Ethical Issue of Physician Assisted Suicide



Ethical Issue of Physician Assisted Suicide

As medicine's technical limits have become increasingly clear, Americans seem more willing to address end-of-life decision-making. A major development during the 1990s was physician assistance in dying: physician-assisted suicide in Michigan, Oregon's Death with Dignity Act, and developments in Europe, most notably The Netherlands. This evolution toward recognizing the appropriateness of assistance in dying raises legal and ethical issues for physicians and healthcare institutions such as nursing facilities and acute care hospitals. These issues include the effects on providers' values systems, the trust between patient and provider, and the "slippery slope" that voluntary, active assistance in dying will become involuntary, active assistance. (Kass 2011)

The differences are particularly clear and important in the issue of physician-assisted suicide. Oregon has passed a law allowing physician-assisted suicide, and a similar statute was recently passed in Washington State. Physician-assisted suicide is even more common in Europe, with some nations such as Switzerland attracting ”suicide tourists”. Bioethicist Jacob Appel has even endorsed physician-assisted suicide for some healthy people who request it.

Patients have a right only to negative autonomy—a right to accept or refuse medical treatments appropriate to their illness. The medical profession decides what acts constitute appropriate medical treatment. Thus the assertion that physician-assisted suicide is a matter of patient autonomy is mistaken and even misleading. The issue of physician-assisted suicide has nothing to do with issues of autonomy; all patients have a right to choose among appropriate medical treatments—about this there is no debate.

The issue of physician-assisted suicide hinges on whether or not killing is medical treatment. If killing is medical treatment, then patients who have a disease for which the medical profession has decided that killing is an effective and appropriate remedy have a right choose it. If killing is not a medical treatment, then patients do not have a right to choose it, at least as a part of their medical treatment. (Walker , et al. 2012)

The assertion that autonomy is an important factor in physician-assisted suicide is a phantom. “Autonomy' conjures specters of freedom from compulsion, yet patients always retain the right to refuse medical treatment. And they never have the right to acts by physicians that are not medical treatment. In the debate over physician-assisted suicide, it is the status of killing as a medical treatment that is the issue.

Predictive futility can be divided into several types: conceptual futility, ...