The debate over Physician-Assisted Suicide (PAS) is momentous, complex and contentious. Since ancient times, there have been arguments about the permissibility of suicide, assisted suicide and physician-assisted suicide without agreement (Kopelman & de Ville 2002, pp 1). The discussions have covered the properly legal, ethical or professional response of the people who feel that they are prepared to assist the terminally ill with suicide or euthanasia.
During ancient times, there were Hippocratic writings that instructed the physicians on how they can help the patients who wanted to relieve their suffering through euthanasia or suicide. On the contrary, there is a Hippocratic Oath that again forbids the physicians from doing the same. For instance, Aristotle and Plato objected to suicide or killing even for merciful reasons, while philosophers like Stoics defended such policies in some incidence (Cohen-Almagor 2001 pp 19).
These divisions are still visible in contemporary societies, where many states are sharply divided on whether to allow physician-assisted suicide in society or not. There are very few jurisdictions that allow for the carrying out assisted suicide, even in cases where there are no sanctions for attempting to commit suicide. Furthermore, clinicians have almost universally been prohibited from participating in euthanasia or assisting suicide. However, the Netherlands and the Oregon States have passed laws that allow for PAS under some conditions (Alpers 1995 pp 485).
Different professionals have got different ethics that have to be observed. On various occasions, this ethics might not be followed or observed by the practitioners due to various reasons. In the medical sector, one of the perennial ethical problems experienced is the PAS issue. The national and international medical societies have been drafting professional codes of ethics to curb this vice in the medical fields. These codes have always been based on the Greek oath for the physicians that declare, “I will neither give a deadly drug to anybody if asked for it nor will I make a suggestion to this effect” (Emanuel 1994 pp 1895). This was as a means of making sure that the physicians do not cause any harm or do anything that will result in harming their patients and ultimately leading to the death of the patient.
In ancient Greek, the physicians were poorly equipped to relieve the pain of patients who turned to them for help. This made the patients consider committing suicide as a means of escaping the painful illness and suffering that accompanied the dying. The most prominent means of committing suicide was the use of poison, and the poison was found easily with the help of the physicians. In essence, then oath was used by physicians who wanted to keep public trust and respect and well distancing themselves from those who contributed to the death of seriously ill patients (Manning 1998 pp 48).
Physician-Assisted suicide for a long time has been a debate of the ethical and legal issue. Many stakeholders have been putting in their voices concerning the issue. The media has been following up on the PAS cases very keenly, thus making the subject to be of substantial interest to the public.
There are different arguments in various states concerning the PAS. Some arguments have been for, while others against the PAS. In the cases of Washington v. Glucksberg and Vacco v. Quill, in 1997, the supreme court of the United States passed a decision that claimed the constitutional protection for PAS (Battin, Rhodes & Silvers, 1998, pp1)
The court’s ruling brought about a continuous differing dispute among the different states due to the differing values, historical circumstances, religious commitments and the political and economic environments among the people. In the ruling, the court was limited to the question of determining whether PAS was unconstitutional. Because of this, the court realized the consequences that the ruling might bring about, hence allowed the debate on the issue to continue in a democratic way. The PAS debate has so far gone beyond the legal debate into the political, social, moral, medical and religious debate (Battin, Rhodes & Silvers 1998, pp 2).
1997, rulings have, however, been confused and misunderstood. In the court’s ruling, it was that physician-assisted suicides were not unconstitutional. This did not in any way make physician-assisted suicide to be a criminal act throughout the land. It, however, meant that criminalizing the PAS act was a matter of which each state to decide (Lagay 2003 Para 1). Oregon State has adopted the act that legalizes PAS. Forty-six states do not, however, agree with Oregon’s legalizing of the PAS act, while North Carolina, Utah and Wyoming are the states that have not criminalized nor legalized the PAS act (Lagay 2003 Para 8).
Those who are opposed to the act argue that legalizing such an act would put pressure on those who feel that their illness is a burden to their relatives. Secondly, such legality would go against the highly held medical ethics that has been there for a long period of time. The role of a physician is to act as a healer, and therefore being involved in the assisted suicide would be incompatible with the role. This would thus lead to there being a problem to control such cases, thus bring a problem to control such cases, posing serious risks in the society.
With some states having legalized the PAS act while others have not, it lays down conflicting issues on the legal and ethical matters, and what the state allows her resident to do and what members of the profession (in this case medicine) feel that they ought to do. Therefore, even though the state can legalize this act, it might not be easy for it to force the medical professions to carry out this duty, especially when they feel that the acts are out of their professional ethics (Boyd N.d, para 10).
In many cases, terminally ill patients would like to commit suicide in a non-violent form which gives respect to themselves and others. It is, however, not just an easy task to administer the assisted suicide, and if in the event the activity fails, then the practice can cause a big trauma than death itself to both the patient and the caregiver. The patients might still request the caregiver to complete the failed attempts. These are some of the circumstances that have convinced some physicians to feel that by helping the patients who are really determined to end their lives might prevent greater harm than what it causes(McHugh 2005 para 6). It is also due to the belief that helping a patient to end his/her life due to the pain or anguish he/she might not recover from does not actually violate the spirit or goals of medical ethics.
