Is The Concept Of Physician Assisted Suicide Ethical Philosophy Essay

Is it ethical for a physician to participate in physician-assisted suicide when this practice clearly defies what is stated in the Hippocratic Oath? People look at their personal physician as a "healer" or "lifesaver" but what if the physician gave you the option to end your life in the situation of chronic, painful illness or injury? Would this cloud your opinion of them or would you still consider them to be helping us? Is it ethical to train physicians to assist in suicide? These questions are what I want to discuss throughout this paper. I would like to discuss the beliefs and opinions on the topic of physician-assisted suicide through the eyes of medical professionals, the Hippocratic Oath, states & countries that have legalized this practice, various religious beliefs, and different moral theories such as Kant and Utilitarianism. The background of this practice will also be discussed. In the areas of the world where it is legalized, should there be certain criteria in place in order to receive it? What about the perspective of insurance companies on the matter? Is this truly devaluing human life? This is a very controversial topic that I hope to make more understandable.

2. Background

Physician-assisted suicide is a form of euthanasia in which the physician does not

actually give the patient a life-ending drug, but provides the patient with the drug that they can take themselves. It is a form of suicide, with the doctor providing the materials used to carry it out (Mackinnon 141). The Netherlands and Great Britain have legalized physician-assisted-suicide. This practice has not been legalized in every state in North America. Montana and Oregon currently allow the practice with no legal consequences for the physician who participates. Thirty five states currently have laws making it a crime to assist in a suicide. Oregon was the first state to pass the Death With Dignity Act, which allowed physician-assisted suicide to be practiced, but there are certain criteria that must be met for it to be considered "legal." Two doctors must examine the patient and come to the conclusion that he or she is mentally stable and has less than six months to live. This must then be certified by a third doctor. The patient has to submit a written request as well as an oral request. A few days following, the patient is given a barbiturate: secobarbital or pentobarbital, and they must take the medication on their own (Mackinnon 143). When researching among patients the reason for requesting physician-assisted suicide, it was not to relieve pain or financial problems, but to preserve autonomy and personal control. Using Kant's moral theory to view this situation, others would look at the motives behind the action. Why are they doing this? For what reason? Some may even view it as a selfish act. Family and friends would be put through much sadness if a loved one were to have their live ended, but they need to consider the true reasoning behind the request for physician-assisted suicide. They want control of their own lives.

One physician, Dr. Jack Kevorkian, was a well known right-to-die activist, who in

the 1990s, assisted in more than 100 suicides. He believed that people who were suffering from an illness or injury and that wanted to end their life, had the "right to die." He believed these people deserved control of their own bodies and lives. He created a euthanasia device consisting of a metal pole that had containers of medications attached to it. The medications were then connected to a line going into the person's vein. The patient would push a button, starting a flow of simple saline into their bodies. Anesthesia would then run into their bodies, causing them to become unconscious. About a minute following, potassium chloride would then start to flow, causing cardiac arrest, and death. Kevorkian was brought to trial in numerous cases but never convicted of what many considered "homicide." After allowing the euthanasia of one of his patients to be videotaped and aired on television, it was seen that Kevorkian directly administered the deadly medication himself to this certain patient. He was then arrested and found guilty of first-degree homicide, sentenced to spend ten to twenty-five years in prison. When asked if he believes physicians should offer the option to end life to their patients, Dr. Kevorkian solemnly stated "This is a medical service. It always was" (Almeder, Humber, and Kasting 100). Are physicians not trained to improve our health or save our life? This leads to much debate on the subject.

