Physician-Assisted Suicide and Ethical Issues

Physician-Assisted Suicide and Ethical Issues

The medical profession has been governed by the Hippocratic Oath since antiquity, according to which physicians must "do no harm" to their patients. However, toward end of the 20th century, medical science had progressed to the point that the definition of doing harm became much more complex than easily resolved by the types of distinctions and analyses sufficed previously. As medical interventions enabled the treatment of most human disease, that raised bioethical issues such as distinguishing extending life and prolonging suffering (Sharma, 2004). In many respects, it is no longer ethically appropriate to criminalize physician-assisted suicide or to otherwise impose restrictions on decisions that should remain strictly personal, although appropriate ethical and legal guidelines for avoiding mistakes and abuse are essential.

Recent evidence suggests that the incidence of suicide is substantially under-reported in the elderly community, precisely because standard medical care available in most "first-world" nations often extends life without regard to the relative quality of life from the point-of-view of the patient (Humphry, 2002). Increased longevity in the population has led to dramatic increase in debilitating ailments associated with old age, including severe cognitive impairment such as Alzheimer's disease, which has a very long and gradual onset after initial diagnosis. In some cases, elderly patients in good physical health have chosen assisted suicide instead of suffering from Alzheimer's (Humphry, 2002).

Justification for Permitting physician-assisted suicide:

Dr. Jack Kevorkian tried to raise awareness of the need for contemporary bioethics and legal definitions to recognize that situations may exist where physician-assisted suicide is more consistent with the fundamental concept of providing medical care than the unitary literal definitions that may have been appropriate previously. He was eventually convicted by the state of Michigan and incarcerated in connection with his purposely crossing the line between providing passive assistance in the suicide of some of his patients and actually initiating the cause of death directly (Martindale, 2007).

Dr. Kevorkian assisted patients who were already diagnosed with terminal diseases who wished to escape the physical suffering, such as the slow paralysis and eventual suffocation from amyotrophic lateral sclerosis (ALS), also known as "Lou Gehrig's Disease."

In principle, the justification for physician-assisted suicide is simply that the patient should have the autonomous authority to determine how much suffering is too much to endure. Some of those opposed to allowing any form of suicide argue that human life is sacred and that only God has the authority to give and take life. That particular objection (although one of the most common) is not an appropriate guideline in the United States because any legislation based on that concept violates the First Amendment prohibition on church and state entanglement (Humphry, 2002).

The other principle objection to any form of physician-assisted suicide is based on the so-called "slippery slope" concern that once physician-assisted suicide is permitted in some cases where it might be justified by circumstances and patient rights, it could be misused for purposes other than the benefit of the patient. Perhaps the most reasonable objection to physician-assisted suicide relates to the subjective element of quality of life and the degree to which that perception (on the part of the patient) is susceptible to temporary influence, such as from clinical depression or temporary physical pain or disability. To overcome that objection, it would be necessary to outline objective principles and guidelines capable of allowing physician-assisted suicide in justifiable situations while also prohibiting potential misuses and abuses.

Reconciling the Issues:

On one hand, there does not seem to be any legitimate justification for preventing a sane, healthy, competent individual from choosing death over prolonged agony, particularly where the condition responsible for the patient's pain is already terminal. On the other hand, the decision to end one's life is irreversible and should not be permitted to be implemented as a result of temporary conditions or states of mind. Medical error exists in all areas and specialties; error in this particular area would result in monumental consequences.