Reasons for Opposing or Supporting Physician Assisted Suicide

There are arguments for and against physician assisted suicide

Writing do not resuscitate form. Credit: Peter Dazeley / Getty Images

The debate over the morality and legality of physician-assisted suicide (PAS) isn’t new. It’s been a topic of heated discussions for hundreds of years. It doesn’t show signs of cooling down anytime soon, either.

Those opposed to PAS argue four main points against the acceptance and legalization of it. And to every argument, there is a counter argument.

Improved Access to Hospice and Palliative Care

Because a model for quality end-of-life care is available through hospice and palliative care programs, there should be no reason anyone would need to seek PAS.

The focus should not be on legalizing PAS, but improving access to hospice. There are over 4,500 hospice agencies in the United States, but because of funding restrictions and the rigidity of the Medicare Hospice Benefit requiring patients to have a life expectancy of six months or less, millions of people in the United States don’t have access to them.

Counter argument: Even with improved access to quality end-of-life care, there will still be rare cases of persistent and untreatable suffering. The most recent statistics we have from Oregon (2007), where PAS is legal, show that 88% of patients who opted for PAS were on hospice. That proves hospice and palliative care aren’t always sufficient to treat severe suffering.

Limits on Patient Autonomy

It was determined in the opinion of Bouvia v. Superior Court (CA) that “the right to die is an integral part of our right to control our own destinies so long as the rights of others are not affected.” This was a matter of patient autonomy.

PAS is not a completely autonomous act; it requires the assistance of another person.

PAS threatens our society by cheapening the value of human life. Society has a responsibility to preserve the sanctity of life, so an individual’s choice of PAS should be overruled for the overall good.

Counter argument: Physicians who are approached with the request to assist in ending a patient's life have the right to decline on the basis of conscientious objection.

Their rights, therefore, are not affected according to the Bouvia decision.

The “Slippery Slope” to Social Depravity

Those in opposition to PAS are concerned that if assisted suicide is allowed, euthanasia won't be far behind. It is a slippery slope towards the "mercy killing," without consent, of individuals with mental illness, physical handicap, elderly, demented, homeless, and anyone else society deems “useless.”

Counter argument: Our highly cultured societies are unlikely to allow this “slippery slope” to happen. Cited examples include Adolf Hitler, Joseph Goebbels, and Joseph Mengele, who were defeated in their mission to “cleanse” Germany’s gene pool.

Violation of the Hippocratic Oath

The Hippocratic Oath states that a physician’s obligation is primum non nocere, “first, do no harm.” PAS directly contradicts that oath, as deliberately killing a patient is regarded as harm.

Counter argument: The Hippocratic Oath should be interpreted and modified as necessary according to an individual patient’s need.

Alternatives to PAS

Those in opposition of PAS argue that there are legal and morally ethical alternatives to assisted death. Patients may refuse further medical treatments that may prolong their death, including medications.

Counter argument: Some patients do not rely on life-sustaining measures to live and still suffer. Withholding life-sustaining treatments would only prolong suffering for these patients.

Another argument is that patients can, and often do, decide to stop eating and drinking to hasten their death. Death will usually occur within one to three weeks, and it is usually reported as a "good death."

Counter argument: One to three weeks of intense suffering is too much for anyone to have to tolerate.

Summary

The final resolution of this debate has yet to be seen. Because of the undercurrent of public support on the subject of physician-assisted suicide, we may see it become more of a reality in our society. It is already legal in the United States in Oregon and bills to legalize it have been presented multiple times in many other states. PAS is also legal in several other countries, such as the Netherlands.

Sources:

Ferrell, BR and Coyle, N, Textbook of Palliative Nursing, second edition. 2006 Oxford University Press.

Kinzbrunner, BM, Weinreb, NJ, Policzer, JS, 20 Common Problems: End-of-Life Care. 2002 McGraw-Hill Publishing.

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