The Hippocratic Oath

The Hippocratic Oath, believed to have been written by Hippocrates in 5th century

B.C., is recited by physicians upon graduation from medical school. This oath states that as a physician these new graduates swear to practice medicine ethically. When applying this to the

subject of physician-assisted suicide, we should focus upon this quote taken from the Oath: "I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion." Physicians are trained in medical school to do what they can in any given situation to save a life. They are taught about various treatments and medications that work to preserve human life, not end it. Physicians do have "obligations" to their patients, which include relieving pain and suffering. When looking at the subject of physician-assisted suicide through the eyes of terminally ill patients who request this service, the negative viewpoints change. Emmanuel Levinas, a Jewish philosopher, closely researched ethics and morals related to the topic of physician-assisted suicide in comparison to the Hippocratic Oath. One immediate objection to assisted suicide can be raised from within a Levinasean perspective. That is, if what constitutes us primarily as human are our "obligations" to one another, and not to our "rights" as individuals, then what of the obligations of a terminally ill person to their community. The obligations (or value) of such a person to their community cannot be measured simply in terms of economics or "active" contributions. Instead, the drawing together of a community or of family members in service to the needs of a terminal patient could serve to deepen and increase their own humanity. Does the terminal patient have the "right" to take this possibility, this response-ability, away from society (Degnin 12)? Are physician's preserving a terminally ill patient's autonomy and human dignity when fulfilling their

request to end their life?

Most of the medical schools in today's society use updated versions of the Hippocratic Oath. Only one school, The State University of New York Upstate Medical School in Syracuse, NY, continues to use the traditional version of the Oath at their graduation ceremonies. Dr. Antonio Grotto, from Weill Medical College of Cornell University, admitted that students did laugh when reciting the original version of the famous Oath. "[Students] would laugh at certain parts," Dr. Gotto said. "Then I'd give them dire threats that I wouldn't graduate them the next day if they laughed during the ceremony (O'Reilly 1)." The majority of students graduating from medical schools today no longer are required to say that they will not recommend the idea of ending a person's life. Does this mean the idea is open for actual consideration and should be legal in situations that meet certain criteria in the entire United States as well as other countries throughout the world? There are still many ethical theories and personal beliefs from physicians

that object to this idea.

4. Ethical Principles

Utilitarianism, the ethical principle of bringing the greatest good to the greatest number of people, is one principle that could be used as a looking glass to view the topic of physician-assisted suicide. Many physicians feel like they were educated to bring relief to those who are suffering from illness or injury. The state of Montana has most recently joined the states that legalize physician-assisted suicide, but they are having trouble finding physicians who will end people's life upon their request. One patient is upset by the fact that her final wish cannot be carried out due to so many objections. "I feel as though my doctors do not feel able to respect my decision to choose aid in dying," said Janet Murdock. "Access to physician aid in dying would

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restore my hope for a peaceful, dignified death in keeping with my values and beliefs." Dr. Kirk Stoner, president of the Montana Medical Association, said assisted suicide goes against the group's code of ethics. "Our reason for being is to care for our patients," he said in the AP report (Baklinksi 1). Is good truly being brought to the greatest number of people by allowing the right to die? It may be, if the thing that is good for that person is to end their suffering. There will always be objections to this theory, such as physicians are doing harm by ending life rather than doing good by saving or prolonging it. Kant's moral theory focuses on the morals behind an action. Why are we wanting do we want(?) to end this life? What is the true motive? This theory also discusses acting "out of duty." or doing what we know is right in our eyes. A doctor finds it right to end suffering or pain, and if this includes ending the person's life for that reason, then they will/should want to do it. The belief that people should have the highest intrinsic or monetary value to us also comes into practice (Mackinnon 76). Are we devaluing human life by allowing physician-assisted suicide? Human life is supposed to be regarded as something that is very precious. By allowing physicians to take life away so easily, this could make others feel that it really does not have high intrinsic value, since it can be ended so quickly and easily, with no questions asked. If you are a physician who wants to end a life because you do not like a person's personality or attitude, then this would be considered homicide, at which you would face criminal charges. On the other hand, if you want to end life to end pain, suffering, or to let someone die with dignity from a terminal illness then this would be legal in the eyes of authority, and no criminal charges would be brought against you. This is how Kant's followers would view the subject. The end result is not important, but the motives used to get to the end are!

