The history of physician-assisted suicide began to emerge since the ancient time. Historians and ancient philosophers especially had been debating over this issue. Thus, this issue is no longer new to us. However, it seems little vague because it has not yet been fully told. The historical story consists of patterns of thought, advocacy, and interpretation on whether to legalize assisted death. “Only until June, 1999, the United States Supreme Court issued decisions in two cases that claimed constitutional protection for physician-assisted suicide, Washington v. Glucksberg and Vacoo v. Quill, by a single 9-0 vote covering the case (Bartin, Rhodes, Silver, 1). They also say that this decision mark the beginning of long period debate, which will not be fully resolved (1). Hence, the debate began by professionals from different aspects, especially the physicians themselves.
“I will never give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect”. A frequent quoted portion of the Hippocratic Oath, written in Greece sometimes during the fifth to forth centuries B.C.E, represented an effort by an apparently small group of physicians to build public respectability by distancing themselves from other physicians who commit assisted suicide. It has had considerable influence in the history of Western medical society and now, once again, physician-assisted suicide has become a major ethical issue in medicine, as well as an issue that involves law and public interests. Of the various issues at the medicine issue, perhaps none has drawn as much attention as assisted suicide. This topic is being discussed with great frequency in newspaper, journals and books about whether it is really necessary and ethical to physicians to participate in this life-ending act. Proponents or advocates of physician-assisted suicide argue that each person has freedom over their own life. Persons whose quality of life is nonexistent and who are having a terminal illness should have the right to decide to seek assistance. In contrast, opponents say that physician-assisted suicide is not an acceptable practice for the physicians legally as well as morally.
This issue has become a central concern to the medical profession, legislators, philosophers, social psychologists, as well as the public. Interests in this controversial matter continue to grow increasingly whether it should be legalized. Perhaps everyone would have one’s own thought and opinion. Nevertheless, assisted death is never a proper expression of compassion. It shows no care for the patients. Besides, it would be inhuman to assist other people to die. We should instead help the ill patient to recognize his self-worth and learn to cope with his problems, not to assist them in taking their lives.
1. Ethical Assessment – Right to die or to live?
Do people have the right to choose how to die? There is unquestionable growing support for permitting doctors to aid patients who wish to hasten their death. Physician-assisted suicide focuses the issue on the right of patients experiencing intolerably suffering to make free decision to end their lives. To propose physician-assisted suicide, Russell writes that many patients will go on suffering in great distress unless their lives are taken away (34). To them, everyone should have the right to request aid in dying if they find that their lives are no longer worth living. Other proponents argue that, in certain circumstances, “it is morally permissible and ought to be legally permissible, for physicians to provide the knowledge by which a patient can take her own life” (Dworkin, 3). Basically, the proponents consider two kinds of reasons for supporting this act. The first reason is that of freedom and the second has little to do with choice, but instead, death is to be given if the patients will suffer forever.
There are countless numbers of hopelessly ill or incapacitated people in hospitals, nursing home, homes for the aged, and institutions for the insane and mentally defective for whom life is nothing but a tragic burden. For those who have never visited such institutions, it is difficult to realize the human tragedy that exists there. No matter how much money is spent to improve their care and living conditions, many are doomed to utter despair year after year. Others equally incapable of any satisfaction in living wait in their homes longing for death, often at the cost of the health and happiness of the person who must care for them. (Russell, 36)
“American should think again before pressing ahead with the legalization of physician-assisted suicide” (Emanuel, 73). Opponents feel that physician-assisted suicide is not an acceptable practice for physician as such action is illegal in most places around the world. Although we will face mortality one day, there is no guarantee that our own death will be of our liking. Opponents also argue that under no circumstance should physicians use their medical skills to aid a patient’s death. “It is not within the power of medicine and probably never will be – to master life and death and to control nature” (Collahan, 85).
