Introduction
In the recent past there have been calls to legalise Physician Assisted Suicide (PAS). There are several arguments given to justify this course of action. In this paper I will outline why it is morally wrong to advocate for the legalization of PAS. I will then analyse the arguments given by the proponents of PAS. Finally I will show why the arguments supporting PAS are not sufficient to warrant such acts.
PAS and moral, ethical and religious considerations
There are three types of PAS. In voluntary PAS, the patient explicitly asks the doctor to end their life. There is also involuntary PAS, where the patient does not want to die and the doctor performs the act without their knowledge. There is also non-voluntary PAS where the patient’s wishes are unknown due to the person’s unconscious state so the family decides what is best for the patient. PAS is only legal in the State of Oregon. It has not been legalized in other States in the country despite the great arguments advanced by different scholars.
For a doctor to participate in PAS, it will require him to break the Hippocrates oath taken when they start medical school. As per the oath, the individual is required to be a healer. He or she is expected to prescribe medical solutions that will prolong life and provide relief to the patient. Legalizing PAS will create issues of trust between the doctors and patients. The patients may become fearful in situations where the expenses of the hospital are high. They may feel that the doctors may take the lives of patients as a cost cutting measure.
Legalizing the procedure will also cause the family and friends of the patient to have great moral and ethical dilemmas. What will the caretakers do when the doctor is not around and the patient requests for assisted suicide? If the legal dose is administered and death does not come quickly, the caregiver may resort to more aggressive means like putting a paper bag over the person’s head and suffocating them.
Such individuals will suffer great guilt and remorse and will take longer even to grieve the death of their loved one (Emmanuel, Fairclough and Emmanuel, 2462). From a religious point of view, life is viewed as a gift of God. It is considered to be a sacred gift. No individual should take the place of God to decide the point at which life should end.
Individuals should only be given a choice when it comes to accepting medication or surgery which is unlikely to provide a cure and in addition will cause a great financial burden to the family or the community. Caring for the sick should be seen as a great opportunity for young people to give back to the family and the community.
The aged and elderly should have their needs addressed. Their needs are not just physical needs but also emotional and psychological needs. There should be the development of a strong bond where there is a lot of nourishment and compassion given to the terminally ill.
The Case for PAS
There are arguments that the terminal patients who request for PAS are suffering from intense pain that cannot really be treated. They therefore feel it is better if they died than continue living on. It is argued that individuals have different thresholds for pain. There are those who have to take massive doses of opium while others would be relieved with only adequate doses of acetaminophen. There are the patients who suffer from severe pain and there is no medication that can lessen the pain (Gill, 32).
The terminal diseases also destroy the organs of the body and someone ends up looking like a ghost of their former selves. In certain types of cancer, the toes of the individual become darker and at times fall off. There may also be secretions from the face and neck. There are also physiological conditions such as shortness of breath, choking, diarrhoea and nausea which cannot really be treated by using the available medicines in the market. They are recurrent symptoms.
There are also terminal diseases where there is no cure or hope of recovery. The doctors have already informed them that they will die in the next six or eight months. If death is inevitable for the patients, then the patients should have the right to choose a “good” death. Death that arises out of the extreme symptoms of certain terminal diseases cannot be classified as a natural death.
There are patients who have lost the ability to perform some of their basic functions. They have involuntary bowel movements. They cannot do anything by themselves. They have to utterly depend on someone to do everything for them. The inability to have independence is not only physical but it extends to economic situations. The terminally
ill find that they cannot work therefore they do not have any income stream to support themselves. They therefore feel that they are a burden to their caretakers emotionally and financially. They feel that the time of active contribution to their homes and the society is over.
In research studies carried out, it was discovered that even in hospitals where there was great palliative care a significant percentage of the patients had taken certain medications with the hope of hastening their deaths. They have therefore made a choice that they do not want to continue living. This shows that the PAS requests are not based on the fact that the end of life care administered is substandard. Even where quality care is administered the patients have made a conscious decision about their future.