Another viewpoint is that of virtue ethics. A person has certain virtues or strengths built into them through the influence of those around them. You become the kind of person you would want to be. Our social interaction with authority figures throughout our upbringing form how we ought to be, or our virtue ethics. Aristotle states that there are two types of virtues: intellectual virtues and moral virtues. Intellectual virtues help us reason and judge well, while moral virtues dispose us to act well (Mackinnon 112). He was most well known for his idea that virtue is the means between the extremes. Our virtues are a middle between deficiency and excess. Physicians or medical students show virtues towards their patients. They want to care for them, give them relief, and/or make them better if they are sick or injured. Are they going against their inner virtues if they participate in physician-assisted suicide? "Physician-assisted suicide isn't about physicians becoming killers. It's about patients whose suffering we can't relieve, and about not turning away from them when they ask for help. Will there be physicians who feel they can't do this? Of course, and they shouldn't be obliged to. But if other physicians consider it merciful to help such patients by merely writing a prescription, it is unreasonable to place them in jeopardy of criminal prosecution, loss of license, or other penalty for doing so (Rogatz)." A physician should be able to bring relief to their patient in any way they see if, and if includes helping someone end their life, then so be it. "The physician's obligations are many but, when cure is impossible and palliation has failed to achieve its objectives, there is always a residual obligation to relieve suffering. Ultimately, if the physician has exhausted all reasonable

palliative measures, it is the patient-and only the patient-who can judge whether death is harmful or a good to be sought. Marcia Angell, former executive editor of the New England Journal of Medicine, has put it this way: 'The highest ethical imperative of doctors should be to provide care in whatever way best serves patients' interests, in accord with each patient's wishes, not with a theoretical commitment to preserve life no matter what the cost in suffering. . . .The greatest harm we can do is to consign a desperate patient to unbearable Suffering - or force the patient to seek out a stranger like Dr. Kevorkian (Rogatz).'" When applying virtue ethics, we should look as what our own personal beliefs (virtues) are and examine them closely.

5. Physicians, Medical Students, Families, Insurance Companies-Their Views

Physicians may never see eye to eye on this highly controversial topic. Some think it is a doctor's right to end suffering while others see the practice as going against what the Hippocratic Oath directly states. An organization called Physicians For Compassionate Care Education Foundation is dedicated to preserving the traditional relation of the physician and patient as one in which the physician's primary task is to heal when possible, comfort always, and never intentionally harm. The view of physicians that take part in this practice is help, not harm. You are helping the person by ending their pain and suffering. However, objectors to the practice feel that ending a life is harmful. You are devaluing the potential of that person. Taking them away physically from their family, creating sadness, and ultimately taking away what they have to have to society before it is even fully experienced. That is a very solid argument. Anyone who

loses a loved one is going to feel grief, it is natural. I feel that everyone on this earth has a special talent to offer society but how can they offer it fully if they are in constant suffering?

The association promotes the health and well being of patients by encouraging physicians to comfort patients and to assist those who are dying by support systems, minimizing pain, and treating depression. The association affirms the health restoring role of the physician and works to educate the profession and the public to the dangers of euthanasia and physician-assisted suicide. As physicians, they come from primary care specialties as well as subspecialties. They work to support each other and to speak out for the inherent value of human life (http://www.pccef.org/whoweare/index.htm). "These physicians focus on the belief that the solution to pain and suffering is not death, but good palliative care. The disciples of the cult of euthanasia and assisted suicide would have society believe that the logical solution for pain and suffering is death. They may even see the infliction of death or the provision of assisted suicide as part of hospice palliative care. They pursue with missionary zeal their gospel of death. Further, they often succeed in getting mainstream media to support their cause. The legalization of euthanasia would remove a patient's autonomy and put it into the hands of professionals with potential control issues; who may be angry, sadistic and abusive. In Oregon, people see the legalization of euthanasia as giving autonomy to the person who requests it. They are able to have complete control of their life, give permission to a physician to end it, and once the procedures to approve the action are in place, it is carried out. As was discussed earlier, there are exact criteria that must be met for physician-assisted suicide to be carried out legally. It is a

slippery slope where we must retain caution. If we allow euthanasia for someone who is suffering, and we continue to do so, then we may end up allowing it in a case where the criteria are not met. Is there a high likelihood that we would slip? This question is the center of many arguments over this subject.

