Introduction
The definition of physician assisted suicide is slightly different from the general term definition of euthanasia. Although some may equate physician assisted suicide with the blanket term, the distinction between euthanasia and physician assisted suicide is that the latter is done with both the patient’s and doctor’s intent to end the patient’s life by unnatural means (Tamayo-Vela´zquez, Simo´n-Lorda, and Cruz-Piqueras, 678). The doctor assists the patient in committing suicide, usually by administering an injection or pill that contains a lethal substance. A doctor may also administer a relaxant to help keep the patient calm during the process (Tamayo- Vela´zquez et al., 678). In contrast, euthanasia can either be active or passive. Active euthanasia is when a doctor gives the patient a lethal substance with the intent of alleviating suffering, provided the patient has informed the doctor that he or she does not wish to suffer. The consent does not necessarily have to be in writing (Tamayo- Vela´zquez et al., 678). Passive euthanasia is when a patient decides to no longer receive treatment for a potentially terminal illness and simply lets the illness run its natural course (Barbuzzi, 16). An example would be a cancer patient who decides to opt out of chemotherapy.
The debate over whether euthanasia and physician assisted suicide should be legally permitted is extensive. The literature reveals that while most doctors are against the idea of euthanasia and physician assisted suicide, the general public tends to support the notion. Those who are religious are more apt to oppose the legality of euthanasia and physician assisted suicide, regardless of the patient’s level of suffering, intent and wishes. It would seem that the mere sanctity of life (in whatever form) is paramount to the actual quality and meaning of life. Similar to the debate on abortion, the medical and religious sectors of society seem to be ignoring the fact that physical life does not last forever and contains inherent needs that have to be supported by society. If an individual is made aware that death is imminent, and more importantly has expressed in written consent that he or she wishes to no longer suffer, doctors should have the legal right to assist the patient in ending his or her life. Although some doctors may feel that the act of physician assisted suicide reaches outside of their moral and ethical boundaries, the legality of the act does not dictate that said doctors must perform the act. In the same way that some doctors choose not to perform abortions and some do, the choice to commit the act would ultimately be up to the individual doctor. Legalizing physician assisted suicide only ensures that those parties who wish to commit the act will not be unduly punished by society in the court of law.
Literature Review and Analysis
Religion’s influence on what is morally and ethically correct for society as a whole seems to be determining whether physician assisted suicide can be legal. The idea that life itself is sacred and should only be eliminated by natural causes does not take into account whether that life is appropriate, beneficial, or desired. In an article arguing against euthanasia and physician assisted suicide, David Richmond states that “Christians endorse the concept of the deepest respect for human life from its beginning in utero to its natural end” (27). He goes on to indicate that “its natural end” is “whenever that may be; because we believe humans are unique, created ‘in the image of God’” (Richmond, 27). The author further implicates himself by following the above statement with the assertion that “although it is unclear what this means exactly, there is reasonable consensus that the inner core of spirituality and reason that enables us to think, reflect and love, give of ourselves for others, communicate, live righteous lives and so on, reflects that image” (Richmond, 27). A reasonable, educated person can ascertain fairly quickly that there are fundamental flaws in Richmond’s reasoning. First, we are not one hundred percent certain what the image of God ascertains. If we are to believe that human life and the human condition is a reflection of the image of God, then God is both dark and light (e.g. suffering and happiness; evil and good). If physician assisted suicide or any act that is labeled as inherently evil is within the realms of human capacity, then it must also be within the realms of divine capacity.
Going back to the debate on the legalization of abortion and subsequently Richmond’s reference to deepest respect for life in utero, if humanity is committing an act which is irrespective of life and should be illegal, why does God or nature allow for natural miscarriages? Is a natural miscarriage not the same as an induced one? The result is that the embryo or zygote simply did not live long enough to become a conscious human being. Does nature or God make provisions for stillborn babies? Why does a divine being allow such physical death to occur naturally? Can the divine being not intervene to end all natural causes of fetal death if this divine being holds the deepest respect for physical human life? In fact, if physical life itself is such a sacred and respected concept to a divine being, why is there physical death at all?
