In earlier periods of human history, physicians could do little to stave off death; now, improvements in public sanitation, and the many technologies of modern medicine have combined to lengthen the human lifespan, particularly in the developed world. The result is that, with its sophisticated health-care systems, most the population in these countries die at comparatively advanced ages marked by a terminal phase of dying, and this gives rise to the assisted-dying issues. Assisted suicide is when someone provides an individual with the information, guidance, and means to take his or her own life with the intention that they will be used for this purpose. When it is a doctor who helps another person to kill themselves it is called “physician assisted suicide.” This act , meaning even though the physician provides prior assistance, the patient him/herself performs the death causing act. This essay would argue that even though patient autonomy should be respected, the small population of people who need this service cannot balance the larger population whose relationship with doctors may be damaged if they find out their GP is involved in PAS. This essay is going to also evaluate the Hippocratic oath doctors take which prohibits them from killing. The second argument is that any proposed safeguard will not be successful in preventing the practice from leading to the undermining of the lives of the old and vulnerable.
The argument on PAS is critical because the ending of life is the most critical thing in the world. Physician-assisted suicide idea is not nascent, it’s roots extend to a years before the birth of Christ, when Hippocratic said in the fourth century B.C:” I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan “. In contrast to the broad consensus supporting physicians’ honouring requests to terminate treatment, there is no consensus on physician-assisted suicide. Organized medical and nursing societies have condemned the practice, and many states have explicit legal prohibitions. Debate over whether to lift those prohibitions continues. The position of UK law is that PAS is illegal, even if the act is unsuccessful. According to s2 of the Suicide Act 1961 as amended by the Coroners and Justice Act 2009, it was an offence to “aid, abet, counsel or procure the suicide of another” and that a person who committed this offence was liable to imprisonment for a term not exceeding fourteen years. This reflects the seriousness of the offence.
Argument 1- relationship
Physicians routinely wield power over life and death almost unmatched by others in our society. A commitment to use those powers only to comfort and heal, and avoiding use of those powers to intentionally cause death, helps orient the profession toward beneficence and non-maleficence and maintain the trust of the population. Psychologically, a prohibition on assisting suicide and may help prevent physicians from acting out ambivalence toward the dying patient by deliberately ending that patient’s life. Practically speaking, the prohibition may help avoid erroneously or abusively taking life. It can be argued that the relationship between the doctor and patient is a delicate and intimate one. The patient must be able to trust the doctor naturally, comfortably, instinctively, completely and without reservation. If the patient is made to feel that the doctor has the power to take away their life, not because of medical necessity but based on other legal, moral or other considerations, they will not seek out a doctor for help, nor will they repose their trust and render cooperation fully even if they have to out of necessity.
People who traditionally relied on their doctors to provide guidance in their health care decisions may become confused, or even alarmed, when one of the treatment options presented is the death machine at the end of the hall. According to Leon R. Kass, the “patient’s trust and whole-hearted devotion to the patient’s best interests will be hard to sustain once doctors are licensed to kill.” This act will be vilified by the media, for example, Jack Kevorkian who was renamed Dr Death by the media, and the population who is heavily influenced by the media may follow in this vilification of doctors who may be involved in these acts. Patients losing trust in their doctors is not a welcome development, as therefore when they’re ill, they are less likely want to go to the hospital, and would rather diagnose themselves online or alternatively and this would take away jobs from doctors.
One of the responses to these arguments has been that a modern physician is committed not only to care and cure but to respect patient autonomy. What is apparent today is the strong move away from medical paternalism to a more patient-centred approach, essential for the facilitation of patient autonomy and informed consent. The patient previously played a very limited role and had little involvement in the medical process. In line with modern society and increased emphasis on autonomy, ‘bioethics has forced medicine to recognise patients as autonomous beings who are entitled to choose among medical treatments’. The medical society has embraced a process which is based on mutual decision making between the doctor and patient, with intense focus on the patient’s interest where ‘medical paternalism has no place’. Therefore, just as a person has the right to determine as much as possible the course of his or her own life, a person also has the right to determine as much as possible the course of his or her own dying. If a terminally ill person seeks assistance in suicide from a physician freely and rationally, the physician ought to be permitted to provide it. Thus, it is argued that a physician should respect and assist the voluntary and competent choice of a patient, even if the patient chooses suicide, it is within the patient’s right. Not respecting a patient’s right is more likely to affect the relationship between patients and doctors than the legalisation of PAS. A doctor respecting that choice and doing what the patient wants is an essential part of the trusting relationship between the two parties.
