Making the Final Choice: Should Physician-Assisted Dying Be Legalized?
It is the purpose of this brief article to present a concise overview of the primary arguments for and against the legalization of physician-assisted suicide. Without a careful consideration of the concerns on both sides, we can find ourselves saddled with ill-conceived policies that fail to serve our best interests and will not be easily dislodged.
The astonishing thing about physician-assisted dying (or what many have called doctor-assisted suicide) is not how many states have legalized it or are debating it. Rather, it’s how few people know any arguments against it.
Unfortunately, pop culture has summed up the opposition view as essentially being a religious one, i.e. “The Bible says it is wrong.” In a secular culture such as ours, this carries little weight today for a majority of thinking people. It seems insensitive, narrow-minded and antiquated.
What if, however, there really were important arguments against widespread legalization that are not being heard? And what if the real solution to the problem were something other than for or against?
Medical advances have created ethical dilemmas which no previous generation of doctors has ever faced. New life-sustaining technologies and practices have forced physicians to ask questions that never needed to asking before. For the past three decades, foremost of these is: “How far do we go to save a life?”
Other questions challenge ethical traditions which have been in place for centuries. “When suffering is immeasurable and a patient’s condition terminal, should doctors be permitted to end a patient’s life?” “Should doctors take an active role in hastening a patient’s death?”
Today, more than ever, the push is on to “change the rules.” In the mid-1990s Dr. Jack Kevorkian, while deplored by most medical professionals for his methods, was heralded as a hero on many fronts for bringing this issue into the public square. This spring Hawaii became the seventh state to enact legislation legalizing the practice of physician assisted dying (P-A-D) and dozens of state legislatures have wrestled with the issue.
Ultimately, here’s the bottom line: When a fully conscious terminally-ill person requests death, should a physician — contrary to the Hippocratic oath — assist the person in dying?
The arguments in favor are fairly well-known and easy to grasp. They are:
l. The Mercy Argument.
This argument states that the immense pain and indignity of prolonged suffering cannot be ignored. It’s inhumane to force people to continue suffering in this way. We put our pets to sleep when they’re suffering, why not people?
2. The Patient’s Right to Self-determination.
Patient empowerment has been a trend for decades. “It’s my pain. Why can’t I get the treatment I want?”
3. The Economics Argument.
The cost of keeping people alive is exceedingly high. Who’s footing the bill for the ten thousand people being sustained in a persistent vegetative state? Aren’t we wasting precious resources when an already used up life is prolonged unnecessarily?
4. The Reality Argument.
“Let’s face it, people are already doing it.”
The combined effect of these four arguments is persuasive. And many people I talk with have been persuaded by them. They can’t imagine why it’s taken so long to make this an alternative treatment option. The need for legalized physician-assisted dying is self-evident, they conclude.
But then, as I present the arguments in opposition to these apparently self-evident truths, I invariably hear an “A-ha!” and an “Oh!” and “Well, I never considered…” So let’s briefly give attention to the reverse side of the coin.
WHEN I FIRST WROTE ABOUT ethical issues in terminal health care in the early 90s, it was with the aim of coming to a conclusion of my own. As I conducted discussions in AOL forums and added books to my library, I found a number of arguments I’d never considered. Here are the most widely cited concerns, some of which have been addressed in more recent legislation.
l. Medical doctors are not trained psychiatrists.
Many, if not most, people have wished they could die rather than face some difficult circumstance in their lives. Doctors who are given authority to grant this wish may not always recognize that the real problem is a treatable depression rather than the need to fulfill a patient’s death wish. Perhaps this post in the General Debate Forum of America Online said it best: “I know many individuals with significant disabilities: quadriplegia, post-polio survivors, persons with MS, etc. A number of them have tried committing suicide in the past and are now thankful that a mechanism wasn’t in place that would have assured their death, because they got over whatever was bothering them at the time and are happy with life again.”
2. How will P-A-D be regulated?
This is Carlos Gomez’s forceful argument, developed after investigating the Netherlands’ experience, and presented in his book Regulating Death. “How will we assure ourselves that the weak, the demented, the vulnerable, the stigmatized — those incapable of consent or dissent — will not become the unwilling objects of such a practice? No injustice,” Gomez contends, “would be greater than being put to death, innocent of crime and unable to articulate one’s interests. It is the possibility — or in my estimation, the likelihood — of such injustice occurring that most hardens my resistance for giving public sanction to euthanasia.”
