Another situation that is not up for ethical debate is when a patient, or a patients family, chooses to refuse treatment when its decided that treatment brings more disadvantages than advantages, thus allowing a patient to die peacefully (American- Physician). Situations like these arise fairly often and a physician wouldnt have to worry about making ethical decisions in either case. There are people, though, who are facing death due to terminal illness and these ones may ask their physician to provide them with the means to bring about their death sooner than nature would allow.
These people know that there is no hope for a cure or for survival of their disease. This is where an ethical dilemma may arise. For many people (including many physicians) physician-assisted suicide sounds like a credible and preferred option since waiting for death to occur naturally could take months and bring a lot of pain and misery with it. Many people believe that this is a humane choice, especially in other countries where assisted suicide is not only legal, but there is widespread acceptance since quality of death is just as important as quantity of life (Friend, 2011).
In the United States, though, the majority of the medical establishment sees assisted suicide as purely unethical- there is no place for it within the medical community. Why does something that, on the surface, sounds like a loving and humane choice bring up so many ethical dilemmas? A terminal patient should be allowed to choose how he/she wants to die, and if assisted suicide is the choice, how can that be wrong? Are physicians bound by a code of ethics that emphatically denies them the choice to help a terminal patient die with dignity, on his/her terms? There are so many questions that are raised by this topic.
The biggest issue is the fact that a physicians role is one of healer (American- Opinion). Helping a patient end his/her life would redefine the role of the medical professional, possibly turning the medical profession on its ear, as it were. Another issue that is brought up is that providing the means to end ones life shows a blatant disregard for the value and sanctity of human life. Finally, there is a religious component to this issue. Most religions oppose any kind of suicide, be it caused by mental illness or with the intent of hastening an already unavoidable death.
Most religions uphold the sanctity of life, no matter what the medical situation of a person may be. From an ethical point of view, there are several ways to approach this topic. One point of view is that of Utilitarianism. The basic principal of Utilitarianism is that the choice should be the one that benefits the largest number of people (Mosser, 2010). In the case of physician-assisted suicide (PAS), the benefit would be to a relatively few people.
The terminal patient and his/her loved ones, who do not want to see the patient suffer needlessly, would be the main eneficiaries of PAS. There are far more people seeking medical care that are not terminal, so looking at this from a Utilitarianism point of view, PAS is not the ethical choice. Another ethical viewpoint is that of Deontology. This viewpoint brings forth the idea that an act should only be judged based on the reasons that the act is being done (Mosser, 2010). Unlike Utilitarianism, the act is not deemed right or wrong by looking at the consequences of the act. Whatever the consequences may be, the actions are judged based on why someone does what they do.
If the actions taken are out of a pure motive, or a motive that is in the best interests of those involved, then the actions are deemed ethical. Yet another ethical theory to consider is called Virtue Ethics. This theory is considerably different from both Utilitarianism and Deontology in that instead of looking at either the consequences or the reason for an act, one would instead focus on the character of the individual making the decision or performing the act (Mosser, 2010). In Virtue Ethics, the virtues that a person exemplifies are examined before judgment is made.
If, for instance, a person has a good heart, is generous and kind, and shows concern for others, a poor choice (or an act considered by most to be unethical) can be overlooked simply due to the fact that that person is a genuinely good person. After looking at all three ethical points of view, the most reasonable means to resolve the issues surrounding Physician-assisted suicide is that of Deontology. Using this theory, one could resolve the issue of PAS by looking at all of the possible consequences before deciding whether this act is right or wrong.
How does one resolve something as complicated as PAS by using an ethical theory? This question can be answered by looking at the basic tenets of this theory. The ethical theory of Deontology looks at the reasons for why an act is done (Mosser, 2010). Why does a physician choose to help his/her patient end his/her life when this choice goes against all that a physician stands for? Why would a person choose to end his/her life instead of allowing things to happen naturally? These questions are not always easily answered as there could be numerous reasons for these actions.
