Ethical Issues of Assisted Suicide and Euthanasia

Ethical Issues of Assisted Suicide and Euthanasia

The ethical issues relating to assisted suicide and euthanasia have captured the attention of the public. The topic of Euthanasia is a contentious one and it inescapably incites strong emotional argument and gives rise to tough beliefs that do not straight away lend themselves to consensual harmony. It is improbable that a decision can be reached which will meet with universal support whenever such clashes of values exist, with apparently little middle ground. It is hard for anyone to anticipate accord on this issue in a society with a plurality of extensively varying moral opinions and faiths. There is an urgent need for the issue of active voluntary euthanasia to be addressed in spite of the difficulties in this area. (Otlowski, 1997)

A constant stress of media attention and increasing anxiety about control at life's end has created severe concern of legalizing the issue of assisted suicide. Public debate has focused on the need for control over the time and way of death, along with forewarning about the possible misuse or damage of intervening society's venerable ban against assisting suicide or absolutely instigating another individual's death. There are deliberations about assisted suicide and euthanasia in the medical and ethical literature. Though it is concomitant with this public discussion, it is discrete from it in many ways. In this discussion, some state that both assisted suicide and euthanasia are ethically incorrect and must not be permitted, in spite of the situation of that specific case. Some others say that assisted suicide or euthanasia is morally lawful in some unusual and special cases, but that professional values and the law should not be modified to approve both practices. Lastly, some support that assisted suicide, or both assisted suicide and euthanasia, should be made officially and ethically fitting options in the case of dying or seriously ill patients. (When Death is Sought Assisted Suicide and Euthanasia in the Medical Context)

Stunning media hype was attained by the campaign that insists legalization of physician-assisted suicide. Almost everyone got exposed to the notion of physician-assisted suicide even though it has not been legalized anywhere in the United States except Oregon. (Olevitch, 2002) The important step forward that the activists had been dreaming about since the days of Charles Francis Potter for the euthanasia movement was given by hopeful opinion polls and the 1994 vote in Oregon supporting the first law in American history allowing physician-assisted suicide. (Dowbiggin, 2003)

1. Should this process be legalized?

Assisted suicide and euthanasia should be allowed only with severe and clear procedures. Justice expects that all must be treated in the same way. Proficient, incurably ill patients are permitted to speed up death by treatment rejection. For some patients, treatment negation will not be enough to speed up death; for them the only alternative is suicide. Justice insists that we should permit assisted death for these patients. Even though society has keen interest in protecting life that interest decreases when person is incurably ill and has keen wish to end life. A total ban on assisted death greatly restricts personal liberty. Thus Physician-Assisted suicide or PAS must be permitted in some cases. (Ethics in Medicine: Physician-Assisted Suicide) Support for physician-assisted suicide has also come from a few public advocates. Dr. Timothy Quill shows the sympathetic side of physician-assisted suicide in addition to Doctor Jack Kervokian's 'death machine'. Dr. Quill, in the story of Diane, attempts to persuade physicians to take sincerely the appeal of a patient to die. At present, physician-assisted suicide is permitted only in Oregon State. The opinion of many of the supporters is that there is a right to choose when and where one dies. (Physician-Assisted Suicide: For and Against)

Justice Benjamin Cardozo, in his explanation on autonomy, says that every human being of adult years and sound mind has a right to decide what shall be done with his own body. Batlle, after agreeing with Cardozo, recapitulates individual autonomy hitherto viewed within the legal system as an individual's right to self-determination that includes choices about death and compensates a societal interest in the holiness of life. (Legalizing Euthanasia and Physician-Assisted Suicide: Self-Determination or Unethical Practice?) A strong support of it in medical physicians has come from many studies and in the general public through two published studies. That the physician-assisted suicide should be legal in some cases is the view of 60% of physician in Oregon. Prescription of a lethal dose is the option for 46%.

Though fulfilling a request of a patient for a lethal dose was illegal at this time, 7% have agreed to do so. The public and physicians were questioned in the Michigan study. While support for the legalization came from 56% of physicians and 66% of the public, support for a complete ban came from 37% of physicians and 26% of the public. As there is a support for the legalization of physician-assisted suicide irrespective of the various reasons for each individual choice, this in some way needs to be tackled. Another example for the support of physician-assisted suicide in Michigan comes from the reality that Dr. Kevokian has never been found guilty. (Physician-Assisted Suicide: For and Against)

