IAS Capstone E-Portfolio/Essay

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PAS Group Sheet

Debate Prep

PHYSICIAN-ASSISTED SUICIDE (Tues. May 23)

Question under debate: Is it ethical to permit physicians to assist terminally ill patients in committing suicide?

Clarifying question: “So are you arguing for physician-assisted suicide just for terminally ill patients or are you arguing for PAS for everyone?”

INTRO: (Clinton/Maciej)

Esteemed colleagues, we are gathered here today to discuss the merits of physician-assisted suicide. However, the evidence we provide today will not only rebuke these merits, but also show you the fallacies associated with this topic.

One such fallacy is the term “physician aid-in dying”. This term is obscured by the fact that the physician isn’t assisting the patient in dying, they are leading them to death. As James K. Boehnlein M.D. wrote “True physician aid in dying is the facilitation of a patient’s encounter with the natural process of dying, using the biopsychosocial perspectives and skills of the medical profession to nurture, comfort, relieve pain, and provide hope and interpersonal contact.” Herein, we will refer to the subject as physician assisted-suicide for the remainder of the debate.

Physicians should not be under the obligation to help their patients end their lives. It is unethical in a myriad of ways with multiple principles that uphold this view.

One such principle is Value Theory. Neil Gorsuch, a Supreme Court Justice, wrote the book on physician assisted-suicide, named The Future of Assisted Suicide and Euthanasia, where he argues that each life has innate value, stating that life if “intrinsically worthwhile, an end that is a reason, sufficient in and of itself, for action and choice and decision…[It is] not something that is good only because of its instrumental usefulness in achieving some other end.” To illustrate this, in Regina vs. Dudley and Stephens in the U.K., two shipwrecked men who would surely die of starvation, ate their cabin boy because it was “necessary”. The court denied this plea, asserting “By what measure is the comparative value of lives to be measured? Is it to be strength or intellect or what?” Each life is inherently valuable. According to Ezekial Emmanual in his article Four Myths About Doctor-Assisted Suicide, only 22 percent of people are motivated by pain to end their life. The other 78 percent, have a fear of losing control of their faculties or are depressed. What this suggests is that we require a more robust therapeutic system to help patients in need, not ask medical professionals to go against their ethical values. Gorsuch represents the fallacy of physician assisted-suicide perfectly, declaring that “Quite unlike unintended side effects, our freely willed choices are entirely and uniquely within our control. Unlike unintended side effects, too, intended decisions to harm someone or something represent a denial that the objects of our actions possess innate value.” Gorsuch is stating that we are not exempt in our actions, and that physicians cannot be written off for the death of a patient just because they requested it.

This holds true in non-maleficence as well, which is defined by medscape as to “[inflict] the least harm possible to reach a beneficial outcome”. The original draft of the Hippocratic Oath, written by the father of modern medicine, states “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.” To assist the patient in their own suicide clearly contradicts this sentiment. Even in the modern iteration of the Oath, Doctors must “. . . tread with care in matters of life and death. Above all, [they] must not play God.” Physicians should be concerned with the best possible way to cure their patients. However, all states where physician assisted-suicide is legal, patients are allowed to go to multiple physicians in order to find one to give the lethal prescription. One such case is the one of Kate Cheney, who died in Oregon under their death with dignity law after shopping around for multiple physicians until she found one who would give her the lethal medication, even though she had early dementia. She was also potentially coerced by her daughter, due to her age. Physicians that prescribe these drugs also run the risk that once the medication is outside the hospital’s jurisdiction, anything can occur with it. A physician's primary responsibility is to heal and this medication creates harm. Additionally, misdiagnosis can occur for terminal illnesses, where according to Gorsuch “Patients in Oregon have waited a year or more after their ‘terminal’ diagnosis to make use of their prescriptions, and physicians have admitted that they cannot be sure of their own ‘terminal’ diagnosis; definitions of terminal illness are thus ‘inherently unstable’”. One Mississippian was diagnosed with a terminal case of Cancer and committed suicide. After the autopsy, it was declared that she never had Cancer to begin with and that it was a misdiagnosis. The patient was 66 and a mother of two. As such, it is unethical to assist someone to commit suicide if physicians cannot even be sure if the patient will truly die from a terminal illness.

