The Ethics of Death: Religious and Philosophical Perspectives in Dialogue

6. End of Life I: Physician-Assisted Suicide

6 End of Life I: Physician-Assisted Suicide Introduction We continue with an analysis of end-of-life issues, focusing in this chapter specifically on physician-assisted suicide, or PAS. PAS clearly falls under the heading of euthanasia, but because of the ethical commitment health care professionals make to work diligently toward the well-being of their patients (beneficence), it poses unique problems that need to be drawn out in their own way. In what follows, what is said about PAS applies equally well to anyone in the health care field who would play a role in active or passive voluntary euthanasia.1 Cooley I will begin as always with the main philosophical arguments for and against the position. These are not developed in any detail, but they show how people are thinking about the issue. I will then develop some ideas that are relevant to any in-depth discussion of physician-assisted suicide. ARGUMENTS AGAINST PHYSICIAN-ASSISTED SUICIDES 1. The slippery-slope argument states that we might start with a morally permissible action, but if we do that action, then we will act unethically in an increasingly egregious way.2 In the case of PAS, if we legally or morally permit some suicides, then morally 1. Among others, Robert Young and Nigel Biggar have excellent overviews of the arguments for and against medically assisted euthanasia. See Nigel Biggar, Aiming to Kill: The Ethics of Suicide and Euthanasia (London: Darton, Longman and Todd, 2004); and Robert Young, Medically Assisted Death (Cambridge: Cambridge University Press, 2007). 229 unacceptable consequences will inevitably occur. Included in the results are that the following outcomes: Physicians will become callous toward life in general and might begin taking the lives of people who do not want to die. a. Physicians will help people commit suicide who are suffering but do not have an incurable condition and are not in the end stages of life. b. If PAS is an acceptable option, then doctors and others might not fight hard enough to save the lives of those who could be saved. c. The problem of making a mistake about a prognosis or diagnosis would increase with the additional number of people turning to PAS. d. There might be a cure for an individual’s medical problem that would benefit him had the person stayed alive long enough for it to be introduced into the market. e. If PAS becomes the standard, then because of the prestige of physicians and the medical field, families and the community will pressure ill people to commit suicide even though they would not otherwise want to kill themselves. f. Since PAS prevents the patient from receiving health care services, revenue-strapped governments and profithungry insurance companies may illicitly pressure physicians into choosing PAS too soon. 2. There are a number of physicians who do not want to be obligated to help people end their lives. PAS forces conscientiously objecting physicians to violate their deeply held moral or religious beliefs. 3. PAS treats human life without the respect it deserves, especially by those who should revere it the most. Medical professionals are prohibited from ending life.3 4. PAS violates doctors’ Hippocratic Oath to do no harm. 5. Desiring to commit suicide and killing oneself is irrational, which all physicians should know, and no physician should aid another in 2. Wesley J. Smith, Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder (New York: Random House, 1997). 3. James Rachels argues persuasively against this argument and its foundational belief in the role of medical professionals in The End of Life: Euthanasia and Morality (Oxford: Oxford University Press, 1986). 230 | The Ethics of Death pursuit of some irrational end; therefore, no physician should help another person commit suicide. 6. Palliative care can replace killing a person. 7. Assisting in someone’s suicide violates the person’s right to life. ARGUMENTS IN FAVOR OF PHYSICIAN-ASSISTED SUICIDES 1. There are two alternatives in PAS cases: either to keep the person alive even though the person’s life is not worth living, according to the person or others, or to help the person to take his own life. A utilitarian would do what is best, which would be to end the person’s life and allow him to die with dignity because doing so maximizes utility and produces the best overall result. An added utilitarian consideration would be that PAS would reduce...