Assisted suicide or euthanasia appears to be, probably, the highest form of acceptance of death. Understanding of its inevitability defines the way one chooses to continue their life while being able to enjoy it. Nevertheless, assisted dying stays quite a questionable matter: Yale University Online portal calls its article on the practice “Human Right or Homicide?” (Chamie, 2018). It is fair to claim that assisted suicide is in multiple ways a debatable issue; however, its public support is increasing, despite the active opposition and rich poll of counterarguments. To prove it, this paper, first, defines the main terms and reviews the statistics of the practice. Secondly, it analyzes the religious stances considering the issue. Finally, it examines the secular arguments in support of and against physician-assisted suicide.
Terminological, Legal, and Statistical Overview
To begin with, it is vital to define the main terms. According to the American Medical Association, “physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act” (AMA, 2016). However, assisted suicide is commonly confused with euthanasia: the former is understood as assistance in an individual’s suicide (NHS, 2020). Meanwhile, the latter is an act of intentionally ending a life to relieve suffering (NHS, 2020). These procedures may be carried out with strong sedatives and muscle relaxants (NHS, 2020). Therefore, these terms appear to be quite close as both these practices occur in case of a patient’s suffering and pain during a terminal illness.
Furthermore, assisted suicide and euthanasia, while being a hugely debatable issue, is legalized in some countries. First, voluntary euthanasia is legal in the Netherlands and Belgium since 2002, in Luxembourg since 2008, and in Canada since 2016. As for the United States, the public support of the practice has been growing since the 1990s: from 47% to 69% (Ezekiel et al., 2016). Assisted suicide is legalized in nine states: primarily, Oregon, and later on, in Washington, Vermont, Maine, New Jersey, Hawaii, California, Colorado, and Washington, D.C. (ProCon, 2019). Moreover, Montana approves of physician-assisted suicide via court ruling (ProCon, 2019). In a word, the developed countries appear to be the pioneers in the legalization of the practice.
Meanwhile, non-Western countries also reflect on the issue of assisted suicide. For instance, in 2015, the High Court of Pretoria granted advocate Robin Stransham-Ford, the South African citizen, an order that would allow a physician to assist him in suicide. However, in 2016, this ruling was overturned by the Supreme Court of Appeal (South African Legal Information Issue, 2016). Due to the instability of the healthcare system in South Africa, the legalization of assisted suicide is considered premature. To mention other examples, none of Eastern Asian or Arabic countries criminalize assisted dying despite well-developed healthcare systems. The reason lies in the mental and religious background – this aspect will be analyzed later (Helmich et al., 2017). Therefore, non-Western communities are believed not to be ready either due to the weakness of healthcare systems or because of the mental unreadiness of the community.
Speaking of the specialists’ approach towards assisted suicide, it significantly varies in the United States. A recent nationwide study carried out by a group of Yale scholars claims that 60% of physicians throughout the country support the idea of the national legalization of assisted suicide (Hetzler et al., 2019). Moreover, 13% of that 60% say that they would perform this procedure in case it was illegal (Hetzler et al., 2019). However, the study demonstrates that there are a lot of nuances. The statistics show that the questions of whether the reason for euthanasia should be exclusively pain or whether a non-psychiatrist can adequately assess the necessity of the procedure are still urgent (Hetzler et al., 2019). For instance, 40% believe that “physicians can predict with certainty whether a patient seeking PAS has 6 months or less to live” (Hetzler et al., 2019, p. 580). Hence, in the U.S., there is yet no consensual vision of assisted suicide shared among American physicians: slightly more than a half of them support the concept.
As for the religious vision of assisted suicide, there seems to be a poles apart situation for different confessions. On the one hand, most confessions deny the possibility of assisted dying. First, The Christian Institute (2020) calls this practice a “killing of the innocent” and gives several Biblical arguments. For example, Christians appeal to the sanctity of life as such. Moreover, it is claimed that human “significance, and so the claim to protection, derives not from our ‘quality of life’ or gifts and abilities, but our status as being made in God’s image” (The Christian Institute, 2020). Secondly, Islam believes that life is given to people by Allah, and he is the one to determine how long each individual must live. As the Quran state, “take not life which Allah made sacred otherwise than in the course of justice” (Death with Dignity, 2020). In a word, the two leading world confessions do not support the idea of assisted suicide, as it is seen as a contradiction to the will of God.
