The practice of physicians is guided by the Hippocratic Oath, which obligates them to practice medicine ethically. According to the oath, medical practitioners are lifesavers; they are expected to do whatever they reasonably can to prevent death. The code of ethics of medical practice also calls for the preservation of life. Society has been conditioned to believe that the role of healthcare specialists is to treat patients and offer the supportive care that they need. Additionally, ethics, faith, the law, and culture, among other social parameters prohibit taking human lives. Therefore, the thought of physician-assisted suicide is usually frowned upon in most societies. However, the practice seems to be gaining popularity. Typically, terminal illnesses incapacitate patients and cause them immense pain among other adverse effects that diminish the quality of their lives. Some choose palliative care, a multi-disciplinary procedure of socialized nursing care for patients who have terminal conditions. Nevertheless, as indicated by scholars such as Materstvedt et al. (2012), palliative care may be significantly stressful mentally, physically, and financially both for patients and their loved ones. Therefore, some terminal patients opt for euthanasia. Assisted suicide is a medical procedure that involves the painless killing of a person with a terminal and painful ailment, or in some instances in an irreversible coma, with the patient’s consent or that of an authorized party. The appropriateness of the procedure is considered from different perspectives: medical, ethical, religious, and cultural.
Public Policy
Currently, the prevailing public policies are split between accepting and rejecting euthanasia. In the U.S., only seven states legally allow physician-aided suicide while the Nursing Council refutes it. Ethics is the foundation of medical practice. However, other aspects, such as the Hippocratic Oath, also govern the practice, as according to the oath doctors pledge, “…I will not give lethal drugs to any individual even when asked to do so, nor will I advise on such an option…” (Miles, 2005, n.p.). From the oath’s perspective, physician-assisted suicide is unethical. However, blindly following a vow that dates back to 275 AD may be counterproductive considering the different circumstances between that period and today. The American Nurses Association (ANA) condemns nurses’ participation in euthanasia-related activities (Matzo & Sherman, 2015). Nevertheless, as Fowler (2008) asserts, the nursing code of ethics emphasizes treatment and cure, which are not viable options in the case of terminal illnesses. Therefore, the requirement to preserve life does not apply to an incurable condition. The code of ethics also highlights the aptitude of caregivers to provide compassionate and humane solutions in instances when pain and suffering are uncontrollable and unavoidable. At times, palliative care does not relieve pain or suffering. For instance, sometimes, safe doses of morphine fail to relieve pain and suffering. In such instances, it is arguable that assisting in a terminal patient’s death is more humane than keeping him alive.
Moral Relativism
According to the principles of moral relativism, general truth does not exist. That is, nothing is universally right or wrong. As such, an issue may be deemed ethical by a particular community but considered evil by another. Consequently, during a period when civility and reasonableness are valuable aspects, it is no surprise that euthanasia is considered ethical in some cases and areas, but not in others.
Historical and Contemporary Aspects
Assisted suicide has been practiced in its different forms for a long time. As indicated by Minois (1998), the origins of what is described as euthanasia today can be traced back to first century Rome. For example, Augustus Caesar’s death was assisted. All through the first to fourth centuries, the Romans and Greeks supported euthanasia. As narrated by Curtice and Field (2010), both aforementioned communities believed that an individual’s life ought not to be preserved in an instance the said person has no interest in living. Subsequently, voluntary euthanasia was allowed, despite the existence of the Hippocratic Oath at the time. During the age of Classical Antiquities, there existed widespread support of physician-aided death, as practitioners then saw it as a better option as opposed to prolonged agony. As indicated by Minois (1998), the physicians often complied to their patient’s request for euthanasia to the point of conducting the procedure with the poison they requested. Presently, euthanasia is unpopular with almost half of the U.S. population protesting against it, despite the improvement in the means with which the practice is conducted. As indicated by Cholbi and Varelius (2015), assisted suicide is currently conducted by using a variety of drugs, that include anesthetics, which guarantee a painless death. Nevertheless, as indicated by Matzo and Sherman (2015), some individuals in current society believe that with improved palliative care, euthanasia ought not to be used as an alternative medical procedure for aiding terminally ill patients.
