PAS
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Running head: WHO GETS TO DECIDE?
1
Physician-Assisted Suicide: Who Gets to Decide Whether We Live or Die?
Catherine Breaux
PHI 103 Informal Logic
Daniel Wagner
July 13, 2018
WHO GETS TO DECIDE?
2
Whenever Physician-assisted suicide (PAS) is mentioned, one word that generally comes
to mind is Euthanasia.
However, unlike euthanasia, where the physician administers a lethal
dose of medication, with PAS, the patient is given access to the medicine, and they choose when
to take it.
In America, PAS is authorized in eight of the fifty states, to include Washington D.C.,
and California (Quill, & Sussman, 2018).
While PAS is also used in various countries
throughout the world, America has begun to voice their concerns on the topic.
With state
legislatures beginning to consider legalizing PAS, the subject has become widely controversial.
PAS gives patients the opportunity to take their lives into their own hands and is not a decision to
be made lightly.
Not every patient is given this option, and it is one that is reserved for those
who have a terminal diagnosis.
Throughout this paper, the PAS discussion will be viewed on
both sides, the positive and the negative.
Argument Against Physician-Assisted Suicide
Premise 1:
Allowing patients to choose death can result in the abuse of the legal system,
and in some cases leading to murder.
Premise 2:
In the past couple of decades there has been a tremendous improvement in
end-of-life care.
This care gives patients peace of mind and allows them to live out their
days virtually pain-free.
Premise 3:
PAS is a violation of the Hippocratic oath, it is the role of the physician to
heal and comfort their patients, not kill them.
Conclusion:
There are a variety of end-of-life care options available to terminal patients.
The authorization of PAS is unnecessary and could jeopardize the physician-patient
relationship.
WHO GETS TO DECIDE?
3
Support for the Argument Against Physician Assisted Suicide (PAS)
A study done by The Seattle Cancer Care Alliance found that out of 114 patients who
requested information on PAS, 36 of those patients are those who "have loss of autonomy, the
inability to engage in enjoyable activities, and loss of dignity," (O'Rourke, O'Rourke, & Hudson,
2017).
There can be no guarantee that PAS when authorized, would not be abused by both
physicians and the family of the terminal patient.
With PAS authorized, the physician-patient
relationship could be greatly affected because "the physician may feel obliged to list PAS as an
option, and the patient may feel obliged to consider it," (O'Rourke et al., 2017).
PAS abuse is not
limited to the medical profession but can be a possibility with family members as well.
Those
who would gain financially from the death of their loved one could pressure the patient into
choosing PAS.
Hospice care, Voluntarily Stopping of Eating and Drinking (VSED) and Palliative
Sedation are all acceptable end-of-life care treatments that are available to terminal patients.
Hospice care is an option that is given to patients who have six months to live.
Through this
option, patients are offered counseling and pain management to make their last few months
comfortable (National Hospice and Palliative Care Organization, 2017).
It is recommended that
VSED is done while in hospice care so that the patient can be monitored adequately.
Through
this option, the patient decides to stop eating and drinking to speed up the dying process and can
be managed in order to prevent pain.
Palliative Sedation, is an option in which the patient is
given medication that renders them unconscious and leaves them pain-free until their final
passing (National Hospice and Palliative Care Organization, 2017).
These and other forms of
end-of-life care make it so that the patient can spend the rest of their days virtually pain-free,
negating the need for PAS.
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WHO GETS TO DECIDE?
4
The Hippocratic oath is a vow taken by physicians and serves as a guideline on how to be
a competent physician.
This oath and its principles are held in high regards by physicians all
over the globe.
In the Hippocratic oath, it states that "I must tread with care in matters of life and
death. If it is given me to save a life, all thanks. But it may also be within my power to take a
life; this awesome responsibility must be faced with great humbleness and awareness of my
frailty. Above all, I must not play at God," (Tyson, P., 2001).
This section of the Hippocratic oath
shows that it is the responsibility of the physician to heal their patients, rather than help them die.
Argument in Support of Physician-Assisted Suicide (PAS)
Premise 1:
Patients suffering from terminal illnesses should have the right to end their
pain in a humane way.
Premise 2:
The costs of end-of-life care can cause immense financial strain on not only
the patient but the patients family as well.
PAS can be an affordable alternative to those
who would view it as an option.
Premise 3:
"Physician-assisted suicide is not about physicians ignoring their ethical
standards and becoming killers," (Ticknor, 2014).
If a terminally ill patient is fully
informed of the process and still wishes to choose PAS as an option, that decision
should fall within the boundaries of helping the patient, rather than harming them.
Conclusion:
PAS should be included as an option given to terminal patients along with
other end-of-life care options.
Support for the Argument in Favor of Physician-Assisted Suicide (PAS)
In the first premise, it is discussed that one of the reasons for PAS is the pain and
suffering caused by terminal illnesses and disabilities.
Within the article, the author goes on to
WHO GETS TO DECIDE?
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point out that when in support of PAS, one should not focus only on pain as the basis for their
reasoning.
While pain is a common factor amongst patients considering PAS, there are other forms
of suffering that can accompany a terminal diagnosis such as "dehumanization, loss of
independence, loss of control, a sense of meaninglessness or purposelessness, loss of mental
capabilities, loss of mobility, disorientation and confusion, sorrow over the impact of one’s
illness and death on one’s family, and the loss of ability even to recognize loved ones," (Ticknor,
2014).
