Physician Assisted Suicide Legalization in the USA
The word euthanasia comes from a Greek phrase meaning good death. In fact, “in some countries, a doctor will not be prosecuted for terminating a patient’s life providing he or she is convinced that the patient’s request is voluntary and well considered and that the patient is facing unremitting and unbearable suffering” (Cundiff, 19). There is abidance in the fact that assisted suicide is not a modern phenomenon but is a practice that dates back to the times of ancient Greece. Whereas works of literature and articles on assisted suicide join hands in the recognition of Jack Kevorkian as a revered practitioner, there is also abidance in the fact that the practice began long before the times of Jack Kevorkian. The history of assisted suicide has generated a lot of controversy across centuries and decades and its opposition is not new. The United States has a long history of opposition towards assisted suicide for several reasons.
Physician-Assisted Suicide has been a controversial topic in United States society. The reasons behind this are not particularly hard to discern given the fact that the topic itself is controversial. The opponents of physician-assisted suicide argue that life is a precious gift that is only received from the supreme creator and should not only be cherished but should also be enhanced in the best way possible. Whereas the proponents argue that “when the potential for meaningful, joyful, desirable life has been thoroughly exhausted and every effort made to prevent the inevitable, we should make it legally possible for the merciful to show mercy to the dying who request intervention to end their suffering” (Cundiff, 19). These arguments and counterarguments contribute to the factors that make this topic controversial.
The need to acquire more knowledge on this controversial topic remains important to all people regardless of their economic, social, and political classes. This is because it has been pointed out that the measure of life depends not only on quantity but also on its quality. The idea of life is the most important issue to mankind and all living things (Scielos public health, 1). Inability to understand the aspects of life and death on the human race would be tantamount to ignorance on fundamental precincts of life. However, this leaves several loopholes in the process because the whole process might present several avenues for deviations both in an application and in practice. Indeed, this issue has constituted a major debate worldwide. This paper insightfully addresses the issue of euthanasia and comprehensively analyses the arguments for and against the process of euthanasia. The paper further gives supportive facts in each argument with a clear summary of the analysis.
After reviewing the arguments for and against physician-assisted suicide, this paper takes a strong stand in support of physician-assisted suicide. The primary research question that this synopsis wishes to address is; should physician-assisted suicide be legal? Three research sub-questions will conversely be addressed;
- What is good about PAS?
- Why is it important?
- How should the law be written when it comes to Physician-Assisted Suicide in the USA/ how the legalization will look like?
These questions will be answered through a comprehensive synthesis of the literature on physician-assisted suicide as availed in peer-reviewed journals and other scholarly articles. The theoretical and empirical research on physician-assisted suicide will be dissected and disseminated in detail and the salient issues highlighted and advanced. The thesis will tentatively argue that physician-assisted suicide should be legal in all states because the power to decide on one’s life should not be under the control of the state. A clear understanding of the important ingredients that go in hand and which fully encapsulates the strategic intents of physician-assisted suicide must however be paid utmost cognizance to ensure for such efforts translate to human good.
Pro for voluntary euthanasia
Choice: Since the end of World War II, proponents of voluntary euthanasia have strongly tried to influence the world to believe that choice is a fundamental right and a pillar principle of liberty. According to Young (28) “people have an interest in making important decisions about their lives in accordance with their own conception of how they want to control their lives and in exercising autonomy or self-determination, people take responsibility for their lives” Since death is a part of life, choices about the manner of their dying and the timing of their death are, for many people, part of what is involved in taking responsibility for their lives. The United States was founded based on people’s quest for ultimate freedom. If euthanasia is made illegal it will take jeopardize the founding freedoms, the freedom of choice, and the freedom for a person to choose a death with dignity and free of pain.
Quality of life: The amount of pain a human being goes through during periods of illness even in cases where pain killers are administered is incomprehensible to a person who has not had the opportunity to experience that level of suffering. The level of emotional pain is often greater even in cases where there is no physical pain due to the burden of losing once power to make important decisions regarding one’s own life. Young (29) buttresses this point by explaining that “many people are concerned about what the last phase of their lives will be like, not merely because of fears that their dying might involve them in great suffering, but also because of the desire to retain their dignity and as much control over their lives as possible during this phase.” Furthermore, according to Humphrey, competent and normal adults have the incontestable right to humankind’s ultimate civil and personal liberty for instance the right to die in a manner and at a time of their choosing (Humphrey, 44).