However, this argument may be refuted on the grounds that true autonomy is rarely possible in this world, especially for someone who is dying. Not only are most choices socially formed, but terminal illness, depression and other psychiatric disturbances are likely to be a factor. Also a physician is not morally obligated to do everything a patient wants, sometimes the physician may actually know better. To hold that a physician is obligated to do everything a patient wants would reduce the physician to the patient’s puppet and suggest there is no ethical limit to what a physician may do. In all of these cases, the physician’s job is not simply to accede to the patient’s request. The physician has duties that may include saying no. Autonomy in medicine is very important, and it is important for a doctor to respect patient’s choice, but the demographic of British people who request PAS is small (273 in 13 years) compared to the general population and numbers in countries that have legalised assisted suicide or euthanasia. Legalising PAS could potentially lead to patients seeing doctors as potential killers, instead of someone wanting to heal and comfort them, but someone that will be willing to eventually kill them.
One argument that has been used to support PAS has been that the Hippocratic Oath which prohibits doctors from killing, also used to prohibit doctors from performing surgery, providing abortifacients, and taking fees for teaching medicine. If the Oath can be modified to permit these practices, why not assistance in suicide, where the patient is dying anyway and seeks the physician’s help?. This line of opposition doesn’t however take away from the fact that ultimately the doctor’s duty to his patients is to save their life, and not take it. Many commentators have argued that a physician has duties to respect a patient’s right to be free of unwanted invasive treatment and to meet a patient’s need for pain relief and palliative care, but that these do not translate into a duty to deliberately cause the patient’s death through lethal prescription or injection, the right to suicide will contrast with the role of health care providers to care and cure the people; even in the critical situations. The United States Supreme Court, in upholding states’ criminalisation of assisted suicide, noted that PAS could ‘‘undermine the trust that is essential to the doctor– patient relationship by blurring the time-honoured line between healing and harming’’. They assert, for instance, that the ‘‘ramifications are too disturbing for the patient–physician relationship and the trust to sustain it’’, and that physician aid in dying would cause patients ‘‘great difficulty believing their doctor intends their best interests’’. Therefore, patients thinking doctors will be allowed to kill them in certain circumstances will damage the relationship between doctor and patient.
Second argument- old and vulnerable- undermine the value of their life (undermine the sanctity of life that every life has value
The second argument against the legalisation of PAS is that it will undermine the value attached to the lives of the old and vulnerable, who can easily be pressured into committing PAS which negates the principle of sanctity of life protected under the ECHR. Permitting physicians to assist in suicide, even in sympathetic cases, may lead to situations in which patients are killed against their will especially old and vulnerable patients, who would feel like a burden to their family close to the end of their life when they need constant care or because of the financial situation of the family. In the United States, thousands of people have no medical insurance; studies have shown that the poor and minorities generally are not given access to available pain control, and managed-care facilities are offering physicians cash bonuses if they don’t provide care for patients. With greater and greater emphasis being placed on managed care, many doctors are at financial risk when they provide treatment for their patients. Legalized PAS raises the potential for a profoundly dangerous situation in which doctors could find themselves far better off financially if a seriously ill or disabled person “chooses” to die rather than receive long-term care.