2. The physician Roles.
We all understand that the group who is designated to carry out assisted suicide falls on physicians. According to Margaret A. Drickamer, support for the participation of physicians in the suicide of terminally ill patients is increasing (146). Proponents claim that if the patients themselves request death due to incurable disease and suffering, the doctor is not killing but doing his duty to relieve patients’ suffering. Kamm argues in his article that, “We may permissibly cause death as a side effect if it relieves pain because sometimes death is a lesser evil and pain relief a greater good” (2). A doctor, he assumes, has a duty to relieve suffering. Nevertheless, physicians should make an initial assessment of their patients’ situation, whether they should be assisted to death, or they are still curable. As Jamison says:
To me, assisted suicide is one of the most intimate acts I can imagine. If I were thinking about helping a patient to die, I would certainly need to know how he lived, the kind of life he had. I ‘d probably have to know him well, meet his family, have dinner with him, and know the designs on his dinnerware. And even then this might not be enough. (85)
Therefore, the physicians should not aid the patients to death without first assessing their situations. Instead, they should treat them with appropriate medication and counseling until they decide to leave.
However, we all also understand that the physicians’ responsibility is to seek treatment alternatives to help patients from suffering and dying, but not to aid them to die. As Byok states: “the focus of the present argument will be that as a matter of public and professional policy, physician-assisted suicide should be rejected as a sanctioned practice” (108). Some people will say that the doctor who intends the death of his patients is actually killing. For giving a lethal injection of morphine to relieve suffering also involves killing. It changes the physicians’ role as a healer. Therefore, it is believed that assisting in death is committing sin.
3. The Religion’s perspective
Most people in a society may have religions conviction, and those beliefs are sometimes reflected in the positions those individuals adopt. We should know that religion attitudes come into play in our society’s conflict. Thus, we can expect that religions will offer perspective on physician-assisted suicide. Generally, the religions will advise against on individual seeking suicide for whatever reason. “Life is a gift from god and that each individual is its steward.”(18). Thus only God can start a life, and only God are allowed to end one. Some of them also claim that God doesn’t send us anything that we cannot handle, but supports people in suffering. To them, actively seek an end to one’s life would represent a lack of trust in God’s promise.
As Ronald Dworkin, a catholic, noted in commentary on the oral argument before Supreme Court in the physician-assisted suicide cases:
One justice suggested that a patient who insists that life support be disconnected is not committing suicide. That’s wrong: he is committing if he aims at death, as most such patients do. Just as someone whose wrist is cut in an accident is committing suicide if he refuses to try to stop the bleeding. (42)
This thesis is correct in the sense that, killing is seen as morally wrong, that all of us cannot withdraw our own life. Nevertheless, there is a significant and growing percentage of religions groups in North America who do not accept these argument, They, in contrast, argue that death can represent a result of intolerable suffering if a terminal illness has become an unbearable burden. In other words, these groups tend to be more in favor of choice.
A 1992 statement on end-of-life matters from the ELCA church council supports passive assisted suicide by stating that:” Health care professionals are not required to use all available medical treatment in all circumstances medical treatment may be limited in some instances, and death allowed to occur”. “deliberately destroying life created in the image of God is contrary to our Christian Conscience, However, they acknowledge that physician “struggle to choose the lesser evil” in some situations. e.g. when pain is so severe” that life is indistinguishable from torture”(ELCA, 26).
To conclude this, it is said that the physician should try their best and provide the patients with every reasonable opportunity to discuss their concerns about their illnesses and treatment, their fears and thought about death and dying. Next, we will discuss about the impact of legalization of physician-assisted suicide.
4) Impact of legalization.
According to Ben Klayman, The U.S. supreme court ruled in June 1977 that people did not have the constitutional right to suicide or dying, but left the question of whether to outlaw physician-assisted suicide to the individual stated (1). Until now, Oregon is the only state that has approved physician-assisted suicide and 15 people took this option last year. However, Klayman acknowledges that, a class-action federal lawsuit was filed in Detroit on March 1999 that, if successful, would establish a federally protected constitutional right to be free from unbearable suffering due to limited medical condition (2). Clearly, this right would allow physician-assisted suicide and protect doctors from prosecution.
