Physician-Assisted Suicide and the Right to Die: An Analysis

Introduction: The Right-to-Die Debate

Suicide is a deeply emotionally and morally charged subject for many people. The discord and divergence of opinion stem from the many different perspectives and motivations people bring to the subject. Some of these viewpoints are rooted in moral beliefs, religion, or a combination of the two. Others are grounded in humanity, empathy, and the belief that suicide can be a solution to ending misery and chronic pain. Some hold that taking one's own life is selfish, immoral, and damaging to family and friends. Others maintain that such a decision should reside with the individual alone. While there is no single answer that will satisfy all pundits, scholars, and ethicists, the right to die should be permitted under the care of a physician, provided that the necessary conditions are met.

Moral and Religious Perspectives on Suicide

Perhaps one of the more strident views about suicide emanates from the Christian church, with Catholic denominations often being among the most outspoken on the subject. Catholics frequently hold that suicide is a mortal sin resulting in damnation. Not all Christian sects share that view, however. Suicide is generally considered a sin within the Christian faith because it is regarded as a form of murder, and ending one's own life is seen as an affront to God, who—per Christian belief and the Bible—created humanity in his own image. This framework of belief is rooted in the Christian definition and construct of morality. It is the same moral code that discourages premarital sex, having children out of wedlock, divorce, and other perceived transgressions that are immoral or unacceptable under Christian doctrine but are not illegal under the law in American or other Western societies.

That said, this has not always been the case; laws against such acts did exist historically but have been relaxed or abandoned over the years. Suicide has even been criminalized in many parts of Western society, including the United States. However, many of those laws have since been struck down or are no longer enforced.

The view of suicide as a moral failing and selfish act is not limited to Christian or other religious ideology. Some people take rigid and hardline stances on the subject, frequently characterizing suicide as "selfish" and harmful to those left behind. Indeed, a person contemplating or actually committing suicide can leave a profound void and cause major distress among coworkers, friends, and family members. At the same time, many people considering suicide do so for reasons that override those concerns. For example, the terminally ill, or those who feel they have no escape from the misery and degradation they endure, may view suicide as the only sure means of escaping their pain. This theme applies not only to the terminally ill but also to people who are severely bullied or experiencing extreme personal distress. Suicide is obviously not the only potential solution in such situations, but it can seem—or genuinely be—the most viable option to those who attempt or complete it.

Individual Autonomy and Medical Ethics

A major perspective in this debate holds that everyone's life is their own to live or to end, and that individuals should be permitted to make that choice if they see fit. While this view has adherents in the United States, it is not supported under current federal law. Europe and other more progressive parts of the world present a different picture. Even so, no country is monolithically for or against the right to die; majorities one way or another are the norm, and some nations remain fairly evenly divided in public opinion.

One particularly complex dimension of this debate involves the role of doctors, nurses, and other medical professionals as it relates to suicide. Many figures in the bioethics and medical communities cite the credo "do no harm," while others take a more moderate view, asserting that while enabling or assisting a person to commit suicide is ethically problematic, the act itself ultimately rests with the person choosing it. Regardless, medical professionals imposing their moral or religious views on patients and their families is a very slippery slope and should be avoided. This does not mean that doctors and nurses are obligated to assist in the right to die for those who request it, but imposing personal religious or moral beliefs on patients and their families is equally inadvisable (Beauchamp & Childress, 2013). Even private corporations that have attempted to impose their religious views on employees or customers have faced significant backlash, and the stakes are even higher in educational and medical institutions.

Scholarly literature is rich with material on suicide and its related subjects—including assisted suicide, euthanasia, who should have a right to die, who should not, and proposed or actual changes to the law in the United States and elsewhere. The medical and suicide intersection remains one of the most contentious arenas in this debate, given the seemingly contradictory positions held by those who desire the right to die and medical professionals whose primary goal is to preserve life and minimize suffering. Advance directives and living wills allow people to state in advance that they do not wish to be resuscitated. There are, however, other less overt forms of choosing death within a medical context. Some cancer patients who feel the fight is no longer worthwhile will stop treatment and enter hospice care. Similarly, some patients who require hospitalization may attempt to leave or refuse treatment and medications.

Medical technology has advanced to the point where a body can be kept technically alive by machines even when brain function has ceased. While some hold that exhausting all possible medical treatment is a moral and professional imperative, many others find the idea of being kept alive solely by a machine—with an accompanying loss of privacy and dignity—to be unacceptable. If brain function is entirely gone, a decision to end care may generally be made, but if there is any chance of recovery and the patient is stable, withdrawing care would typically be viewed as illegal and unethical. Even when terminating future care is a legal option, making that decision on behalf of an incapacitated patient without an advance directive can be extraordinarily difficult, particularly when family members disagree. A prominent real-world example of this conflict was the Terri Schiavo case, in which the patient was technically conscious but in a persistent vegetative state with no chance of recovering even basic motor functions or speech. An earlier landmark case was that of Karen Ann Quinlan in the 1970s and 1980s. That situation differed slightly but carried similar tensions: the family wished to discontinue care, but the doctors refused out of concern for legal and criminal liability (Ball, 2006).

References

Ball, S. (2006). Nurse-patient advocacy and the right to die. Journal of Psychosocial Nursing & Mental Health Services, 44(12), 36.

Beauchamp, T. L., & Childress, J. R. (2013). Principles of biomedical ethics (7th ed.). Oxford University Press.

Behuniak, S. M. (2011). Death with "dignity": The wedge that divides the disability rights movement from the right to die movement. Politics & The Life Sciences, 30(1), 17–32. doi:10.2990/30•1•17

Chetwynd, S. B. (2004). Right to life, right to die and assisted suicide. Journal of Applied Philosophy, 21(2), 173–182. doi:10.1111/j.0264-3758.2004.00271.x

Hendry, M., Pasterfield, D., Lewis, R., Carter, B., Hodgson, D., & Wilkinson, C. (2013). Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying. Palliative Medicine, 27(1), 13–26. doi:10.1177/0269216312463623

Westefeld, J., Doobay, A., Hill, J., Humphreys, C., Sandil, R., & Tallman, B. (2009). The Oregon Death with Dignity Act: The right to live or the right to die? Journal of Loss & Trauma, 14(3), 161–169.