Regard for personal independence consents the validation of assisted suicide and euthanasia. Moral and ethical opinions supporting assisted suicide and euthanasia contains the principle of freedom to control the time, place, and nature of one's death, putting quality at the end of life above the purity of life. Other factors are the wish to maintain self-respect and personhood in the dying process and resistance to extending life by means of modern medical technology when it is known that care is ineffective. (End of Life Issues and Care) People have a basic freedom to lead the way of their lives, a freedom that should include control over the time and conditions of their death. In suitable cases suicide can decrease suffering or increase self-respect, and people in these conditions should have the permission to take their own lives. A doctor's contribution in assisted suicide or euthanasia can encourage an option taken by the patient, depending on his or her own value system. Personal attitudes about the significance of life and the implication of death differ very much. Ascertaining assisted suicide and euthanasia, as established options would revere this diversity. (When Death is Sought Assisted Suicide and Euthanasia in the Medical Context)

According to a research study published in the Journal of General Internal Medicine, patients were encouraged to visit a doctor for their death wish did so after a decisive and attentive process rather than on one's impulse. The study presenting data that until now has been very limited, involved 35 cases in which patients believed physician-assisted suicide. Researchers worked to get complete information concerning their thought processes, motivations, and experiences by means of interviews with these patients and their family members. The patient's motivation to take part in physician-assisted suicide was revealed in this study and is found to contain three types of issues, namely, illness-related experience weakness, loss of functional activity or uneasiness or loss of sense of self or identity, and worries about the future. (Physician-Assisted Suicide and Why Patients are motivated to Seek Death)

At the time of planning the assisted suicide, none of the patients appeared to be gravely sad. The motivations expressed are comparable to those of other patients who refuse life-sustaining treatment. As per Robert A. Pearlman, lead author of the study, the motivations for physician-assisted suicide recognize issues for physicians to explore with patients who have unceasing illness and life-shortening disease. While addressing the sweeping effects of the illness, including the quality of the dying experience with their patients, the health care providers can take help from these studies. (Physician-Assisted Suicide and Why Patients are motivated to Seek Death)

Thus making assisted suicide and voluntary euthanasia legally lawful is a positive step to give people more control over their dying process. Neutrally, there is no single reply as to when in one's life all things become a saddle and redundant. If freedom is a basic value, then the great inconsistency among people on this question makes it particularly significant that people control the way, situation, and timing of their death and dying. (When Death is Sought Assisted Suicide and Euthanasia in the Medical Context) The principle of autonomy is very much associated with self-deciding capacity. This principle asserts that people should have the freedom to make their own resolution about the track of their own lives at any time they can. Similarly they should also have the right to decide the way of their own dying. As per these discussions, even when options are communally formed they should be valued as independent as long as there is proper assessment of decisional capability. No person should tolerate terminal suffering that is chronic, intolerable, or delayed.

The dying person should be capable of seeking and getting help in assisted suicide, when the saddle of life overweigh the benefits due to unmanageable pain, acute psychological suffering, damage to his self-respect, or loss of class of life as considered by the patient and when the conditions are not curable. It is also squabbled that assisted suicide for fatally ill people undergoing severe pain can be differentiated from euthanasia used for the purpose of genocide on the basis that it is on the basis of the principles of self-respect, respect, and reverence and is selected and performed by the dying persons, instead of being forced on them in opposition to their will. (End of Life Issues and Care) Some would disagree that assisted death already happens in secrecy. For instance, morphine drips apparently used for pain relief is a secret form of assisted death or euthanasia. That PAS is unlawful avoids an open argument, in which patients and doctors could take part. Making PAS legally lawful will encourage open discussion. (Ethics in Medicine: Physician-Assisted Suicide)

The pain experienced by friends and family of the patient is frequently equivalent to or more than the patient himself. Observing a loved one in such suffering for so long is very hard. The stress drawn out for so long is emotional and physically challenging. Generally, the death of patient takes place abruptly or followed by a period when the patient has lost consciousness. The patient gets a chance to say his final goodbyes and end his life with dignity if it is physician-assisted suicide. (Should an incurably-ill patient be able to commit physician-assisted suicide?)

Legal arguments assert that it would be in the best concern of dying patients to be able to control methods that are presently being used secretly for assisted suicide. This set of laws would also defend the doctors who are presently fulfilling unlawfully the patient desires out of sympathy. Medical arguments squabble that fit incurably ill patients desiring to opt for assisted suicide may feel deserted by doctors who decline to help them. The censure that medical doctors who help in suicide would be disobeying the Hippocratic Oath is disproved on various grounds. First, the original Oath barring killing also banned abortions, surgery, and charging teaching fees, all of which have been changed to meet modern realities. Second, assisted suicide, unlike euthanasia, does not entail the ending of life by a doctor, as it is the dying person himself or herself who takes the steps to end his or her life. Third, the Oath necessitates the doctors to take all steps required to reduce pain, and some understand this to include assisted suicide when that is the only way pain can be reduced. (End of Life Issues and Care)

