Physician-assisted suicide (PAS) oreuthanasia is an intense topic in the healthcare field today. Is it morally permissible to allow aterminally ill person to choose when it is their time to die? According to the Ethical and ReligiousDirectives for Catholic Health Care Services, “euthanasia is an action oromission that of itself or by intention causes death in order to alleviatesuffering.
“1 Unconvincing arguments have been presented infavor of allowing a terminally ill person to choose when and how they wouldlike to die. A common argument is thatletting the patient choose is allowing them to die with dignity; however, withoutargument PAS and euthanasia, no matter the circumstances, is morally wrong andshould never be permitted to occur. Euthanasia and PAS are immoral and represent a serious failure of thehealthcare system and corruption of the mission of the physician. PASdates back to the Fifth Century B.C.2 From the latest date that is recorded forthis event until now, one thing is for certain…PAS has been controversial andwill remain so in the future. Earlyrecords suggest that groups such as the ancient Greeks and Romans supported theconcept of PAS.3By the Twelfth Century the views of Christianity begun to be more widespread; theseviews helped to reinforce the Hippocratic Oath, which did not allow euthanasia.
4 Atthat time, PAS and euthanasia begun to be frowned upon. Fast forward to thefuture and the most notable modern physician who supported PAS and broughtnational attention to the subject was Dr. Jack Kevorkian. PAS was thrust into the national spotlightwhen Dr. Kevorkian euthanized a man with Lou Gehrig’s disease on nationaltelevision.
5 In 1999, Dr. Kevorkian was convicted ofsecond-degree murder and sentenced to jail for ten to twenty-five years.6 Dr.
Kevorkian admitted to assisting over 130people commit suicide.7 Another recentcontroversial headline surrounding PAS was the twenty-nine year old, BrittanyMaynard. Brittany was a young womandiagnosed with terminal brain cancer who resided in California.
California law,at that time, did not allow PAS or euthanasia. Therefore, Brittany chose to move from California to Oregon so that shecould choose when to end her own life. In1997, Oregon enacted the Death with Dignity Act. The Death with Dignity Act allows “an adultwho is capable, is a resident of Oregon, and has been determined by theattending physician and consulting physician to be suffering from a terminaldisease, and who has voluntarily expressed his or her wish to die, may make awritten request for medication for the purpose of ending his or her life in a humaneand dignified manner.”8 As expected, Brittany’s decision garnerednational attention from the media since Britney publically announced when shewould end her own life. Unfortunately, Britney Maynard did fulfill her promiseto end her own life on November1, 2014.9 Notably after Britney’s death, California didsign into law in November 2015 the End of Life Option Act, which is similar toOregon’s Death with Dignity Act.
10 Allowing PAS oreuthanasia sets a societal norm that suicide is acceptable. On separateoccasions, the Supreme Court has unanimously ruled that there is noconstitutional right to PAS; however, there are states that allow PAS bystatute.11 The states that currently allow PAS oreuthanasia are California, Colorado, Montana, Oregon, Vermont, Washington, andWashington DC.
12Clearly, the concept of PAS and euthanasia are becoming a more widespread trendacross the healthcare system and in legislation across the United States. Onceeuthanasia is considered acceptable for the terminally ill, who is to say thatthis would not extend to other groups (i.e. blind, deaf, mentallychallenged)? Permitting and/ortolerating PAS and euthanasia to occur demoralizes human worth and sends amessage to society that human life is not respected or valued. Itcan be argued that most individuals who seek physician-assisted suicide oreuthanasia suffer from a mental illness, physical illness, or simplyloneliness.13 Dr.
Herbert Hendin, Professor of Psychiatryand Behavioral Services at New York Medical College notes:Mental illnessraises the suicide risk even more than physical illness. Nearly 95 percent of those who killthemselves have been shown to have a diagnosable psychiatric illness in themonths preceding suicide. The majoritysuffer from depression that can be treated. This is particularly true of those over fifty, who are more prone thanyounger victims to take their lives during the type of acute depressive episodethat responds most effectively to treatment.
14 When patients express concern to endtheir lives, more compassionate care should be expressed upon thesepatients. These patients should undergoextensive therapy to help establish the reasoning behind their choice. Educationto healthcare workers on how to recognize signs of mental illness andloneliness in chronically ill patients would help reduce the feelings byallowing these individuals to seek help before they reach the point of wantingto end their own lives. Dr. Hendin and Dr. Foley, Professor of Neurology atCornell University’s medical school and attending neurologist, pain andpalliative care services, at Sloan-Kettering Cancer Center, found in their manydecades of professional practice that that when patients who ask for PAS “aretreated by a physician who can hear their desperation, understand theambivalence that most feel about their request, treat their depression, andrelieve their suffering, their wish to die usually disappears.15Insteadof providing the option of PAS to these patients, we should offer more humaneoptions that align with the Church’s beliefs. The Ethical and ReligiousDirectives for Catholic Health Care Services states that, “Dying patientswho request euthanasia should receive loving care, psychological and spiritual supportand appropriate remedies for pain and other symptoms so that they can live withdignity until the time of natural death.