Economic costs and human resources: Today’s life is majorly controlled by the economies of individual countries. The amount of manpower and human know-how spent on those who are on the verge of death could be diverted to support those whose lives could be saved. It is an economic burden not only to families but also to the country’s economies to keep people alive past the point at which they can contribute to the growth of the nation. Terminally ill patients often fear being a burden to others and may feel they ought to request euthanasia to relieve their relatives from distress
Con for voluntary euthanasia
Moral/Theological: Religious people hold the view that euthanasia for whatever reason is totally unacceptable and morally wrong. This class of people considers euthanasia as a form of murder or suicide while in the belief that only God has the sole power to give and take life and all human beings are created to wait until that time comes and that time is only set by God. One question this group asks is what if euthanasia is carried today only for a permanent solution to the problem to be discovered e tomorrow? It is often said that it is not necessary nowadays for anyone to die while “suffering from intolerable or overwhelming pain because we are getting better at providing effective palliative care, and hospice care is more widely available” (Young, 28).
Another moral aspect of the opposition of euthanasia is the doctrine of double effect. Young (30) explains the doctrine of double effect by demonstrating that” it is for example, permissible to alleviate pain by administering drugs such as morphine, knowing that doing so will shorten life, but impermissible to give an overdose or injection with the direct intention of terminating a patient’s life (whether at her request or not).” The opponents of Euthanasia on moral grounds also argue that the request for one to die may not necessarily mean a complete desire to die. Young (27) postulates that “it is certainly true that a request to die may not reflect an enduring desire to die- just as some attempts to commit suicide may reflect temporary despair.” “That is why advocates of voluntary euthanasia have argued that normally a cooling off period should be required before euthanasia is permitted” (Young, 27).
Professional role: The administration of euthanasia has got the negative aspect of compromising the professional duties of doctors. Many doctors in the Netherlands and, to judge from available survey evidence, in other Western countries as well, see “the practice of voluntary euthanasia as not only compatible with their professional commitments but also with their conception of the best medical care for the dying and that being so, they should not be prohibited by law from lending their professional assistance to those competent, terminally ill persons for whom no cure is possible and who wish for an easy death” (Young, 27).
Necessity: The measurement to determine the level at which euthanasia is necessary is not practical to put down. If there is even the slightest possibility that one’s suffering can be brought to an end, the best way to go about it is to attempt a cure or subject the patient to palliative care. Young (28) argues that others will think that “what may be done with the consent of the patient sets a strict limit on the practice of euthanasia band the difference is not one of logical acumen; it has to be located in the respective values of the different supporters (e.g. whether a person’s self-determination or her best interests should prevail).”
The element of the feasibility of implementation is controversial because it can only be considered voluntary in a strict case where the patient is proved mentally competent to make such a decision. Another related objection to permitting the legalization of voluntary euthanasia argues that we “can never have sufficient evidence to be justified in believing that a dying person’s request to be helped to die is competent, enduring and genuinely voluntary” (Young, 29).
Consent under pressure is always given due to hard economic situations that place patients under emotional stress. Critics of euthanasia argue that terminally ill patients are likely to experience high levels of physiological pressure in their attempts to relieve their families of the financial burden. If euthanasia became socially acceptable, “the sick would no longer be able to trust either doctors or their relatives: many of those earnestly counseling a painless, ‘dignified’ death would be doing so mainly on financial grounds. Euthanasia would become a euphemism for assisted murder” (Prowse, 19).
A congregation among researchers is that physician-assisted suicide can still be perfectly practiced while at the same time respecting human life and dignity on the interplay of all the above factors. The following therefore is a comprehensive review of both theoretical and empirical literature that will attest to the fact that physician-assisted suicide is a multidimensional phenomenon that is dependent on the interplay between all the above research questions. Several literature articles have projected questions as regards our stand on moral wisdom and human life. According to Blendon, Szalay, and Knox (2658),
Deciding what is right is especially difficult when the permissibility of deliberately ending a human life is involved. In these extreme situations, the normal rules of morality are stretched to the breaking point. Self-defense against a would-be murderer, killing enemy soldiers in war, capital punishment for the most horrendous crimes, intentional suicide by a spy to prevent torture or a coerced disclosure of vital military information, killing a berserk man who is systematically murdering a line of hostages — all these instances pose questions that severely test our moral wisdom.
Breitbart, Rosenfeld, and Passik (240) on the other hand supports that some kinds of killing are permissible and may not be considered morally wrong. One question that formed a central debate in most articles is the morality behind physician-assisted suicide. This includes “providing medicines or other means the patient can use to commit suicide or by directly administering medicines that end the patient’s life” (Breitbart, Rosenfeld and Passik, 241)
The need to legalize physician-assisted suicide is for the background knowledge that has been presented in articles and works of literature on the topic. Cautious submissions have been made in support of physician-assisted suicide to hasten death and avoid unnecessary, unwanted, and intolerable suffering of patients. Most literature abides in the fact that the choice of a patient should take priority in some situations. According to Brock (20), “consider a person with an incurable illness or severe debility such that life has become so racked with pain or so burdensome that desirable, meaningful, purposeful existence has ceased.” “Suppose that person says – My life is no longer worth living; I cannot stand it any longer; I want to end it now to avoid further pain, indignity, torment, and despair” (Cundiff, 56).