On the other hand, one may speak of some religions approving of suicide in various contexts. For instance, the liberal confession of Unitarian Universalism General Resolution of 1988 postulates that every individual has a right to self-determination in dying (Unitarian Universalist Association, 2020). It also advocates “the release from civil or criminal penalties of those who, under proper safeguards, act to honor the right of terminally ill patients to select the time of their deaths” (Unitarian Universalist Association, 2020). Moreover, the Methodist church accepts “individual freedom of conscience to determine the timing and means of death” (Death with Dignity, 2020). Hence, it is fair to conclude that the number of churches supporting the idea of assisted suicide is quite limited.
What is more, there is a reasonable number of religions that represent an ambivalent point of view on assisted suicide. To begin with, the Hindu position on this relatively new phenomenon is quite variable. Most Hindus believe that the separation of body and soul at an unnatural time is unacceptable; hence, a physician cannot agree on euthanasia (Gielen, 2020). However, there is also an interpretation that assisting in ending a miserable life contributes to one’s karma as a doctor fulfills their moral obligations. As Gielen claims (2020, p. 75), “Hindu bioethics can integrate various perspectives and avoids the pitfalls of both ethical absolutism and relativism.” What is more, in Buddhism, euthanasia is called “mercy killing” (Kumar, 2018). This confession differentiates three types of assisted suicide: voluntary, non-voluntary, and involuntary – and rejects the first two (Kumar, 2018). Moreover, there is no Buddhist who does not entirely agree with passive euthanasia. While Vinaya Pitaka is opposed to this activity, life is not seen in Buddhism as an absolute value (Kumar, 2018). In a word, global religions do not necessarily have a consensus on the issue of euthanasia.
Secular Ethical Arguments
On the one hand, there are two main arguments in favor of assisted suicide and euthanasia. First, there is the need for respect for patient autonomy that is highly valued in mainstream bioethics (Dugdale et al., 2019). Secondly, the believers in assisted suicide appeal to Hippocrate’s admonition to “administer a poison to anybody when asked to do so” (Dugdale et al., 2019, p. 749). Hence, physicians must seek to relieve patients’ suffering: “relief of suffering through lethal ingestion is humane and compassionate” (Dugdale et al., 2019, p. 750). Finally, there is an argument for safe medical practice: a specialist’s aid can ensure death that unassisted suicide cannot. In other words, the arguments for such practice have a lot to do with liberal values of providing each individual with the opportunity to make decisions in their own lives.
On the other hand, conventional medical ethics do not support the concept of assisted suicide. The most recent version of the American Medical Association’s Code of Ethics (2016) prohibits physician-assisted suicide as it is “fundamentally incompatible with the physician’s role as healer.” Suicide is believed to devalue human life, and the relief of pain can be realized via means other than the end of life (Silmasy et al., 2016). Moreover, the defenders of this position believe that voluntary euthanasia in the case of demented or disabled children is impossible, which makes the issue quite questionable in such circumstances (Silmasy et al., 2016). Opponents argue that the opposite camp’s vision of human dignity is inadequate: the intention of turning “somebody” into “nobody” is believed to “violate the fundamental basis of all of interpersonal ethics” (Silmasy et al., 2016, p. 250). Many believe that physicians having such an opportunity would choose the so-called “slippery slope” (Dugdale et al., 2019). Up to half of the patients with cancer suffer from depression, and, hence, their decision on assisted suicide is affected. Therefore, there is a lot of logical arguments that counter assisted dying.
To conclude, assisted suicide is an extremely debatable issue even in the countries where this practice is at least partially legalized. It is vital to keep in mind the difference between assisted suicide and euthanasia though it is usually unified in the legislature. Assisted suicide is legalized in a very small number of developed countries. As for the developing world, it is either the weakness of the healthcare system or mindset limitations that do not allow the communities of those countries to support the concept. In the United States, physicians’ vision of the latter also varies, but the dominant position is that assisted suicide is the procedure the American society needs. There is a significant poll of arguments for both sides from various religions as well as the secular, logical ones. Both parties value human life and dignity, while the perception of these concepts is different. In the future, it would be fair to deepen the exploration of specific cultural and religious arguments in favor of or against assisted dying to expand one’s analysis of this phenomenon.
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