Physician-assisted suicide is a patient’s intended act to end their life with medical help. It is ethically different from patient refusing life-sustaining treatment and euthanasia, where a physician terminates a patient’s life to relieve pain. There is an ethical debate on the question, is physician-assisted ethically? Proponents and opponents of physician-assisted suicide refer back to the basic principles in medical ethics and in the establishment of what a physician duty in reference to the patient and the physician-patient relationship. These components are essential in determining whether or not physician-assisted suicide should be morally acceptable. Physician-assisted suicide is not ethical because society’s goal medically is to make dying less and control over the manner and timing of a person’s death had not been and should not be the goal and duty of a physician.
There are four basic principles for ethics in public health; beneficence, nonmaleficence, autonomy, and justice. The principle of non-maleficence, do no harm, states that a physician should act in such a way that he or she does no harm, even if her or his patient or client requests this. The principle of beneficence obligates the physician to act in the patient’s best interest. Physician must respect patients autonomy, right to self-government. (Schröder-Bäck, P., Duncan, P., Sherlaw, W., Brall, C., & Czabanowska, K., 2014) The duties of physicians, ethically is established through the four medical ethical principles; beneficence, nonmaleficence, autonomy, and justice. These ethics will be discussed and taken into consideration when evaluating the question, is physician-suicide ethical?
ACP is the largest medical specialty organization and the second-largest physician group in the United States. ACP does not support legalization of physician-assisted suicide and deems it unethical. ACP argues that physician-assisted suicide affects trust in the patient-physician relationship and conflicts physician’s role in society. Physician-assisted suicide brench two principles of medical ethics; principle of nonmaleficence and principle of beneficence. It disproves the argument that supporters of physician- assisted used, that physicians must respect patients autonomy by stating that patient’s autonomy is important but is not absolute and is balanced by beneficence and nonmaleficence principles. Thus, the control over the manner and timing of a person’s death has not been and should not be a goal of medicine. (Sulmasy, L. S., & Mueller, P. S., 2017)
Timothy E. Quill, MD and colleagues, from the Palliative Care Division, Department of Medicine, University of Rochester Medical Center in Rochester, New York, state that physician-assisted suicide is justifiable under the principle of beneficence because the patients can experience substantial benefits. In fact, it is stated, “patients with serious illness wish to have control over their own bodies, their own lives, and concern about future physical and psychosocial distress. Some view potential access to physician-assisted death as the best option to address these concerns,” (Quill, T. E., Back, A. L., & Block, S. D., 2016) Thus, being willing to explore the options with patients is important for the physician-patient relationship and is within the duties of physician’s duty. David Goodall, an 104 years old accomplished Australian scientist, fought to promote euthanasia and physician-assisted suicide in Australia. Goodall isn’t terminally ill, but he wants to die because his quality of life has deteriorated so badly that he has no reason to live. He wanted to end his life through assisted suicide, but he can’t do it in his own country because the practice is banned. Mr. Goodall went to Switzerland, a country that allowed assisted suicide for decades. Mr. Goodall said “One should be free to use the rest of one’s life as one chooses. If one chooses to kill oneself, then that’s fair enough. I don’t think anyone else should interfere.” David Goodall died on May 10, 2018. (Joseph, Y., 2018, May 03) Both sides of the argument argue that patient’s autonomy must be respected. In this case, the patient’s self determined for themselves that they want to die and according to Quill and his colleagues, this is a case where physician-assisted suicide is justifiable because a physician duty is to actively contribute to the welfare of their patients and to respect their autonomy.
- Tony Yang, ScD, LLM, MPH, from the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, and Farr A. Curlin, MD, from the Trent Center for Bioethics, Humanities & History of Medicine, Duke University, Durham, North Carolina, has a conflicting view against Quill and supports ACP position paper that physician-assisted suicide is unethical. It is stated that “if the medical profession accepts physician-assisted suicide, it will be declaring decisively that ‘physicians’ are mere providers of services, to be guided only by the desires of the individual patient, the will of the state or other third parties, and what the law allows.” (Yang, Y. T., & Curlin, F. A., 2016) They argued that patients already have the right to refuse life-sustaining treatment and the liberty to end their lives in ways that do not involve physicians.
Physician-assisted is an issue of trust and contradicts Quill’s view that physician-assisted suicide is important for the physician-patient relationship. Physicians are sworn only to heal, not to harm and physician-assisted suicide breach ethical principles and duties of a physician.
Medical ethics establishes the duties of physicians to patients and society and physicians have duties to patients on the basis of the ethical principles discussed previously. Medical ethics and the law strongly support a patient’s right to refuse treatment respecting a patient’s autonomy and such situations don’t violate principles beneficence and nonmaleficence because death follows naturally, after the refusal. A main arguments in support of physician-assisted suicide highlight the principle of respect for patient autonomy and the interpretation that a physician’s duty is to relieve suffering. Opponents argue that physicians should not participate in intentionally ending a person’s life because it violates the principle of maleficence since the physician is harming the patient. In conclusion, physician-assisted suicide requires physicians to neglect general duties of beneficence and nonmaleficence and as a result, makes physician-assisted suicide unethical.
Schröder-Bäck, P., Duncan, P., Sherlaw, W., Brall, C., & Czabanowska, K. (2014). Teaching seven principles for public health ethics: Towards a curriculum for a short course on ethics in public health programmes. BMC Medical Ethics, 15(1). doi:10.1186/1472-6939-15-73
Sulmasy, L. S., & Mueller, P. S. (2017). Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Annals of Internal Medicine, 167(8), 576. doi:10.7326/m17-0938
Joseph, Y. (2018, May 03). Why David Goodall, 104, Renowned Australian Scientist, Wants to Die. Retrieved from https://www.nytimes.com/2018/05/03/world/australia/david-goodall-right-to-die.html?action=click&module=inline&pgtype=Article
Quill, T. E., Back, A. L., & Block, S. D. (2016). Responding to Patients Requesting Physician-Assisted Death. Jama, 315(3), 245. doi:10.1001/jama.2015.16210
Yang, Y. T., & Curlin, F. A. (2016). Why Physicians Should Oppose Assisted Suicide. Jama, 315(3), 247. doi:10.1001/jama.2015.16194