For centuries palliative care was the best way to manage fatal illnesses until natural death occurred. Nonetheless, this form of care may not be the solution to caregiving for all the dying (Quill, Cassel, & Meier, 2007). For example, physicians are ethically and professionally restricted from performing particular pain-relieving procedures (Matzo & Sherman, 2015). Therefore, such patients experience agonizing pain. The only other way to relieve their pain is to allow them to die.
Consider the case of Craig Ewert, a motor neuron disease patient. The ailment is known to cause excruciating pain (Curtice & Field, 2010). Currently, it does not have a cure, and there is very little that can be done to help such as a patient. Mr. Ewert’s palliative care did not ease his pain and suffering. The patient reported feeling that his body was a ‘living tomb’ as his life was ‘in full tide’ (Tomasini, 2014). He felt that he had suffered enough pain and suffering in life that death seemed like a much-needed reprieve. In such cases, physician-assisted suicide seems like a necessary evil.
Reasonableness in the Ethics of Euthanasia
The aspect of reasonableness in ethics is not easy to define because different communities view responsibility in different ways. According to Mr. Ewert, “…I have two choices; I go on with the procedure and die, or I avoid it and suffer, inflict the pain on my family and then I die…” (The Betamax Man, 2018). Individuals who have terminal diseases have limited choices in the medical field with reference to treatment or a cure. Palliative care as mentioned has glaring weaknesses, mainly when an individual is in excruciating pain or is helpless as in Mr. Ewert’s case. In an article published in The Independent (2008), Mary Ewert, Craig Ewert’s wife, explains that her husband’s assisted suicide allowed society to realize that sometimes life is the cruel option and an individual can be allowed to die comfortably. Without the assistance of euthanasia, he was bound to die a painful and agonizing death. As cited by Pence (2015), reasonableness is based on being fair-minded, thus allowing the concept of open-mindedness and willingness to analyze best the views of other people. It is for this reason that calls for the legalization of physician-assisted suicide are not unreasonable.
Civility in the Ethics of Euthanasia
The Nursing code of ethics emphasizes treating patients with utmost care. Therefore, it calls for these professionals to be civil. The Hippocratic Oath notes that giving a lethal drug to a person is unacceptable since it goes against the civility of the profession. However, Quill (2003) states that the oath is unreasonable since it does not consider extreme cases, such as painful terminal illnesses that lower the quality of life. Civility implies courtesy. Therefore, taking away irreversible pain may be considered courteous even if it means taking the life of a person. Mr. Ewert’s initial indications of motor neuron disease were noticed in 2005. By the spring of 2006, he had lost all his motor capabilities and was on a ventilator permanently (Tomasini, 2014). His suffering, as well as agony, is what led to his decision to seek the aid of assisted suicide. Civility requires the parties against euthanasia to at least care for the individual in such as a state. A terminally ill person may view life as cruel and those around him or her as cruel for not taking away the pain, yet the loved ones believe that holding to the person is being loving and caring.
Universalization and Impartiality in the Ethics of Euthanasia
Currently, assisted suicide is practised legally in countries such as Belgium, Canada, Germany, the Netherlands, and Luxembourg. In the U.S. it is legal in Washington DC, California, Montana, Oregon, Washington, Hawaii, Vermont, and Colorado. The reason for the partial acceptance is based on the different beliefs that people and leaders of diverse countries and states have regarding the matter. Generally, for one to qualify for the practice, he or she has to satisfy three significant criteria.
Foremost, the person should be a mentally competent adult with the aptitude to make sound and autonomous decisions without duress or external influence. Practitioners are expected to share all the relevant information regarding treatment (palliative care and euthanasia) to patients impartially and allow them to make judgments on their own (Behuniak & Svenson, 2003). If the decision to be euthanized is illegally influenced, then the guilty persons are liable to prosecution.
Secondly, those seeking physician-assisted suicide ought to comprehend the notion of death. That is, they must understand the implication of the choice to die. When patients understand that euthanasia allows them to control how they die and find it acceptable, then doctors in the areas where the practice is legal are allowed to perform it. According to Cholbi and Varelius (2015), only when a patient comes to terms with the realities of death and gives a clear and uninfluenced acquiescence is he or she allowed to choose to undergo euthanasia.