This fact is supported by Emanuel and Clarridge (2661) in illustrating that
In the end, after all, alternatives have been thoroughly considered, I believe this person has the right to choose to die and that it ought to be honored. We would want to urge consultation with physicians, clergy, lawyers, therapists, family, and others so that such a serious and irreversible decision can be made after sufficient time has passed and every alternative thoroughly weighed. We have obligations to others and should take their needs into account. The state has an interest in protecting life. But, in the end, individuals should be given wide latitude in deciding when life has become an unendurable hardship.
These similar findings have also been projected by Cox (44) in disposing that physician-assisted suicide does not constitute disrespect for human life when ending suffering takes propriety over extending life. Whereas there is a complete abidance on the importance of life as a natural gift from the creator that should be protected and nourished with all efforts, there are circumstances that extending life only breeds more suffering on a patient. Emanuel and Emanuel (44) echo that “some circumstances may turn it into a heartbreaking, hopeless burden filled with suffering, pain, and despair. We desire to live, but in some situations death may be preferable to the continuation of an intolerably burdensome existence.” These are the critical situations that call for the legalization of physician-assisted suicide. If some person comes to that dreadful that there is no need to continue with the business of life, our duty as those who are close to him or her becomes into question. Fairclough and Slutsman (49) intone that “the moral imperative forbids us to kill, but it also enjoins us to be merciful.”
One reason that has been projected by several works of literature in support of physician-assisted suicide regards the duty of physicians in ensuring that patients return to normal life. According to Hendin (101) “the role of the physician is to do what is best for the patient, and in some extreme situations this may include hastening death upon the voluntary request of the dying.” Legalizing physician-assisted suicide may then be viewed as enhancing the role of physicians in lessening pain on their patients. If the role of physicians was defined simply and solely in the terms of healing; they would have no role in being part and parcel in hastening the death of a patient. However, the definition of the role of the physician transcends to lessening pain on a patient. The best way to define the role of a physician has been advanced by Humphrey (1) in stating answering the question –“What is the best thing I can do to help my patients in whatever circumstances arise, given my special knowledge and skills?” Foley (85) has answered this question by echoing that
In nearly every case the answer will be to heal, to prolong life, to reduce suffering, to restore health and physical well-being; to preserve and enhance life. But in some extreme, hopeless circumstances, the best service a physician can render may be to help a person hasten death to relieve intolerable, unnecessary suffering that makes life unbearable as judged by the patient.
Such a definition only project an expended role of a physician, not a contradiction of it
Another point that has been supported by literature on the “need to legalize physician assisted deaths is the when death becomes preferable to life, everyone would benefit if it were legal to show mercy” Foley (85). Our human nature of compassion and benevolence calls us to the duty of demanding that we legalize assisted death in reducing the level of pain on the afflicted. This point is best presented in the literature by Cauthen (1) in succinctly illustrating that
The most powerful argument in favor of physician-assisted death comes from the families of those who have witnessed loved ones die in extreme agony. When medical science has done all it can and death has not yet brought merciful relief, family members suffer a sense of powerlessness and despair as they watch in horror someone they love dearly writhe in torment as they wait and hope for a quick end to their awful suffering
Such arguments portend that choosing death over acute suffering and hopelessness would be beneficial to the victims and the afflicted if the procedure is carried out in circumstances that prevent abuse. Could this be one of the reasons behind the increase in homicide in American society? Very little evidence can point to the correlation between the two in human life. However, hopelessness and pain are drivers to most attempted and successful cases of suicide ref. One literature that has provided a groundbreaking analysis on the need to legalize physician-assisted deaths is Cauthen (1) in his analytical essay Physician-Assisted Suicide and Euthanasia.
Cauthen has effectively used a comparative analysis of the pros and cons of physician-assisted death to justify that the process would not be an abuse to the sanctity of life if done in a manner that prevents abuse. By presenting the concerns that have been raised by a section of the society in regards to physician-assisted death and then proceeding to point out critical areas in which this process would be beneficial, it is important to understand that if legalized in a manner that its abuse can be reduced, physician-assisted death can translate to a congregation of benefits to the victim and the afflicted.
One fact that has remained important to note is that whereas the topic of physician-assisted death has remained controversial throughout history, the perception of Americans has not changed much in the past. Prowse (4) gives a vivid example in this assertion by stating that “in June 1997, the U.S. Supreme Court ruled that people do not have a constitutional right to assisted suicide; although a constitutional right was not established, the ruling did not preclude states from passing laws prohibiting or permitting assisted suicide.” Physician-assisted death only became legal in Oregon State throughout the history of America in 1997.
