Assisted Suicide Ethics: A Three-Step Model Analysis

Introduction

Assisted suicide, or euthanasia, is a controversial topic because it contradicts one of the most fundamental values of American and broader Judeo-Christian teaching: namely, that human life is sacred. Similarly, in medicine, euthanasia violates the Hippocratic Oath, according to which the first ethical obligation of doctors is to do no harm. However, in modern society, the traditional prohibition against assisting others in ending their lives has increasingly been challenged — most notably in connection with the highly publicized efforts of the late physician Jack Kevorkian, who willingly served a prison sentence for violating the criminal statutes prohibiting assisted suicide in Michigan. In addition to legal issues, the concept of euthanasia also raises important questions about balancing various ethical concerns, and it challenges the deeply held beliefs and personal reactions of many people. The Three-Step Ethical Model provides an analytical approach that addresses all of these issues.

Legal Issues

In the United States, euthanasia is illegal in all 50 states and subjects physicians who administer medication to terminate the life of a patient to criminal prosecution and incarceration (Beauchamp & Childress, 2009). Several states have exempted physician-assisted dying, which involves a physician prescribing medication and advising dying patients in the process of ending their own lives, but still strictly prohibits physicians from administering the medication or otherwise participating in the process directly (Beauchamp & Childress, 2009). The principal legal argument against the continued illegal status of physician-assisted suicide in the U.S. stems from the fact that the original basis for the notion of the sanctity of human life in relation to suicide is religious philosophy and belief. Meanwhile, the concept of separation of church and state is guaranteed by at least one of the two applicable clauses of the First Amendment to the U.S. Constitution (Dershowitz, 2002). More specifically, the establishment clause of the First Amendment prohibits the government from establishing any religion, and the free exercise clause prohibits the government from interfering with the religious practices of individuals. Therefore, the argument against government prohibition of euthanasia when it is desired by a patient is that such a prohibition constitutes an establishment of religion on the part of the government (Dershowitz, 2002).

Naturally, there is a legitimate legal justification for government regulation of assisted suicide to prevent abuse of patients, as well as to ensure that patients seeking to end their lives are mentally competent and capable of making those types of decisions as a matter of law (George, Finlay & Jeffrey, 2005). On the other hand, it is difficult to find an objective legal justification for prohibiting a mentally competent patient from choosing to terminate his or her life with the assistance of a physician, especially when the reason is that the patient is either already dying or suffering from intractable pain that cannot be treated effectively.

Balance of Ethical Concerns

The principal ethical concerns raised by physician-assisted suicide at the request of patients are patient rights and patient autonomy (Levine, 2008). In principle, the ethical argument supporting the right of adult patients who are mentally competent to direct their own medical care is simply that there is no objective basis for the government or anyone else to second-guess or thwart their autonomous decisions. The Hippocratic Oath does prohibit physicians from harming their patients, but it was conceived two thousand years ago, long before Hippocrates could have imagined the complexities of modern medicine. Today, it is possible to definitively identify terminal conditions that physicians from the era of Hippocrates could not have recognized. That modern capability means that contemporary biomedical ethicists must interpret concepts such as "harm" far more broadly than Hippocrates could have.

More specifically, if a patient is suffering from great pain that cannot be alleviated by medical treatment — particularly where that pain is caused by an incurable terminal illness — there is a very strong argument that preventing a patient from ending his or her life to escape suffering amounts to a greater "harm" than helping that patient end his or her suffering. The same argument applies where a patient seeks only to avoid dying in a much more painful way when the medical prognosis predicts that outcome with great certainty (Levine, 2008). On balance, the objective comparison of these competing concerns suggests that patients should not be prohibited by law from ending their lives with the assistance of their physicians, but that government should regulate the process to guard against conceivable abuses and to ensure that patients seeking to end their lives are mentally competent to make that momentous decision.

Conclusion

The notion of euthanasia in the form of physician-assisted suicide continues to be controversial. It raises legal issues, as well as ethical questions about the autonomous rights of patients to determine what medical care they desire. It also challenges the fundamental concept of the Hippocratic Oath. However, on balance, the valid concerns justifying its illegal status are outweighed by the autonomous rights of patients to direct their own care. Ultimately, careful regulation by government is appropriate, but an outright prohibition on the decision to end one's life — especially to escape suffering — is not.