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LIFE-AND-DEATH DECISION MAKING: IS PHYSICIAN-ASSISTED SUICIDE ETHICAL?
Physician-assisted suicide (PAS) has caused a furor in the media and debate within the medical and legal professions. Consider the reasoning that follows as you develop your own position on PAS.
Arguments in favor of PAS
Those who argue that PAS is ethically justified offer the following sorts of arguments:
- Respect for autonomy. Decisions about time and circumstances of death are very personal. Competent persons should have the right to choose death.
- Justice. Justice requires that we \"treat like cases alike.\" Competent terminally ill patients are allowed to hasten death by refusing treatment. But for some patients, cutting off treatment will not suffice to hasten death; their only real option is suicide. Justice requires that we should allow assisted death for these patients.
- Compassion. Suffering means more than pain; other physical and psychological burdens also accompany some forms of terminal illness. It is not always possible to relieve suffering. Thus PAS may be a compassionate response to unbearable suffering.
- Individual liberty versus state interest.
Though society has a strong interest in preserving life, that interest lessens when a person is terminally ill and has a strong desire to end life. A complete prohibition on assisted death excessively limits personal liberty. Therefore PAS should be allowed in certain cases.
- Openness of discussion. Some would argue that assisted death already occurs, albeit in secret. For example, morphine drips ostensibly for pain relief may be a covert form of assisted death or euthanasia. The fact that PAS is illegal prevents open discussion of the issue and secrecy in administration of PAS. Legalization of PAS would promote open discussion.
Arguments against PAS
Those that argue that PAS should remain illegal often present arguments like these:
- Sanctity of life. This argument points out strong religious and secular traditions against taking human life. It is argued that assisted suicide is morally wrong because it contradicts these beliefs.
- Passive versus active distinction. This arguments hold that there is an important difference between passively \"letting die\" and actively \"killing.\" It is argued that treatment refusal or withholding treatment is equivalent to letting die (a passive measure) and is justifiable, whereas PAS is equivalent to killing (an active measure) and is not justifiable.
3. Potential for abuse. Certain groups of people, lacking access to care and support, may be pushed into assisted death. Furthermore, assisted death may become a cost-containment strategy. Burdened family members and health care providers may unscrupulously encourage the option of assisted death in certain cases. To protect against these abuses, it is argued, PAS should remain illegal.
4. Professional integrity. Here opponents point to the historical ethical traditions of medicine, strongly opposed to taking life. For instance, the Hippocratic Oath states, \"I will not administer poison to anyone where asked\" and \"Be of benefit, or at least do no harm.\" Furthermore, major professional groups (AMA, AGS) oppose assisted death because linking PAS to the practice of medicine could harm the public\'s image of the profession.
5. Fallibility of the profession. Another concern is based on the acknowledgment that physicians will make mistakes. For instance, there may be uncertainty in diagnosis and prognosis, errors in diagnosis and treatment of depression, or inadequate treatment of pain. Thus the state has an obligation to protect lives from these inevitable mistakes.
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GENERAL HEALTH
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