personally, there is nothing wrong with physician-assisted suicide as long as all proper parties – the patient, his family members and the doctor who will assist him – are all in agreement. There is justice when the decision is unanimously supported. If one member of the party fails to support it, then an alternative to death and a temporary reprieve from pain should be considered for the meantime, until the opposing party concedes.
If there are no alternative therapeutic or palliative techniques to alleviate the patient’s suffering, then it would be more justifiable to let the patient exert his right to die.
Conclusion
It cannot be concluded with finality that physician-assisted suicide is a moral act or decision. Depending on the person’s background and the lens he uses to view this issue, it may or may not be moral. There is no one-size-fits-all standard of goodness or morality, so the subject of physician-assisted suicide sifts and shifts from person to person, from country to country and from one circumstance to another. In the utilitarian perspective, if the act has utility and contributes to the functioning of society, then its performance is not morally wrong. Whereas physicians who help patients forfeit their life are likewise in the gray area. Though by the virtue of self-interest, both patient and physician are not morally wrong, utilitarian principles uphold that unless society or the majority benefits from the act of assisted suicide, such an act would remain morally questionable.
References
Angell, M. (2006). The supreme court and physician-assisted suicide – the ultimate right. In C. Levine (Ed.), Taking sides: Clashing views on controversial bioethical issues (11th ed.). Dubuque, IA: Mc-Graw Hill/Dushkin.
Bentham, J. (1879). An introduction to the principles of morals and legislation. Gloucestershire, UK: Clarendon Press.
Garner, R. & Rosen, B. (1967). Moral philosophy: A systematic introduction to normative ethics and meta-ethics. New York: Macmillan.
Lo, B. (2013). Resolving ethical dilemmas. Philadelphia, PA: Lippincott Williams & Wilkins.
Mill, J. S. (2011). Utilitarianism. C. Heydt (Ed.). Ontario, Canada: Broadview Press.
Rand, A. (1964). The virtue of selfishness. New York: New American Library.
Rogatz, P. (2001). The positive virtues of physician assisted suicide. Humanist, 61(6), 31.
Smart, J. & Williams, B. (1973). Utilitarianism: For and against. Cambridge, UK: Cambridge University Press.