Lastly, Respect for Persons, as defined by the Belmont report: “first, . . . individuals should be treated as autonomous agents, and second, that persons with diminished autonomy are entitled to protection.” The mindset of the patient is called into question. A patient who can no longer afford their care may see physician assisted-suicide as a way out of a financial obligation, a poorly educated person may not fully understand what PAS is, and all of these patients may be coerced by family members or swayed by things like money to agree to die. Vulnerable groups can be easily victimized with physician assisted-suicide, as they could be pressured into the decision. Physicians have a responsibility to help protect these groups, ensuring that no matter how detached they may attempt to be, they are involved in the process and take an ethical responsibility. Our group believes that there cannot be a separation between the Physician and Patient in the process. The Physician is undeniably involved in every scenario, speaking with the patient, giving advice and options, to ultimately providing the medication. There’s no way to detach the process or make it ethically sound for the physician. Additionally, Boehnlein brings up the point that a depressed individual may “attempt to convince their provider of the worthlessness and hopelessness of their lives, and the potential impairment of their autonomy may be forgotten”. To exemplify this, the Disability Rights Education and Defense Funds organization showcases a man named Michael Freeland, who had acute depression and attempted to commit suicide multiple times. After one visit to arrange an assisted suicide, the physician stated that Freeland didn’t need a psychiatric counsel. In both Oregon and Washington, laws dictate that patients may receive only one psychiatric visit if the Doctor believes that a consultation is necessary. This is indicative of a system that allows for Physicians to commit unethical acts due to flimsy state laws.

Value Theory

· 78% of people are not motivated by pain

· Sanctity of Life

· Respect for Persons

· A person who is burdensome to their family may be coerced into agreeing to PAS so that the family no longer has to pay for their care.

· Broad legalization of physician-assisted suicide and euthanasia would have the paradoxical effect of making patients seem to be responsible for their own suffering; rather than being seen primarily as the victims of pain and suffering caused by disease, patients would be seen as having the power to end their suffering by agreeing to an injection or taking pills, and refusing would mean that living through the pain was the patient’s decision, the patient’s responsibility (Boehnlein, 1999).

· Beneficence

· A patient who can no longer afford their care may see PAS as a way out of a financial obligation, a poorly educated person may not fully understand what PAS is, and non-maleficence is applied by saying that PAS is more likely to harm poor and poorly educated people. All of these patients may be coerced by family members or swayed by things like money into agreeing to dying.

· A depressed person may “attempt to convince their provider of the worthlessness and hopelessness of their lives, and the potential impairment of their autonomy may be forgotten” (Boehnlein, 1999)

· Cases

· Rules and Rights

· Not against 14th amendment (Washington v. Glucksberg)

· The Court held that the right to assisted suicide is not a fundamental liberty interest protected by the Due Process Clause since its practice has been, and continues to be, offensive to our national traditions and practices. Moreover, employing a rationality test, the Court held that Washington's ban was rationally related to the state's legitimate interest in protecting medical ethics, shielding disabled and terminally ill people from prejudice which might encourage them to end their lives, and, above all, the preservation of human life.

· A patient may be misdiagnosed with a terminal condition and use PAS in order to prevent suffering, even though there wasn’t any. (Cite case)

· Patients in oregon have waited a year or more after their ‘terminal’ diagnosis to make use of their prescriptions, and physicians have admitted that they cannot be sure of their own ‘terminal’ diagnosis; definitions of terminal illness are thus ‘inherently unstable’” The Future of Assisted Suicide and Euthanasia by Neil M. Gorsuch“

· Compassion in Dying, 49 F.3d at 590.

· One such case is the one of “Kate Cheney, [1] 85, who died by assisted suicide under Oregon’s law even though she had early dementia. Her physician had declined to provide the lethal prescription. Her managed care provider then found another physician to prescribe the lethal dose. The second physician ordered a psychiatric evaluation, which found that Cheney lacked “the very high level of capacity required to weigh options about assisted suicide.” Cheney’s request was denied, and her daughter “became angry.” Another evaluation took place, this time with a psychologist who insisted on meeting Cheney alone. Disturbingly, the psychologist deemed Cheney competent while still noting that her “choices may be influenced by her family’s wishes and her daughter, Erika, may be somewhat coercive.” Cheney soon took the drugs and died, but only after spending a week in a nursing home.”

