One Prescription of Euthanasia Please - Ethics of Physician Assisted Suicide
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Dec 6, 2023
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Uploaded by DukeTarsier3547
Ivey Shadburn
Professor Barton Moffat
PHI 3323 Medical Ethics
10 May 2022
“One Prescription of Euthanasia Please” : Ethics of Physician Assisted Suicide
In this paper, I will argue that it is morally unethical for physicians to approve or initiate Euthanasia, more commonly known as “Physician Assisted Suicide”, in patients who wish to use lethal medical intervention as a form of terminal care. I argue that physician assisted suicide is not a reasonable form of medical treatment because it undermines the overall value of human life. To begin
this discussion, a literature review will be placed in the beginning section of the paper that cover major points in the arguments for the use, misuse, and ideologies behind physician assisted suicide. Next, I will formalize my argument on the unethical nature of physician assisted suicide and explain how the argument emphasizes the improper justification of physician assisted suicide. Then, I will take into consideration an objection that advocates for the use of physician assisted suicide. Finally, I will finish by responding to the considered objection using the basis of my arguments and then conclude with a short discussion.
An individual with a disability, as defined by the Americans With Disabilities Act, is a person
who has a physical or mental impairment that substantially limits one or more major life activities. This includes a person who has prior history of having or developing an impairment or is perceived by others as having an impairment. Therefore
, individuals w
ith
disabilities are those who
need protection
from common oppressions such as discrimination
and acts of coercion, and must
be given equal opportunities in social and occupational settings. This ideology aligns with the principle of nonmaleficence, which is society’s duty to bring harm upon no one (National Commission for the
Protection of Human Subjects of Biomedical and Behavioral Research, 1979). However, the newly adopted practice of medicine described as physician-assisted suicide, occurs when a physician promotes the death of a patient by providing the necessary information and possible means to enable the patient to perform the life-ending act (American Medical Association, 2021). Many campaigns and medical research studies have shown an array of varying opinions and beliefs of the ethical validity of physician assisted suicide.
The opposing side that supports physician-assisted suicide as a
medical practice suggests that a patient’s autonomy trumps all else and that they should be given the right to choose their care, especially if it includes end-of-life care (Campbell, 2019). Though this opposition holds significant justification, it does not consider the vulnerabilities that those with disabilities will be succumb to if physician-assisted suicide is legalized (Anderson, 2015). Therefore, we must explore if a
balance can be established between what is good for one and also good for all.
1.
In society we have a moral obligation to promote nonmaleficence
2.
No harm to any means no harm to all. As a society, we must protect those who cannot
protect themselves especially those with a physical or mental disability 3.
Restrictions of physician assisted death can be fluid and amplify potential vulnerabilities of those that have disabilities
______________________________________________________________________________
Therefore, encouraging the use of euthanasia in medicine undermines the value of life to those with disabilities and should be considered maleficence and inconsiderate
The Belmont Report outlines a set of moral principles that were designed to respect and protect individuals with
regards to finding ways to deem research acceptable in the biomedical or behavioral fields. (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979). Specifically, the Belmont Report highlights a principle labeled
nonmaleficence, which can simply be stated as the promotion to do no harm in society. Claude Bernard, a French physiologist who dealt in the domain of experimental medicine, spoke to this specific principle stating, “one should not injure one person regardless of the good that might come to others and that even avoiding harm requires learning what is harmful” (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979). Overall, there is a strict obligation in society to not bring harm upon yourself, or others, no matter the benefits that may come from it. To gain information behind the reasonings of support for physician assisted suicide without comprehending the harm that it can potentially cause to disabled individuals, is too not fully understand the concept of nonmaleficence. Permitting individuals the actionable right to choose life or death, will give way for the coercion of those individuals with physical and mental disabilities/disadvantages.
