Ethical Issues in Terminal Health Care
Part Five: Making The Final Choice: Should Physician-Assisted Suicide
Be Legalized?
by Ed Newman
Published in the Truth Seeker (Volume 121 No. 5)
Medical advances have created ethical dilemmas which no previous generation
of doctors has ever faced. New life-sustaining techniques and practices
are forcing physicians to ask questions that never needed to be asked before.
Foremost of these is: "How far do we go to save a life?"
Other questions challenge ethical traditions which have been in place for
centuries. "When suffering is immeasurable and a patient's condition
terminal, should doctors be permitted to end a patient's life?" "Should
doctors take an active role in hastening a patient's death?"
Today, more than ever, the push is on to "change the rules." Dr.
Kevorkian, while deplored by most medical professionals for his methods,
is heralded as a hero on many fronts for bringing this issue into the public
square. By all accounts a time of decision is upon us. When a fully conscious
person requests death, should a physician -- contrary to the Hippocratic
oath -- assist the person in dying?
It is the purpose of this brief article to present a concise overview of
the primary arguments for and against the legalization of physician-assisted
suicide. Without a careful consideration of the concerns on both sides,
we can find ourselves saddled with ill-conceived policies that do not serve
our best interests and will not be easily dislodged.
There are four primary arguments for legalizing physician-assisted suicide.
They are:
l. The Mercy Argument, which states that the immense pain and indignity
of
prolonged suffering cannot be ignored. We are being inhumane to force people
to continue suffering in this way.
2. The Patient's Right to Self-determination. Patient empowerment has been
a
trend for more than twenty-five years. "It's my life, my pain. Why
can't I
get the treatment I want?"
3. The Economics Argument, which notes that the cost of keeping people alive
is exceedingly high. Who's footing the bill for the ten thousand people
being sustained in a persistent vegetative state? Aren't we wasting precious
resources when an already used up life is prolonged unnecessarily?
4. The Reality Argument runs like this: "Let's face it, people are
already doing it."
The combined effect of these four arguments is persuasive. And many people
I talk to have been persuaded by them. They can't imagine why we have waited
so long to make this an alternative treatment option. The need for legalized
physician-assisted suicide is self-evident, they conclude.
But then, as I present the arguments in opposition to these apparently self-evident
truths, I invariably hear an "A-ha!" and an "Oh!" and
"Well, I never considered..."
And so we give ear to the reverse side of the coin.
There are a variety of arguments against legalizing physician- assisted
suicide. Here are the most widely cited concerns:
l. Medical doctors are not trained psychiatrists. Many, if not most, people
have wished they could die rather than face some difficult circumstance
in their lives. Doctors who are given authority to grant this wish may not
always recognize that the real problem is a treatable depression, rather
than the need to fulfill a patient's death wish. Perhaps Bob Liston's
posting in the General Debate Forum of America Online said it best when
he wrote, "I know many individuals with significant disabilities: quadriplegia,
post-polio survivors, persons with MS, etc. A number of them have tried
committing suicide in the past and are now thankful that a mechanism wasn't
in place that would have assured their death, because they got over whatever
was bothering them at the time and are happy with life again."
2. How will physician-assisted suicide be regulated? This is Carlos Gomez's
forced argument, developed after investigating the Netherlands' experience,
and presented in his book Regulating Death. "How will we assure ourselves
that the weak, the demented, the vulnerable, the stigmatized -- those incapable
of consent or dissent -- will not become the unwilling objects of such a
practice? No injustice," Gomez contends, "would be greater than
being put to death, innocent of crime and unable to articulate one's interests.
It is the possibility -- or in my estimation, the likelihood -- of such
injustice occurring that most hardens my resistance for giving public sanction
to euthanasia."
3. The "Slippery Slope" Argument. A Hemlock Society spokesperson
acknowledges this to be the strongest argument against legalization. In
ethical dialogue, it is conceded that there are situations when an acceptable
action should not be taken because it will lead to a course of consequent
actions that are not acceptable. Our attitudes toward the elderly, people
with disabilities and the devaluation of individuals for the "higher
good of society" should be reflected upon. How long will it be
before our "right to die" becomes our "duty to die"?
4. The "Occasional Miracle" Argument. Sometimes remarkable recoveries
occur. Sometimes diagnoses are far afield of the reality. Countless stories
could be told. I know a few first hand. How about you?
5. Utilitarian versus sacred view of life. This is probably a subset of
the Slippery Slope argument, focusing on our cultural shift in attitude
toward what it means to be human. Huxley's Brave New World vividly demonstrates
an aspect of this argument. We need to be reminded of the role social engineers,
doctors and geneticists played in 1930's Germany. Are we
important only as long as we are making a contribution to society? Or is
value something inherent in our being human? History has shown that when
we devalue human beings, we open the door to abuse. The U.S. Supreme Court,
in
its Dred Scott decision, declared that blacks were not persons. This devaluation
helped permit slavery and inhumane treatment of blacks to continue.
6. What effect will this have on doctor/patient trust? People who traditionally
rely on their doctors to provide guidance in their health care decisions
may become confused, even alarmed, when one of the treatment options presented
is the death machine at the end of the hall. According to Leon R. Kass,
distinguished M.D. from the University of Chicago, the taboo
against doctors killing patients, even on request, "is the very embodiment
of reason and wisdom. Without it, medicine will have lost its claim to be
an ethical and trustworthy profession." Kass asserts that "patient's
trust in the whole-hearted devotion to the patient's best interests will
be hard to sustain once doctors are licensed to kill."
7. What about doctors who don't believe in killing? Will they be required
by law to prescribe a treatment [death] they don't believe in?
Conclusions
Clearly, the ethical dilemmas surrounding terminal health care will be with
us for years to come. There are more than seventy million baby boomers in
this country, most of whom are currently grappling with the issue of aging
parents. And in the decades to come we ourselves won't be getting any younger.
Ironically, our current situation is due in large part to the successes
of medical science, not its failures. More people live longer today than
ever in history because we have eliminated many of the diseases that once
terrorized us as a society.
But some of the problem is due in part to our love affair with technology.
When machines, tubes and computers take over, compassion and common sense
sometimes seem to suffer. Fortunately, there seems to be an increased awareness
of the intrusiveness of technology. Living wills, ethics committees and
hospice care are all responses to this awareness.
How we choose to die in America is a complicated subject that needs clear
thinking and a fair discussion of the ethical and technical dilemmas surrounding
it. But let's keep in mind that even if we agreed that death technologies
are wrong, this would not be an endorsement of the notion that people must
be kept alive for as long as possible at any cost.
- 30 -
Any information in this article pertaining to legal or medical matters
is not to be construed as professional advice. Copyrights remain the property
of the authors.
A variation of this article originally appeared in The Senior Reporter
in the summer of 1992.
contact: ennyman@cp.duluth.mn.us
Part One: Issues and Their Implications
Part Two: Ethics Committees
Part Three: Local Perpsectives on the Right-to-Die
Debate
Part Four: Patients Have Rights, But Doctors Have Rights,
Too
Part Five: The Pros and Cons of Physician Assisted
Suicide
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