We have all seen colleagues both at the bedside and in health care management who have significant personality flaws, and, lacking compassion for the pain and suffering of others, feel they can take the law into their own hands (Echlin 3). Medical students are now reciting the updated version of the Hippocratic Oath, as we discussed earlier. Does this mean that the subject is becoming okay? Should families be allowed to make this decision for their child who may be on life-support, with little chance of remaining function or should the government take over? It is very expensive to keep someone on life-support when they have a poor prognosis. Is it ethical to end their lives in order to save money?

If physician-assisted suicide is legalized throughout the world or the United States,

insurance companies may begin to support it. Why spend millions of dollars of palliative or

comfort measures, if the person can end their life quickly and easily. Why would we need to spend money to research cures for cancer or other chronic diseases if a person's suffering can be ended this way? Many factors play a part in making a decision of this magnitude.

6. Argument and Conclusion

When addressing my ethical question, "Is it ethical for a physician to participate in physician-assisted suicide when this practice clearly defies what is stated in the Hippocratic Oath?", I have been influenced by various opinions to believe it can be an ethical practice when

closely monitored. Physicians have said that they are trained to care for people, to be a healer. They must examine their own morals when they first take the Hippocratic Oath and begin direct patient care. They do not want to see continual suffering of their patients. To many, it would be more humane to give relief this way than allowing suffering to remain until death. The judgment to allow physician-assisted suicide would give those diagnosed with chronic, debilitating illness hope that their suffering can be relieved when all other methods of relief fail. The patient would also be able to maintain autonomy, having a voice throughout the process.

I believe that the system of meeting certain criteria must remain in place if this practice were legalized throughout the country. If it were not, then the motive behind the means (Kant) could not be justified, leading to easy cover-up of homicide. In other's views, this practice does devalue human life. I feel if someone is in a state of constant struggle and suffering, what true value does their life have. To them, they may feel as if they are a burden to family and friends. When does life become less precious? These subjects are where this practice sits on a fine line.

Life is something that should be nurtured and cared for, event in the event of serious illness or injury. There are holistic ways to provide comfort that can be used on a trial basis, with euthanasia being a last resort. The use of medications, counseling, massage, diet change, and activity level changes. These have all been used to provide relief for those suffering with chronic illnesses and have been shown to be successful. If these practices fail to bring long-term relief and improve quality of life, they should be documented in the criteria when under consideration for physician-assisted suicide.

The major objection would be that a physician is trained to make us feel better, and if that means ending life to end pain, then they have failed as a healer. Family and friends never want to see someone they love die. They also not want to see them suffer. They should come together with the afflicted family member to research other methods of relief, while letting the person maintain control of their own life and the situation surrounding it.

Overall, physicians should be allowed to participate in this practice when the patient is meeting the criteria that were originally discussed. Many will feel that legalizing physician-assisted suicide completely goes against what medical professionals stated in the Hippocratic Oath, do no harm. They are helping to relieve someone's suffering, which is what a physician is trained to do. This practice could be beneficial to many if controlled and used under a watchful eye. For future physicians, they must look inside themselves, and personally examine their own beliefs. They also need to maintain their autonomy. When involved in an ethical dilemma so personal and controversial as this one is, they should have every right to not participate. We control our own actions. In the end it is our choice.

In the case of physician-assisted suicide, there are two major participants: the physician and the patient. They must always be heard! If our court could work to lay proper criteria into a groundwork for this practice, I believe it would be beneficial to those who are plagued with chronic pain. The criteria being met would provide proof to others that the situation was closely monitored and it was the person's decision, with no persuasion from the doctor. It is controversial

ethical decision, but one that I feel physicians as well as their patients should have voice in. We have a right to be heard!