· “Michael Freeland, [8] age 64, who had a 43-year medical history of acute depression and suicide attempts. Yet when Freeland saw a doctor about arranging an assisted suicide, the physician said he didn’t think that a psychiatric consultation was “necessary.” But the law’s supporters frequently insist that as a key safeguard, depressed people are ineligible. When Freeland chanced to find improved medical and suicide prevention services, he was able to reconcile with his estranged daughter and lived two years post-diagnosis. Oregon’s statistics for the years 2011 – 2014 show that each year, only 3% of patients (or fewer) were referred for psychological evaluation or counseling before receiving their prescriptions for lethal drugs. [9] N. Gregory Hamilton, M.D., Distinguished Fellow of the American Psychiatric Association, demonstrated how Oregon’s flimsy safeguards do not protect people with psychiatric and other mental health disabilities. [10] Moreover, a majority of clinical and forensic psychiatrists believe “that the presence of major depressive disorder should result in an automatic finding of incompetence” to make decisions about assisted suicide. [11] And only six percent of Oregon psychiatrists are confident they can diagnose depression after one visit, [12] yet the Oregon and Washington State definitions of a psychiatric consultation permit one visit only. [13] ”

· Non-maleficence

· The original draft of the Hippocratic Oath, written by the father of modern medicine, forbids physicians from administering any poison to their patients.

· Medication that is taken outside of the hospital is not only causing harm to the patient, but is potentially causing harm to other individuals if the medication falls in the wrong hands (EVIDENCE)

REBUTTAL:

(Joseph)

· The claim that PAS is necessary to prevent suffering is becoming more and more untrue as palliative care and modern therapeutics are getting better and better at adequately managing pain.

· Brock (reading) states that “we call on fellow physicians to say that they will not deliberately kill.”

· Cohn points out that in the Netherlands “there [were] a significant number of unreported cases and instances in which physician assisted suicide was provided without patient request or consent.”

· SUICIDE: Practicing medicine, misdiagnosis may occur

· Definitions of terminal illnesses are inherently unstable, doctors cannot be sure of their own diagnoses.

· Doctors should not be forced to facilitate a patient’s suicide, “we are not instruments of death”

· The claim that allowing PAS is necessary to maintain a patient’s sense of self-control is offensive to the nature of self-control because it minimizes the severity and gravity of suicide; people can exercise autonomy without needing to commit suicide

· A person’s fear of losing their autonomy when faced with a terminal illness can lead them to the conclusion that suicide is the best option for them; even with all of the safeguards that PAS has in place, patients may still decide to end their lives as soon as they can rather than deciding to wait and see how the disease plays out. They may give up many more years of a happy life simply because their terminal diagnosis, of which even multiple doctors cannot be certain. Giving people this option could lead to the early termination of many valuable lives for no good reason.

· If you make PAS a choice for people, then you also make continuing to live with a terminal diagnosis, which often requires expensive treatment, a choice which people must justify. If the pro side has their way, they’ll lead to conversations where families berate terminally ill members for not choosing to end their lives and subsequently end the financial burden they place on their families. “We could’ve sent Jenny to college, but grandma decided to keep living with her terminal cancer instead of ending her life.”

· PAS is not the only remedy for suffering or loss of autonomy

· “Which god?” Everyone knows what god someone is talking about when someone says “it was an act of god.” Playing god is not an act which is different based on one’s god.

· Terminally ill people with depression should be treated for their depression and not killed

· “Even regulation of PAS does not guarantee that its practice will be limited according to the legal and clinical boundaries we create, nor can it ensure protection of those who may be most in need of protection.” - Cohn

(from the UW Medicine PAD page)

1. Respect for autonomy: Decisions about time and circumstances of death are personal. Competent people should have right to choose the timing and manner of death.

But it’s not really a choice. It’s a choice between dying of their illness or committing suicide, neither is the choice that most people would make if they were truly allowed to choose the timing and manner of their death. Most people would choose to die of natural causes after a long and fulfilling life, and neither of the options presented truly gives the patient what they want. And does anyone truly decide the timing and manner of their death? No. The Cohn reading for class today also points out that legalizing PAS may have the effect of constraining choices because PAS may become a societal obligation, to “avoid suffering, indignity and impoverishment.”

