Ethical Issue: Assisted Dying

 

There are four principles in biomedical ethics: autonomy, beneficence, nonmaleficence, and justice (Akdeniz et al., 2021). Autonomy is defined as the right of the patient to decide the care that they should receive (Akdeniz, 2021). Beneficence is defined as the responsibility of the physician to provide the best care they can for the patient (Akdeniz, 2021). Nonmaleficence is a principle in which the physician should not give harm to patients (Akdeniz, 2021), a vow called the Hippocratic Oath that is derived from Latin called “Prinum non nocere”, or “first, do no harm” (Shmerling, 2015). Due to the first three principles, Assisted Dying or Assisted Suicide has been a controversial ethical problem facing the medical field (Dugdale et al., 2019).

Assisted Dying (AD) is a term that includes both physician-assisted dying and voluntary active euthanasia (Fontalis et al., 2018). Physician-assistant dying is when a physician aids in the process of dying of the patient upon the patient’s wish by providing lethal drugs for the patient to self-administer (Fontalis, 2018). The same happens in voluntary active euthanasia, except in this case, the physician performs the administration of the lethal drugs (Pereira, 2011). In both cases, the patient will die an unnatural death through the administration of lethal drugs. Currently, AD is legal in four European countries (Netherlands, Belgium, Switzerland, and Luxemburg), Canada, Colombia, and the United States (Fontalis, 2018).

Pro arguments for AD include the right for patient autonomy and the relief of suffering (Dugdale, 2019). Another pro argument is that AD is safe medically and provides an option for people to choose to die safely instead of committing suicide and die other ways (Dugdale, 2019). Cons argument include the slippery nature of the determination of what is considered an “incurable and irreversible” terminal illness (Doerflinger, 2018); (Dugdale, 2019). An investigation on Oregon’s law on Assisted Dying shows that the eligibility of patients for AD is based on “two doctors think they are likely to die in six months without treatment – even if they could have been cured by treatment or could live for years or decades if treated” (Doerflinger, 2018). Another con argument is that seriously ill patients are usually influenced by depression and suicidal thoughts (Doerflinger, 2018); (Dugdale, 2019), which can influence their decision for AD, but they are often not referred to for psychological evaluation for clinical depression (Dugdale, 2019). In addition, the financial stress of an expensive healthcare system could definitely be a contributing factor to end-of-care decisions, and 55% of patients who agree to assisted dying because they don’t want to become a “burden on family, friends, or caregivers” (Doerflinger, 2018).

Citations:

Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care. SAGE Open Medicine, 9, 20503121211000918. https://doi.org/10.1177/20503121211000918

Doerflinger, R. M. (2018). Oregon’s Assisted Suicides: On Point.

Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Pros and Cons of Physician Aid in Dying. The Yale Journal of Biology and Medicine, 92(4), 747–750.

Fontalis, A., Prousali, E., & Kulkarni, K. (2018). Euthanasia and assisted dying: What is the current position and what are the key arguments informing the debate? Journal of the Royal Society of Medicine, 111(11), 407–413. https://doi.org/10.1177/0141076818803452

Pereira, J. (2011). Legalizing euthanasia or assisted suicide: The illusion of safeguards and controls. Current Oncology (Toronto, Ont.), 18(2), e38-45. https://doi.org/10.3747/co.v18i2.883

Shmerling, S. R. H. (2015, October 13). First, do no harm. Harvard Health. https://www.health.harvard.edu/blog/first-do-no-harm-201510138421