Physician-Assisted Death: Arguments For and Against

Introduction

Physician-assisted suicide, or physician-assisted death, refers to "the process that allows terminally ill adults to request from their physician, receive from their pharmacist, and take a lethal dose of medication to end their life" (Death with Dignity, n.d.). Although seemingly similar to euthanasia, physician-assisted death is different in that euthanasia tends to refer to situations where the patient does not act with autonomy. Physician-assisted death remains controversial and is illegal in most states. However, Oregon, Washington, Vermont, California, and Colorado have legalized physician-assisted death, and several other states had pending legislation to do so as of 2018 (Quill & Sussman, 2018).

The medical community itself is divided on the practice. Arguments for physician-assisted death center on the rights of patients to self-determination. Arguments against include the obligation of the physician to heal rather than kill, the potential for abuse in ambiguous situations, and administrative fears of litigation arising from familial disputes. This paper presents multiple sides of the physician-assisted death debate, with an analysis of the reasoning used by both sides.

The Case Against Physician-Assisted Death

Many, but not all, arguments against physician-assisted suicide are based on moral reasoning. Those grounded in morality refer to the presumed sanctity of life, the belief that "purposefully helping a patient die is categorically wrong under any circumstances," and the corollary that the role of the physician or healthcare worker is as healer (Quill & Sussman, 2018). A physician who believes that the ultimate objective of the profession is to preserve life will therefore believe that physician-assisted death is wrong, and would instead ask that the patient use other methods to alleviate suffering. For example, Appelbaum (2016) claims that physicians "traditionally have been dedicated to sustaining life" (p. E2). The doctor presumably knows what is best for the patient, and as long as the patient is under the doctor's care, the patient cannot receive any treatment that would hasten death. Physician-assisted suicide is therefore said to undermine the life-affirming moral tenets of the medical profession.

Another extension of the moral argument is that physician-assisted death would "undermine trust between physician and patient" (Quill & Sussman, 2018). Finally, arguments against physician-assisted suicide warn that the practice could be too easily abused, and that persons who are not capable of making an informed choice about their end of life may be euthanized.

The Case for Physician-Assisted Death

The argument that physician-assisted death is morally permissible is also dependent on situational variables; no claims for this position are universal. In other words, no argument holds that physician-assisted death is always permissible, even for all patients experiencing a terminal illness. The position is contingent on the patient's capacity to make the decision consciously and with the support of a medical care team (Quill, Back & Block, 2016). Moreover, a patient eligible for physician-assisted death is presumably already in palliative care — that is, the patient is terminally ill and death is inevitable (Chochinov, 2016).

Arguments in favor of physician-assisted death focus above all on patient autonomy, but also on the beneficence of alleviating unnecessary suffering. Beneficence is, in fact, one of the pre-eminent moral objectives of the medical profession. Likewise, respect for patient autonomy and the right of the patient to dignified treatment have led to the "death with dignity" movement that precipitated the Oregon Death with Dignity Act (Death with Dignity, n.d.). If autonomy, dignity, and respect are to remain cornerstones of the medical profession, then physician-assisted suicide must remain a legal option for patients who are terminally ill and who have the mental capacity to make such a decision in conjunction with their medical team.

Conclusion

When the topic of physician-assisted death is analyzed from a logical perspective, it becomes clear that one side is more prone to fallacies than the other. The opponents of physician-assisted death rely on several logical fallacies, including the slippery slope, begging the question, and false dilemmas. Physicians who oppose the practice fear that it could be abused, but in places where it is legal, strict systems are in place to prevent such abuse. The ethics of the medical profession are not necessarily to sustain life at all costs, but to alleviate suffering, promote patient dignity, and ensure respect for the person and for individual autonomy.

Physician-assisted suicide is already legal in several states and countries. To enhance the ability of the medical profession to empower patients, physician-assisted suicide should be a legal option across a broader range of jurisdictions. Legalizing the practice would also eliminate some of the fears and concerns healthcare workers currently hold, because it would ensure that physicians and institutions are protected from litigation as long as the patient makes the decision consciously and in conjunction with the healthcare team.

References

American Medical Association (2018). Physician-assisted suicide. https://www.ama-assn.org/delivering-care/physician-assisted-suicide

Appelbaum, P. S. (2016). Physician-assisted death for patients with mental disorders. JAMA Psychiatry, 73(4), 325–326. https://doi.org/10.1001/jamapsychiatry.2015.2890

Chochinov, H. M. (2016). Physician-assisted death in Canada. JAMA, 315(3), 253–254. https://doi.org/10.1001/jama.2015.17435

Death with Dignity (n.d.). Terminology of assisted dying. https://www.deathwithdignity.org/terminology/

Quill, T. E., Back, A. L., & Block, S. D. (2016). Responding to patients requesting physician-assisted death. JAMA, 315(3), 245–246. https://doi.org/10.1001/jama.2015.16210

Quill, T. E., & Sussman, B. (2018). Physician assisted death. The Hastings Center. https://www.thehastingscenter.org/briefingbook/physician-assisted-death/