In addition, Richmond’s assertion does not make sense when it comes to the meaning of the natural end of life. Even though one can reasonably interpret this to mean the end of life without human intervention, this statement does not encompass the reality of human existence. For example, in the event of war it is legal for soldiers to kill other humans. Are these deaths considered to be the natural end of life for the victims of war? In the event of car accidents, are those who die on impact or as a result of their injuries considered to be at their natural ends? If we were to compile a percentage of each life that ended from true natural causes against those who have met their deaths against their own (but legal) wills, would we be able to justify Richmond’s assertion?
What we as a society deeply influenced by religious texts written centuries ago seem to have forgotten is that life itself negates death. Some philosophers argue that the moment we are born, we also begin to die. For some of us those moments are merely shorter than the moments of others, as this holds true in natural wildlife as well. This is yet another point that Richmond’s assertion fails to address. If a divine being has created all life and has the utmost respect for such life, then why is it that animals prey on each other, nature destroys portions of itself, and humans are allowed to destroy both animal life and the life of the planet? Richmond and those who hold the scriptures as literal fail to see the reality of the interdependence of all life and the reality of the interdependence of physical life and physical death. One can simply not have one without the other and since death is inevitable, it makes sense that humans would want to exercise the same degree of control over their own existence as they do over the existence of other life forms.
Individuals who are aware they are dying without the hope for successful medical treatment may or may not decide to pursue control over the remainder of their existence. In other words, they may or may not ask a physician to assist them with committing suicide. One of the reasons terminally ill patients seek out physician assisted suicide is physical and emotional suffering (Fernandes, 259). The Christian perspective, as explained by Ashley K. Fernandes is that it is more than the patient who suffers. The caregivers of the patient also suffer by watching their loved one battle with a terminal illness. Fernandes argues that there are more positives in letting the person live out his or her life and these positives outweigh the negatives that people endure as a result of emotional and/or physical pain (260). She goes on to say that suffering is subjective, and that deeper meaning and divine order can be attributed to suffering (Fernandes, 271). It is better to love the person who wishes to end his or her life prematurely, instead of assisting that person in ending his or her life (Fernandes, 271).
With all due respect to Ms. Fernandes, she fails to consider the idea that letting go of someone and following his or her wishes is also an expression of love. If the person is in extreme pain or does not wish to live out the rest of his or her life in pain, would it not be more beneficial to assist that person in ending his or her life before the agony erodes any sense of happiness? It does not make emotional or logical sense to deny a person the right to reduce or eliminate suffering. It may, in fact, take more strength and more love to let that person exit the world in a way that actually preserves a sense of happiness. Particularly if that person has an illness or condition which assures his or her near exit from life and that person is of sound mind to provide written consent, it is no different than those individuals who chose to jump from the Twin Towers of the World Trade Center on September 11th, 2001. Rather than endure the suffering of unbearable smoke inhalation, thousand degree temperatures and being burnt to death, those individuals chose to die in a way they deemed more tolerable. The end result was the same – death and suffering – but it was the type of suffering and the type of death that they could bear.
