Autonomy, Dignity & Assisted Suicide: Terminal Illness Case

I. Assisted suicide should be an option for terminally ill patients

The topic discussed in this paper is assisted suicide as an option for terminally ill patients. Assisted suicide for terminally ill patients consists of a terminally ill patient requesting that a physician write a prescription for a medication that intentionally results in the patient’s death. The terminally ill patient then self-administers this medication, ending his or her life. I will explore the ideas of autonomy, dignity, and the role of the physician and connect these ideas to physician-assisted suicide. My argument is: Physician-assisted suicide should be an option for terminally ill patients; physicians should be able to prescribe life-ending medication without being held civilly or criminally liable for having caused the death.

In most of the United States, physician-assisted suicide is a crime, though there are doctors willing to practice assisted suicide and patients that wish to partake in assisted suicide. Many people who die each year in the United States experience many hospitalizations over the course of an illness, especially terminal illnesses, in the last few months of their life. These individuals experience pain and suffering as well as loss of autonomy and dignity. Assisted suicide allows the patient to die when and how they would like. It utilizes autonomy and preserves dignity. It allows the doctor to fulfill his or her role of relieving suffering when treatment is not an option or treatment causes more suffering. Yet, more of the population is against physician-assisted suicide than for it; I hope to change opinions on the topic.

I would like to mention that physician-assisted suicide is different from euthanasia. Though both are medical procedures classified as physician-assisted deaths, in euthanasia, the patient does not self-administer the lethal medication. The argument I am going to present applies only to physician-assisted death by assisted suicide. Due to my having little knowledge on end of life protocol in other countries, I will limit my argument to terminally ill patients in the United States. I will assume that everyone agrees that autonomy and dignity are moral rights that should be granted to all human beings.

II. I will prove that assisted suicide should be an option for terminally ill patients in the following way:

Patient autonomy should be honored. This means that a person capable of making his or her own decisions should be able to. Respect for autonomy is an important aspect of medical practice. I will go on to explain that terminally ill patients deserve to die with dignity. Dignity is often lost in end-of-life treatment and care. Finally, I will explain that the role of doctors is to minimize suffering. Many people with terminal illnesses experience some form of suffering or will experience some form of suffering. In situations where a patient cannot be healed, the role of the doctor shifts from healing to minimizing the patients suffering. Assisted suicide allows the patient to decide when and how they wish to die, allows terminally ill patients to die with dignity, stops the patient’s suffering, and allows the doctor to carry out his or her role of minimizing suffering.

III. Not only does my argument have a sound structure, it is valid because I have used precise and consistent language in the following ways:

Patient autonomy should be honored. The definitions of the following terms are needed to understand this premise. Autonomy is the right of adults deemed capable of making decisions to make decisions. A person with autonomy, an autonomous person, is an individual capable of deliberation about personal goals and of acting under the direction of such deliberation. Terminally ill patients deserve to die with dignity. The definitions of the following terms will be useful in understanding this premise. Dignity is self-determination and respect. In medical practice, it is a highly valued principle. End-of-Life will be abbreviated EoL. EoL care is

Care is provided to patients with terminal illnesses in their final stages of life. The role of doctors is to minimize suffering. The definition of the following term will be useful in understanding this premise. Suffering is physical and or emotional pain. It can be caused by an illness and or attempted treatment for an illness.

IV. My argument is comprised of well-researched premises that effectively demonstrate why assisted suicide should be an option for terminally ill patients

Patient autonomy should be honored. Autonomy is an important aspect of medical practice. It involves the patient making a decision about their care and their doctor respecting, and helping to carry out, the patient’s wishes. “To respect autonomy is to give weight to autonomous persons’ considered opinions and choices while refraining from obstructing their actions unless they are clearly detrimental to others” (Belmont Report). The Belmont Report explains that applying autonomy involves the patient’s decisions and actions. In cases of physician-assisted suicide, the patient decides when and how they wish to die, and the ultimate act of causing death is performed by the patient, not the physician.

When it comes time for end-of-life treatment and care for an individual with a terminal illness, the individual is the only person that can and should decide if physician-assisted suicide is the procedure that should be provided. This is because the only person that can decide if a life is worth living is the person living that life. Each person is the best judge of the value that the continuation of their life would afford them. (Velleman). Someone may choose to end his life while he is capable of living and dying with dignity rather than continue to suffer from an illness that takes away their ability to choose.

In 2019, in Oregon, where physician-assisted suicide is an option, one of the most reported end-of-life concerns for individuals with terminal illnesses was “losing autonomy” (Public Health Division). These individuals were able to choose to die before their illness, resulting in a loss of dignity and loss of autonomy. This option to exercise autonomy in the final medical procedure of an individual’s life should be given to all terminally ill patients.

Terminally ill patients deserve to die with dignity.

A person’s life is comprised of physical aspects as well as intellectual, emotional, psychological, and spiritual aspects. “Life is not mere living but living in health. Health is not the absence of illness but a glowing vitality – the feeling of wholeness with a capacity for continuous intellectual and spiritual growth. Physical, social, spiritual, and psychological well-being are intrinsically interwoven into the fabric of life” (Yeo). End-of-life (EOL) care, and procedures must consider all of these aspects of the person.

