Right to DIe Paper
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The Right to Die: Review of the Arguments in Favor and Against Physician Assisted
Suicide and Euthanasia Jessica M. Leonard
College of Humanities and Social Sciences, Grand Canyon University
PSY 510: Contemporary and Ethical Issues in Psychology
Mark Segraves
August 16
th
2023
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The Right to Die: Review of the Arguments in Favor and Against Physician Assisted
Suicide and Euthanasia Physician assisted suicide and euthanasia (PAS&E) are complicated, polarizing, and contentious issues. The literature on the topic is fraught with political, religious, ethical, and psychological implications that have progressed and developed throughout history alongside changing societal views and cultural norms. The articles “The Right to Die in Chronic Disorders of Consciousness: Can We Avoid the Slippery Slope Argument?” (Calabro, et al., 2016) and “Euthanasia and Physician-Assisted Suicide are Unethical Acts” (Goligher, et al., 2019) respectively present views in favor and against PAS&E to influence medical professionals and political legislators to support the views each present. The following will briefly summarize the main assertions presented in each of the articles and will also discuss the historical significance of the views in both articles. Finally, the strength of the claims made in each of the articles will be assessed and valuated based on the degree to which a clear and convincing argument was asserted. Historical Background The concept of euthanasia is not a unique to modern, progressive ideology. Ancient Greek and Roman authors described euthanasia in their writings, although the term conveyed a meaning different to our modern interpretation. Euthanasia, to the Greeks, meant a specifically positive, euphoric, peaceful mindset of a person experiencing a peaceful death (Robben, 2018). The cultural emphasis on health of the body translated into the idea of youth and health as sacred
and worthy of preservation. However, there were circumstances which society permitted the intentional and deliberate ending of one’s life as an honorable or at least accepted response to ill health, tragic circumstances, or other unique, misfortunate events. It was not until 1605 when the
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modern concept of palliative care was introduced into the lexicon by Francis Bacon’s term “outward euthanasia” (Zavala, 2015). Bacon’s term contrasted with the concept of “inward euthanasia” which meant a priest preforming a ritualistic releasing of the soul or essential core of
a dying person to a more peaceful and pain-free state upon transition from this world into an afterlife characterized by peacefulness and spiritual freedom from the profane and harsh reality of earthly life. In the 1870’s, chloroform was used in euthanasia to end the suffering of patients who were chronically ill and whose prognosis supported the imminent end of life (Baker, 2006). This prompted the American Medical Association (AMA) to decry the use of chloroform by physicians to aide their patients in their end-of-life decision (ELD). The AMA famously remarked that the use of the drug by doctors to end the suffering of patients was an “attempt to make the physician don the robes of an executioner” (Zavala, 2015). Over time, two distinct sides to the argument have solidified as the main voices both for and against PAS&E. Proponents
of the controversial practice claim several assertions that are discussed in the Innovations in Clinical Neuroscience journal article “Right to Die in Chronic Disorders in Conscience: Can We Avoid the Slippery Slope Argument” (Salvatore Calabro et al., 2016). Opponents of the practice cite several claims and ethical issues condemning the practice of PAS&E for reasons outlined in the World Medical Journal article titled “Euthanasia and Physician Assisted Suicide are Unethical Acts” (Goligher et al., 2019). The Right to Die The main points in the Salvatore Calabro et al., article (2016) is specific to patients who are suffering a disorder of consciences (DOC). DOC’s are typically divided into two distinct categories. The first DOC category of DOC is known as an unresponsive wakefulness state, popularly known as a vegetative state (VS) characterized by an unawareness of the self and 3
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inability to demonstrate voluntary, intentional behaviors typically due to impairments in the region of the brain responsible for cognition and executive function (Salvatore Calabro et al., 2016). The second category is known as a minimally conscious state (MCS) wherein the patient can demonstrate minimally intentional responsive behaviors and brain imaging tends to show some level of cognition and awareness of the self. Patients suffering MCS typically have a limited repertoire of responsive behaviors that while indicative of awareness, are extremely dependent on others for their day-to-day care and for their basic needs (Salvatore Calabro et al., 2016). The author makes the point that DOC states are not only tragic for the victim and families
but also require the use of highly technical and costly life prolonging treatment known as artificial nutrition and hydration in addition to other complex life sustaining treatments. Given that the patient may be facing a prognosis of complete dependence on others for their day-to-day life and care, the author proposes it should be the choice of the patient or designated surrogate to accept or reject the continuation of life prolonging treatments like ANH. The author then states however, that there are many occasions when prognosis is wrong and patients miraculously recover from the DOS states, or at least begin to demonstrate improved functional ability despite being told by medical providers that they were unlikely to recover. The author makes the argument for the right of patients with DOC’s to choose whether or