In her arguments, Fernandes is also being arrogant enough to define what love means. Should love mean the preservation of life at all costs or should it mean accepting that eternal physical life is not possible? Is it not more selfish to demand that someone suffer and simply let a devastating, terminal illness run its course so that caregivers, loved ones and society can justify their own needs? While almost everyone would prefer to keep their loved ones with them for their entire lives, anyone who has lived knows that love also constitutes the ability to put the other person’s needs before one’s own. Love means wanting to ensure that the other person in the relationship is happy. If ending one’s life in order to avoid pain, suffering and undue burden is what will make someone happier, why not allow that to happen? Proponents might argue that the line is blurred between what constitutes acceptable suffering and potential abuse of the legality of physician assisted suicide. The answer is that there is not a perfect way to make physician assisted suicide legal or determine which case bears more merit. Abortion is legal for the purpose of protecting the rights of women to make a decision regarding the quality of their own lives in the event that they unwillingly become pregnant. All the legal provisions in the world will not prevent abuse by some; as undoubtedly some use abortion as a fallback method of birth control. Still, this does not negate the fact that the legality of abortion prevents incest and rape victims from having to carry an unwanted pregnancy to term. Legal abortion also saves the lives of would-be mothers whose pregnancies have induced life-threatening situations. Legal abortion prevents the births of children with genetic deficiencies that would render their lives near useless. There is abuse and loopholes with any law, but it does not correlate with the importance of why legality (or illegality) of an act is necessary.
The line between physician assisted suicide and suicide is thin. While suicide is when someone intentionally ends his or her life by him or herself, physician assisted suicide requires the assistance of someone else. Perhaps it is this “assistance by someone else” that prevents the majority of society’s legal code from condoning physician assisted suicide. Even though it is the intent of the patient to commit suicide, it is the physician’s actions that carry it through. Since murder is typically defined as the intentional killing of another individual, it would make logical sense that society would equate physician assisted suicide with murder. Furthermore, there is a lot of stigma surrounding the act of suicide; especially when the person seems to commit it without reason. Many view suicide as a selfish act; one that robs loved ones and society of the life and gifts of that individual. The problem with this perspective is that it does not recognize that the physician is merely acting on behalf of the patient, and it is not the intent of the physician to commit suicide; it is the intent of the patient to end his or her life. In addition, the patient may not be acting selfishly in wanting to terminate his or her life. He or she may in all actually be thinking of others. Some may not want their children or loved ones to witness the decay and destruction that terminal illness can bring. They may also not want to put undue burden on loved ones or society.
In Canada suicide is legal, but physician assisted suicide and active euthanasia are criminal acts (Barbuzzi, 16). In the Netherlands, physician assisted suicide and active euthanasia have been legal since 2002, as long as medical professionals follow certain stipulations (Barbuzzi, 16). The country introduced the Termination of Life on Request and Assisted Suicide Act, which allows patients to pursue physician assisted suicide, provided at least two medical professionals have examined them and their case is analyzed by a team of medical, legal and ethical experts (Barbuzzi, 16). Since the passing of the act in 2002, one in twenty-eight deaths in the Netherlands is now classified as the result of physician assisted suicide (Ross, 25). The law does not require that patients provide proof of a terminal illness, which has led many to speculate that abuse is running rampant (Ross, 25). What is interesting about Netherland’s Termination of Life on Request and Assisted Suicide Act is that other nations are starting to follow the country’s initiative. Luxemburg, Belgium and Switzerland are some examples. Although physician assisted suicide is still considered illegal in Canada, the country recently prevented a bill from passing that would outright ban all forms of physician assisted suicide (Jackson, 475). It would seem that there is a growing momentum of support for physician assisted suicide, at least in countries where the majority of legislators have the capacity to view the issue from a secular and practical standpoint.
The majority of those in the medical field, including physicians and psychiatrists, tend to have a more difficult time coming to terms with the acceptance of physician assisted suicide. A survey of physicians and psychiatrists revealed that physicians tend to be sensitive to the topics of euthanasia and physician assisted suicide due to the nature of their jobs (Levy, Azar, Huberfeld, Siegel, and Strous, 403). Physicians, after all, are in the business of saving lives and prolonging life as long as possible. The very acts of euthanasia and physician assisted suicide go against what they signed up for. There is a lot of gray area regarding physician assisted suicide that the medical community has yet to iron out (Levy et al., 403). For instance, should the act of physician assisted suicide be condoned as a medical procedure? Are there certain circumstances where the act would be considered a medical procedure and certain situations where it would not? What if the physician has a personal relationship with the patient? Should that physician assist the patient in committing suicide? (Levy et al., 403). Levy et al.’s questions also raise the idea of whether physician assisted suicide should be standardized. Should there be certain policies and procedures for both patients and medical professionals to follow, and what would those policies and procedures entail? If physician assisted suicide is to be condoned as a medical procedure, is it a procedure that would be presented as an option to all patients with terminal illness and would insurance cover the procedure?
