Physician-assisted suicide: ethical and legal considerations

Death & Dying - Euthanasia

THE ETHICAL ISSUES of PHYSICIAN-ASSISTED SUICIDE

Since the inception of medicine, the most fundamental concept guiding physicians in the ethical practice of medicine has been the traditional principle of "do no harm" expressed in the Hippocratic Oath. However, in the modern era of medicine, that ancient maxim is inadequate because contemporary medical science and treatments often make it possible to prolong life beyond the point where a natural death would otherwise occur (Levine, 2008; Tong, 2007).

Much more often than not, the prolongation of human life through methods of medical intervention that were never conceived by Hypocrites provides a profound benefit. Less frequently, some of those same technologies prolong human life even where doing so is neither desired by, nor in the best interests of patients suffering from certain ailments (Humphry, 2002).

In some cases, for example, individuals have no other means of eliminating excruciating pain or preventing a more painful "natural" death besides physician-assisted suicide. In the United States, one of the most ardent supporters of the right to a death at the time and in the manner of one's choosing was Dr. Jack Kevorkian, only recently released after his incarceration for violating Michigan state laws prohibiting physicians from assisting in euthanasia. Doctor Kevorkian is unable to continue as a public advocate of euthanasia rights as a condition of his parole (Martindale, 2007).

Nevertheless, his efforts demonstrated that a new ethical consideration may be overdue to whatever extent the purpose of modern medicine is to reduce suffering; such changes may also be overdue purely in the modern context of individual rights of privacy and personal autonomy that have evolved as much since the time of Hypocrites as the "hard science" of medicine.

Governmental Paternalism, Suicide, and Euthanasia:

Suicide is prohibited by all of the predominant Western religions, as well as under secular law of most modern human societies, probably as a direct consequence. In the U.S., secular law must, at least in theory, reflect only objective ethical analyses rather than religious ideals. Certainly, there are ethical bases that justify the involvement of societal authorities in efforts to prevent suicide in many instances. Prevention of reckless suicide is justified from the simplest perspective of protecting innocent members of society from being harmed by reckless forms of suicide that put others at risk without their consent.

Similarly, society may have a legitimate right to intervene where the motivation for suicide is as a symptom of a recognizable illness, particularly if it is treatable. In those cases, it is reasonable and not violative of any individual rights to privacy or autonomy to prevent suicide where the individual would almost certainly be appreciative after the fact, as opposed to situations where an individual in his so-called "right mind" would not be appreciative. In that regard, it is difficult to articulate any logically cogent rational for intruding in what should be purely private matters.

Physician-Assisted Suicide:

There may indeed be other valid reasons for governmental regulation of suicide apart from the protection of others from direct harm, such as from reckless suicide attempts. Namely, where the individual is under a legal obligation to others, particularly where those obligations include parental obligations to minor children. Even if the individual maintains a fundamental moral right of personal privacy to choose his preferred time and method of death ab initio, that right is rightly suspended where premature death by choice deprives others to whom even the autonomous individual is rightfully obligated by law or by ethics. On the other hand, it is much less clear what the presumed logical basis is of governmental intrusion into the choice to end one's life where that decision is made by a sane person who is not responsible for others.

In medicine, that dilemma arises only among patients whose choice to end life is motivated by the understandable desire to escape untreatable physical pain or discomfort.

In some cases, it is not necessarily pain per se that the patient, but physical or cognitive debilitation that patients wish to escape by authorizing their physicians to end their lives painlessly. Typically, Dr. Kevorkian's patients suffered from incurable illnesses and congenital diseases that caused them more pain than they wished to endure until their natural death. All of Dr. Kevorkian's patients suffered from incurable conditions that either caused continual physical pain that could not be relieved by any medical treatment or they wished to avoid a tremendously uncomfortable death, albeit by "natural causes," such as by slow suffocation from gradual paralysis of their respiratory function at the end stage of disease (Humphry, 2002; Martindale, 2007).

In the modern age of medicine, the arsenal of treatment modalities undeniably provides tremendous benefits to millions of people, the overwhelming vast majority of whom would gratefully welcome additional years of life made possible by medical science. Unfortunately, in a comparatively few cases, medical treatment that is perfectly routine in the modern medical era increases pain and suffering if the patient is deprived of the right to decide how much pain and/or debilitation is too much to endure. The "luckiest" of those patients need only refuse medical treatment that is necessary to prolong life. However, for the suffering patient whose medical health is "stable" from a clinical perspective, there is no legal right to solicit the assistance of physicians to end life.