Lastly, and quite importantly, such persons must have irremediable medical conditions. Over the years, palliative care has improved notably due to the advancement of medical equipment. However, in such cases, like that of Mr. Erewit, when palliative care does not alleviate the pain and suffering of dying patients, there is no point in administering it further. The practice is acceptable in instances when a victim is unable to endure suffering, and it is possible that the strain may get worse (Engelhardt Jr & Malloy, 2008).
Personal Opinion
On the surface, the notion of physician-assisted suicide may seem immoral and a betrayal of the medical practitioner’s role of saving lives rather than taking them. Typically, the medical code of ethics does not advocate euthanasia, irrespective of the prevailing circumstances. However, the reality is that at times medical experts deal with extreme cases, such as painful terminal illnesses that debilitate patients. Away from the medical codes of conduct for practitioners, the issue of euthanasia is looked at from different perspectives. Regarding ethics, reason and civility demand that terminally ill patients be allowed to die in the manner of their choosing. Most laws guarantee the right to life and harshly punish murder. However, some nations and states recognize the importance of euthanasia; hence they have legalized it and not classified it as murder. These nations have put in place criteria of judging the eligibility of people for the practice to prevent it from being misused. The conventional threshold of right and wrong should not apply to terminally ill patients and their decision to end their lives because cruelty and mercy are not simple issues that can be categorized easily into good and bad. Additionally, the traditional code of ethics for healthcare practice should not apply to physician-assisted suicide because this code advocates treating patients to preserve life, which is impossible when it comes to terminal illnesses.
References
Behuniak, S. M., & Svenson, A. G. (2003). Physician-assisted suicide: The anatomy of a constitutional law issue. Lanham, MD: Rowman & Littlefield Publishers.
Cholbi, M., & Varelius, J. (2015). New directions in the ethics of physician-assisted suicide and euthanasia. Cham: Springer.
Curtice, M., & Field, C. (2010). Assisted suicide and human rights in the UK. The Psychiatrist, 34(5), 187-190.
Engelhardt Jr, H. T., & Malloy, M. (2008). Suicide and assisting suicide: A critique of legal sanctions. Sw. LJ, 36, 1003.
Fowler, M. D. M. (Ed.). (2008). Guide to the code of ethics for nurses: With interpretive statements (2nd ed.). Silver Spring, MD: American Nurses Association.
Independent (2008, Dec. 10). Mary Ewert, ‘why I want the world to see my husband die’. Retrieved from https://www.independent.co.uk/life-style/health-and-families/health-news/mary-ewert-why-i-want-the-world-to-see-my-husband-die-1059442.html
Materstvedt, L. J., Clark, D., Ellershaw, J., Førde, R., Gravgaard, A. M. B., Müller-Busch, H. C., … Rapin, C. H. (2003). Euthanasia and physician-assisted suicide: A view from an EAPC Ethics Task Force. Palliative Medicine, 17(2), 97-101.
Matzo, M., & Sherman, D. W. (2015). Palliative care nursing: Quality care to the end of life. New York, NY: Springer Publishing Company.
Miles, S. H. (2005). The Hippocratic oath and the ethics of medicine. Oxford: Oxford University Press.
Minois, G. (1998). A history of suicide: Voluntary death in Western culture. Baltimore, MD: Johns Hopkins University Press.
Pence, G. E. (2015). Medical ethics: Accounts of ground-breaking cases. New York, NY: McGraw-Hill Education.
Quill, T.E. (2003). Doctor, I want to die. Will you help me? Journal of the American Medical Association, 270, 870-873.
Quill, T.E., Cassel, C.K., & Meier, D.E. (2007). Care of the hopelessly ill: Proposed criteria for physician-assisted suicide. New England Journal of Medicine, 327, 1380-1384.
The Betamax Man. (2018, May 3). The Suicide tourist [Video file]. Retrieved from https://www.youtube.com/watch?v=BtQFdOEN3eA
Tomasini, F. (2014). Stoic defense of physician-assisted suicide. Acta Bioethica, 20(1).