It is worth noting that these questions are additional side notes or consequences of legalizing physician assisted suicide. These questions do not in fact bear much weight on whether the doctor has a legal right to accept a patient’s request to assist in his or her suicide and not face criminal charges for doing so. The Netherlands provides a base model for other nations to consider, but it does leave many questions unanswered. It also perhaps provides too much flexibility so that abuse of the system can flourish. This is to be expected in any groundbreaking legislation, but in Western nations such as the United States additions or revisions to legislation is always possible as society and legislators deem necessary.
Another survey of physicians and ethical experts on the notion of euthanasia and physician assisted suicide found that the majority were not knowledgeable enough about the topics. J. Donald Bourdeau and Margaret A. Sommerville differ from the other literature in their distinction between euthanasia and physician assisted suicide. Bourdeau et al. define euthanasia as someone else giving the patient the lethal substance that induces death, whereas physician assisted suicide occurs when the doctor prescribes the patient the lethal substance, but the patient takes it on his or her own (2). For Bourdeau et al., there is no difference between active and passive euthanasia; they are the same. This is an interesting deviation from the remainder of the literature, but it does reveal how professionals in the medical and ethical communities disagree. If the communities cannot agree on even what the terms mean and which behaviors fall under which definition, it is no wonder why legislation has failed to pass in the majority of modern nations. As Bourdeau et al. argues, the first step is to come to an agreement and understanding on what physician assisted suicide means and what it entails.
It is worth noting that some states in the U.S. have legalized physician assisted suicide. Those states include Oregon, Washington, Montana and Vermont (Bourdeau et al., 3). This does not mean that all doctors in these states freely practice physician assisted suicide, but rather that the state does not criminally punish those who do. In the United Kingdom, where physician assisted suicide is still illegal, a survey of physicians revealed that most do not support legislation for the legalization of physician assisted suicide (McCormack, Clifford, and Conroy, 26). The percentage of physicians who were willing to medically assist with patient suicides was 24.9 percent (McCormack et al., 26). Religious beliefs tended to have a strong influence on whether physicians were pro or anti-legislation, although it was inconclusive as to whether the type of religious beliefs had a direct influence (McCormack et al., 27). In contrast to physicians in the U.K, sixty percent of the public supports legalizing physician assisted suicide (McCormack et al., 28). Valuing individual choice and autonomy, as well as possessing higher levels of education seem to correspond with a favorable view of physician assisted suicide amongst the general public (McCormack et al., 30). This begs the question of whether those who enter into the medical profession are more religious than the general public and whether they value collectivity more so than autonomy. This is an area that the literature did not reveal.
Conclusion
Physician assisted suicide should be legal in cases where the patient has no other outcome but death and the patient has expressed consent in writing. Legislation passed in the Netherlands in 2002, which decriminalizes physician assisted suicide under certain circumstances, provides a model for other jurisdictions to follow. The debate on whether it is morally correct to end one’s life or to assist in ending the life of another before nature has run its course will continue whether physician assisted suicide is legal or not. The moral and ethical beliefs of one individual or a subgroup of individuals should not dictate what is best for society at large.
Besides the discrepancies in religious arguments over whether and when life is sacred, religion is supposed to have no bearing over the laws of Westernized nations, such as the United States. Unfortunately, this is not the case as the legal code is often modeled after information contained in the Christian Bible and the Republican Party continues to become more extreme in incorporating religious beliefs into proposed legislation. The quality of life and wishes of the patient should be the only matters considered, and those who wish to offer help and express empathy should not be punished for their solidarity.
