Physician Assisted Suicide Thesis Statement

In the world today there are arguments for everything, ranging from matters of great importance to things that may seem ridiculously trivial. However, there are always different sides to every case and right and wrong is in the eyes of the person involved in the dispute.

This argumentative essay is based upon a very serious situation that faces our medical community. The topic of assisted suicide and/or euthanasia is a highly debated subject with many issues and sides. In this essay, each topic will be discussed and analyzed and the arguments for and against this topic will be debated. I will discuss my reasons for advocating physician-assisted suicide and I will also provide objections to my argument, but even though these counter arguments have merit, I will provide enough evidence to support my thesis.

The topic of my paper is physician-assisted suicide. Sometimes it is incorrectly referred to as euthanasia, but however subtle, there is a difference between the two. Euthanasia is when the doctor provides the means with which the patient may end his own life whereas physician-assisted suicide is when the doctor causes the patient's death, for example through a lethal dose. In his own words, the infamous Dr. Jack Kevorkian describes the difference between euthanasia and his own profession: "It's like giving someone a loaded gun. The patient pulls the trigger, not the doctor. If the doctor sets up the needle and syringe but lets the patient pull the plunger, that is assisted suicide. If the doctor pushed the plunger, it would be euthanasia." (McCuen 1994 p.54)

Both euthanasia and physician-assisted suicide will be discussed in this paper as they pertain to the arguments for and against this subject.

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There are many arguments for both sides of this case. In this part of the essay I will discuss the argument against assisted suicide. The Bible reads, "Thou shall not kill". The American Nursing Association (ANA) position statement reads, " A nurse must not act deliberately to end a person's life." These are two of the very basic arguments against euthanasia. However, the subject is much more complex than these two defining pieces of literature suggest - there are many reasons why it is morally wrong and unethical to take a patients life away, even though they may have requested it.

The religious argument is one of the strongest and most powerful opponents to assisted suicide. It is based on two main points, the first defining the sanctity of life. "All life, but particularly human life, is recognized as a direct gift from God, one that never becomes personal property. It is ours not to give away, to damage, or to destroy at will, but to preserve intact until the moment when it is taken back" (McKhann, 1999, p.

63). The second point is entrenched in the Christian belief that suffering can be beneficial in its own right. Suffering should be looked at as a positive thing when it is unable to be avoided because it means the entry to something good. "An extension of this thinking is that suffering is a result of guilt that leads to repentance. The greater the suffering, the greater the guilt, hence the greater the need for repentance" (McKhann,

1999, p. 63).

Besides the religious case against physician-assisted suicide, another argument would be that it violates medical ethics. The American Nurses Association (ANA) position statement reads, "A nurse must not act deliberately to end a person's life" (Sullivan, 1999, p. 31). The Hippocratic oath also states; "I will give no deadly medicine

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to anyone if asked, nor suggest any such counsel" (Woodman, 1998, p. 162). Taken from two of the most prestigious and important documents in the medical field, these statements strictly forbid the taking of a patient's life or aiding a patient in his or her death.

One of the most important things in health care is the relationship between the health care worker and a patient because it is the health care worker's job to provide not only medical care but also support, hope and a caring relationship.

If a patient were distressed enough to bring up

the subject and the physician were to agree that

the choice is a rational one and that assisted

suicide is a reasonable alternative, would this

not reinforce the patient's feelings of despair

and worthlessness? Even a suggestion of

agreement might undermine any remaining hope.

McKhann, 1999, p. 150

The last argument against assisted suicide that I am going to deal with is the patient's state of mind. When making any important decision in life, one must give it plenty of thought and be completely unbiased. When something tragic has happened to make one consider death, their state of mind must come into question. Are they considering death for the 'right' reasons? If a physician assisted death is to be considered, a patient must be considered mentally competent. There are many issues that interfere with a patient's mental capacity to make such a drastic decision. The patient may be temporarily depressed or may undergo a change of mind. Patients should be given

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sufficient time and counselling in order to enable them to make sure their decision represents their true wishes.

Guilt is another reason a patient's state of mind may come into question.

Patients might feel guilty for staying alive and choose death to lift the financial burden or the strain on loved ones. Desperate and emotionally exhausted, families may give up too quickly and eagerly lend their support to the termination of a relative's misery, as well as their own.