The Americans with Disabilities Act Amendments Act categorizes those deemed as “disabled” in three separate ways: having a physical or mental impairment that substantially limits one or more major life activities; having a previous history of an impairment; or being treated in societal settings as having an impairment (Gostin, 2015). This act was redesigned from its original 1990 format to include all aspects needed for consideration when informing the general public and public offices as to the meaning of a disabled person, and the rights they have to accommodations in society, employment, and especially health care. Before the ADAAA, many medical institutions viewed those with disabilities as a liability or an unnecessary stress to the natural functioning of their practice. They would not only refuse accommodations, but in some cases, refuse treatment. In 2020, an incident in Oregon recalled a woman with an intellectual disability being asked to sign a form that
allowed the hospital to deny her care. The hospital then proceeded to request the institution, from whence she came, to make all residents in her condition sign ‘Do Not Resituate’ orders for the purpose of saving hospital resources and supplies for other patients who could use it more. (Shapiro,
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2020). The decision stemmed directly from the hospital’s unwillingness to give her care because of her “low quality of life,” given her disability. Jake Cornett, an executive director of the Disability Rights Oregon, described this incident as “wildly inappropriately” because she was wrongfully influenced to sign a form that would forgo the hospital’s duty of providing life-saving treatment (Shapiro, 2020). This provides evidence that the institution
, which was built on the moral grounds to preserve lives no matter their origin, was allowed to coerce this woman into an accelerated grave. This begs the question: If a medical institution were allowed to withhold life-saving treatment, in turn would they also be allowed to administer life-ending treatment?
This would only grant permission to medical organizations to allow physicians the right to assist someone in death whether it truly be that patient’s intentions
;
because as mentioned before, coercion can lead to wrongful death (Stainton, 2019). This form of reasoning undermines the true value of their life and forfeits an individual’s rights due to
the physical or mental disability that puts them at a disadvantage to others.
Physician assisted suicide, as previously explained, is when a physician promotes the death of a patient by providing the necessary information and possible means to enable the patient to perform the life-ending action. A brief example to enlighten the process of physician assisted suicide would be a physician prescribing a patient a medication then informing them of the amount that could potentially be lethal. The physician does this while fully aware that the patient may end their life through means of suicide using the medication they were given (American Medical Association, 2021). Though this may seem that the decision only affects the person who will consume the medication, it is not nearly that simple. The District of Columbia Death With Dignity Act of 2016 is a
known legislation that contains information on the process and regulations that promote the safe use of physician assisted suicide. It explains that medications prescribed for physician assisted suicide are regulated by federal entities and if a person chooses not to take the medication, they must legally dispose of it (
Death with Dignity Act, 2016
).
Serious punishments such as criminal charges follow if
these policies are not upheld.
It further states that
these medications are to be taken by the prescribed person when and wherever the person chooses to end their life, as long as it is not in a public place. Yet, w
hat if a person does not take them and
instead gives them to someone else? Of course, this is prohibited by law, but when has a written rule ever stopped someone with an ulterior motive from getting what they desire?
Further and stricter policies
say that to receive a physician’s assistance in death, the patient must make two oral requests (separated by two weeks or more) and the patient must also make a written request that is no less than 48 hours before the medication is administered (
Death with Dignity Act, 2016)
. This written request must be witnessed by two individuals, who attest that the patient is acting out of their own free will and that they are not being forced to make this decision. These two witnesses must not include the patient’s physician and only one of the witnesses can be considered family to the patient, but not stand to inherit benefits from the death of the patient (
Death with Dignity Act, 2016
). Though the regulations seem to grant an extended process
to make sure this is the desire
of the patient, they do not account for the coercions that could potentially take place
, nor the significant state of distress the individual could be experiencing.
One of these potential witnesses, though they may not directly benefit from the patient's death, could be working with an individual that shall benefit from the result of this physician assisted suicide (Anderson, 2015). These ideas of coercion are only further escalated when an individual with a disability is involved.
To that extent, extreme harm can arise when an individual with mental disabilities (of any severity) are deemed legislatively lucid, but psychologically, they are impaired and unable to understand the ramifications of physician assisted suicide. This vague approval leaves room for a detrimental and permanent case of coercion, a.k.a. death. Therefore, even if these proper guidelines are enacted, what protects the disabled individual from this self-harm when in, arguably, the most distraught time in their existence?