The arguments about the legalizing of physician-assisted suicide have been with time taking different angles. The initial argument has been whether to permit physician-assisted suicide at all. However, in recent cases, there have cases of how to go about physician-assisted suicide and not conceptualizing on whether to permit it (Quill 1991, 693). This is because the issue is seen to be taking an angle that was taken by the arguments concerning abortion, which has seen the practice being undertaken underground. With the legalization, it is argued it would enable the states to be in a position to control the condition in which the practice is carried and thus suppress the situation in which the physician and the patients make the private arrangements, thus breaking the law.
The patients’ interested groups have also contributed to the debate of legalizing the PAS act and its potential consequences to the patients. These groups mostly have been focusing on those groups they feel are more vulnerable due to their specific features of physical or social characteristics. For instance, those people with disabilities, the racial minority groups, the elderly women and patients who are not competent.
Those arguing in defence of such groups are worried about abuse that can be directed towards them since these vulnerable groups might receive assistance at the time when they least or do not require it at all. The vulnerable interested group’s concern is rooted in the economics of medicine in the US, whereby the medical policies have been unable to provide medical cover to all citizens. This has created a cutthroat competition among the institutions offering medical services in the United States (Kopelman & de Ville 2002 pp 54).
The degree of physician-assisted suicide and euthanasia has led to many researchers being conducted so as to receive a public opinion on the issue. In a research carried out in 1989, twenty per cent of the interviewed physicians felt that patients who had the incurable terminal illness should have an option of euthanasia. Forty per cent said that they could personally carry out the exercise, while thirty-five per cent were opposed to the exercise (Newfield N.d. para 6).
In another public poll contacted in 1994, sixty-three per cent of lay respondents were pro the legalizing of physician-assisted suicide & euthanasia. Eighty-one per cent supported the passage of laws that would allow physicians to carry out patients advance directives that includes euthanasia. Those who supported the withdrawal of life support from hopelessly ill patients were seventy-six per cent. Fifty-six per cent also felt that they could consider the option of ending their lives if they had a terminal illness (New field N.d Para 7). Although in this research, there were ranging responses. It is evident that the majority of the people were pro-euthanasia in some form (Angell 1996 pp1677).
In many aspects, religion plays a big role. Many people who are considered to be more religious have always shown reluctance to accept the legalization of assisted suicides, whether as physicians who provide the exercise or as the requestors of the exercise to be administered to them. This is, however, much different from those people who do not take religion to be so important.
Even though the most argumentative idea about physician-assisted suicide has been about moral issues, there are questions that have also risen from it. For instance, does mortal life belong to an individual, and is one sovereign over their bodies, or they belong to the society or family in which they are embedded. The other question that arises due to moral consideration is that will the legalization of the assisted suicide give the terminally ill a sense of control over their circumstances, or will it weaken respect for life? (http://www.123HelpMe.com/view.asp?id=16816).
In this respect, it is right to say that since individuals have sovereignty over their lives, then it is prudent to argue that a terminally ill person should be able to choose death over life. This is due to the fact that the terminally ill are the people feeling the pain and suffering as a result of the disease and not anybody else, i.e. the relatives, friends or even the state.
On the other hand, terminally ill patients can have a sense of control over their lives when they feel that it is enough for them to end their lives with the assistance of physicians. The sick are capable of deciding the course of life rather than having to wait for the disease to dictate the course of life. The diseases at some point, especially towards the last stages, do overtake the life and dignity of the patient. Hence with the aid of the legally aided suicide, the patients can be able to end their lines in a more dignified manner (Cohen-Almagor 2001 pp 78).
The lack of a legal framework in the United States that governs euthanasia clinics has left many patients with incurable diseases (e.g. Cancer, Aids & multiple sclerosis) to be in the hands of the hospital indefinitely. Passive euthanasia is legally accepted in the United States. However, this step might increase suffering and more pain. In this respect, many have agreed that active euthanasia with mentally competent patients’ full consent should be made legal (Behuniak & Svenson 2004 pp 112).
Those opposed to euthanasia argue that doctors should follow the Hippocratic Oath. In this argument, it is felt that if any part of the oath is disregarded, then the doctors won’t be in any way compelled to maintain any of the oath’s parts. However, the oath has undergone so many alterations as time goes by, with doctors sometimes seeing it necessary to take life.
Many people who are terminally ill have opted for different ways of ending their lives due to the fact that there lacks a legal framework for them to end their lives. These options include strangling, drowning and overdosing. This can, however, be averted by allowing a more humane alternative of physician-assisted suicide (Newfield N.d para 8).
“In Europe, a patient in just the first stages of Alzheimer’s can choose active euthanasia; qualifying for this procedure in the United States should be far more difficult” (McHugh 2005, para 8). Those who are terminally competent hopefully suffering patients are voluntarily eligible.
It is therefore important to allow for the physician’s assisted suicide to take place within certain limitations. For instance, the patient should be within the proximity of death and this should be documented by a licensed physician. The patient can be in unbearable pain which makes it reasonable to continue with the procedure. The decision by the patient to end their lives should not be taken lightly. To help such patients, there should be counseling service to help them to weigh the options of suicide.
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