Bioethical Debate on Assisted Suicide
In his book Practical Ethics, 2nd edition, Peter Singer states that “voluntary euthanasia occurs only when, to the best of medical knowledge, a person is suffering from an incurable and painful or extremely distressing condition. In these circumstances, one cannot say that to choose to die quickly is obviously irrational.” (200). Singer is referring to the right that a terminally ill patient should have to die with dignity under certain circumstances. Oregon’s death with dignity act of 1997 states that, in order for a patient to be eligible for assisted suicide they need to be over the age of 18, be competent in making the end of life decision, have a primary physician and a consulting physician diagnose them with a terminal illness and give them less than six months to live. They must also wait 15 days before filling the prescription and may be required to attend one or more counseling sessions with a licensed psychiatrist or psychologist (Oregon’s Death With). With these stipulations in place, I agree with Peter Singer in that all terminally ill patients should be given the option of assisted suicide to hasten their death and to avoid suffering.
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In the stories of Brittany Maynard, Nancy Crick, and Elizabeth Bouvia, three common reasons for wanting assisted suicide are discussed. They all want to have a choice in their death, they want to die with dignity and have assurance against suffering. Some will question the ethical rationale behind assisted suicide but I, like Peter Singer, believe that terminally ill patients should have the right to choose their death, to die with dignity and without suffering.
- Choice in Death
Terminally ill patients do not have control over their illness or the prognosis, they also begin to lose control over their general health. In all the loss of control, they should be given a choice to be able to control their death. Brittany Maynard wrote “Who has the right to tell me that I don’t deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me” (Maynard)? In the documentary “A Dangerous Mind”, Nancy Crick had suffered from bowel cancer. She had undergone three surgeries but her health continued to deteriorate. She had reached a point where she no longer wanted to fight and was ready to make the choice to die peacefully (Dangerous Mind 7). Patients have a right to autonomy in health care, and to govern how they want their care to be. This right should be the same in death. Medical technology today has gotten good at prolonging life, but there is also a point where this care just becomes prolonged suffering (De La Torre). This is where patients who are of sound mind and given a terminal prognosis should have the right to govern how, when and where they will die. It could be one of the only choices they have left in their life. Gregory Pence, in the book Medical Ethics, wrote about the questions surrounding the risks associated with the assisted suicide choice (48), but statistics from Oregon show that the law and its stipulations seem to be working well. In the 20 years that the act has been in place a total of 2,216 terminally ill patients have received a prescription however, only 1,459 used the medication (Oregon’s Annual Report).
- Dying with Dignity
In the case of Elizabeth Bouvia, she was born with cerebral palsy and was almost completely paralyzed. Due to her physical disability, she was dependent on others for help. Elizabeth wanted to be in control of her fate, she wanted to stop eating so she could die with dignity (Pence 19-24). For Brittany Maynard, she was diagnosed with terminal brain cancer that would eventually leave her struggling with seizures, personality changes, and with verbal, cognitive and motor loss (Maynard). She did not want to put her family through watching her suffer, Brittany wanted to die with dignity.
A study done at Stanford School of Medicine on palliative care showed that 80 percent of Americans want to be able to die with dignity at home. However, the reality is that only about 20 percent will die at home. It showed that 20 percent die in nursing homes and 60 percent will die in a hospital setting (Stanford). In dying, patients often suffer from dehydration and fatigue they are often incontinent, have fears and anxiety. Death is a complete loss of dignity. While the body is shutting down the mind is often still fully functioning, and patients continue to think about what is happening to their bodies (Pence 48).
- Assurance Against Suffering
Many do, but, no one should suffer, not in life or death. Pence stated that about 10 percent of pain cannot be controlled and that even with the best palliative care there is still 2-5 percent of terminally ill patients that will experience pain. Medications can help to treat the physical pain but this comes with a risk of sedation. Patients may be forced to choose between the treatment of pain and their conscious state (Pence 48). Even with the treatment of pain patients are still struggling with other symptoms of suffering such as helplessness, stress, exhaustion, and fear, these symptoms are harder to treat with medications (Pence 48).