“16 PAS and euthanasia willaffect the physician-patient relationship. Physicians are trained to treat and cure. Allowing a physician to determine whether aperson’s life has quality is permitting the physician to ultimately play God. In the end, this will affect the relationshipbetween the physician and the patient.
The patient will start to question the motives of the physician. Allowing PAS and euthanasia in the healthcaresetting is a slippery slope of troubles involving the physician-patientrelationship for fear that the physician will encourage or facilitate theirdeath. Legal philosopher, Jon Finnis, stages how PAS could change a patient’sbehavior:A new zone ofsilence. Can I safely speak to myphysician about the full extent of my sufferings, about my fears, about myoccasional or regular wish to be free from my burdens? Will my words be heard as a plea to bekilled? As a tacit permission? And whydoes my physician need my permission, my request?17 This mistrust willaffect adversely affect the relationship.
Physicians are unable to heal by assistingpatients to kill themselves or by killing them. The American Medical Association (AMA) code of ethics does not allowPAS. The AMA states: “Physician-assisted suicide is fundamentally incompatible withthe physician’s role as healer.”18 In the Backgrounder,Ryan Anderson, PhD writes:Introducing PASchanges the culture in which medicine is practiced.
It corrupts the profession of medicine bypermitting the tools of healing to be used as techniques for killing. It also distorts the doctor-patientrelationship by reducing patients’ trust of doctors and doctors’ undividedcommitment to the healing of their patients. Physician-assisted suicide also creates perverse incentives forinsurance providers and the financing of health care.19 Inaddition to the AMA opposing PAS, physicians take a Hippocratic Oath to “do noharm.” The Hippocratic Oath was revisedin 1964 by Dr.
Louis Lasagna, a physician at Johns Hopkins University. In the modern revision of the HippocraticOath, it specifically addresses euthanasia by stating: “…it may…be within mypower to take a life; this awesome responsibility must be faced with greathumbleness and awareness of own frailty. Above all, I must not play God.”20 If a physician writes a patient a lethal doseof a medication to help facilitate the end of life, the physician is, in fact,playing God and breaking the very oath they took. Dr. Leon Kass states:We must care forthe dying, not make them dead.
Byaccepting morality yet knowing that we will not kill, doctors can focus onenhancing the lives of those who are dying, with relief of pain and discomfort,moral and social support, and, when appropriate, the removal of technicalinterventions that are merely useless or degrading additions to the burdens ofdying.21 Physician responsibilityappears to be clear… to do no harm. Then what responsibility does the patienthave? The patient has a moral obligationto preserve their own life. The Ethical and Religious Directives forCatholic Health Care Services states that:We are not theowners of our lives and, hence, do not have absolute power over life. We have a duty to preserve our life and touse it for the glory of God, but the duty to preserve life is not absolute, forwe may reject life-prolonging procedures that are insufficiently beneficial orexcessively burdensome. Suicide andeuthanasia are never morally acceptable options.22 The patient has a moralobligation to comply with the Church’s teachings and beliefs.
Patients should be permitted to die adignified death by offering them spiritual, emotional, and physical support;such as, palliative care or hospice. Forexample, it is permissible for a terminally ill person to request to be madecomfortable by means of pain medication; as long as the dose was not lethal. Wecould use the double effect principle in this example.Theact itself must be good – The act in this example would be to alleviate painand suffering.Oneonly intends the good – The intention in this example would be alleviate painand suffering and not to harm the patient. Therefore, increasing the dose to free a patient from suffering would beacceptable.Theevil is never the means to the good – The pain medication is being used totreat pain and suffering and not to help commit suicide.Thereis a proportionately grave reason for the act – The patient will be free ofpain and suffering.
In addition to thedouble effect principle, the Ethical andReligious Directives for Catholic Health Care Services, Directive 61 statesthat:Patients shouldbe kept as free of pain as possible so that they may die comfortably and withdignity, and in the place where they wish to die. Since a person has the right to prepare forhis or her death while fully conscious, he or she should not be deprived ofconsciousness without a compelling reason. Medicines capable of alleviating or suppressing pain may be given to adying person, even if this therapy may indirectly shorten the person’s life solong as the intent is not to hasten death. Patients experiencing suffering that cannot be alleviated should behelped to appreciate the Christian understanding of redemptive suffering.23 As referenced above,the Church wants to help patients die a dignified death.