In the preceding paragraphs an extremely convincing argument has been made

against assisted suicide. After all, it violates personal and medical ethics and it undermines the relationship of patients with their health care workers. Besides, what happens if a miracle cure is found after the patient has already made the decision for assisted suicide and gone through with it? Once suicide has been committed it is irreversible. What's done is done and there is no changing it.

If the Hippocratic Oath and the ANA states that it is wrong, and the ever influential Bible argues against assisted suicide, then who are we to question it? Instead of trying to help end patients' lives, people and physicians would be better served by improving all patients' state of life and mind so that they can live out their last days free from pain and enable them to gain a sense of spiritual fulfillment.

As mentioned in my thesis statement, I support assisted suicide. I want

to make a cautious argument because I believe that under some carefully limited circumstances, it is permissible for a physician to assist a person in taking his or her own life in order to put an end to unwanted and unnecessary suffering. This includes

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providing medicines or other means the patient can use to commit suicide or by directly administering these medicines themselves.

As stated earlier in the religious argument against assisted suicide, life is a gift. However, in a time of suffering "the gift may no longer be wanted and the loan gladly repaid" (McKhann, 1999, p. 63). If it is God's place to give and take away life, then an implication of that objection is that we should not interfere at all with any life threatening condition because it is God's will. After all, what would happen if a person is bleeding to death from an accidental cut? To interfere and help would mean to interfere with God's prerogative to determine time and place of death.

The religious argument is also flawed for two other reasons. What if a

person has no faith or what if that person's faith suggests something different? With so many religions in the world, there are bound to be conflicting views on almost everything including suicide. The second reason is challenged "by those who do share the faith when the suffering seems out of proportion to any possible spiritual benefit. Even the most devout Christian will ask, "what have I done to deserve so much pain?" (McKhann,1999, p. 64). The religious argument against assisted suicide is quite strong but if one were to take a closer look, large holes in this argument can be blatantly seen.

It is true that the physician-patient relationship is important. However, I feel that a patient's trust would not be undermined with the implement of assisted suicide. I would want to be able to trust my doctor to do what is best for me in every situation. If my life has become so unbearable that I feel I need to end my life, I would want my

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doctor to help me die a painless, peaceful death and not one racked with pain and misery. I would want to trust that my physician will respect my every wish.

Dr. Charles F. McKhann concludes, " most patients interviewed in my study felt that knowledge that their physicians had helped others to die would either have no effect or would enhance their respect for their physicians" (McKhann, 1999, p. 150). The role of the physician is to do what is best for the patient, and in some extreme situations this may include hastening death upon the voluntary request of the dying. If the role of the physician is defined solely in terms of healing, then, of course, this excludes assisting someone to die, but this is the wrong way to go about defining a doctor's role. I feel that a doctor's role is to do the best thing for the patient, whatever the circumstances may be. In nearly every case the answer will be to heal, to prolong life, to reduce suffering, to restore health and physical well-being. However, in some extreme circumstances, the best service a physician can render may be to help a person end their life in order to end intolerable pain as judged by the patient. This would be an enlargement of the physician's role, not a contradiction to it. Sometimes ending suffering takes priority over extending life.

I feel the most powerful argument comes from the families of those who have witnessed loved ones die in extreme agony, helplessly watching as they slowly and painfully deteriorate in front of their eyes, their bodies ravaged by pain and suffering. Meanwhile, the medical profession has done all it can to help but has failed to ease the suffering. I feel in these extreme cases that assisted suicide would provide a way for patients to end both their suffering and the suffering of their loved ones who are forced to

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sit by, helpless and powerless to do anything.

It seems unfair that after living their whole lives independently, making important decisions everyday, that a person is required to leave much of the responsibility of their death and dying to someone else. Given the chose, most people would want to live to old age, accomplishing what they could along the way, then die a peaceful, satisfying death. That is not always the case. A persons life can be marred by severe disability, incurable disease and may come to a conclusion with a slow, painful, agonizing death.

After taking into account the arguments presented in this essay, I feel there is only one conclusion to draw. Assisted suicide is an idea that needs to be explored further and given serious consideration. If assisted suicide and/or euthanasia is to be legalized than very strict regulations would have to be used to insure that it would only be used as a last resort after all other options had been exhausted. If the patient is so overcome with pain and suffering then it is best that they should be given the option to end their suffering. The job of the people in the medical field is to do what is best for the patient and sometimes ending the suffering is the best option.

