Physician-assisted suicide: arguments and ethical considerations

Physician-Assisted Suicide and Euthanasia

The debate about Euthanasia is an ancient one but it has acquired a new relevance in recent times as advances in medical science have greatly extended human life-spans and it is now possible to sustain life for indefinite periods through artificial means. A closely related issue is whether it is ethical for physicians to assist in their patients' suicide in order to relieve their pain and suffering. Seemingly weighty arguments have been advanced both for and against the issue, but the debate still remains unresolved. A closer scrutiny of the pro and con arguments, however, reveals that the case against physician-assisted suicide does not carry sufficient weight and it is, in fact, a humane act which should be allowed in all civilized societies. In this essay, I shall explain why I believe so.

To start with, it would be appropriate to differentiate between certain closely related "euthanasia" terms. "Physician-assisted suicide" (PAS) is the act of providing a patient with the information, guidance, and means to take his or her own life by a physician, with the last act, i.e., taking a lethal injection or medicine being performed by the patient herself. In "active euthanasia," the last act of putting a person to death is performed by another person; albeit with his/her consent. Both these acts are considered to be illegal except in certain places such as the Netherlands and in the State of Oregon in the U.S. On the other hand, withdrawing life-sustaining medication or turning off life-prolonging equipment with the consent of a patient or his/her proxy, usually called "passive euthanasia," is considered to be acceptable in most countries. (Braddock and Tonelli)

Now let us look at some of the arguments against physician-assisted suicide and to what extent they are valid? Perhaps the most oft-repeated argument against PAS is that it is contrary to the historical traditions in medicine and the Hippocratic Oath "to do no harm"; assisting their patients in suicide would, therefore, be a violation of the oath and amount to murder (Braddock and Tonelli). This is strange logic, since withdrawal of life-sustaining treatment at the patient's request, which is arguably a more definitive act than PAS, is generally accepted by the society and has been upheld by several U.S. courts as legal (Dombrink and Hillyard, 9-10). How can acceding to a request by a patient to help in bringing a humane end to her pain and suffering, when all other efforts to do so have been exhausted, be considered illegal or contrary to the Hippocratic oath? On the contrary, the refusal to help a patient in such a situation, to my mind, would be a cruel act. Thus, any physician who accedes to a request of a patient and prescribes appropriate medication to bring the dying process to a merciful end is, in fact, entirely in line with the Hippocratic tradition.

Another common argument against physician-assisted suicide is that once it is made legal, it would put us on a "moral slippery slope" leading to more severe forms of euthanasia and targeting of vulnerable groups of people; it would be used as a "cost cutting solution" by doctors who would put pressure on the elderly and patients without health insurance to request death against their wishes; or even lead to a situation similar to the one experienced in Nazi Germany when mentally deranged and 'undesirable' people were put to death. Such alleged psychological inevitability of moving from voluntary physician-assisted suicide to non-voluntary euthanasia is not supported by credible evidence. The example of Hitler's Germany is irrelevant because what the Nazis practiced was eugenics, which is quite different from PAS or euthanasia. Evidence from the Netherlands (where PAS and euthanasia are legal) is more relevant and serious studies on the subject reveal that there has been no slide on the "slippery slope" there (Young). In Oregon, the only U.S. State where physician-assisted suicide is allowed, no such feared "victimization" of the poor and the uninsured has taken place; nor has there been a precipitous rush by Oregonians to embrace assisted suicide, which seems to suggest that the "slippery slope" apprehension is largely unfounded (Rogatz, 32).

People who oppose physician-assisted suicide also opine that depression, often accompanying chronic and terminal diseases, is a major cause of requests for assisted suicide, and most people, after being treated for depression would withdraw their request. (Foley, 54; Braddock and Tonnelli). This again, is an argument based more on conjecture rather than solid evidence. While it is true that depression may accompany many serious and terminal diseases and there are anecdotes about patients who changed their minds about suicide after treatment; no credible studies are available about how often it happens or even if antidepressant treatment would make patients requesting death, change their minds. (Angell, 52)

Kathleen Foley, in her article "Competent Care for the Dying Instead of Physician-Assisted Suicide" observes that advances in modern medicine have made it possible to alleviate almost all kinds of pain and even when it is not possible to eliminate pain entirely; lessening it to a manageable level is almost always possible. She, therefore, feels that the problem is lack of proper pain management training for doctors and the solution is greater access to pain relieving medicine for everyone, rather than a need for physician-assisted suicide (Foley, 53). There is no arguing with the suggestion that every effort must be made by a doctor to relieve the pain of a patient and the best available palliative care be provided to them. However, there are many terminal conditions such as full-blown AIDS and several forms of cancer in which no amounts of medicines can alleviate the nausea and pain. In such cases, no one except the patient herself can decide whether her suffering is bearable or unbearable. If a patient requests help from her physician to end her suffering by hastening a dignified death in such circumstance, the only humane thing for the physician to do would be to accede to the request.

The anti-PAS lobby has also contend that people who want to end their lives, have the choice of committing suicide themselves rather than asking for assistance in suicide from physicians. This is perhaps the most callous argument of all. Peter Rogatz counters this objection with an appropriate query: "Are patients to shoot themselves, jump from a window, starve themselves to death, or rig a pipe to the car exhaust?" (Rogatz, 33) Terminally ill, bed-ridden patients usually do not have the energy or the means to go out and look for appropriate poisons or a gun to end their lives. Many of them desire a pain-less dignified end of their lives and their physicians can provide them with the best possible advice to do so. When such a choice is not available, some patients do try the afore-mentioned violent means of suicide, with traumatic consequences for their families; and for the survivors if the effort fails. (Ibid.)