The basic truth behind any question raised is that all of those involved in the decision making look to help a patient who is suffering from a terminal illness. No doctor or loved one of a terminal patient wants to watch as life comes slowly and painfully to its bitter end. Over the years the medical field has seen advancements that are able to save the lives of people who, in a previous era, would have died from certain illnesses or accidents. Advances in medicine have brought forth the term micro-preemie as infants who are born months early are not just able to survive, but to thrive.
There are so many positives that have come as the medical field grows and advances, but some negatives have developed along with the great advances. People who are suffering from terminal illnesses or who have lost mental faculties due to illness are now able to live much longer than was once possible (Andre & Velasquez, 1987). Where at one time people would have died fairly quickly from certain diseases, they now linger on for years, sometimes in great pain. Those in the medical field have taken an oath to protect the sanctity of life, sometimes at the cost of those who are asking to be put out of their misery.
Which is the better choice, the right choice? A Deontologist would say that if assisted suicide is done out of compassion, out of a desire to help end the suffering of an already terminal patient, than its the right thing to do, despite what medical ethics dictates. As a rational moral agent, a deontologist would deem assisted suicide to be the ethical choice (Mosser, 2010). There are many, many people who disagree with this choice. The majority of those in the medical field strongly disagree with any physician making the choice to help his/her patients end their life.
As a matter of fact, the American Medical Association goes so far as to say that PAS threatens the very core of the medical professionals ethical integrity, essentially saying that this act undermines the medical profession as a whole (American- Physician). However, the medical establishment needs to look at more than just quantity of life. Is it okay to prolong a life simply because there is the medical means to do so? Does not quality of life count for more than the number of days we could be marking off? There are, of course, alternatives to the ethical theories that have been covered thus far.
First, there is the viewpoint called Relativism. Relativism is a fairly simple point of view- it looks at values relative to the culture or society in which one lives. If one looks at PAS as an example, opinion varies greatly based upon what part of our country one lives, or even where in the world a person is raised or lives. For instance, in the US it is illegal for a physician to actively assist a patient in ending his/her life- except in Oregon, Washington, and Montana (Friend, 2011). In these three states laws have been passed, and upheld, that makes it acceptable for a physician to help his/her patient die on their own terms.
The American Medical Association may vehemently disagree with these laws, but relative to where a physician practices medicine, PAS has a different place, a different meaning, and a vastly different outcome for the physician who engages in this practice. Outside of these three states, a physician can be prosecuted for helping his/her patient to end his/her life and while a physician may wish to do more to help a suffering patient, state law (and the consequences of breaking such laws) govern the actions a physician will take.
In other countries, such as the Netherlands, PAS is accepted as part of a physicians job in caring for the needs of his/her patient. For the people in that country there is widespread acceptance of active euthanasia, an attitude that is strongly influenced by the writings of a physician who argued that patients should be allowed the right to choose how they would die (Friend, 2011). So, relative to that culture, PAS is accepted as a part of good doctoring- life and death are both given the same amount of respect and choices.
Another approach to ethical dilemmas is called Emotivism. This approach seems very simplistic in nature compared to other ways of viewing things. With Emotivism one would view an action as right or wrong based upon how that action makes one feel (Mosser, 2010). If the action makes one feel good, then the action is acceptable, but if the action makes one feel bad, then the action is not acceptable. For instance, if someone were to hear a mother tell her child to shut-up and this didnt bother the person, then the mothers actions would be considered acceptable.
However, if someone were to hear the mother speak to her child this way and become angered by this, then the mothers actions would be deemed bad, or unacceptable. This approach turns a very serious social issue into an emotional response. If someone has never had to deal with a loved one who was terminal, or who doesnt know anyone who has dealt with this type of situation, then an Emotivist point of view would really be meaningless as the reaction and the decision would not be based on facts or knowledge, but instead on a simple emotional response.