2. Justice: Justice requires that we "treat like cases alike." Competent, terminally ill patients have the legal right to refuse treatment that will prolong their deaths. For patients who are suffering but who are not dependent on life support, such as respirators or dialysis, refusing treatment will not suffice to hasten death. Thus, to treat these patients equitably, we should allow assisted death as it is their only option to hasten death.

Why is it important to hasten death for either of them? And why should patients who are terminally ill but not dependent on life support make the doctor provide them with lethal medication? The act of providing a patient with lethal medication is much more involved than removing a life sustaining treatment.

3. Compassion: Suffering means more than pain; there are other physical, existential, social and psychological burdens such as the loss of independence, loss of sense of self, and functional capacities that some patients feel jeopardize their dignity. It is not always possible to relieve suffering. Thus PAD may be a compassionate response to unremitting suffering.

It’s normal to experience suffering in life and sometimes it’s not possible to relieve suffering. Suicide is also a very severe response and solution to suffering; it prevents suffering but it also prevents that person from ever experiencing happiness or any other positive emotion again. Is suicide really a good solution to unremitting suffering? Some people may experience unremitting suffering due to a chronic, non-terminal illness or because of a disability, but that doesn’t mean that suicide is an appropriate response to their suffering. Even if we come to the conclusion that suicide is an appropriate response to suffering, why should a doctor be forced to facilitate their suicide?

4. Individual liberty vs. state interest: Though society has strong interest in preserving life, that interest lessens when a person is terminally ill and has strong desire to end life. A complete prohibition against PAD excessively limits personal liberty. Therefore PAD should be allowed in certain cases.

The government limits personal liberty all of the time, and what is an ‘excessive’ limit of personal liberty is highly subjective. For example, your personal liberty to drive as fast as you want is limited, your liberty to own whatever type of gun you want is limited, etc. Some people consider laws against murder and rape to be ‘excessive limits of personal liberty’ but most do not. Some people believe that laws requiring people to pay taxes or preventing them from owning automatic weapons is an “excessive limit on personal liberty” but most recognize that that law is reasonable. Most people recognize that certain limits on personal liberty are acceptable. Additionally, as author Jane St. Clair said: “[y]ou already have the power to commit suicide at any time. But if you sign a paper agreeing to have your doctor do it for you, you are turning over your power to someone else. You are creating a mechanism for the government and medical people to enter into decisions as to who lives and who dies. You are taking away the power of the individual.”

5. Honesty & transparency: Some acknowledge that assisted death already occurs, albeit in secret. The fact that PAD is illegal in most states prevents open discussion between patients and physicians and in public discourse. Legalization of PAD would promote open discussion and may promote better end of life care as patients and physicians could more directly address concerns and options.

Discussion of illicit drugs and illegal procedures isn’t illegal. We discussed several topics which are illegal in class (kidney sales, for example) without consequence; we didn’t need kidney sales to be legal in order to openly discuss it.

· Respect for autonomy

· Justice

· Compassion

· Individual liberty vs state interest

· Honesty & transparency

SUMMARY: (Kyle)

Our group wholeheartedly rejects the notion that physician-assisted suicide is ethical. As we expressed throughout the course of this exchange, we believe that physician-assisted suicide should be banned, and our reasoning derives from the following principles (and theories?): Value Theory, Respect for Persons, and Non-Maleficence. As compelling as it may seem, at least on the surface, to legalize these “mercy killings” we affirm that life is innately valuable and worthy of protection,regardless of any perceived instrumental worth. Moreover, we hold to the precept that no one should be coerced into taking an action that is not of their own volition. This includes both doctors and nurses alike, not just the more traditional vulnerable populations that generally come to mind. Finally, We employed the principle of non-maleficence in this debate because taking a life is undeniably a form of harm, even with the best intentions in mind. We stand by what our founding fathers laid out in the Declaration of Independence: “We hold these truths to be self evident...that all men [and women] are created equal” and enjoy “certain unalienable Rights” and “that among these are Life”.