The case for legalizing physician-assisted suicide rests on two well-known arguments – argument from those who are against it and argument from right-to-die supports. The argument from the opponents claim that there is a conflict between assisting a suicide and the professional ethic of physicians (Marquis, 267) What this argument means is that legalizing physician-assisted suicide will make the physicians’ role ambiguous. However, professional codes are subject to change. Beside, theorists of natural law states that assisted death break the law of nature. If physician-assisted suicide is legalized, Marquis writes that, “patients who experience hopelessness, or anxiety, or who are fearful of the loss of dignity, or who are depressed, no matter how unbearable his illness, will ask for and obtain the assistance of their physicians in committing suicide” (269). He regards this claim as showing that physician-assisted suicide should not be legalized.
In contract, the proponent support legalization of physician-assisted suicide by arguing as follow:” What makes a condition a misfortune for a patient when she is a candidate for physician-assisted suicide is that the condition involves suffering. The cause or the nature of the suffering,” Marguis writes,” is morally irrelevant (269).
However, Vellemen made another argument that the legalization of physician-assisted suicide would be harmful to the incompetent patients (670). As they are unable to make their own decision and thus their lives will depend on a third party, it could be the patient’s guardians or friends. Thus, if direct killing is legalized, someone who is not competent could be killed at the direction of that person’s guardian even though the incompetent patient had never expressed a desire to die. This happens to those who were minorities, poor, or uneducated, they would be more likely to be forced to choose physician-assisted suicide because of their financial impact of their illnesses. As a result, physician-assisted suicide brings more bad impact to our society as well as to ourselves.
5. Legalized physician-assisted suicide in Oregon: The first year’s experience.
Currently, Oregon is the only place in the world where physician-assisted suicide is legal. Physician-assisted suicide is thus unique to Oregon. It is reported that of the twenty-three patients who participated in the Death with Dignity Act. In 1998, fifteen died after taking their lethal medications. This actually represented a relatively small number of patients in Oregon. This limits the Oregon Health Division (OHO) the ability to detect the differences between the patients who chose physician-assisted suicide. However, several findings and data have been collected on 1998 participants in this Death with Dignity Act. Among them are:
1. Physician-assisted suicide accounted for approximately 5% every 10000 death in Oregon.
2. Patients who choose physician-assisted suicide were not as poor, less educated lacking of access to hospital care as some people suggested.
3. Financial impacts of the patient’s illnesses were not the factors of them choosing physician-assisted suicide.
4. The choice of physician-assisted suicide was most strongly because of the patients concerns about the loss of freedom.
5. Many hospitals and physicians in Oregon were unable to participate in physician-assisted suicide represented a wide range of specialties, ages and experiences.
These have been summarized from O.H.O 1998 annual report on physician-assisted suicide.
We also find that the average operation of the prescription patients was 69 years and 52% were male also, these patients had a psychological consultation before they could decide to choose to die, and all physician were in full compliance with the law.
As a result, it is clear that the death with dignity had become a focal point for debate, and some people will remain as a neutral party. However, this Oregon’s Death Dignity Act may play an important role in the legalization of physician-assisted suicide in the future.
The demand for assisted suicide has increased since the past decades. Theoretically, the act of helping other people to die violates the law of nature. It changes the nature of medical practice and the physicians’ role as well as the relationship between the physicians and the patients. Therefore, legalization of physician-assisted suicide shows no conscience of the physicians as well as value of human life. It is hopeful that the care of the dying will improve and thus eliminating the chance for assisted suicide. Instead of aiding then to die, the physicians should pay more attention and medical care to the patients. They should try their best to heal, or at lest to care, but not to neglect or disappoint the patients.
From this perspective, I continue to find great and needless risks in moving toward legalizing physician-assisted suicide. Such measure will not deal in any way adequately with the needs of most patients at the end of life. There is still a long way to go before we arrive at a social resolution of this controversial issue.