Given the proper education and guidance fromhealth care professionals, patients can be guided towards more support to helpduring the difficult transition towards end-of-life. Dr. Aaron Kheriaty,Associate Professor of Pscyhiatry at U.C. Irvine School of Medcine notes:Suicidal individualstypically do not want to die; they want to escape what they perceive asintolerable suffering.
When comfort or relief is offered, in the form ofmore-adequate treatment for depression, better pain management, ormore-comprehensive palliative care, the desire for suicide wanes.24 People seek PAS fordifferent reasons. “In Oregon HealthAuthority research, 91 percent of those who were assisted with suicide cited lossof autonomy as their motivation to end their lives, and 71 percent cited lossof dignity as their motivation. Only 31percent cited inadequate pain control.”25 Helping to provide resources for thesepatients will decrease the need to pursue PAS. In conclusion, PAS andeuthanasia is immoral and should never be permissible under anycircumstances. Allowing physicians todetermine human worth, places the health care system at a disadvantage bycorrupting relationships between patients and physicians. It impresses upon physicians the right todetermine whether a life is no longer worth living.
Patients, also, have a responsibility touphold when preserving the dignity of their life. They should seek alternative options to PASand acknowledge the immorality of the act. Victoria Reggie Kennedy summed up PAS best:My late husbandSen.
Edward Kennedy called quality, affordable health care for all the cause ofhis life. PAS turns his vision of health care for all on its head by askingus to endorse patient suicide-not patient care-as our public policy for dealingwith pain and the financial burdens of care at the end of life. We’re better than that. We should expand palliative care, painmanagement, nursing care and hospice, not trade the dignity and life of a humanbeing for the bottom line.26 1 Ethicaland religious directives for Catholic health care services, Directive 60(Washington, D.C.: United States Conference of Catholic Bishops, 2017), pp.
27.2 http://euthanasia.procon.org/view.timeline.php?timelineID=0000223Ibid4Ibid5 http://euthanasia.
org/view.resource.php?resourceID=000132 9 https://www.theatlantic.com/heatlh/archive/2014/11/brittany-maynard-and-the-challenge-of-dying-with-dignity 10 http://coalitionccc.org/tools-resources/end-of-life-option-act/11Ryan T.
Anderson, “Physician-Assisted Suicide is Always Wrong,” Newsweek,March 24, 2015, http://www.newsweek.com/physician-assisted-suicide-always-wrong-31704212 http://euthanasia.
php?resourceID=00013213Ryan T. Anderson, “Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine,Compromises the Family, and Violates Human Dignity and Equality,” Backgrounder, March 24, 2015, http://report.heritage.org/bg3004(accessed June 15, 2017).14Herbert Hendin, Seduced by Death: Doctors, Patients, and Assited Suicide(New York: W.W. Norton, 1998), pp.
34-35.15 Hendinand Foley, “Physician-Assisted Suicide in Oregon,” pp. 1625-1626.16 Ethicaland religious directives for Catholic health care services, Directive 60(Washington, D.C.: United States Conference of Catholic Bishops, 2017), pp27-28.17 RyanT.
Anderson, “Physician-Assisted Suicide Corrupts the Practice of Medicine,” The Issue Brief, No. 4391, April 20,2015.18American Medical Association, “Opinion 2.211-Physician-Assisted Suicde,” June1996.19 RyanT. Anderson, “Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine,Compromises the Family, and Violates Human Dignity and Equality,” Backgrounder, March 24, 2015,http://report.
heritage.org/bg3004 (accessed June 15, 2017).20 http://www.health.harvard.edu/blog/the-myth-of-the-hippocratic-oath-20151125844721 LeonKass, “Dehumanization Triumphant.” 22 Ethicaland religious directives for Catholic health care services (Washington, D.
C.:United States Conference of Catholic Bishops, 2017), p. 25.23 Ethicaland religious directives for Catholic health care services, Directive 61(Washington, D.C.: United States Conference of Catholic Bishops, 2017), p.
28.24Aaron, Kheriaty, “Apostolate of Death,” FirstThings, April 2015, p. 19.25Oregon Public Health Division, “Oregon’s Death with Dignity Act – 2014.”26Victoria Reggie Kennedy, “Question 2 Insults Kenendy’s Memory,” Cape Cod Times, November 3, 2012.