For some patients, suicide is ultimately their answer to end this pain and hardship.
"If
patients who might otherwise attempt suicide on their own were offered a merciful, effective,
and proven way to end their lives this might bring far greater peace to not only the dying but to
their relatives who might otherwise wonder if there was suffering involved," (Smith, 2011).
Authorizing PAS would not only help to give terminal patients the tools to end their life
humanely and on their terms, but also provide relief to the patients family and friends.
One of the arguments against PAS is that there are a variety of end-of-life care options
available to those who have terminal illnesses.
End-of-life care can become a financial burden,
and PAS can be a more affordable alternative.
In fact, one study found that "the last month of
life [of a terminally ill patient] can consume 40% of the total spent on healthcare during the
lifetime of an individual" (Smith, 2011).
However, PAS should not be readily available to all
terminal patients.
When a patient becomes eligible to receive PAS, "the patient's physician must
explore all of the physical, psychological, and spiritual reasons for the request and explain all of
the options available," (Ticknor, 2014).
This would help to combat any future abuse of the
product via coercion from either the physician or family members.
WHO GETS TO DECIDE?
6
The last premise discusses the ethical standards of physicians.
A common argument
against PAS is that it violates the Hippocratic Oath taken by many physicians.
PAS is not about
physicians becoming killers and ignoring their moral and ethical standards (Ticknor, 2014).
PAS
is about helping those patients who are terminal and suffering. There will be physicians who do
not agree with PAS, and they should not be forced to go against their beliefs.
However, if their
patient requests information regarding PAS, a physician who is comfortable with PAS should be
assigned to the patient instead (Ticknor, 2014).
In 2017, the Hippocratic oath was revised to
bring it up to date with the medical profession of today.
The updated oath states that, " “I will
respect the autonomy and dignity of my patient” (Cook, 2017).
This proclamation allows for the
consideration of PAS being an option, as it would give terminal patients the chance to die with
dignity.
Analysis of the Reasoning on Both Sides
Both arguments listed above reference scholarly sources and various studies to provide a
solid foundation for their conclusions.
The conclusions of each discussion are relatively similar
in that they both discuss options regarding how a patient spends the last moments of their life.
While the argument against PAS concludes that the variety of end-of-life care options negate the
need for PAS, the case in support of PAS states that PAS should be listed as one of those options.
While one of the arguments referenced a specific study regarding PAS, the other
argument addressed many concerns made by the opposing side.
Non-scholarly sources are often
biased and make claims that are unsupported by evidence.
However, scholarly sources can also
be subject to using fallacies and bias.
One article used the slippery slope fallacy, and both
articles contained the appeal to pity fallacy.
While it is well known to take anything that a non-
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WHO GETS TO DECIDE?
7
scholarly source says with a grain of salt, scholarly sources aren't always perfect and can contain
biased information and logical fallacies as well.
Conclusion
With advancements in technology and the ease of access to the internet, it can be easy to
form opinions based off of what you read online.
Critical thinkers are those who analyze and
question what they read before trusting any sources online.
Society will see and article and make
their decision based off of that article after just reading the headlines.
It is essential to use
critical thinking skills by researching and verifying all information before coming to a
conclusion, rather than coming to a conclusion based off of emotions and the beliefs of others
alone.
After researching both sides of the argument regarding Physician-assisted suicide, I found
that one side of the argument did not necessarily have more information on it than the other side.
In opposition to PAS, there was a vast amount of information and data regarding the
advancement in healthcare and the moral and ethical dilemmas regarding PAS.
However, on the
other side of the argument, I found countless studies and information discussing the financial
benefits of PAS and the dignity and well-being of patients who deserve the option of PAS.
WHO GETS TO DECIDE?
8
References
Anderson, R. T. (2015). The alternative to physician-assisted suicide: respect human dignity
and
Offer
True
Compassion.
Retrieved
June
17,
2018,
from
https://www.heritage.org/health-care-reform/report/the-alternative-physician-assisted-
suicide-respect-human-dignity-and
Cook, M. (2017). New hippocratic oath for doctors approved. Retrieved from
https://www.bioedge.org/bioethics/new-hippocratic-oath-for-doctors-approved/12496
National Hospice and Palliative Care Organization (2017). Hospice care. Retrieved from
https://www.nhpco.org/about/hospice-care
O'Rourke, M. A., O'Rourke, M. C., & Hudson, M. F. (2017). Reasons to reject physician
assisted suicide/physician.
Aid in Dying. Journal Of Oncology Practice, 13(10), 683-
686. doi:10.1200/JOP.2017.021840
Smith, N. (2011). The positive aspects of physician assisted suicide. Retrieved June 17, 2018,
from http://www.articlemyriad.com/positive-aspects-physician-assisted-suicide/
Ticknor, H. R. (2014). Whose life is it, anyway?. Torch, 2-5
Tyson,
P.
(2001).
The
hippocratic
oath
today.
Retrieved
from
https://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html
Quill, T. E., & Sussman, B. (2018). Physician assisted death. Retrieved June 17, 2018, from
https://www.thehastingscenter.org/briefingbook/physician-assisted-death/