Works Cited
Barbuzzi, Miranda. "Who Owns The Right To Die? An Argument About The Legal Status Of Euthanasia And Assisted Suicide In Canada." Penn Bioethics Journal 10.1 (2014): 16-20. Web. 12 May 2015.
Barbuzzi studies the history of euthanasia and assisted suicide in Canada. She defines the difference between active and passive euthanasia versus physician assisted suicide. Barbuzzi defines passive euthanasia as the withdrawing of medical care that would prolong a terminally ill patient’s life versus active euthanasia, which is the taking of lethal substances by the patient. Barbuzzi also explores the contrast between euthanasia legislation in Canada versus the Netherlands.
Boudreau, J. Donald, and Margaret A. Somerville. "Euthanasia And Assisted Suicide: A Physician's And Ethicist's Perspectives." Medicolegal & Bioethics 4.(2014): 1-12. Web. 12 May 2015.
Fernandes, Ashley K. "Suffering In The Context Of Euthanasia And Assisted Suicide: Transcending Job Through Wojtyla's Anthropology."Christian Bioethics: Non-Ecumenical Studies In Medical Morality 16.3 (2010): 257-273. Web. 12 May 2015.
Ashley Frenandes takes a religious perspective on why euthanasia and physician assisted suicide are not the best options for patients. She explores the meaning of physical and emotional suffering, and advocates for the preservation of life.
Jackson, Adam. "'Thou Shalt Not Kill; But Needst Not Strive Officiously To Keep Alive': Further Clarification Of The Law Regarding Mercy Killing, Euthanasia And Assisted Suicide." Journal Of Criminal Law 77.6 (2013): 468-475. Web. 12 May 2015.
Jackson provides details on the Canadian legal measure to ban all physician assisted suicide. The court’s rulings are presented as well as reasons why the ban was not passed. The reasons had to do with what the court felt was a misinterpretation of the definitions of life, suffering and euthanasia.
Levy, Tal Berman, Azar, Shlomi, Huberfeld, Ronen, Siegel, Andrew M., and Strous, Paul D. "Attitudes Towards Euthanasia And Assisted Suicide: A Comparison Between Psychiatrists And Other Physicians."Bioethics 27.7 (2013): 402-408. Web. 12 May 2015.
McCormack, Ruaidhri, Margaret Clifford, and Marian Conroy. "Attitudes Of UK Doctors Towards Euthanasia And Physician-Assisted Suicide: A Systematic Literature Review." Palliative Medicine 26.1 (2012): 23-33. Web. 12 May 2015.
Richmond, David. "How Should Christians Respond To Proposals To Legalise Euthanasia And Assisted Suicide?." Stimulus: The New Zealand Journal Of Christian Thought & Practice 21.1 (2014): 20-28. Web. 12 May 2015.
David Richmond explores why the legalization of euthanasia and assisted suicide go against Christian dogma and theology. He gives the reason that humans are made in the image of God and that the deepest respect for all life should supersede a patient’s wishes. He also explores alternatives to euthanasia and assisted suicide.
Ross, Winston. "Dying Dutch. (Cover Story)." Newsweek Global 164.7 (2015): 24-35. Web. 12 May 2015.
Ross illustrates the contrast between end of life care in the United States versus
The Netherlands. He gives an example of his own grandmother and how she suffered with illness and her quality of life was diminished. Ross travels to The Netherlands and interviews Dutch citizens to get a gist of how they feel about physician assisted suicide and euthanasia as a means of ending one’s life in the face of terminal illness or debilitation.
Tamayo-Velázquez, María-Isabel, Pablo Simón-Lorda, and Maite Cruz-Piqueras. "Euthanasia And Physician-Assisted Suicide: Knowledge, Attitudes And Experiences Of Nurses In Andalusia (Spain)." Nursing Ethics 19.5 (2012): 677-691. Web. 12 May 2015.