Those who favour assisted suicide often assume that they can design a process free of error and abuse, but it would be unrealistic to assume such perfection. Physicians are human beings, they make mistakes. They often may not know the patient well and may not appreciate what concerns are contributing to a patient’s request for assisted suicide or the range of options that exist for addressing those concerns. One may cogently argue that what these individuals need is access to good care and supportive settings, not a lethal prescription. Individuals with disabilities may properly worry that they are especially vulnerable to error and abuse. Too often, their quality of life may be undervalued. It may be far easier for clinicians to respond to a disabled individual’s situation with a lethal prescription than to address the underlying problems and to open options. This argument has been objected in the view that a basis for these predictions must be demonstrated before they can be used to suppress personal choices and individual rights, as there is no empirical data to support this view of possible undermining of lives. However, the basis for these predictions are increasing cost pressures, greed, laziness, prejudice, and other factors affecting physicians, family members, health-care institutions, and society. Vulnerable patients may become socially programmed to think of themselves as unworthy to remain alive, and the elderly, the chronically ill, the disabled, and others will be manoeuvred into choosing to end their lives. Arguing that only patients with documented terminal illnesses would be allowed this option will ignore that fact that restrictions of this sort cannot be enforced; pressures to die would spread beyond the terminally ill.
The risks of PAS would be particularly great for those in vulnerable groups. For instance, Susan Wolf has sought to show that the impact of legalization would fall particularly heavily on women; Adrienne Asch has worried about the impact on people with disabilities; Leslie Francis has been concerned about the elderly. The NY state task force on life and law have stated this worry very succinctly that “to the extent that laws prohibiting physician-assisted suicide and euthanasia impose a burden, they do so only for individuals who make an informed, competent choice to have their lives artificially shortened, and who cannot do so without another person’s aid, very few individuals fall into this group. Legalizing assisted suicide for the sake of these few – whatever safeguards are written into the law – would endanger the lives of a far larger group of individuals, who might avail themselves of these options as a result of depression, coercion, or untreated pain.” This prohibition on PAS which has been criticised as being too absolute is meant to protect vulnerable persons from acting upon a death wish which might be merely transitory in nature, induced by third parties, or related to personal conditions affecting the validity of individual judgments. Any loosening of the absolute and unqualified prohibition of assisted suicide risks weakening the effectiveness of the protection afforded under the current law to vulnerable persons, over whom undue influence might be exercised. The possibility of undue influence occurring in cases is high, therefore the law should not take this risk.
From the case of Regina (Purdy) v DPP, the House of Lords held that the DPP should promulgate specific guidance to produce some kind of clarity and coherence for those contemplating assisted suicide, in regards to the factors that the prosecution will consider when deciding a case. DPP Policy Guidance has emphasised in the guidelines that PAS is a crime by saying that a prosecution will be likely if the suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer etc., and the victim was in his or her care. Any attempt to legalise PAS would require the support of medical organisations, as they provide the majority of regulation and guidance which would undoubtedly be heightened in this context. The vast majority of UK doctors are opposed to legalising euthanasia along with the British Medical Association, the Royal College of Physicians and many more, so even if it is legalised, doctors may be reluctant to make use of it anyways. In a dissertation of 1990, the German lawyer Karl Michael von Lutterotti passed in review the professional codes of the most important countries of the world and found none that tolerated physician-assisted suicide apart from the well-known exception, the Netherlands, where at that time, however, the legal prohibition of assisted suicide was still officially upheld. The legacy of Bland is that, whilst the patient’s right to self-determination is effective to authorise withdrawal of treatment on request and non-treatment where refused, it cannot authorise, at the very least, active administration of drugs by the physician, except where that constitutes “terminal sedation.”
To conclude, while this act of PAS is criminalised in England and Wales, prosecution of such cases is, however, relatively rare as is conviction, and, in what might be seen as a tacit critique of current law, sentences are generally light, even when the act is carried out by a non-healthcare professional. This may mean the law allows the practice to an extent as the only doctor that has ever been convicted is Dr Cox, who was still given a suspended sentence anyway. However, the law in the UK still remains that, a competent person who is physically or psychologically incapable of committing suicide (which is not a crime) cannot – unlike those who have life-sustaining treatment they can refuse – be provided with the means to end their experienced suffering; they cannot choose death. This law should stay this way and PAS should not be legalised in the UK, because of reasons explored above and legalisation can lead the law down a slippery slope where acts can proceed from strictly regulated PAS to voluntary active euthanasia, then involuntary active euthanasia and eventually even to the killing of babies suffering from relatively minor disabilities.