Many arguments have been raised against the nonlegitimacy and illegalization of physician assisted suicide with the primary focus of it being placed on the disrespect of a person’s autonomy. Autonomy labeled out in the Belmont Report is, “an individual’s capability of deliberation about personal goals and of acting under the direction of such deliberation. To respect autonomy is to give weight to autonomous persons' considered opinions and choices” (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979). We have a moral obligation to respect a person’s choices and allow them to do what they believe brings the most benefit to them, even if it means terminating their life. According to Campbell, a patient under medical treatment has three morally relevant rights that include: bodily integrity, freedom to refuse medical treatment, and end of life decisions aligning to personal values (Campbell, 2019). Along with the promotion of those three patient rights, these advocates also fight to say that physician assisted suicide is the equivalent of a patient refusing lifesaving treatment and choosing to die naturally and possibly suffering through that process (Dugdale & Callahan, 2019
). They wish for a patient to choose relief from suffering via a prescription, which will alleviate pain by ultimately removing both physical agony and a financial burden within the final days. By justifying the right of a person to choose against accepting treatment, they also believe that it should be up to the patient to also accept an option that advances the end of their life. The value of life is bestowed upon the hands it belongs to; therefore it should be that person’s right to choose whether they live or die before their appointed time.
Though the argument advocating for physician assisted suicide is commissioned on a fundamental principle of autonomy in the Belmont Report, it is a close-minded practice that is strictly focused on the individual it pertains to. It does not take into consideration how that person came to be in that situation, nor the majority of people it could potentially affect in the future. The fluid regulations of physician assisted suicide can be open to many interpretations of how an
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individual can come to achieve the necessary requirements to be considered for this medical intervention. A
gain
, as previously stated, these regulations provide a greater risk of mistrust among families as immoral incentives are amplified. As John Finnis put it, “many people will find that their nearest and dearest are less and less near, and less and less dear” (Finnis, 2013). As of now, there is no true way to distribute life-ending medication effectively and safely without causing significant harm
in the process, especially when this harm affects those with disabilities the greatest. I have argued that physician assisted suicide is an unethical form of medical treatment due to the factors that allows its burdens to outweigh its benefits. As mentioned in the Belmont Report, we have a moral obligation to promote non-maleficence by bringing no harm to others. Society also has the moral obligation to protect those who may be easily manipulated because of their disabilities. That those in society, with these disadvantages, should still be seen as valued and not have their life shortened because another individual stands to gain upon their demise. Their life should also not be deemed as less worthy because of factors that hinder them from promoting society. They should be cared for in the same respect as everyone else. Physician assisted suicide as a form of medical treatment should therefore be seen as unjust. Though it makes a case for the respect of a person’s autonomy, it does not fully consider the ramifications it may cause. Those who promote for the legalization of physician assisted suicide choose a shallow autonomic validation for its approvement and do not truly consider the harm it will cause individuals with disabilities. Therefore, physician assisted suicide as a form of end-of-life medical treatment is unethical and if the possibilities of its use in the future are considered, then serious reforms must be made to its restrictions and regulations.
REFERENCES
AMA: Physician-Assisted Suicide
. American Medical Association. (2021) https://www.amaassn.org/delivering-care/ethics/physician-assisted-suicide Anderson, Ryan. “Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality.” The Heritage Foundation
, Backgrounder, (2015)
Campbell, Courtney S. “Mortal Responsibilities: Bioethics and Medical-Assisted Dying.” National Library of Medicine: National Center for Biotechnology Information
, The Yale Journal of Biology and Medicine, 20 Dec. 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913808/.
Death with Dignity Act, D.C. LAW 21-182 U.S.C. (2016) https://dchealth.dc.gov/sites/default/files/dc/sites/doh/page_content/attachments/Death%20With
%20Dignity%20Act.FINAL_.pdf
Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Pros and Cons of Physician Aid in Dying. The Yale journal of biology and medicine, 92(4), 747–750. https//www.ncbi.nlm.nih.gov/pmc/articles/ PMCC6913818/
Finnis, John Mitchell. “Part Four: Autonomy, Euthanasia, and Justice.” Human Rights and Common Good
, 1st ed., vol. 3, Oxford University Press, Oxford, (2013), pp. 260–262. The Collected Essays of John Finnis.
Gostin, Lawrence O. “The Americans with Disabilities Act at 25.” JAMA
, JAMA Network, 9 June 2015, https://jamanetwork.com/journals/jama/fullarticle/2319149.
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health and Human Services. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-
report/index.html
Shapiro, Joseph. “Oregon Hospitals Didn't Have Shortages. So Why Were Disabled People Denied Care?” NPR
, NPR, 21 Dec. 2020, https://www.npr.org/2020/12/21/946292119/oregon-hospitals-
didnt-have-shortages-so-why-were-disabled-people-denied-care.
Stainton, Tim. “Disability, Vulnerability and Assisted Death: BioMed Central
, BMC Medical Ethics, (2019), https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-019-0426-2.
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