Making assisted suicide and euthanasia legally lawful will not create any dangerous effects for the society and suitable protection can reduce those possible dangers. For instance, in spite of the present ban, assisted suicide takes place. Explicitly allowing assisted suicide in agreement with the necessary protection can thus hearten doctors to converse without restraint with their patients and to discuss with professional colleagues. Permitted consultation with an approved psychiatrist would enhance the identification and cure of many patients who are dejected. Thus, when it is done under cautiously defined situations it would lead to larger professional responsibility and lesser cases of insults. Though there are some criticisms against legalizing assisted suicide or euthanasia, the number of improper deaths is small, and the chances to lessen pain in other cases outweigh the cost. The significance of criticism suggests the requirement for protection, but should not prevent authorizing assisted suicide and euthanasia. (When Death is Sought Assisted Suicide and Euthanasia in the Medical Context)

The discussions concerning protection and the greasy slant holds that it is possible to safeguard people from criticism through suitable laws which would give control by an arrangement of state legislation and professional regulation by soothing care consultants and ethics committees that would have professionals and community representatives. Many methods for protection have been planned and in general have affirmation of diagnosis, prognosis, treatment options, and decision-making capacity; evaluation for optional means of lessening pain; nondirective counseling; education of physicians; and education of the public. It is also disputed that extensively used and generally believed legal end-of-life interferences like maintaining or retreating treatment, double effect, and terminal sedation are also subject to the greasy slope or to criticism and yet are thought to be manageable by standards of care and suitable law and supervision.

Similarly, financial concerns may be a feature in needs for legal interferences as well as in needs for assisted suicide and yet are not thought of as a validation for banning these other interferences. The protection argument posits that concerning mental health professionals to offer suitable and complete treatment planning would enhance quality of care and minimize the prospective for criticism regarding all end-of-life interferences that may concern the time of death. Concerning the matter of dejection which, if taken care of, can change a fatally ill individual's demand for assisted suicide, it is pointed out that first, cure of dejection does not always alter the wish for assisted suicide, and second, psychologists can play a significant part in evaluation and cure of dejection and other psychological factors that may have an effect on judgment and wishes for a range of interferences that have an effect on the time of death including but not restricted to assisted suicide. (End of Life Issues and Care)

Making assisted suicide or euthanasia legal must support eventual procedure: for instance, necessitating that the attending doctor discuss with his colleagues and that the patient willingly and constantly wish for assisted suicide or euthanasia, get psychological assessment and advice, and experience unbearable pain with no hope for relief. There should also be provisions for the patient's medical situation: for instance, that assisted suicide or euthanasia can be permitted only if a patient is fatally ill or has an untreatable disease. A board or committee should appraise the patient's wishes before assisted suicide or euthanasia is done. Course of action should mention the types of cases that would not subject doctors to any punishment. Doctors can evade penalty by providing evidence that they acted aptly in special conditions; proving that the doctor reacted sympathetically and proficiently to a deliberate wish made by a competent patient would form a protection to criminal trial. Finally, there should be a test period of voluntary active euthanasia or steps to make the practice legally lawful in a few states, in order to get data on the result of the practice. (When Death is Sought Assisted Suicide and Euthanasia in the Medical Context)

2. Is physician-assisted suicide appropriate in cases of unrelenting suffering, or should it be a last resort

Ethical predicaments hitherto unknown to earlier generation of doctors has come from medical advances. Physicians are compelled to ask questions that never needed to be asked before, as new life-sustaining techniques and practices became available. The main question is the extent to which to go for saving a life. The ethical customs that have been in place for centuries are disputed by other questions. Can doctors be allowed to end a patient's life if suffering is vast and a patient's condition is incurable? (Newman, 1999) Many patients with advanced and incurable illness find that they cannot reckon on dependable care with only reasonable saddles on loved ones. People may desire for a suicide to great pain, debasing nursing home conditions, or family insolvency. Patients contemplate the effect of their endurance and death on their loved ones, and monetary and emotional pressures can influence decision-making. (Lorenz, Lynn, 2003)