Another argument advanced is that an individual has the right to choose whether they want to die in dignity or not. They do not want to become completely dependent on their family and friends. They do not want to watch their bodies getting disfigured every day from diseases which are incurable.
They know that they will lose their mental faculties and even functional abilities. They will also be vulnerable since they will not have control over their external environments. They will not be able to perform basic functions. They will have no control of their bowel movements. In light of all these conditions, the proponents of PAS argue that people should be allowed to have choice and autonomy in their lives.
Finally, it is argued that the decision of PAS is done between two consensual adults. There is no coercion. The doctor and patient are not being forced to do anything. It is two adults who know the matter being discussed. It is voluntary PAS therefore it should not be termed as wrong whether on legal or moral grounds.
The Case against PAS
The arguments supporting legalization of PAS are hollow. The truth of the matter is that the requests for PAS usually come from patients who are depressed. It stems out of psychological distress rather than physical stress. Depression is one of those conditions where the patient may desire for an early death. The elderly frequently find themselves in positions where they are neglected causing them to feel lonely and neglected. The caregivers may also make them feel that they are a burden.
It would be better for doctors to find ways of detecting depression and treating it instead of looking for ways to legalise PAS. These are self-destructive wishes of the patients which need to be addressed adequately. If the patients were in an environment where they are receiving competent care, the requests for PAS would be minimal (Foley, 54) .
There is also the slippery argument against PAS. There is the danger that if PAS is legalized, it would now become the norm instead of being used for only exceptional cases. It would eventually be used for the disabled, the chronically ill and the psychological depressed. There are healthy individuals who do not want to continue living. They have lost hope and want to die.
If the argument that an individual should have access to PAS due to individual choice and autonomy suffices, then it would mean that PAS would be administered even to the mentally unstable. It may be argued that in Oregon before PAS is administered, a
psychological evaluation is carried out to rule out patients suffering from depression. It is however a risk that should not be ignored since they are patients who have different forms of depression and it may not be detected.
If we look at the intensity of pain argument, there are patients who have conditions where they suffer from extreme pain. Will these patients also be eligible for PAS? What will be the criterion used to include certain patients and exclude others?
There are patients who do not want to be a financial or emotional burden to their family and friends. They are frustrated with the fact that they cannot work and do their basic activities without the support of someone. They want to be allowed to die. Is it only terminal ill patients who experience such frustrations? They are people suffering from severe forms of disability. They have to be assisted to do almost everything by their caregivers. Their hospital visits are costly.
If PAS is allowed for the terminally ill patients, the doctors will be placed in a tough position since their predictions on life expectancy is what may be used as a yard stick. There are times the predictions are true however there have been situations where the patient’s body proves resilient and the patient ends up living for longer periods. Looking at the arguments for PAS based on physical, physiological and mental grounds, they do not provide sufficient justification at all for the legalization of PAS.
Conclusion
I began by outlining the moral, ethical and religious arguments against PAS. Doctors are employed to provide medical care and relief. They have taken an oath to do so. Life
is sacred and no one should be allowed to play God. I have highlighted the arguments supporting PAS and shown why they are weak and unacceptable. Experts should be looking for medical solutions for suicidal depression and severe pain. PAS is a shortcut and refusal to deal with the problems facing the terminally ill.
Works Cited
Emmanuel Ezekiel, Dianne Fairclough and Linda Emmanuel. “Attitudes and Desires Related to Euthanasia and Physician Assisted Suicide among Terminally Ill Patients and their Caregivers.” Journal of the American Medical Association, 284(2000): 2460-2468. Print.
Foley, Kathleen. “Competent Care for the Dying Instead of Physician-Assisted Suicide.” New England Journal of Medicine 336(1997):54-58. Print.
Gill, Michael. “Is the Legalization of Physician-Assisted Suicide Compatible with Good End-of-Life Care?” Journal of Applied Philosophy, 26.1(2009): 27–45. Print.