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Euthanasia and Physician-Assisted Suicide

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Euthanasia and Physician-Assisted Suicide

Euthanasia and physician-assisted suicide (PAS) have been subject to intense debate in the United States following the recent social and legal developments. Physician-assisted suicide entails prescribing lethal medication to patients so that they can self-administer (Emanuel, 2017). The doctor does not take the action to kill the patient, for example, when a doctor gives a patient a hypodermic needle that can end life but does not inject the patient with the needle. Euthanasia involves the direct involvement of a physician in causing death in a patient. It can be voluntary, non-voluntary, and involuntary (Emanuel, 2017). There is an argument for and against euthanasia and PAS. This essay reviews both sides of the debate and theorist perspective.

Ethical Debate

The New Mexico law review provides that a patient has four choices to end their life. The options are termination of all medication, physician-assisted suicide, complete sedation till death, or opting not to eat anything till they die (Cohen-Almagor, 2015). PAS is illegal in the United States. This argument pushed for the principle of autonomy. The patients should have the ability to choose PAS if they want to and the decision should be respected. Some states support euthanasia and PAS, for example, in Oregon (Cohen-Almagor, 2015). Therefore, the argument is euthanasia and PAS follows the principle of autonomy which allows the patient to decide their death.

Many people argue that a patient has the human right to end their life, especially terminally ill patients, and those in severe pain. However, this right only applies in the nine states in the U.S. where PAS is legal under strict guidelines. These are New Jersey, Oregon, Hawaii, Vermont, Washington, District of Columbia, California, and Maine (Cohen-Almagor, 2015). Terminally ill patients in these states are eligible to seek legal, medical help to end their life from a licensed physician. In addition, physicians in these states can decide whether to assist the patient.

Some states like Idaho, Arizona, Louisiana, Utah, Alabama, South Dakota, and New Mexico have strengthened their laws against assisted suicide. For example, in 2018 Utah included assisted suicide in its manslaughter statute. Also, groups have merged to favor medical aid in dying, for example, Death with Dignity and Compassion and Choices (Cohen-Almagor, 2015). These groups argue that patients have a right to choose their death because living in pain and suffering caused by terminal diseases makes life unbearable and agonizing. Therefore, death seems like an act of humanity, with PAS and euthanasia as ways of dying with dignity. The physicians in this case act under the principle of beneficence to relieve the pain of terminally ill patients.

There are arguments against euthanasia and PAS. Scholars argue that it goes against compassionate care by physicians. A physician deciding to stop medication on a terminally ill patient and allow the natural course of the illness to take it to cause is different from a physician prescribing PAS to the patient. In the United States, appropriate withdrawal of care is widely practiced with no PAS or euthanasia (O’Rourke et al., 2017). Also, DNR orders are available in the United States, which allows terminally ill patients to let the natural course of their illness. These do not require euthanasia or PAS. Thus, this is consistent with excellent medical care standards in the United States. Therefore, PAS and euthanasia are not a requirement for terminally ill patients because they have other options like excellent terminal care which is legal and available in the United States (O’Rourke et al., 2017).

The desire to have autonomy over a patient’s life is not a sufficient reason to legalize PAS and euthanasia. According to a study by The Seattle Cancer Care Alliance, patients want to take part in PAS because they could not enjoy normal activities, loss of autonomy, and loss of dignity (O’Rourke et al., 2017). Thus, these patients request for PAS to control their time of death rather than symptom control. The major problem is the insistence of some terminally ill patients to have ultimate autonomy actualized by the action of physicians. However, there is not a situation where nothing can be done, but the legalization of PAS declares that the conditions are extreme and there is nothing that can be done. There are extreme circumstances in the care of terminally and non-terminally ill patients, but patients need to revisit their needs than choose PAS (O’Rourke et al., 2017). For example, support, education, and patient engagement. Therefore, PAS and euthanasia should not be the last resort.