not they want to receive life prolonging therapy treatments like ANH. The author states that the commonly agreed upon concept of everyone deserving a chance at a “worthy life” implicitly includes the notion of “the right to a worthy death”. Finally, the author addresses a popular logical fallacy argument known as the “slippery slope argument”. The argument contends that the legalization of PAS&E will eventually result in the assisted suicide or euthanasia of many people who are not suffering a DOC or a chronic illness marked by pain and suffering. In other 4
words, if PAS&E is allowed, then sooner or later the assisted suiside of everyone considered “undesirable” will be the inevitable result. This argument is the definition of a logical fallacy because it implies that if A occurs (legalization of PAS&E) then a series of smaller events will inevitably occur (B,C,D…W,X,Y), leading to Z (the assisted suicide or euthanasia of people considered undesirable) will occur. This is an illegitimate “slippery slope” argument that is illogical because it equates two results that are not the same (Purdue University, 2022). The author concludes his argument with variations on the claims described above. Namely, that there is an ethical obligation to obtain the expressed permission of the patient to determine if life prolonging treatments should be used. He additionally includes claims made by those who oppose the use of PAS&E, and frankly delivers the opposing points with clarity and cohesiveness resulting in the opposing view more likely to be adopted by his readers than his own. PAS&E as Unethical Acts
Unlike the first article, “Euthanasia and Physician Assisted Suicide are Unethical Acts” lays out the arguments against PAS&E with directness, clarity, and simplicity. The main claims in the article are that medical providers have an obligation to honor the best interests of their patients which obviously translates into doing everything in their power to preserve the life of those under their care. In the article, the authors address their points directly, section by section, with evidence and elegant citations of fact that are nearly impossible to disagree with. An example is the well delivered claim about the inability to obtain informed consent from the patient for the purposes of initiating PAS. The authors claim that because neither the patient nor the medical provider know what occurs at or after death, and the inability to foresee the existence
or not of an afterlife, there is simply no way to ask for or receive informed consent from the 5
patient. The authors conclude this point with the notion that proponents of PAS reach beyond the
boundaries of the clinical domain in their assumptions (speculation) that death is simply the ending of all forms of existence. Therefore, to presume that PAS is even a legitimate medical procedure is false because no one is aware of the result of death and no follow up care can be pursued for obvious reasons (Goligher et al., 2019). In yet another concise and rather moving claim, the authors suggest that any indication by their organization would be seen globally as a “tacit endorsement” of the practice of PAS&E. They contend that to issue any decree outside of the position that states PAS&E are unethical acts would be to show the rest of the world that the organization is neutral on the practice. They then go on to claim that “any society wishing to transform suicide from a freedom to right should do so by upholding some other procession to support its claim as “killing does not belong in the house of medicine” (Goligher et al., 2019).. This powerful and nearly impossible assertion to argue against was delivered in the most convincing and noble way imaginable. The Unethical Act of PAS&E
The more convincing of the two articles is the World Medical Journal article claiming that PAS&E are unethical acts. Many of the claims stated in the article, namely the above cited statements, are concise, direct, and difficult to argue against. The same cannot be said for the former article, which frankly made equally as convincing an argument for both sides of the debate by including the opposing arguments in the body of the article (Goligher et al., 2019). Another convincing element of the World Medical journal article was the inclusion of the significant cultural and societal influence on the scope of freedoms and rights. Culturally, there is
a current narrative which focuses squarely on the rejection of what is considered oppression and unethical suppression of the rights of certain marginalized groups. While the cultural narrative is 6
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certainly not with merit and righteous cause, there is a need for discernment and distinction between inalienable rights like freedom of speech and the right to life, liberty and the pursuit of happiness for all people, and the argument that PAS&E should somehow become the right of individuals based on the, often inaccurate, diagnosis and prognosis of a serious medical condition (Salvatore Calabro et al., 2016).
Final Thoughts The article written in the World Medical Journal was more convincing and laid its argument in a streamlined, easy to follow, and rational format. Readers of both articles will likely walk away with a better understanding of the argument claiming that PAS&E is unethical and should not be considered a medical procedure for reasons listed above. Both articles were an interesting read and provided crucial information to assist the reader in better understanding both sides of the debate. 7
References
Baker, R. B. (2006). A concise history of euthanasia: Life, death, God, and medicine.
Bulletin of the History of Medicine, 80
(4) Goligher, E. C., Cigolini, M., Cormier, A., Donnelly, S., Ferrier, C., Gorshkov-Cantacuzène, V. A., Harding, S. R., Komrad, M., Kyrillos, E., Lau, T., Leiva, R., Leong, R., Tang, S., & Quinlan, J. (2019). Euthanasia and physician-assisted suicide are unethical acts. World Medical Journal, 65
(1), 34-37. Purdue University. (2022). Logical fallacies. Fallacies - Purdue OWL® University College of Liberal Arts. https://owl.purdue.edu/owl/general_
writing/in_argumentative_
writing/fallacies.html
Robben, A. C. G. M. (Ed.). (2018). A companion to the anthropology of death. John Wiley & Sons, Incorporated.
Zavala, A. (2015). S18. The history of euthanasia and physician-assisted suicide. Journal of Anesthesia History
, 1(3), 94-95. https://doi.org/10.1016/j.janh.2015.07.020
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