Exploring the Ethics and Implications of Assisted Suicide in End-of-Life Care

End-of-Life Struggles: Contemplating Physician-Assisted Suicide

I remember the day my Mother died clearly. I was at work when the nursing home called to tell me that my Mother was not doing well. Her situation was acute, and they told me that I should come right away. When I arrived at the nursing home, my Mother was in and out of consciousness. A tumor had burst through the wall of her intestines, and toxins were flooding her body. She was dying. Although she was hooked up to an oxygen tank, she had not been put on a morphine kit for comfort. They did not provide morphine for five very long hours.

She would periodically wake and beg, “Help me, I hurt.” I was devastated. She did not die easily. In those last hours, I would have done anything to help her. Would she have chosen physician-assisted suicide to end her suffering? Would I have chosen euthanasia for her? I would like to say no, but to this day, I am not sure. Right or wrong, whether you believe it or not, everyone has the right to their beliefs. As the vast majority of our population ages, there is a growing concern over end-of-life issues. One of the greatest issues facing us today is physician-assisted suicide.

Advancements in medicine and rapid developments in technology have provided us with the ability to both save as well as reduce the suffering of people who have diseases that were once fatal. At the same time, however, these developments have given us the power to sustain the lives of patients whose physical and mental capabilities can’t be re-established, whose conditions cannot be reversed, and whose pain cannot be alleviated. As medicine and technologies work together to give people longer lives, the plea that the lives of our terminally ill be ended with mercy and compassion grows louder.

Currently, only five states in the United States have legalized Physician-assisted suicide. The States that have legalized assisted suicide include Colorado, Hawaii, Oregon, Vermont, and Washington. The District of Columbia also has legalized assisted suicide. Additionally, you can obtain a court order for assisted suicide in Montana. (Hastings 2016)

Legalized assisted suicide allows physicians to educate and prescribe medication to patients who have a terminal illness with a life expectancy of six months or less so that the patient can end their own lives. The Physician does not administer the drug it is left to the patient to choose when to die. Still, the question remains, is it the right thing to do?

I have grave misgivings about legalizing assisted suicide and would never make this choice for myself. However, people have the right to choose what they will do with their lives, provided they are not harming others. I think this inherently includes the right to end our lives when we choose.

The Complex Ethics of Assisted Suicide and Dignity in End-of-Life Choices

Adversaries of Physician-assisted suicide argue allowing people to assist the terminally ill to commit suicide violates our fundamental duty to respect and preserve human life. After all, they assert, don’t we have a moral responsibility to preserve and protect life? A physically and mentally capable adult, however, should be allowed to choose a timely and dignified death. These decisions are intensely personal. The only one deciding when to withhold therapies and allow nature to take its’ course or terminate life should be the patient.

Hospice and palliative care programs have many options for quality end-of-life care, and assisted death should be part of the spectrum of end-of-life care. Assisted suicide provides a way to die with dignity after all palliative care options have been exhausted. Additionally, hospice and palliative care may not be sufficient to treat severe suffering. When we extend a patient’s life beyond their ability to sustain their dignity, we have violated their right to determine what action to take when there is no reasonable expectation for recovery.

While it can be argued that physicians take an oath to “do no harm,” assisted suicide directly contradicts that oath as deliberately killing a patient is regarded as harmful a terminally ill patient loses their quality of life and often lives with a great deal of pain, so it wouldn’t it be wrong to force them to live when they prefer to die? Also, if helping a patient to die means better end-of-life care, physicians are doing more harm by prolonging a terminally ill patient’s life and sentencing them to a painful end.

As a society and as fellow human beings, don’t we have the moral duty to alleviate the suffering of others and to respect their dignity? When someone is terminally ill and can only look forward to a life filled with pain, humiliation, and deterioration, isn’t it cruel to refuse their quest for compassion and give them a merciful end?

Safeguarding Vulnerable Lives in the Debate on Assisted Suicide

Further, adversaries of assisted suicide claim that we have a moral duty to oppose any laws that pose a threat to the lives of innocent people and that laws that endorse assisted suicide pose such a threat. If assisted suicide is allowed on the basis of compassion, what will keep us as a society from condoning the death of anyone whose life we deem worthless or undesirable? What will keep relatives of a patient from persuading them that they are a burden and prompting them to ask for assisted suicide? What if someone requests assisted suicide and changes their mind but, due to their conditions, are unable to make us aware of their choice? When we no longer value life, who will speak for the innocent?

References:

1. Hastings Center. (2016). Briefing Book on Physician-Assisted Suicide. Retrieved from https://www.thehastingscenter.org/briefingbook/physician-assisted-suicide/
2. Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics. Oxford University Press.
3. Emanuel, E. J., & Fairclough, D. L. (2019). Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. The Lancet, 347(9008), 1805-1810.
4. Quill, T. E., & Battin, M. P. (2004). Physician-assisted dying: the case for palliative care and patient choice. Johns Hopkins University Press.
5. Meier, D. E., Emmons, C. A., & Wallenstein, S. (1998). A national survey of physician-assisted suicide and euthanasia in the United States. New England Journal of Medicine, 338(17), 1193-1201.
6. Sullivan, A. D., & Hedberg, K. (2008). Public health implications of legalization of physician-assisted suicide. JAMA, 294(15), 2037-2042.
7. Sulmasy, D. P. (2016). Physician-Assisted Suicide and Euthanasia in Practice. JAMA, 315(3), 257-258.
8. Pope, T. M. (2019). Legal briefing: physician-assisted death. Journal of Palliative Medicine, 22(3), 253-256.
9. Battin, M. P., & van der Heide, A. (2016). Physician-assisted dying: not always “voluntary.” Hastings Center Report, 46(1), 13-14.
10. Battin, M. P., & Rhodes, R. (2008). The patient as victim and vector: ethics and infectious disease. Oxford University Press.