A person who finds him/herself facing a long, drawn out illness, the choice as to whether or not to pursue PAS cannot be made based solely on emotion. A physician needs to know that the decision to end ones life is not coming from an emotional reaction. Something as serious as assisted suicide should never be decided upon emotionally. Serious ethical issues cannot be solved based simply on a thumbs up or thumbs down reaction. Yet another approach to ethics is in the form of Ethical Egoism.
This point of view is skewed heavily by the desires of a person. In Ethical Egoism, our moral evaluations are made simply by what our desires and goals are (Mosser, 2010). If one were to use this view point to evaluate PAS the outcome would vary greatly from person to person. Anyone who gets diagnosed with a terminal illness needs to decide how to proceed. Some choose to wage an all-out war- using every single means at their disposal to fight the disease and prolong their life as much as medicine could allow.
Some choose to fight for a while but reach a point where the pain of the disease or the misery of living is no longer worth fighting for- death becomes preferable to the treatments necessary to stay alive. And there are yet others who find that they would rather let the disease take its course as the idea of months or even years of uncomfortable, miserable treatments is too much to consider and the possible side-effects make the treatments (or the very idea of the treatments) is unpalatable- thus choosing death whenever it comes, with no fight or resistance at all.
Ethical Egoism fits these situations well as the choices are made based on the desires and goals of each person. None of the choice made in these situations are wrong, but they are all different and are made for different reasons. Part of this assignment is to state which of these ideas is closest to my own. I find that Ethical Egoism seems to ring the most true for me. What is it about Relativism or Emotivism that I do not find appealing?
I do find the idea of Relativism to be very much my way of thinking as I do believe that everyone makes decisions and sees the world based upon their own culture, their own experiences. I do not think that Relativism works for me in this instance though because PAS is such a personal issue. Those who participate in PAS are not doing something that affects millions of people, nor are they making decisions based on what others think or what society dictates.
The choice to end a life by way of suicide is deeply personal and every person must decide for themselves if this is something that they want to do. How our own culture views that decision has no bearing when someone is lying in a bed racked with pain, or facing years of unfruitful treatments, all the while knowing that the end result will be death, regardless. Relativism has no bearing on such a personal choice, in my opinion. Emotivism seems like such a simplistic approach that I simply cannot give it credence. End of life decisions are fraught with emotions.
A person suffering the effects of a terminal disease has good days and bad- on a good day he/she may feel that PAS is not the way to go, thus giving the Emotive thumbs down to the idea. The very next day could be one full of pain and sadness and anger, making PAS seem like the best option to deal with such a terrible disease. The emotional response would be different depending on the day. Such decisions cannot be made based on emotion, they must be made with a clear head, weighing the pros and cons and deciding what the best option is for the entire family.
Emotivism is not a method I agree with at all. This is why I choose Ethical Egoism. The decisions are not based upon emotion (although emotion is definitely involved), they are based on what each person wants for themselves. If someone wants to fight until there is no more fight left, then this is part of his/her goal. No matter how a person chooses to approach his/her illness, the decision is not made spur of the moment and I find this to be the most reasonable way of dealing with such a situation.
Physician-assisted suicide is a debate that will continue on for many years to come, especially as the AMA stands firmly opposed to this course of action. However, for the people who are the ones faced with a prolonged illness, oftentimes dealing with extreme pain and suffering, the issue isnt as black and white as the medical professionals would make it seem. Everyone has a right to decide how they will live their lives, and at the end, everyone should be allowed to decide how they want to die. PAS gives people this option.
Its a humane way to quietly exit this life. Not everyone will ultimately choose to end their life if given the means, but the option should be theirs should they choose it (Yardley, 2010). Life is precious, yes, there is no disagreement with that. But refusing to allow a patient to choose how to die removes the sanctity of life and this is simply wrong. PAS is a debate that is best left up to those who are in the hospital bed and their loved ones, not those healthy members of congress who are free from the ugliness that terminal illness brings with it.