Preservation of dignity at the EoL requires that self-respect be promoted and that the patient be treated with respect. Part of respecting the patient is considering all aspects of the person. Most currently used EoL interventions focus predominantly on symptom control rather than holistic care, and with that, the patient is not respected, and dignity is lost (Kennedy).

A study done to address the human context of dying, known by the acronym SUPPORT, involved 10,000 terminally ill people, five medical centers, and five cities in the United States. The study found that approximately half of all patients spent their EoL in what the researchers called an undesirable state in which their wishes were not respected or they were in serious, insufficiently treated pain. (Dorff).

Healthcare professionals cannot ensure that someone dies with dignity, but they can contribute to death without indignity. This can be done by ensuring that they respect people’s autonomy and incorporate human reason. They can also ensure people die without indignity. This can be done by not imposing indignities such as taking choices away from people at the end of their life and by minimizing indignities such as suffering. (Allmark).

Physician-assisted suicide would allow the individual to die before parts of their person are lost. In carrying out physician-assisted suicide, the individual and their wishes are respected. Along with this, the patient’s suffering is relieved, and further suffering is not imposed.

The role of doctors is to minimize suffering.

A bioethicist, Daniel Callahan, and his colleagues conducted a five-year international study to come to an agreement on the goals of medicine. It was determined that “medicine has four primary goals: prevention of disease and injury and maintenance of health, relief of pain and suffering, care for those that cannot be cured, and pursuit of a peaceful death” (Panicola). According to the American Medical Association, “Physicians have an obligation to relieve pain and suffering and to promote the dignity and autonomy of dying patients in their care.” Yet, when it comes to current EoL treatments, physicians often fail to prevent or treat suffering adequately and sometimes, inadvertently, cause it as a result of treatment (Cassell).

Suffering is experienced by persons, not just bodies. “Suffering comes from challenges that threaten the intactness of the person as a complex social and psychological entity. Suffering can include physical pain but is not limited to it” (EJ Cassel). In the United States, conditions such as heart disease and cancer are the leading causes of death. Patients with these diseases often deteriorate slowly and painfully.

Medical interventions may prolong their suffering or keep them alive until they have lost their autonomy (Steck). These patients suffer both physically as a result of the illness, but also mentally and emotionally as they lose autonomy and dignity. Physicians should be able to carry out physician-assisted suicide and help patients who are suffering from a terminal illness exercise their autonomy and die with dignity.

One objection to my argument stated: I will object to your second premise on the grounds that a universal definition of human dignity (and, therefore, dying with dignity) cannot be codified into law or practice without contradicting someone’s religious or personal beliefs. My response is that this objection is valid. The term dignity has different meanings. Some of these different meanings are self-respect and the value of humankind.

Two different United States Medical organizations talk about dignity in the following ways. In an article from one organization, the Nuffield Council on Bioethics, the following comment was made, “an essential ingredient in the conception of human dignity is the presumption that one is a person whose actions, thoughts and concerns are worthy of intrinsic respect because they have been chosen, organized, and guided in a way which makes sense from a distinctively individual point of view” (Horn).

According to a second organization, the General Medical Council, “doctors respect their patient’s dignity by listening and responding to their concerns, giving patients information in an appropriate way, and by respecting their right to make their own decision” (Horn). Both of these explanations, accepted and used in healthcare, explain that dignity is self-determination and respect. Just as this definition of dignity, self-determination, and respect has been applied to medical practice in the past, it should apply to physician-assisted suicide now.

References:

1. Allmark, P. (2002). Death with Dignity. Journal of Medical Ethics, 28(4), 255–257. Retrieved February 22, 2020, from https://www.jstor.org/stable/27718927
2. American Medical Association. (2013). AMA Code of Medical Ethics’ Opinions on Care at the End of Life. American Medical Association Journal of Ethics, 15(12). Retrieved from https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-05/coet1-1312.pdf
3. Cassell, E. J. (1991). The Nature of Suffering and the Goals of Medicine (2nd ed.). Retrieved February 22, 2020, from https://books.google.com/books?id=54JAaetSPqAC&printsec=frontcover&dq=The Nature of Suffering and the Goals of Medicine Eric Cassell&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwjDx4OxhOfnAhUFC6wKHS_gD_4Q6AEwAHoECAUQAg#v=onepage&q&f=false
4. Dorff, E. N. (1999). Assisted Suicide. Journal of Law and Religion, 13(2), 263–287. Retrieved February 22, 2020, from https://www.jstor.org/stable/1051468
5. Horn, R., & Kerasidou, A. (2016, July). The Concept of Dignity and Its Use in End-of-Life Debates in England and France. Retrieved May 2, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5355899/#fn24
6. Kennedy, G. (2016). The Importance of Patient Dignity in Care at the End of Life. The Ulster Medical Journal, 85(1), 45–48. Retrieved February 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847835/
7. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979, April 18). The Belmont Report. Retrieved February 22, 2020, from https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html
8. Panicola, M. R., Belde, D. M., Slosar, J. P., & Repenshek, M. F. (2007). Health Care Ethics. Winona, MN: Christian Brothers Publications.
9. Public Health Division. (2020, February 25). Oregon Death with Dignity Act 2019 Data Summary. Retrieved May 9, 2020, from https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf
10. Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and Assisted Suicide in Selected European Countries and US States: Systematic Literature Review. Medical Care, 51(10), 938-944. Retrieved February 22, 2020, from www.jstor.org/stable/42568837