Evidence Medication has been misused

Evidence that Doctors/Residents are overworked (Statistics)

State Laws of Death with Dignity

· California (End of Life Option Act; 2016) (CLINTON)

· Colorado (End of Life Options Act; 2016) (KYLE)

· District of Columbia (Death with Dignity Act; 2017) (JOSEPH) (http://www.nolo.com/legal-encyclopedia/the-district-columbias-death-with-dignity-act.html)

· Oregon (Oregon Death with Dignity Act; 1994/1997) (VINCENT)

· Vermont (Patient Choice and Control at the End of Life Act; 2013) (MAC)

· Washington (Washington Death with Dignity Act; 2008) (VINCENT)

· Montana does not currently have a statute safeguarding physician-assisted death. In 2009, Montana’s Supreme Court ruled nothing in the state law prohibited a physician from honoring a terminally ill, mentally competent patient’s request by prescribing medication to hasten the patient’s death. Since the ruling, several bills have been introduced to codify or ban the practice, none of which have passed. (MAC)

Evidence of Counsel and Caring for terminally ill

THE FUTURE OF ASSISTED SUICIDE AND EUTHANASIA

We argue for “...retaining existing law on the basis that human life is fundamentally and inherently valuable, and that the intentional taking of human life by private persons is always wrong.” - p. 157

Clarification by Neil Gorsuch: “To be clear from the outset, I do not seek to address publicly authorized forms of killing like capital punishment and war. Such public acts of killing raise unique questions all their own.” - p. 157

Human life as a basic good: “In claiming something as a basic good, I have in mind something that is understood and felt as intrinsically worthwhile, an end that is a reason, sufficient in and of itself, for action and choice and decision. I have in mind something that is categorically good, not something that is good only because of its instrumental usefulness in achieving some other end.” - p. 157

“the House of Lords Select Committee on Medical Ethics recognized . . . the belief that human life is inherently valuable and worthy of protection.”

SOURCES:

http://www.thecompassionatechoice.com/articles/30-logical-reasons-against-assisted-suicide/

https://www.dallasfortworthinjurylawyer.com/2008/10/medical_malpractice_judgment_u_1.html

http://www.insurancejournal.com/news/southeast/2008/10/27/94996.htm

http://www.heritage.org/health-care-reform/report/always-care-never-kill-how-physician-assisted-suicide-endangers-the-weak

http://wrtl.org/assisted-suicide/personal-stories-assisted-suicide/

https://link.springer.com/article/10.1023/A%3A1018739807708 (let me know if link breaks)

https://www.theatlantic.com/health/archive/2012/10/physician-assisted-suicide-is-not-progressive/264091/

http://www.tandfonline.com/doi/abs/10.1080/00243639.2016.1201375 (again, let me know if the link breaks)

http://www.vaeh.org/doctors-often-misdiagnose-the-terminally-ill/ (list of people with terminal diagnoses which turned out to be wrong)

https://www.oyez.org/cases/1996/96-110 (Washington v. Glucksberg)

https://www.oyez.org/cases/1996/95-1858 (Vacco v. Quill)

https://www.deathwithdignity.org/

http://notdeadyet.org/2017/05/ndy-activists-deliver-counter-to-ny-assisted-suicide-proponents-lobby-day.html

http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct/FrequentlyAskedQuestions

State-by-State Guide to Physician-Assisted Suicide http://euthanasia.procon.org/view.resource.php?resourceID=000132

https://dredf.org/public-policy/assisted-suicide/some-oregon-assisted-suicide-abuses-and-complications/

http://www.seattletimes.com/seattle-news/health/death-with-dignity-doctors-thwart-steep-price-hike-for-lethal-drug/

https://www.theatlantic.com/business/archive/2017/02/doctors-long-hours-schedules/516639/

Position Paper Structure:

Intro/Conclusion: Kyle

There are two sides to every issue, and physician-assisted suicide is no different.

FOR: Joseph, Maciej

Respect for autonomy

Justice

Compassion

Individual liberty vs state interest

Honesty & transparency

Respect for autonomy is perhaps the most important factor in supporting physician-assisted suicide (PAS). PAS is a very personal decision and represents a person deciding their own fate as an autonomous agent, which they are to be treated as under the Belmont Report. To prevent someone from choosing PAS as their ultimate fate is to show a lack of respect for their ability to make choices for themselves. According to Ezekiel Emanuel, 78% of people who choose PAS do so out of a fear of losing their personal autonomy, and so in the process they actually exercise their autonomy to its furthermost reach. This is also a compassionate response to the mental anguish and feelings of hopelessness, in addition to the physical pain that these people go through due to their terminal illness.