Ethical Egoism

According to Rachels & Rachels (2019), ethical egoism is the doctrine that each person ought to pursue his or her self-interest exclusively. An ethical egoist would say that the patient needs to decide what will benefit them in the long term because they must do what is best for themselves. In euthanasia and PAS, ethical egoists will support that if a patient decides to end their life or not, the desire is motivated by their self-benefit and their actions are ethical (Murphy, 2016). This could create a conflict of loyalty to self and the community. Conflict to self is that the terminally ill patient is having a hard time figuring out whether they should opt to have their life preserved or terminate their life. It conflicts with the community because if the patient chooses to be euthanized, then the family could become emotionally distraught and some may think that it is an act of selfishness. It does not mean just because the patient doing what is best for them, that they are avoiding the feelings of others. The family may choose between preserving their loved one to the end and try to fight the illness, but the patient is going through a lot of discomfort and pain.

Sometimes your interest will coincide with the well-being of others, so you will help yourself by helping them (Rachels & Rachels, 2019). In this case, euthanasia and PAS can allow patients that have terminally ill conditions with no possibility of recovery to terminate their own life and not cause the family emotional and financial trauma. I feel that the best course of action is for the family to respect their loved one’s wishes and to let them decide whether they choose to be euthanized or not. We must be supportive of the dying patient’s decision because no one should go through the physical and emotional suffering as well as pain.

The Social Contract Theory

The social contract theorist describes how rules and laws relate to society, and why we need them to establish moral and political rules of behavior. According to Rachels & Rachels (2019). Morality consists of the rules that rational people will accept on the condition that others accept them as well. So, if we can accept the individual’s decision on terminating their life through euthanasia and/or PAS to reduce their suffering then we can accept that it is what is best for them. Rules and laws are important in guiding the decisions on PAS and euthanasia. The purpose of laws and rules on euthanasia and PAS is to prevent people from deciding in their moment of misery. Therefore, social contract theorists would argue that society needs rules and laws on euthanasia and PSA. Euthanasia and PAS involve a collision between personal obligations and national ones. Both are against the law in most countries and can lead to time in jail. In the United States, the law varies between states, therefore, the individual may have to relocate to be euthanized or receive PAS. I believe that the best course of action is for the family to understand that this is in their loved one’s best interest and to make the travel to the state that allows the procedure to be done. In the meantime, make the best of the time that they have left with them.

Code of Ethics

The American Nurses Association’s (ANA) Code of Ethics states that nurses should provide supportive care to dying patients, and intervening to enable the patient to live with as much physical, emotional, social, and spiritual well-being as possible (American Nurses Association, 2019). It conflicts with professional duties because nurses should not participate in assisted suicide. Nurses that work in states will care for patients that elected for assisted suicide, although they cannot assist, they are to still care for the patient with dignity and compassion. The debate on PAS and euthanasia has been ongoing for a decade. Some people are for PAS and euthanasia, arguing that it protects human rights and the principle of autonomy. It is important as nurses that we understand the professional stance on assisted suicide and the reasons behind why this debate continues.

References

American Nurses Association. (2019). The nurse’s role when a patient requests medical aid in dying. https://www.nursingworld.org/~49e869/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/social-causes-and-health-care/the-nurses-role-when-a-patient-requests-medical-aid-in-dying-web-format.pdf

Cohen-Almagor, R. (2015). An argument for physician-assisted suicide and against euthanasia. Ethics, medicine and public health, 1(4), 431-441. https://www.sciencedirect.com/science/article/pii/S2352552515001553?via%3Dihub

Emanuel, E. (2017). Euthanasia and physician-assisted suicide: focus on the data. Med J Aust, 206(8), 339-340. http://www.healthprofessionalssayno.info/uploads/1/0/9/2/109258189/mja_euthanasia_and_physician_assisted_suicide_focus_on_the_data.pdf

Murphy, S. (2016). Legalization of assisted suicide and euthanasia: Foundational issues and mplications. BYU J. Pub. L., 31, 333. https://www.researchgate.net/publication/323295018_Legalization_of_Assisted_Suicide_and_Euthanasia_Foundational_Issues_and_Implications

O’Rourke, M. A., O’Rourke, M. C., & Hudson, M. F. (2017). Reasons to reject physician assisted suicide/physician aid in dying. Journal of Oncology Practice, 13(10). https://ascopubs.org/doi/full/10.1200/JOP.2017.021840

Rachels, S., & Rachels, J. (2019). The elements of moral philosophy (9th ed.). Mcgraw-Hill Education.