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References

McCuen, G.E. (1994). Doctor Assisted Suicide and the Euthanasia Movement. New York: Gary E. McCuen Publications Inc.

McKhann, C.F.(1999). A Time to Die: The Place for Physical Assistance. Connecticut: Yale University Press.

Sullivan, M. (1999). Are We Prolonging Life or Extending Death?, 30(3), 31-33

Weir, R.F. (1997). Physician-Assisted Suicide. Indiana: Indiana University Press

Woodman, S. (1998). Last Rights: The Struggle Over the Right to Die. New York: Plenum Publishing.

Howard Ball’s lead essay on this issue is clear and helpful. Yet I think the term “Physician Assisted Death” is evasive and euphemistic. Physicians have for centuries helped patients to die—that is, to endure the process that ends in their death. The question is whether physicians should help them kill themselves—and whether the law should allow physicians to do so. Thus I will use the term Physician Assisted Suicide (PAS). This raises a moral question (Is PAS morally right?), and a legal question (Should PAS be against the law?).

First the moral issue. Morality centrally concerns how our choices bear on the intrinsic goods of human persons—such goods as life and health, knowledge, friendship, and others. We ought to care for every person, and that means helping them to attain or preserve these intrinsic goods. Since these goods are the aspects of persons, to act directly against any of them is to act against the person herself. Human life is not something we have; rather, one’s life is identical with one’s concrete reality, that is, identical with oneself. So, a choice to kill a human being, even for a good end, such as to prevent suffering, is contrary to the love and appreciation for the person herself. This is true both of killing others and of killing oneself. Suicide and assisting suicide are objectively morally wrong because they are choices contrary to the intrinsic good of an innocent human person. (I say objectively morally wrong, to distinguish that from moral guilt: someone who makes a choice that is objectively wrong is not at fault for a morally bad choice if she thought what she was doing was right and was not at fault for this mistaken judgment—often referred to as an inculpably erroneous conscience.)

This does not mean, however, that we must always take all measures possible to preserve someone’s life, our own included. It can be morally right to forgo some means of preserving life, even foreseeing that this will result in dying more quickly than one otherwise would. Such a choice is quite distinct from intentional killing—say, choosing to kill oneself by swallowing lethal pills. A choice to forgo excessively burdensome treatment does not involve a failure of respect for the intrinsic good of life. Rather, it is a choice not to use certain means of prolonging life in order to avoid the burdens of that treatment.

This distinction between intentional killing and accepting death as a side effect is important because by our choices we not only select which external behavior will be performed, but we direct our will (the capacity for choosing and intending) toward or against human persons. If I choose to kill someone, then I direct my will against the life—the concrete reality—of a human person.

Some hold that human life is only an instrumental good—not good in itself but only a condition for realizing what is intrinsically valuable. And so they claim that near the end of life our “mere biological life” may be all that is left, and our personal life—our selves—is gone. But that is a mistake: we do not just have or inhabit bodies; rather, we are bodily beings. As I type this sentence I am directly aware that it is the same agent that moves his fingers (a bodily being) and that thinks what to say (a conscious being): it is one and the same being that is both conscious and bodily. And so one cannot justify euthanasia or PAS on the grounds that they destroy a “mere biological life.” To choose to kill the biological life of grandfather is a choice to destroy the one being that grandfather is. (This remains true even though grandfather’s soul—which is only a part of him—survives).

But, it is often objected, why should we not be able to relieve someone’s misery by helping her to die? Isn’t it the compassionate thing to do—as Howard Ball claims—to assist them to kill themselves? We should distinguish between the person who is suffering, and the suffering. When someone we love is suffering grievously we have a strong emotional response. However, what we are reacting to with emotional repugnance is, precisely, the suffering itself of someone who is dying, in severe pain, and gradually losing their vigor and faculties. But it is a different thing altogether to assert that, given that emotion, the best way to act—the best way of helping someone who is suffering a great deal—is to help her kill herself. We rightly abhor the pain and suffering, but not the person herself in that condition. It is right to try to remove the pain and suffering; it is not right intentionally to destroy the person, as a means of removing that pain and suffering.

