Physician-assisted suicide: morality and legality

  Physician assisted suicide is a concept that involves the actions of two individuals, one of which wants to voluntarily end their life, and the other who assists in achieving death. Although physician assisted suicide, also known as active euthanasia, remains illegal in all but two states, many moral questions and concerns still linger. On one side, it is believed that an individual possesses personal autonomy and therefore has a right to die under their own circumstances and wishes. On the other side, coupled with legal precedent, is the belief that physician assisted suicide is a slippery slope that violates the sanctity of life and the professional integrity of those assisting in it. This paper will provide examples and arguments for both sides of the issue, and will delve deeper into the morality of physician assisted suicide.

            Before jumping into the arguments of James Rachels, it is necessary to clarify the distinction between active and passive euthanasia. Active euthanasia involves that actual voluntary “killing” of an individual by another individual. This normally happens via lethal injection. Passive euthanasia, a legal alternative, involves the withholding of a life sustaining treatment such as food and water or life supporting machines. Rachels argues in favor of euthanasia and states that if a person thinks passive euthanasia is morally acceptable, then they ought to think that active euthanasia is morally valid as well. Rachels bases his argument on three points, two of which will be covered in the next paragraph. His first point is that both active and passive euthanasia involve an individual choosing to die, under their autonomy. On the passive side, the individual is choosing to refuse life sustaining treatment, which will ultimately lead to their death. On the active side, the individual is choosing to receive a lethal injection, which will also result in death. On the same token, the physician involved must remove life support (or other forms of life sustaining treatment), as well as administer a lethal injection. This makes his or her involvement apparent on both sides, which is a critical issue when it comes to assisted suicide. The doctor’s involvement is a crucial argument for those against physician assisted suicide, because they consider it a homicide. However, the physician must be directly involved in passive euthanasia as well.

            A second argument in support of physician assisted suicide also stems from the ideas of James Rachels. He states that active euthanasia can actually reduce the amount of suffering and pain that an individual experiences. Often times, an individual who is considering active euthanasia is suffering from a painful, terminal disease and must succumb to equally painful treatments. Some face weekly dialysis treatments, and for an unlucky few with diseases such as brain or throat cancer, treatments are unavailable due to the location of the cancer, and they must constantly suffer. Rachels argues that active euthanasia is sometimes more humane than passive in achieving minimal amounts of pain. Both of Rachels’ arguments, individual autonomy and the reduction of suffering, boil down to the fact that there is no intrinsic moral difference between active and passive euthanasia. In the example of Smith and Jones this becomes clear. Smith killed his nephew by drowning him in a bathtub, in order to receive his life insurance money. Jones was planning on doing the same exact thing, except before he could follow through with his plans, his nephew hit his head in the bathtub and consequently drowned. Morally speaking, there are no differences between Smith and Jones. They sought the same motive, and achieved the same results. With that being said, the difference between actively killing and passively letting die is morally insignificant.

            Although Rachels’ arguments seem valid, and reason enough to legalize physician assisted suicide, the United States Supreme Court has a very different story to tell. In Vacco v. Quill (1997), the Court held that a prohibition on assisting suicide does not violate the equal protection clause under the fourteenth amendment of the United States Constitution. This decision kept physician assisted suicide illegal in the United States, and followed precedent set forth by the Court in earlier years. In its decision, the Court went on to say that when an individual refuses life sustaining treatment, they will die. However, they will die due to natural causes and their underlying disease, not because the treatment was removed. On the contrary, if an individual chooses a lethal injection they will die due to the medication that is administered to them. Death by overdose of medication is not a “natural cause”. Not only is death by lethal injection an unnatural cause, it has to involve another person, which constitutes as homicide. The patient who chooses a lethal injection as a means to an end must consult a physician, who in turn offers advice and ultimately administers a lethal overdose of medication in order to achieve death. The Court stated that not only is homicide illegal, but also that the ones “killing” in this situation are doctors. In the eyes of society, doctors are regarded as healers, not killers. Furthermore, by assisting others in suicide, the doctor involved is violating his or her Hippocratic Oath to heal and protect. The Court held a similar stance in the case of Washington v. Glucksberg. In this decision, the Court held that the state “has an interest in protecting the integrity and ethics of the medical profession”, as well as the vulnerable from coercion. The Court’s decision in this case raises two very important arguments against physician assisted suicide. The first, mentioned earlier in this paragraph, is the issue of doctors being “killers” instead of healers. The second argument is that if voluntary assisted suicide were made legal, then a possibility of involuntary assisted suicide exists. Financial burdens and mental illness could become grounds for an individual seeking out active euthanasia, which defeats the purpose behind physician assisted suicide, which is to relieve intolerable pain and suffering from those facing death. By looking to the Supreme Court for answers to moral questions concerning physician assisted suicide, the legality of the issue is made clear. Physician assisted suicide is illegal in the law of the land.

            In his article I Will Give no Deadly Drug, Leon Kass argues against physician assisted suicide on grounds that it is a slippery slope. By slippery slope it is meant that by legalizing active euthanasia, doors leading to abuse of the system are opened. To back up his argument Kass states that there is no objective way to measure or define an amount of pain or suffering that is intolerable consistently for every individual. For example, a tolerable amount of pain for one patient might be completely intolerable for another. This becomes a problem when it comes to applying the “rules” of physician assisted suicide. Who is allowed to choose it? How much pain is too much? It is a problem in that the solution cannot be measured or inferred. Furthermore, extending on his slippery slope argument, Kass states that “the vast majority of candidates who ‘merit’ an earlier death cannot request it for themselves” (Kass 26). By this it is meant that many people who would be faced with the option of assisted suicide are in a vegetative state. If an individual is in a coma, or is already on life support, and they can’t make the decision for themselves, who is to make the decision for them? This goes hand in hand with the question asked earlier: If we cannot objectively measure intolerable suffering, who do we administer lethal injections to? These are questions that are hard to answer due to people’s moral differences, but they remain valid questions when it comes to opposing physician assisted suicide.

            Personally, I believe that although there are some positive benefits to physician assisted suicide, it is impossible to evenly apply it to everyone who seeks it. In my eyes, assisted suicide is morally acceptable and “legal” in theory, but it remains inappropriate and morally unacceptable in practice. I do admit that there are certain rare cases that could justifiably warrant the use of active euthanasia. However, the law must be evenly applied to everyone and it cannot just be valid for an accepted few. If it is available to one, it is available to all. Not everyone who wishes to die by physician assistance should be subject to its availability. For some, the amount of pain and suffering they experience is subject to their mental state and will to live at the time of their decision. Others may seek it for the wrong reasons, or as an easy way out of a difficult financial or emotional situation. With that being said, I ultimately have to agree with the decisions of the United States Supreme Court and the arguments of Leon Kass. Physician assisted suicide is a slippery slope that cannot be evenly applied or justified and therefore must remain illegal.

*submitted for pol324 do not steal.