For those who have witnessed a loved one die from a painful disease, the option to have a physician assist a patient in hastening death seems obvious, but what are the surrounding ethical, moral, and legal implications involved? Does helping a patient end his or her life violate medicine’s central mission to prolong life, or does it fulfill medicine’s mission to ease suffering?
Below, we’ll discuss three reasons in support of physician-assisted suicide, and three arguments against it.
Life support, not death support
Terminally ill patients can (and do) live.
Gauging how long a person has to live is tricky business. Only in around one-fourth of doctor’s life expectancy predictions are right on the money. According to the Center for Disease Control, between 5,000 and 20,000 of the 100,000 patients who enter hospice (which is to say, doctors have declared they’ve six months or less to live) each year survive and even live several more years. Some patients recover from serious diseases after failed treatment or even after having received no treatment at all. In the face of such recoveries, delivering medication to hasten death denies patients their full chance for survival.
Physician-assisted death goes against the core principles of medical practice.
Offering patients treatment (and where there is no treatment, comfort) is a physician’s obligation, whether or not a problem has a cure. Doctors forswear “therapeutic nihilism,” or resignation that there is no treatment for a condition or disease. Administering drugs which hasten death is the height of therapeutic nihilism. As radiologist Richard Gunderman points out, “The fact that an injury is unfixable does not necessarily give us license to give up on it.” Physicians handle life-and-death situations every day, not to be the deciders of who shall live and who shall die, but to give life the upper hand when death waits at the doorstep.
Physician-assisted death can be abused.
Even physicians who support right-to-die laws admit that they may pose dangers for the disabled. Advocates for disabled people warn that such laws inadvertently create motivation for the healthcare system (and for for-profit insurance providers) to underserve terminal populations, and disabled populations by extension. Worse, disabled or terminal patients could be coerced by family or caregivers to end their lives, or to seek death prematurely to relieve their family of the burden of caring for them. Right-to-die laws risk making already vulnerable populations even more vulnerable.
Live and let die
We already have several right-to-die measures in place.
Many seniors and terminally ill people file a “living will,” a document which specifies what medical practitioners should do if they are rendered mentally incompetent. Advanced medical directives, which have been recognized by law for over twenty years, can specify an incapacitated patient’s refusal to undergo CPR or intubation, effectively allowing patients to choose death over treatment. It seems that unconscious patients have more authority over their life and death than those able to speak their desires. As such, if one can use a legal document to end their lives, having a doctor write a prescription for life-ending drugs is not much different.
Forcing terminal patients to suffer is inhumane.
The pain and loss of functionality caused by terminal diseases can be truly insufferable. It is a fact that not all pain can be effectively managed. If a central goal of medicine is to alleviate suffering, then insisting that terminal patients languish in irremediable pain will always be counterproductive to this goal. Pain is not the only devastating consequence of terminal disease. The loss of function that accompanies diseases like ALS compromises independence – patients lose the ability to feed themselves, relieve themselves, speak, and more. If a disease has the power to rob an individual of his or her personhood, death may be more humane than seeing such a disease through to its end.
Life and death is a matter of individual liberty.
Choice and individual liberty are core tenants of democratic values. It follows that in democracies, competent men and women nearing the end of their lives should be able to face death on their own terms. These values are reflected in a Gallup poll, which showed that nearly 72% of Americans believe that doctors should be able to help terminal patients end their lives without legal recourse. The choice to forego the hardest parts of disease is a personal matter in which society needn’t be involved.
The Bottom Line: There is obvious appeal in circumventing suffering at the end of one’s life, but is suffering in itself a good enough reason to prematurely end a life? And who decides – Physicians? Patients? Society at large? Where do you stand?