Justice plays a role in giving terminally ill patients equal access to the ability to end their lives, if they so choose. People who are reliant on a feeding tube for their survival may opt to have the tube removed so that they may die of starvation or dehydration. This is described as a “very comfortable way to die” (Cohn) and allows the patient to decide whether or not they want to continue living. People without this dependence on artificial life-sustaining methods, however, lack this option, thereby increasing their feelings of helplessness. Thus, they must resort to other means to end their lives if they choose to do so. Allowing for physician-assisted suicide gives these people the same opportunity and autonomy that other terminal patients have.

Even though the State does have a legitimate interest in protecting life, as described in court cases like Roe v. Wade, their interest in the life of a person is diminished when that individual has reached an end-stage of life. When a person is going to die within six months, the State’s ability to protect their life is almost non-existent. Unless the State manages to outlaw terminal illnesses they have no ability to protect individuals from the end stage of life. Therefore due to this lack of ability, people should be given the personal liberty to make the decision to end their own lives with the assistance of a physician. Additionally, to limit physician assisted-suicide limits the liberty of the vulnerable person affected by this illness. Not every case may be treated similarly, however there are certain circumstances where the patient may be allowed to follow this course of action.

Compassion is a necessary component of physician assisted-suicide. To understand what the patient is going through, and do what can be done to assist them in every way. This includes allowing them to keep their dignity. An argument made in the debate was that life and dignity are both equally important to one another. In ‘Four Myths About Doctor-Assisted Suicide’, it’s stated that “A multitude of studies based on interviews of patients . . . have demonstrated that patients who desire euthanasia . . . or physician-assisted suicide . . . tend not to be motivated by pain.” (EMANUAL). People that wish to die before they lose their faculties, mind, or otherwise, wish to keep their dignity intact. In ‘Contemporary Issues in Bioethics’, it’s stated that “A central aspect of human dignity lies in people’s capacity to direct their lives . . .” (BEAUCHAMP). More than just pain is considered with compassion, as you have to take into account to mental status of the patient.

Another claim made in the debate was that there was no possibility for a vulnerable person to be allowed to perform PAS. Each State that allows for this course of action has strict guidelines to ensure that whoever chooses to die is not plagued by depression, coerced by family, etc. The honesty and transparency involved in the Death with Dignity act showcases the ability to go to a physician and discuss openly the subject. However, physician assisted-suicide is still illegal in the majority of states, making it difficult for individuals to learn more about it from their physicians. In terms of ethics, it’s stated that “Some acknowledge that assisted death already occurs, albeit in secret. The fact that PAD is illegal in most states prevents open discussion between patients and physicians and in public discourse. Legalization of PAD would promote open discussion and may promote better end-of-life care as patients and physicians could more directly address concerns and options.” (BRADDOCK III). Due to this road block, it is easier to speak with a physician in a state where PAS is legal about the procedure than a state where it is illegal, or to speak about it on a nation wide scale. There is a need for more honesty and transparency regarding the issue.

Emanuel, Ezekiel J. "Four Myths About Doctor-Assisted Suicide." The New York Times. The New York Times, 27 Oct. 2012. Web. 28 May 2017.

Beauchamp, Tom L. Contemporary issues in bioethics. 7th ed. Australia: Wadsworth Cengage Learning, 2014. Print.

Braddock III, Clarence H. "Physician Aid-in-Dying." Physician Aid-in-Dying: Ethical Topic in Medicine. University of Washington School of Medicine, n.d. Web. 28 May 2017.

AGAINST: Clinton, Vincent

Sanctity of life

Passive vs. Active distinction

Potential for abuse

Professional integrity

Fallibility of the profession

Physicians’ aid in dying is against the sanctity of life and is in contrast with religious and secular traditional values upheld since time immemorial. The act actually equates to murder since the physician willingly kills the patients. Moreover, allowing assisted-deaths will have a strong impact on the poor since they may opt for the deaths when they are unable to raise money for their treatments. They may choose to die early by assuming that they might eventually succumb to the diseases, yet they might get well when they continue living. Furthermore, assisted-deaths should never be legal since the medical profession’s ethical traditions strongly oppose deliberate killings, and this is evidenced in the Hippocratic Oaths they take (Starks, Dudzinski and White).