The moral issue does not by itself settle the legal issue, to which I now turn. Proponents of PAS argue that people’s autonomy should be respected and so the law should allow PAS. It is true that a large degree of autonomy, that is, the absence of restraint on one’s choices and actions, is important as a means to leading a responsible life. But both law and medical practice recognize rightful limits to autonomy. The law requires drivers to wear seatbelts and motorcyclists to wear helmets. There are laws against prostitution, dueling, and the use of certain addictive drugs. All laws limit liberty or autonomy to some extent; the question is whether there is a sufficient public good at stake to limit the liberty at issue.

The protection of life has always been recognized as an essential component of the public good. Especially important is how the culture as a whole—which is profoundly influenced by the law—regards human life. If a culture regards human life as inviolable, that fact protects all of us; if not, then the most vulnerable among us—especially the elderly and the disabled—are in danger. A culture that condones PAS views life as merely conditionally valuable and so views the lives of many of the most vulnerable among us as mere burdens. The elderly, the dying, and the disabled in that type of culture will receive treatment far inferior to what they would receive in a culture that recognized their equal and inherent dignity.

Consider the laws that prohibit physicians from amputating healthy limbs or performing female genital mutilation. If laws prohibiting those procedures were rescinded and those acts became widespread, the message would be sent that these practices are not inherently harmful. Such laws are in place because physicians should perform surgery only to provide a real medical (or cosmetic) benefit to the patient—or at least not significantly harm the patient. In the same way, if the law against PAS were rescinded and PAS were widely practiced, that would send the message that in many cases a person’s life is simply not worth living. The message sent to the elderly and the disabled would be that they may very well lack inherent value. That itself would be a pressure—and not a very subtle one—on the elderly, and on many disabled, to opt for death rather than life. A person’s sense of self-worth is profoundly affected by the views of others in her life and so the sense of self-worth among the elderly, dying, and disabled would be profoundly harmed by the practice of PAS, leading many to despair and to request suicide out of undue deference to others.

Moreover, the logic of decriminalizing PAS for the terminally ill who are suffering grievously would lead inexorably to allowing (and encouraging) other types of killing. If the rationale for PAS is to respect autonomy, then why limit it to those are terminally ill? Why privilege the autonomy of those who are suffering and terminally ill above those who are suffering chronically? If the rationale for PAS is that a person is in misery or has allegedly lost her dignity—if, for such people, death is a benefit—then it will be impossible to deny this alleged benefit to those who lack decisionmaking capacity, those who are unconscious, or demented, or too young to have such capacity (as has occurred in the Netherlands with the open euthanasia of infants).

Thus, out of respect for life, and out of compassion and care for the elderly, dying, and disabled, PAS should remain illegal.

Also from this issue

Lead Essay

  • Physician Assisted Death in America: Ethics, Law, and Policy Conflicts by Howard Ball

    Howard Ball reviews the recent history of physician-assisted death (PAD) in America. He argues that it is a fairly direct outgrowth of other trends in our society, including the medicalization of death, the movement toward palliative end-of-life care, and the longstanding concern for individual autonomy that has characterized American legal and political thinking. Social values evolve, and he argues that allowing physicians to assist patients in dying will eventually come to be an accepted value as well, as a matter of compassion for those who are suffering.

Response Essays

  • The Decriminalization, and Medicalization, of Suicide by Philip Nitschke

    Philip Nitschke looks back at the Baby Boom generation. All through their lives, they have broken the mold, in women’s rights, contraception, divorce, and many other areas. Now, as they approach retirement and the end of life, they are again breaking the mold. Death isn’t what it used to be, and a long, drawn-out, medicalized death may not be to everyone’s liking. Yet the law has often lagged behind, and one might even question, with Nitschke: Why do we need law, or physicians, in deliberately ending our own lives?

  • Say No to Physician Assisted Suicide by Patrick Lee

    Patrick Lee urges us to observe the difference between committing suicide and foregoing burdensome treatment. Committing or assisting a suicide both disrespect the intrinsic good of human life and are objectively morally wrong. We rightly abhor pain and suffering, but this sentiment should not lead us to attack the person who is experiencing the pain and suffering. If we do, the lives of the elderly and disabled throughout our society will be devalued, with grave consequences for all.

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