But assisted suicide and euthanasia must be made lawful only if all methods of decreasing the pains have been worn out allowing a person to undergo inconceivable pain. Hence, it is essential to legalize physician-assisted suicide as a last option and only with stringent regulations or precautions. These precautions will save the individual requesting euthanasia and will lessen the incidences of misuse. Before physician-assisted suicide is thought about, all likely actions must have been taken to assuage the pain. (Howard; Fletcher; Gostin; Meier; Miller, 2001) American Medical Association recommends physician-assisted suicide, as a last resort, only after the following issues have been carefully looked at and exhausted or discarded by the patient: All suitable standard and experimental allopathic and osteopathic therapies; all pertinent culturally receptive alternative therapies; all sedative care options, such as hospice; All-inclusive pain management and All-inclusive psychiatric, psychosocial and spiritual support. (Principles regarding Physician-assisted Suicide)

Some authors agree to the view that physician-assisted suicide should be approved in situations where medical treatment could not offer any advantage and where legally the physician can pull out treatment, including food and water. The argument that if death is in a patient's best interest then death comprises of a moral good and should be used as a last option comes from the critics of the AMA's position against legalizing euthanasia namely Len & Lesley Doyal. The statement that there is no ethical or constitutionally identifiable difference between a doctor's pulling the plug on a respirator and his prescribing drugs which will allow an incurably ill patient to end his own life from ninth circuit judges strengthens the above views. Due to differing opinions, we can wrap up that it is one of degree and not one of kind. (Legalizing Euthanasia and Physician-Assisted Suicide: Self-Determination or Unethical Practice?)

Thus for few fatally ill patients, doctor-aided death may be a tolerable decision of last choice. Currently, it is not known what rates of physician-aided death are correct. High rates would propose that the method is not just being used as a benevolent method to reduce obstinate suffering at the wish of the patient. Instead, high rates could reveal lack in the capability of health care practitioners, need of access to suitable services, deflation of the dying, or even stress from others to end life impulsively. If society estimates the dying and can guarantee courteous medical care for all fatally ill patients, then legalized physician-aided death should be applicable to only a few numbers of cases. But this implies that considerable funds and cultural change are essential. We require the funds to enhance the education of health care professionals, a promise to continuing communal discussion about the care of the dying, and an assurance of universal access to good care for all fatally ill persons, with checking of quality to make sure that such care is given. The test for states and countries thinking about laws sanctioning doctors-aided death will be to bind justification to such an oath. (Lorenz, Lynn, 2003)

3. We euthanize animals in attempt to be humane and spare them the suffering and we consider human euthanasia unethical...

We are dealing with animals more humanely than we deal with humans, if physician-assisted suicide is against the law. It is lawful for the animal doctor to end the lives of those animals that are incurably ill. But it is not so for human beings. (Chamberlain, 2004) Anti-cruelty decrees in every state including felony provisions in 38 states show that we do not put up with animal suffering. Arguments reveal that giving animals the humane care and also a humane death is our duty. Arguments also reveal that the last moments of any conscious being's life should be made as relaxed as possible. Animals are often euthanized within 3-10 days when they are incurably ill depending on local ordinances, as all animal shelters have space limitations. (About Implementing Humane Euthanasia in NM Animal Shelters)

Human life is considered more precious than animal life in our society. In the case of human beings there are possibilities of providing better treatment facilities and opportunities for reducing the suffering and even saving the lives. However in the case of animals, society is not willing to provide these facilities at a larger level and animals have to deal with suffering due to lack of proper treatment. Hence the case of providing euthanasia is different in the case of animals than in the case of human beings. Because of recent advances in medical technology, it is today possible to save or prolong the lives of many persons who in an earlier era would have quickly perished. (Baird, Rosenbaum, 1989) In the case of human beings since opportunities for treating diseases and alleviating suffering are at higher levels when compared to animals, these options should be made use of and euthanasia should be considered only a last resort when all other treatment methods fail. There is a need to legalize euthanasia and to make it unethical when all other treatment methods prove to be ineffective.

4. On the other hand all religions value suffering as part of human experience and therefore from religious point-of-view euthanasia is unacceptable not only because it is an active act of killing but also because suffering is a part of our life path towards god.

Many religious societies are against assisted suicide and euthanasia as these systems go against the fundamental value of human life, seen as God's gift. They state that every individual is a warden for his life as life is a present from God. Therefore, only God should be permitted to end a life as he only can begin a life. An individual is carrying out a sin if he commits suicide. (Euthanasia and Physician-Assisted Suicide: Further Information) In the viewpoint of many religions, suicide itself is not a morally permitted option. Various religious customs disallow assisted suicide and euthanasia on the basis of their knowledge of general values, as well as admiration for the life and worth of each person, the person's liability to the community, and society's commitment towards all of its members, mainly the deprived and helpless. Some religions value life itself as that which is given to people by God, requiring a sense of individual liability that is often uttered in terms of stewardship. Various religious viewpoints also share a promise to sympathy for patients and others who are in pain. They think that this sympathy must be uttered by giving care and friendship, not assisted death or medical killing, to the seriously ill. (When Death is Sought Assisted Suicide and Euthanasia in the Medical Context)