The importance of PAS has also been a focal point of discussion in attempts to justify the need to legalize it. These have been presented through the pros of physician-assisted death. This argument has been brought forward by assisted suicide advocates who contend that the slippery-slope argument is one of the fallacious attempts to deny the citizens their rights. America was founded on the grounds of democratic rights and legalizing physician-assisted death will only further that right as opposed to contradicting it. According to Van der Maas, Van der Wal, and Haverkate (1699)
Is this the start of the slippery slope toward killing off the burdensome—our expensive elder folk, our physically and mentally handicapped, our citizens on welfare? If you believe that, it would be best to leave the country now because you have no faith in the goodness of human nature or the ability of the American democratic system to protect the weak
Where then does such an argument leave us as a society in dealing with the controversial and sensitive topic that touches on our morality as a nation? Physician-assisted deaths would therefore not be contradictory to the democratic space of the American society that has ensured propriety for centuries.
The writing of the legislation legalizing physician-assisted deaths should not present challenges to the American lawmakers given the fact that efforts towards the achievement of physician-assisted deaths in the Netherlands would undoubtedly provide a framework under which the foundation can be laid. The weaknesses of the Dutch system would enable us to gain critical insight into whether legalizing physician-assisted deaths would threaten moral the foundations upon which the American society thrives. According to Betzold (44)
Although the practice is technically illegal, Dutch physicians are permitted to assist a patient’s suicide if certain guidelines are followed. These guidelines require that the patient make a voluntary, informed, and repeated request for euthanasia because of unbearable suffering and that the doctor consults at least one colleague and writes a report.
Such premises would form the groundbreaking theories on which the legalization of the law on physician-assisted deaths would be bestowed. Mcser and Corning (130) on the other hand have provided a framework that would enable us to pinpoint reasons behind the inabilities to strictly follow the guidelines of regulations that govern physician-assisted deaths. “Supporters of the practice argue that similar guidelines in the United States—such as the ones in Oregon that include waiting periods and confirmation from two doctors that the patient has less than six months to live—will actually protect patients by increasing physician accountability” (Rachels, 18). Strengthening such sections in the law would protect the law from abuse by unscrupulous physicians.
In addition to the above, some authors contend to the fact that other roles of physicians are more sensitive and thus legalization would enhance their roles and judgments concerning what is best for a patient. It must however be pointed out that the decision to end a patient life based on whatever reason cannot be left in the hands-on of the physicians alone. Works of literature have pointed out three parameters that are best brought forward when drawing up this legislation. The first has been dissected by the ref in stating that “there should be sufficient proof beyond any trace of doubt that the patient is near death” (Rachels, 18). Accurately ascertaining that a patient is near death may present several challenges given the fact that different physicians will give different verdicts concerning the state of a patient. This approach should involve an assessment of two or more physicians in making such judgments.
The second premise on how to draw up this legislation is presented by the ref in stating that the patient must be in an unmanageable and unbearable state of pain and discomfort. Last, the legalization of the must take into consideration of the mental capacity of the patient to make a voluntary request. This issue is expounded by Dworkin (47) in stating that
The restricted argument for physician-assisted suicide does not logically authorize the killing of all innocent people but only those who meet all three requirements stipulated. It is illegitimate to abstract some remote generalized feature and makes deductions from it as if all the other factors don’t matter.
The study of physician-assisted deaths on moral grounds in American society has empirically reinforced the previously held beliefs on this topic and illustrated that legalizing physician-assisted deaths does conflict with the democratic space of the American citizen. It has been established that through the proper legalization process, physician-assisted deaths can translate to a cocktail of benefits for the victims and the afflicted. It would seem though that there were significant differences in the levels of agreements in regards to this controversial, general abidance is demonstrated by most literature on the ability of legalization of physician-assisted deaths. Overall, however, the opposition and concerns towards this process cannot be disregarded given the fact it touches on the core moral aspect of human life and human sanctity.
The findings of this research may provide useful information to lawmakers, governments, policymakers as well as physicians on all-encompassing issues that surround physician-assisted deaths. The fact that proper legalization of this process can translate to several benefits for the society and especially the critically ill point out the fact that it should not be wished away. It can therefore be discerned from the literature above that whereas there has been strong opposition to this legislation, the current situation where critically ill patients are supported to die by their relatives is worse. The fact is that legalization of the physician-assisted deaths may take a long time to achieve because of the diverse nature of the American society and may indeed require much more than these, this literature contributes to opening the myths on the topic.
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