3. The “Slippery Slope” Argument.
A Hemlock Society member I spoke with acknowledged this to be the strongest argument against legalization. In ethical dialogue, it is conceded that there are situations when an acceptable action should not be taken because it will lead to a course of subsequent actions that are not acceptable. Our attitudes toward the elderly, people with disabilities and the devaluation of individuals for the “higher good of society” should be reflected upon. How long will it be before our “right to die” becomes our “duty to die”?
4. The “Occasional Miracle” Argument.
Sometimes remarkable recoveries occur. Sometimes diagnoses are far afield of the reality. Countless stories could be told. I know a few first hand. How about you?
5. Utilitarian versus sacred view of life.
This is probably a subset of the Slippery Slope argument, focusing on our cultural shift in attitude toward what it means to be human. Huxley’s Brave New World vividly demonstrates an aspect of this argument. We need to be reminded of the role social engineers, doctors and geneticists played in 1930’s Germany, as well as here in the United States where the practice of forced sterilization of undesirables was legalized in 30 states, a shocking and forgotten part of our recent history with laws that remained on the books in some states until the 1960s.
Are we important only as long as we are making a contribution to society? Or is value something inherent in our being human? History has shown that when we devalue human beings, we open the door to abuse. The U.S. Supreme Court, in its Dred Scott decision, declared that blacks were not persons. This devaluation helped permit slavery and inhumane treatment of blacks to continue.
6. What effect will this have on doctor/patient trust?
People who traditionally rely on their doctors to provide guidance in their health care decisions may become confused, even alarmed, when one of the treatment options presented is a death machine or meds. According to Leon R. Kass, distinguished M.D. from the University of Chicago, the taboo against doctors killing patients, even on request, “is the very embodiment of reason and wisdom. Without it, medicine will have lost its claim to be an ethical and trustworthy profession.” Kass asserts that a “patient’s trust in the whole-hearted devotion to the patient’s best interests will be hard to sustain once doctors are licensed to kill.”
7. What about doctors who don’t believe in killing?
Will they be required by law to prescribe a treatment [death] they don’t believe in?
Those in favor of legalizing assisted dying have crafted new legislation addressing some of these problems. Minnesota’s most recent legislation, which was bottled up in committee and never reached the floor, stated that doctors who do not believe in “mercy killing” can be exempt. The Minnesota legislation also relieves doctors from having to play the role of psychiatrist to determine if the patient is of sound mind and capable of making this decision. Evaluation by a trained professional psychiatrist other than the treating physician is required.
One of the reasons people want to have the option to choose what many call “death with dignity” pertains to what some have called inferior palliative care in the U.S. An oncologist I spoke with 20 years ago was involved with a national cohort of oncologists seeking to address this issue.
According to this MD Magazine article, a study of Oregon patients requesting aid-in-dying were not primarily seeking release from suffering. They were more concerned about losing their autonomy as well as their inability to engage in enjoyable activities. A third significant matter is the loss of dignity.
One area of battle that is still ongoing has to do with language. In many circles it is still called “physician-assisted suicide.” Opponents of this language prefer “physician assisted death” in order to remove the stigma carried by the word suicide. No matter what it is called, there will be others wanting to call it something else. Within the past month I read an article about someone who wants to call it “assisted end-of-living” because words like death and dying make people uncomfortable.
Clearly, the ethical dilemmas surrounding terminal health care will be with us for years to come. There are more than seventy million baby boomers in the U.S., most of whom have already grappled with issues related to aging parents and whom are now entering their own twilight years.
Ironically, our current situation is due in large part to the successes of medical science, not its failures. More people live longer today than ever before because we have eliminated many of the diseases that once terrorized us as a society.
Some of the problem today though is due to our love affair with technology. When machines, tubes and computers take over, compassion and common sense can sometimes suffer. Fortunately, there seems to be an increased awareness of the intrusiveness of technology. Living wills, ethics committees and hospice care are all responses to this awareness.
How we choose to die in America is a complicated subject that needs clear thinking and a fair discussion of the ethical and technical dilemmas surrounding it. But let’s keep in mind that even if we decide that death technologies are wrong, this should not be an endorsement of the notion that people must be kept alive for as long as possible at any price.
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Any information in this article pertaining to legal or medical matters is not to be construed as professional advice. The author is neither a doctor or lawyer. Copyright remains the property of the author.
This article originally appear in the Senior Reporter as the final piece in a five-part report on Ethical Issues in Terminal Health Care. It was later published in the Truth Seeker (Volume 121 №5)
Recommended Eugenics Law for U.S. states.
Bad Ideas Have Bad Consequences: The U.S. Eugenics Movement
Eugenics Revisited https://pioneerproductions.blogspot.com/2010/02/eugenics-revisited.html