After being granted the right to refuse medical treatment Elizabeth Bouvia chose not to die. Having the choice to withdraw care at any point relieved much of her suffering and gave her a reason to live (Pence 24). Just knowing that one has the choice to end their suffering can be relief enough to help them through the dying process.
- The Critics
Peter Singer as well as other philosophers and even supports of assisted suicide face daily criticism. Wesley Smith criticized Singer in the documentary, A Dangerous Mind, by saying that the answer is not assisted suicide. The answer is the obligation of humans to help carry the burdens of others, to help them through their difficult times (Dangerous Mind 8). Wesley argued that humans must show compassion, look out for each other in times of need and ease the suffering by distributing the burden and helping to carry the weight of the stressor. While I agree with Wesley, that we as humans are supposed to be there for each other, to help our neighbors when they are in need and to ease the load. I do not agree that this is the answer to all human suffering in all situations. Autonomy is different for every human being in every situation. There are times where easing one’s suffering involves simply being present and supportive of their autonomy and wishes, whether one agrees with it or not. Sometimes this means being with a loved one and holding their hand as they ingest medications to end their suffering. One cannot assume that simply helping to carry the burden of others is going to ease the suffering of all.
- Principles of Ethics
Autonomy is giving patients the right to make the best decision possible for themselves (Pence 16). In support of assistive suicide, Peter Singer is fighting for another choice in the death of terminally ill patients. In doing this he is hoping to give these patients the autonomy to choose to die in peace, with minimal suffering, and with dignity. The decision of assistive suicide is an autonomous choice and is fully patient-driven.
Beneficence is the principle of doing what is best for the patient (Pence 17). Assistive suicide is not a choice that will be right for all patients, there will be some that will not have the cognitive state needed to make this decision and some that simply feel that this is not the right decision for them. Having this option available to all is what provides beneficence. The choice of assistive suicide will give patients the autonomy to choose what is best for them.
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Non-maleficence is to do no harm to patients (Pence 17). Providing patients with medications that will end their lives is completely against this principle. This is a big argument against physician assistive suicide. Physicians take the Hippocratic Oath which states they will do no harm, yet in some states and countries, they are being asked to provide medications that will end one’s life.
Justice is the fair treatment of all patients (Pence 17-18). The choice of assistive suicide, when used with its legal guidelines, will provide another option for all those who are terminally ill. It gives them the choice of dying in dignity. While some may choose not to use it, there are others like Brittany Maynard, that will choose it to ease the pain and suffering at the end of their lives. If everyone had the option of Death with Dignity, it would bring fair treatment, in that all terminally ill would have the option to choose how, when and where they will die. Currently, this is not the case, so the treatment is not fair for all terminally ill. For the states that do not have laws in place this action could be considered killing a person and could have legal ramifications. With its strict guidelines to protect others, death with dignity will never be something that all patients will have access to.
Peter Singer, in advocating for assistive suicide is not looking to kill people, he is simply looking to give those with a terminal illness, that wish to die with little suffering and dignity the choice to do so. This is an autonomous choice that all terminally ill patients should be free to have.
- “Brittany Maynard.” Compassion & Choices, https://compassionandchoices.org/stories/brittany-maynard/.
- “Oregon Death with Dignity Act: Annual Reports.” Death With Dignity, https://www.deathwithdignity.org/oregon-death-with-dignity-act-annual-reports/
- “Oregon Revised Statute: Oregon’s Death with Dignity Act.” Oregon Health Authority : Oregon Revised Statute: Oregon’s Death with Dignity Act : Death with Dignity Act : State of Oregon, https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ors.aspx, 1997.
- “Peter Singer: A Dangerous Mind.” Australia Broadcasting Corporation, 2003, 33059.
- “Where Do Americans Die?” Palliative Care: Education & Training, 21 Apr. 2013, https://palliative.stanford.edu/home-hospice-home-care-of-the-dying-patient/where-do-americans-die/.
- De La Torre, Esther The Right to Assisted Suicide, http://www.lonestar.edu/rightto-assist-suicide.htm
- Pence, Gregory. “Requests to Die: Terminal and Nonterminal Patients.” Medical Ethics: Accounts of Ground-Breaking Cases. Eighth ed., McGraw Hill Educations, 2017, PP. 19-51.
- Practical Ethics. Cambridge University Press, 2017
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