The Ethical Dilemma of Physician-Assisted Suicide and Euthanasia
It is hard to argue that physician-assisted suicide and euthanasia are a strong concern for the government, healthcare providers, patients, their relatives, and society in general. Promotion of physician-assisted suicide and euthanasia is always a profound ethical dilemma, as long as it relates to a matter of life and death of a patient. Different entities provide their arguments in support of their standpoints, but nurses and doctors are still expected to make a specific decision, which is not always desired by themselves and relatives of an unconscious patient. In spite of the fact that the law presupposes a possibility of physician-assisted suicide and euthanasia admission, the ethical dilemma has been raged unabated. That is why it is necessary to hold a distinct position in order to establish a basis for a complex and flexible framework, which will ultimately define whether physician-assisted suicide and euthanasia are ethically appropriate or not. However, the recent situation within a sphere of healthcare and respective legal basis suggest that the use of physician-assisted suicide and euthanasia can be justified, especially under circumstances of a strong patient’s suffering and inability to survive a disease. Thus, the following position paper focuses on explanation and promotion of a positive opinion towards physician-assisted suicide and euthanasia.
It is essential to outline criteria, which determine the problem of the ethical dilemma in that regard. First, a large presence of a particular sound reason should be present in favor or against conduction of the assisted suicide and euthanasia. At any rate, reasoning of these actions is the primary requirement to the resolution of this ethical dilemma, as long as justification of a particular decision implies serious consequences in any case. Second, legal validity of assisted suicide and euthanasia is also a persistent factor. That is why measurement of appropriateness of physician-assisted suicide and euthanasia is largely determined with the current legislation. The law determines cases of the legal use of physician-assisted suicide and euthanasia and specific events of their prohibition, which is why that factor should be taken into consideration. Nonetheless, clinical appropriateness is still preexisting criterion for distinguishing ethical insight of physician-assisted suicide and euthanasia. It is becoming increasingly apparent that cases, which presuppose any chance of a patient’s survival, should include prolonged palliative care and intervention. By the same token, cases of a persistent patient suffering and absence of any possibility for recovery and survival imply physician-assisted suicide and euthanasia. Eventually, a patient’s agreement and determination to be admitted to physician-assisted suicide or euthanasia procedures, or his/her refusal to undergo these procedures should be taken into account. Various cases presuppose a patient’s being unconscious, so that relatives are expected to decide. However, patients’ admission without relatives to physician-assisted suicide or euthanasia is always a controversy, and additional factors have to be recognized.
It is becoming increasingly hard to ignore the fact that such ethical dilemma is accordingly a strong moral, legal, and public controversy. The basis of this controversy is divided into two opposite opinions. The first opinion is based on a support of physician-assisted suicide and euthanasia. This opinion promotes a view that patients who cannot bear their physical and moral pain, or cannot survive a prolonged sever illness can be admitted to physician-assisted suicide or euthanasia. The supporters of such standpoint argue that a nurse or a doctor should act in the best interest of a patient, and if a patient cannot resist his/her pain or does not have any chances for survival, an appropriate end of life care should be provided. This opinion often includes the statement that physician-assisted suicide or euthanasia is the last resort decision for doctors, relatives, and patients. Conversely, an opinion that stands against physician-assisted suicide and euthanasia is also present. The supporters of this position claim that physician-assisted suicide and euthanasia are extremely unethical, as long as they mean a patient’s factual murder. This statement is determined with a common moral principle that no one can take somebody else’s life under any circumstances. In like manner, autonomy of a patient cannot be violated, which is why physician-assisted suicide and euthanasia are a direct breach of a patient’s independence. Surprisingly, this opinion is also based on a statement that nurses and doctors are expected to act in the best interest of a patient. However, the best interest is defined as an ability to live till a natural death, since a patient himself/herself cannot decide what is his/her best interest.
Pros and Cons of Physician-Assisted Suicide and Euthanasia
In order to speak about generally positive aspects of physician-assisted suicide and euthanasia, first of all, relief of a patient’s physical and moral pain should be indicated. Patients, who have a severe form of diseases that most probably will cause death, quite often cannot bear strong physical pain as well as psychological pressure of the fact that they will not survive. Hence, physician-assisted suicide is a way of delivering satisfactory end-of-life care to a patient, who asks for pain relief. The other perspective of that is pragmatic. It may sound extremely unethical, but physician-assisted suicide and euthanasia considerably reduce moral trauma and expenses of unconscious patients, who will not survive at any rate. Physician-assisted suicide or euthanasia suggest a faster patient’s death but without his/her suffering and substantial expenses for relatives. Eventually, the largest clinical scale suggests that patients, who do not have any chances for survival, can be admitted to physician-assisted suicide or euthanasia owing to the fact that nurses and doctors can work on other patients, whose lives still depend on clinical interventions.
As for negative aspects of physician-assisted suicide and euthanasia, its main problem is a strong ethical controversy that is discussed within this paper. The main contradiction revolves around the right of a doctor to take a patient’s life, even though, he/she is not likely to survive and give a permission to admit him/her to physician-assisted suicide or euthanasia. As a consequence, the second negative aspect is a potential violation of a patient’s autonomy and independence. Provided that a patient is unconscious, a doctor is legally allowed to admit this patient to physician-assisted suicide or euthanasia after specifically outlined period of a patient’s being in coma or any other vegetative state. Unfortunately, such legally approved possibility may imply the fact that some care providers may use this right in order to neglect their care for patients. In such a way, patients in a vegetative state risk to fall the pray to unethical and factually, illegal actions of healthcare providers.
