Since many
of us are going to be entering the medical field sometime in the future, we
should know of the situations that may arise or may test our moral compass. Debates
around physician assisted suicide (PAS) and euthanasia is focused on the
physician and the autonomy of the patient at the time of suffering. If anyone
has watched the movie “Me Before You,” the main male character is a quadriplegic
who in the end dies through PAS because he believes that being paralyzed is no
way to live and those who are living with him or is in association with him are
the ones that are suffering because he is a hindrance to their everyday life. This article dives into the moral principles
that is associated with PAS and euthanasia. The first value is autonomy the
freedom from external influence, the ability to self-determine, this value has
been respected when a patient refuses medical treatment, because in the end it
is the patient’s choice whether to continue with treatment or not. Some
advocates for PAS and euthanasia argues that this value of autonomy should be
spread to some patient’s request for relief in suffering by helping them die
quicker. Lack of consensus resulted in the following position in all but 5
jurisdiction who has allowed for physician assisted suicide, it states that: “If
you were on a life-sustaining treatment, you have a right to withdraw from that
treatment and be able to die, but if you are not on a life sustaining treatment
then you are only allowed to refuse nutrition, hydration and give you palliative
care until you die no matter how undignified, and painful” (Shibata, 2017). This way of looking at it denies a patient’s
their autonomy because they are being forced into a death that is undignified
and painful, something that may not have happened if PAS was utilized. But autonomy
does not give an individua the right to force others, in this case physicians,
to engage in acts that they think are immoral. If a physician thinks and feels
that PAS and euthanasia are immoral, he or she does not have to participate in
it, but it hinders the act of relieving the patient from suffering who is
requesting assistance in dying.
The next value
is non-malfeasance, which falls into the physician’s attempt to avoid acts or
treatments that would bring harm to the patient. In PAS and euthanasia both of
those can be argued as inflicting harm in the case of death, causing those
procedures to be unethical under the value of non-malfeasance. But in the case
of supreme suffering, where pain cannot be relieved, PAS and euthanasia can be
seen as a compassionate way to help a person die when they freely chose to do
so. Beneficence is another value, it is the ethical principle of doing good to
others, almost all physicians have an imperative ethical principle of causing
no harm and doing the most good. Pro-PAS argues that ending the suffering of an
individual can be viewed as being beneficent and merciful, if no other means
can save the person assisted dying can be seen as compassionate. In contrast,
those against PAS sees it as abandonment and not beneficent because it is causing
another person’s death regardless if they wanted to die or not, they argued
that life is sacred, and a direct human act has no right to end a life. Individuals
who are in favor of PAS and euthanasia argue that these acts are merciful and
humane because it respects and individual’s request to end his or her prolonged
suffering. Those who are against PAS and euthanasia argue that ending a life is
morally and innately unacceptable, they believe that it is never okay to end a
life, because human life is sacred and should be lived until the last dying
breath.
The
questions I want to ask is: is it ethical for physicians to help a patient end
their life, when their will to live is no longer there? Is it ethical to take
the life of a patient away when the purpose of medicine is to help treat and
prolong life?
Article source: Shibata, B. (2017). An Ethical Analysis of
Euthanasia and Physician-Assisted Suicide: Rejecting Euthanasia and Accepting
Physician Assisted Suicide with Palliative Care. Journal of Legal Medicine, 37(1/2),
155–166. https://doi-org.dml.regis.edu/10.1080/01947648.2017.1303354
In my opinion, autonomy and beneficence are the most important factors here. I have no conflict that patients who are competent and deemed to be in good mental health should have the right to request physician assisted suicide to avoid prolonged suffering. The question then becomes, what do we consider prolonged suffering?
ReplyDeleteIn Belgium individuals suffering from mental illness have the right to request physician assisted suicide. While this may seem like a breach of beneficence, I was surprised to hear that only 4% of physician assisted suicide in Belgium in 2012 was due to neuropsychological disorders. While this statistic is less than I would have assumed, it does highlight the concern that patients may be acting outside of their best interest, or without seeking proper help. Additionally, as you mentioned, some consider long-term disability prolonged suffering, while others learn to live happy and healthy lives. There are many external factors that can influence someone’s opinion of their situation including financial stability, and support systems. At what point do we consider those as manageable, and when do we not?
Also, if a patient is mentally incompetent should the patient’s power of attorney (POA) have the right to request physician assisted suicide? In the past, refusal of treatment has been granted for POA’s. In these cases, legalization of physician assisted suicide could put vulnerable people at risk. At the same time, disallowing physician assisted suicide to individuals who are incompetent but have a trusted power of attorney discriminates against their rights as citizens.
Moving forward, I see the value in physician assisted suicide, however, there are many cases where a law like this could be potentially very harmful. I think it’s important to consider the impact this would have on the entire patient population and continue to have open conversations about what a law like this would entail.
https://www.agingcare.com/articles/things-you-can-and-cant-do-with-poa-152673.htm
https://theincidentaleconomist.com/wordpress/assisted-suicide-mental-illness-and-the-competence-to-consent/
https://www.cbc.ca/firsthand/m_features/misconceptions-about-medical-aid-in-dying-in-canada