Additionally, some patients seeking suicide assistance may not be in pain. Instead, they may be opting to die rather than undergo the pains associated with a disease. Furthermore, some patients may be suffering from psychological problems and physicians should not help them in ending their lives. Instead, they should offer them treatment and care. In areas where assisted-deaths are allowed, less than 3% die of their diseases at the end while patients who are interested in assisted-suicides are less than 10%. Generally, allowing physicians to help patients in dying will lead to increased cases of euthanasia, for example on the disabled, poor and elderly (EMANUEL).

Passive vs. Active distinction

Those who oppose Physician aid-in-dying argue that there is a clear distinction between allowing a patient to die versus killing them. Some individuals find that letting a patient die by means of refusing treatment or simply withholding treatment is justifiable. The ethical principles of beneficence argue that the doctor is doing good by the patient, in terms of ending the patient’s suffering, and thereby considered justifiable. On the other hand, some individuals find that physician aid-in- dying is equivalent to murder and is by no means justifiable. The act of withholding treatment that may prolong the life of a terminally ill patient can be viewed as a violation of the ethical principle, non-maleficence. Whether a patient is terminally ill or not, doctors shall not partake in the harm of a patient. Regardless, both result in death and the distinction between the two is largely debated.

Potential for abuse

Physician aid-in-dying can be viewed as the only means for treatment for vulnerable populations that lack the funding for lengthy and expensive treatment (Stark, 3). Family members that carry such burden are often manipulated by healthcare professionals to think that ending the patient’s life may be, financially, in their best interest. This business point of view conflicts with the ethical principles of both non-maleficence and beneficence. Never should to best interests of sustaining the life of the poorer patient be coerced by the burden of financial consequences that may come from those treatments.

Professional integrity

Medicine has been historically aimed to treat the ailments of a patient and rid them from that ailment through the practice of various treatments. All medical doctors have historically taken the Hippocratic Oath, requiring them to swear to uphold specific ethical standards. The Oath clearly states that they are not to administer poison to anyone where asked, and are to be of benefit, or at least do no harm (Starks, 3). Therefore, under this ancient moral code by which all doctors swear to upheld, physicians who aid-in-dying violate their professional integrity and moral obligation. Remnants of the Hippocratic oath are the basis of several other ethical principle that modern societies deem ethical and what is not. All of which continue to draw upon the duty of a physician be that he shall do good by the patient and at the very minimum, shall be only of benefit.

Fallibility of the profession

Those who opt for death do so because a medical professional has deemed their condition terminal. The patient and the medical professional believe that based on the evidence at hand, it is morally sound and often the best decision (Stark, 3). But the patient fails to realize that doctors can be wrong. In fact, it is highly likely that the medical professional making these life or death decisions are overworked residents that are straight out of medical school with little to no experience. Furthermore, patients fail to realize that medical professionals are merely practicing the art of medicine. The understanding of the human body is still being studied and the understanding of it is still highly controversial and often misunderstood. A doctor’s mere lack of experience subjects the patient to uncertain diagnosis and prognosis that result in the coercion of a patient to opt for a fatal injection that is thought to save them from the pain and suffering. However, the patient is likely misdiagnoses and the the physician murders a patient that would have been cured in the care of another physician with more experience or understanding..

INTRO

There are often thoughtful and compassionately motivated attitudes that drive each side of a controversy, and physician-assisted suicide is not an exception. With the vast amount of sophisticated advertisements trying to lead us towards certain conclusions, it is often difficult to evaluate this topic objectively. Nonetheless, because this is a matter of life or death, it is important that individuals make the effort to listen and use critical thinking in discerning one’s own position on the topic. In the paragraphs that follow, our group will weigh the arguments made by each of the two differing viewpoints. While we recognize that each position has valid opinions and reasonings, we reject the notion that physician-assisted suicide is an ethical course of action. We believe that physician-assisted suicide should be banned, and our conclusions are grounded in the following principles: Value Theory, Respect for Persons, and Non-Maleficence.

