Title: The Supreme Court and Physician-Assisted Suicide — The Ultimate Right
Claim: The Ninth and Second Circuit Court of Appeals decisions were right in holding that state statutes banning physician-assisted suicide (PAS) are unconstitutional and that the Supreme Court will uphold their decisions.
Reasons Supporting the Claim
One of the most ethical principles in medicine is respect for each patient’s autonomy and should almost always take precedence when this principle conflicts with others.
The highest ethical imperative of doctors should be to provide care in whatever way best serves patients’ interests, in accord with each patient’s wishes, not with a theoretical commitment to preserve life no matter what the cost in suffering
Death is not fair and is often cruel. Those who are not receiving life-sustaining treatment may desperately need help. PAS should be allowed when efforts to relieve suffering are unavailing and patients desperately long to end their lives.
One should consider whether the patient’s role is active or passive, rather than considering whether the doctor’s role is passive or active. Assisted suicide, by definition, cannot occur without the patient’s knowledge and participation and is thus active or voluntary on behalf of the patient.
The reason for allowing PAS outweighs the risk and the moral “slippery slope” could be avoided.
No human endeavor is immune to abuses. The question is not whether a perfect system can be devised, but whether abuses are likely to be sufficiently rare to be offset by the benefits to patients who otherwise would be condemned to face the end of their lives in protracted agony.
The principle that patients who really wish to end their suffering could perform suicide with enough determination is the most cruel arguments against PAS.
Evidence of Support
Laws requiring informed consent on any treatment including the honoring of a patient’s request to withdraw life-sustaining treatments provided that the patient is mentally competent are supportive of the patient’s autonomy over his or her own life.
Doctors should be unambiguously committed to life but most of them would readily honor a patient’s decision to have life-sustaining treatment withdrawn. On the other hand, if a patient requests help with suicide and the doctor believes the request is appropriate, requiring someone else to provide the assistance would be a form of abandonment.
Dying sometimes hold great indignities and existential suffering. Some people such as those with cancer, AIDS, or progressive neurologic disorders die slowly and in great anguish. Furthermore, while some pain can nearly be relieved, some cannot while some others still are more difficult to control. There will always be a few patients whose suffering could not simply be allevated.
The right to stop treatment—that is the withdrawal of life-sustaining treatment—is recognized and affirmed by the US Supreme Court in the 1990 Cruzan decision as well as the US Congress Patient Self Determination Act of 1990. The doctor’s role in the withdrawal of life-sustaining treatment is considered passive and active in euthanasia, while their role in PAS is considered to be something in between the active role of injecting drugs in euthanasia and the passive role of turning off the switch in the withdrawal of life-sustaining treatment.
Proxies have the right to decide the withdrawal of life-sustaining treatment when the patient is not sufficiently mentally competent despite the obvious potential for abuse. The voluntary nature of PAS is the best protection against sliding down the slippery slope. Reports from the Netherlands where euthanasia and PAS are both permitted indicate that fears about a slippery slope have not been borne out.
Overburdened families or cost-conscious doctors might pressure vulnerable patients to request suicide, but similar wrongdoing is at least as likely in the case of withdrawing life-sustaining treatment, since that decision can be made by proxy. Yet, there is no evidence of widespread abuse.
Patients are often physically unable to commit suicide on their own while others lack the resources to do so. Percy Bridgman, a Nobel laureate in physics who in 1961 shot himself rather than die of metastatic cancer, said in his suicide note, “It is not decent for Society to make a man do this to himself.”
Marcia Angell has refuted virtually every argument against PAS. Her reasons in defense of PAS are adequately justified and deserve merit. Instead of focusing on the role of the physicians in their role in assisting suicide, Angell emphasized on the autonomy of the patient whose decisions and right should be the main concern while at the same time justifying the role of physicians to honor the requests of their patients without withdrawing their support and care for the patients.