The Main Argument
Physician-assisted suicide and euthanasia should be ethically approved within all states of the United States, since these actions contribute to relief of patients and relatives' suffering. Patients in a persistent vegetative state will not survive or will not live without being connected to medical equipment of living processes support. At any rate, such states make patients and their relatives suffer without any purpose, since patients cannot live out of their vegetative states. Hence, the law protects these people and their relatives from any further moral and physical harm. Beyond a doubt, admission of physician-assisted suicide and euthanasia is legally and ethically appropriate as the last resort decision, when all possible medications were deployed in vain. Likewise, the nursing scope of practice requires nurses to act in the best interest of a patient, which is why end-of-life care should involve minimum of physical and moral suffering. Provided that a patient complains about such suffering and asks for physician-assisted suicide or euthanasia, it is ethically right to admit this patient to these procedures. Also, admission of a patient to PAS or euthanasia help to preserve his/her sense of dignity. More specifically, a patient may no longer value his/her life in a vegetative state or persistent suffering. The opposition to legalization of physician-assisted suicide and euthanasia often argues that admission of these procedures is illegal, and many patients die without giving a permission for being admitted to physician-assisted suicide or euthanasia. Nevertheless, the recent statistics suggest that only 1% of related cases end with admission of physician-assisted suicide or euthanasia without patient/relatives’ permission. In 69% of cases, relatives are satisfied with such decisions, because they felt depressed watching their beloved suffering strong pain and inability to survive. In such a way, physician-assisted suicide and euthanasia can be ethically justified, as it helps to prevent patients and relatives' from moral devastation.
The main counterargument is that admission of physician-assisted suicide and euthanasia disregard a patient's autonomy of choice, and violate a fundamental right to life. Physician-assisted suicide and euthanasia are considered as killing in any instance without respect to justification, even though a patient asked to be admitted to these procedures. The advocates of the counterargument claim that taking someone's life is ethically wrong, as long as the right to live is an innate rather provided as a privilege by any governmental or public agencies. In addition, definition of suffering and pain is often challenged, since it is hard to distinguish what suffering and pain mean to every single patient. Physician-assisted suicide and euthanasia conducted without patient/relatives permission but on a legal basis are also criticized, because such actions violate autonomy and independence of other citizens. On the contrary, it is worth saying that nurses and doctors have to act in the best interest of a patient. Thus, it is presupposed that patients in vegetative state or with a suffering persistent physical/psychological pain may ask for physician-assisted suicide or euthanasia as a way of pain relief. It is quite reasonable to differentiate killing and letting a patient die, especially if he/she supports such a decision. Therefore, admission of physician-assisted suicide and euthanasia should be deployed only in cases when all possible methods of treatment proved to be ineffective. Therefore, physician-assisted suicide and euthanasia are a pragmatic but adequate solution to the ethical dilemma.
A proactive promotion of physician-assisted suicide and euthanasia as a method of end-of-life care for patients unable to survive will primarily motivate healthcare providers for enhancement of their performance in order to avoid such cases. Physician-assisted suicide and euthanasia are ethically appropriate, but it does not necessarily mean that these procedures should be an ultimate solution to related cases. That will advance establishment of one of Healthy People 2020 objectives of a quality health services across all stages of a citizen’s life (HealthyPeople.gov, n.d.). Also, it is fair to return to the subject of healthcare expenses, as normal attitudes towards physician-assisted suicide and euthanasia will save costs of relatives, who are hopelessly suffering a slow death of patients in vegetative and persistently severe state. That is why the government is expected to initiate a policy, which covers relatives’ expenses on a patient’s admitted to physician-assisted suicide or euthanasia treatment within the last stage of a disease (HealthyPeople.gov, n.d.). Such type of policy will sustain already existing HIPAA and Affordable Care Act policies and Healthy People 2020 objective of affordable and quality healthcare services for all populations of the United States.
It is appropriate to make a general comment on the admission of a patient to physician-assisted suicide or euthanasia. Employment of these procedures is the best judgment of a situation when a patient is unable to survive. In the same vein, physician-assisted suicide and euthanasia can be used as a decision in the best interest of a patient, if the patient confirms such a statement. PAS and euthanasia can be ethically appropriate, as long as they suggest suffering and pain relief for a patient or his/her relatives. Preservation of human dignity becomes another ethical consideration for healthcare providers. Obviously, a patient cannot fruitfully live with a severe pain or in a vegetative state. Evidence shows that the majority of the deceased patients' relatives experienced a relief after the end of life care with PAS or euthanasia. In addition, promotion of physician-assisted suicide and euthanasia will motivate healthcare researchers and practitioners to enhance their performance in order to avoid such last resort decisions. Moreover, end of life care will need to reach a new level of quality as well as related policies such as HIPAA and Affordable Care Act, since relatives, who support a patient’s end of life care expect recovery or at least survival of the patient.