FOR

An argument made by the “pro” side, regarding respect for autonomy, is perhaps the most important factor in supporting physician-assisted suicide (PAS). PAS is a very personal decision and represents a person deciding their own fate as an autonomous agent, which they are to be treated as under the Belmont Report. To prevent someone from choosing PAS as their ultimate fate is to show a lack of respect for their ability to make choices for themselves. According to Ezekiel Emanuel, 78% of people who choose PAS do so out of a fear of losing their personal autonomy, and so in the process they actually exercise their autonomy to its furthermost reach. This is also a compassionate response to the mental anguish and feelings of hopelessness, in addition to the physical pain that these people go through due to their terminal illness.

AGAINST

Those who oppose Physician aid-in-dying argue that there is a clear distinction between allowing a patient to die versus killing them. Some individuals find that letting a patient die by means of refusing treatment or simply withholding treatment is justifiable. The ethical principles of beneficence argue that the doctor is doing good by the patient, in terms of ending the patient’s suffering, and thereby considered justifiable. On the other hand, some individuals find that physician aid-in- dying is equivalent to murder and is by no means justifiable. The act of withholding treatment that may prolong the life of a terminally ill patient can be viewed as a violation of the ethical principle, nonmaleficence. Whether a patient is terminally ill or not, doctors shall not partake in the harm of a patient. Regardless, both result in death and the distinction between the two is largely debated.

Physician aid-in-dying can be viewed as the only means for treatment for vulnerable populations that lack the funding for lengthy and expensive treatment. Family members that carry such burden are often manipulated by healthcare professionals to think that ending the patient’s life may be, financially, in their best interest. This business point of view conflicts with the ethical principles of both non-maleficence and beneficence. Never should to best interests of sustaining the life of the poorer patient be coerced by the burden of financial consequences that may come from those treatments.

Those who opt for death do so because a medical professional has deemed their condition terminal. The patient and the medical professional believe that based on the evidence at hand, it is morally sound and often the best decision. But the patient fails to realize that doctors can be wrong. In fact, it is highly likely that the medical professional making these life or death decisions are overworked residents that are straight out of medical school with little to no experience. Furthermore, patients fail to realize that medical professionals are merely practicing the art of medicine. The understanding of the human body is still being studied and the understanding of it is still highly controversial and often misunderstood. A doctor’s mere lack of experience subjects the patient to uncertain diagnosis and prognosis that result in the coercion of a patient to opt for a fatal injection that is thought to save them from the pain and suffering. However, the patient is likely misdiagnoses and the the physician murders a patient that would have been cured in the care of another physician with more experience or understanding.

Upon weighing the pros and cons that each side of this debate has to offer, we have determined that physician-assisted suicide is immoral for several reasons. From a Value Theory standpoint, we affirm that “human life is fundamentally and inherently valuable, and that the intentional taking of human life by private persons is always wrong” (Gorsuch, 157). As much as we would like to believe that PAS does not involve the intentional taking of another individual’s life, we cannot in good conscience deny that physicians are responsible for the deed in question. Furthermore, we worry that coercion will lead people undesired premature deaths, no matter how many safeguards are put in place. Untimely deaths resulting from coercion go against the principle of non-maleficence, as well as Respect for Persons as defined in the Belmont Report. And finally, we stand by the assertion that doctors ought to be healers and comforters on the patient’s journey to a natural death. Although accidents happen in the field of medicine (e.g. a surgeon makes a mistake that kills their patient), intent is everything. When a doctor prescribes a fatal cocktail of “medicine” to a patient, they do so with the intent to end life. As our founding fathers laid out in the Declaration of Independence over 240 years ago: “We hold these truths to be self evident...that all men [and women] are created equal” and enjoy “certain unalienable Rights” and “that among these are Life”.

Works Cited

Emanuel, Ezekiel J. "Four Myths About Doctor-Assisted Suicide." The New York Times. The New York Times, 27 Oct. 2012. Web. 28 May 2017.

Beauchamp, Tom L. Contemporary issues in bioethics. 7th ed. Australia: Wadsworth Cengage Learning, 2014. Print.

Braddock III, Clarence H. "Physician Aid-in-Dying." Physician Aid-in-Dying: Ethical Topic in Medicine. University of Washington School of Medicine, n.d. Web. 28 May 2017.

Gorsuch, Neil M. “The Future of Physician-Assisted Suicide and Euthanasia.” Princeton University Press, 2009. Print.