Ethical Issues in Physician-Assisted Suicide

Introduction: The Hippocratic Oath and Modern Medicine

Since the inception of medicine, the most fundamental concept guiding physicians in the ethical practice of their profession has been the traditional principle of "do no harm," as 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 Hippocrates 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, 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 die at the time and in the manner of one's choosing was Dr. Jack Kevorkian, who had only recently been released after his incarceration for violating Michigan state laws prohibiting physicians from assisting in euthanasia. Dr. Kevorkian was unable to continue as a public advocate of euthanasia rights as a condition of his parole (Martindale, 2007).

Governmental Paternalism, Suicide, and Euthanasia

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, which have evolved as much since the time of Hippocrates as the "hard science" of medicine itself.

Suicide is prohibited by all of the predominant Western religions, as well as under the secular law of most modern human societies — probably as a direct consequence. In the United States, 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 a symptom of a recognizable illness, particularly if that illness 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. This stands in contrast to situations where an individual of sound mind would not be appreciative of such intervention. In that regard, it is difficult to articulate any logically coherent rationale for intruding in what should be purely private matters.

Conclusion

In principle, logically sound criteria for respecting the patient's right of privacy and personal autonomy should include untreatable persistent physical pain, impending loss of cognitive or physical function, or a medical prognosis of a painful "natural" death. In many respects, secular laws that prohibit physician-assisted suicide may actually violate the most fundamental function of medicine in the modern era: namely, to treat pain and physical discomfort. In fact, it may be the very narrow definition of the concept of harm that accounts for the apparent inconsistency between the permissibility of physician-assisted suicide in the modern medical era and the ancient oath to "do no harm."