Debating Pro for the Fight for Life
The decisions we make at the end of a patient’s life determine the peace, fulfillment, and dignity with which they are able to pass away. These defining moments on one’s deathbed play a large role in their legacy and loved ones’ well being, which makes end-of-life decisions immeasurably important. When we place the event of death in the hands of humans rather than leaving it to nature, numerous issues result that often worsen an already grave situation. In order to prevent an abuse of power, halt potential medical risk, and avoid normalizing suicide, physicians should not be legally allowed to assist in the death of terminally ill patients.
In a situation where the diagnosis of the disease, the expected length of time left to live, and the method of assisted suicide is all determined by a physician or healthcare provider, the patient is left with no power and is in danger of abuse and coercion. Particularly vulnerable to abuse are the uneducated, those frightened by illness, and those with disturbed emotional or mental states (Hendin, 1993). The well-documented phenomenon of physicians taking more and more liberty in assisted suicide is known as euthanasia’s slippery slope (Sulmasy, 2016). In the Netherlands and Australia, analysis of dozens of cases show that assessments of a patient’s qualifications for physician-assisted suicide gradually became more “lenient” with consistently improper documentation of a patient's ability to consent, the time they have left to live, and the nature of the terminal illness (Ryan, 1998). Families who cannot bear the financial burden of care pressure physicians to approve a patient for the case even when it is not appropriate (Hendin, 1993). Because there is little oversight over the physician’s decision, these instances can easily go unnoticed (Ryan, 1998). For example, by the 1990s, 50 percent of physician-assisted suicides in the Netherlands were involuntary (Sulmasy, 2016). Thus, the total responsibility of physicians to make the medical decisions and the system of advance directives that leaves family members in charge leaves little autonomy for the patient and thus subjects them to abuse and coercion.
Despite the immense knowledge and care a physician may take in physician-assisted suicide, mistakes in the procedure occur often, and with devastating results. If the point of this procedure is to relieve pain and ease suffering, a mistake could cause the exact opposite. In nearly a fifth of physician-assisted suicide cases in the Netherlands there were problems of completion, including: a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient (Groenewoud, 2000). In a study of 114 cases, 19 cases required additional prescriptions of drugs due to the first drug’s failure (Groenewoud, 2000). All of these scenarios created even more physical and emotional suffering than the terminal illness itself and thus go against the very purpose of physician-assisted suicide. There is far less risk involved in palliative care, and palliative care resolves the extreme pain a patient is going through very effectively (Sulmasy, 2016). Therefore, the high percentage of medical failure in physician-assisted suicide cases contradicts the claims of safety and painlessness that supporters of legalization frequently make.
The possible suicidal tendencies that result from terminal illness should be treated with concern and intervention in the manner that suicidal tendencies in any other circumstance are treated. The overwhelming majority of those with terminal illness fight to the end, while those who show suicidal tendencies respond positively to treatment for depressive conditions and pain medications (Hendin, 1993). An extremely thorough psychiatric evaluation is rarely accomplished by a physician who doesn’t have experience in depression and suicide (Hendin, 1993). A physician could easily confuse the behavior of a rational patient with a terminal illness with that of a suicidal individual (Sulmasy, 2016). Thus, the legalization of physician-assisted suicide would cause us to ignore the more ethical approach of treating suicidal tendencies and encouraging patients to fight for happiness in favor of giving patients the “easier” solution.
The policy recommendation regarding the legalization of physician-assisted suicide is to make the procedure illegal for any patient and any circumstance in all 50 states. The importance of this policy lies in the incredible sanctity of life that holds true even in the face of terminal illness and should not be diminished by a procedure which removes autonomy from the patient, has incredibly high medical risk, and encourages suicidal tendencies instead of treating them. Our very belief in science is at stake as well: medicine is always progressing forward and as other end-of-life options become more efficient at reducing pain, physician-assisted suicide becomes more and more unethical and inappropriate as a solution. For all of human history, people all across the world have fought to defend their right to live. To legalize physician-assisted suicide is to say that all of our efforts to save, protect, and maintain human life are in vain.
References
Groenewoud, J.H., (2000). Clinical problems with the performance of euthanasia and physician-assisted suicide in the Netherlands. The New England Journal of Medicine, 342, 551-556. doi:10.1056/NEJM200002243420805
Hendin, H., Klerman, G., (1993). Physician-assisted suicide: The dangers of legalization. Am J Psychiatry, 150, 143-145. Retrieved from
Ryan, C.J., (1998). Pulling up the runaway: the effect of new evidence on euthanasia's slippery slope. J Med Ethics, 5. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9800591
Sulmasy DP, Travaline JM, Mitchell LA, Ely EW. Non-faith-based arguments against physician-assisted suicide and euthanasia. The Linacre Quarterly. 2016;83(3):246-257. doi:10.1080/00243639.2016.1201375.
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