Assisted suicide is obviously incorrect is the belief of Groups like the Catholic Medical Association. The group argues before the Supreme Court against assisted suicide by employing the influential international law firm Morgan, Lewis and Bockius. The group sticks to the teachings of the Catholic Church that God or nature is the judge of life and death, and man should play no role in speeding up death or ending life ahead of time. (A Village Life Exclusive) Statements on suicide and physician-assisted suicide were released by a number of religious organizations. The strongest spoken opposition to suicide is from the conservative faith groups. According to Quran, life, sanctified by Allah, should not be taken out in any way other than through justice. As we did not construct ourselves, we do not own our bodies is the argument found in an essay on the web page of the Islamic Center of Southern California. It is an offense and a serious sin to try to kill oneself. As per Qur'an, Allah has been most compassionate to all individuals and hence, individuals should not kill or destroy themselves. In Islam, there is exists no idea of life not worthy of living. (Euthanasia and Physician-Assisted Suicide: Further Information)

A decentralized faith group called The Mennonite denomination supports individual conferences to make their own statements on social issues. A resolution was accepted in 1971 by a Synod of the Christian Reformed Church in North America which stated that synod, aware of the sixth commandment; denounce the wanton or arbitrary destruction of any human being at any state of its development from the point of beginning to the point of death. The Conference of Mennonites in Canada released a statement in 1995. According to the statement, grief, separation and terror are the main factors that force dying persons to think suicide and felt that the state should not make possible suicide, but it should control physical and emotional pain and support the dying in the context of a caring community setting.

A 1992 statement on end-of-life issues from the Evangelical Lutheran Church in America -- ELCA Church Council supports inert euthanasia because health care professionals are not needed for using all available medical treatment in all situations. In cases where medical treatment may be incomplete, death is permitted to occur. As intentional destroying of life created in the image of God is against our Christian conscience, they resist active euthanasia. However, they do recognize that physicians make a great effort to decide the lesser evil in some situations like when pain is so harsh that life is the same as torment. Surprisingly, they do not mention on physician-assisted suicide even though it is a fiercely discussed topic. (Euthanasia and Physician-Assisted Suicide: Further Information)

The Greek Orthodox Archdiocese of America resisted murder, whether it be suicide, euthanasia or whatever, and regardless if it is covered in terms like 'death with dignity', when mentioning on the case before the U.S. Supreme Court in 1996. A person should resort to God for strength and support instead of considering ending it all because of hopelessness. An instance of an individual conquering great pain by staying focused on God is given in "The Book of Job." In 1997, a brief was filed to the Supreme Court by The Union of Orthodox Jewish Congregations of America. They supported the laws that prohibited physician-assisted suicide. According to Nathan Diament, director of their Institute for Public Affairs, this is a subject of critical constitutional and moral significance that Jewish tradition evidently speaks to. According to them, the appreciation of a constitutionally recognized right to die for the incurably ill is a clear statement against the acceptance and holiness of human life.

According to the Salvation Army, people do not have the right to death by their own resolution. The grace of God can maintain through any torment or hardship and only God is ruler over life and death. Everyone is accountable for his life before God who has given it to him as per the Catechism of the Roman Catholic Church. For His honor and the salvation of our souls, we are indebted to accept life thankfully and protect it. For the life God has handed over to us, we are not owners but are only wardens. Hence, we cannot get rid of our life, as it is not ours. (Euthanasia and Physician-Assisted Suicide: Further Information)

As informed in the 1980 Vatican Declaration on Euthanasia, and declared in speeches by Pope John Paul II, the Catholic Church determinedly castoffs assisted suicide and euthanasia. The Vatican's 1980 Declaration on Euthanasia portrays euthanasia as an act or an oversight, which of itself or by purpose brings about death, in order that all pain may in this way be removed. The council of all branches of Judaism has the same belief. Many Protestant denominations, like the American Lutheran Church and the Episcopal Church, also are against the methods as morally intolerable. As mentioned in a report of the American Lutheran Church: Some might argue that active euthanasia can symbolize a proper course of action if forced by the craving to end pain. But Christian stewardship consents cherishing and maintaining the life, which God has given, be it our own life or the life of some other person. This outlook is encouraged by the assertion that sense and trust are feasible in all of life's conditions, even for those having immense pain. But the Unitarian-Universalist Association has given its encouragement for permitting these procedures. (When Death is Sought Assisted Suicide and Euthanasia in the Medical Context)