Euthanasia Ethics: A Better way to die
Professor Michael Guth
HCA 311-Health Economics
Euthanasia Ethics: A Better way to die
There are numerous controversial issues that currently affect the evolving field of psychology. Unsolved issues on human experimentation, abortion, genetic testing, and animal rights are a few examples of themes that arouse conflict and contention. Euthanasia and Physician-Assisted suicide is yet another controversial issue that has particular relevance to the field of psychology because of the apparent moral and ethical dilemmas involved. The American Heritage Dictionary defines euthanasia as "the act of killing an individual for reasons considered being merciful". Killing in this case is a physical action where one individual actively kills another. The word "euthanasia" comes from the Greek EU; "good" and THANATOS; "death" or "good death". Doctor assisted-suicide can be considered auto-Euthanasia. The Doctor provides the means for a patient to take their own life painlessly but does not actively or physically help that person die. Euthanasia, by definition a happy death, implies an easy or painless death.
On one side of the argument, Euthanasia would appear to be contradicting the Hippocratic Oath, which forbids inducing death, even if it is requested by the patient. On the contrary, medicine could be referred to as the practice that not only prevents death, but enhances the quality of life through prevention of suffering. The issue of assisted suicide also stimulates the debate of legality versus situation ethics. Should jurors, in physician-assisted suicide cases involving Dr. Jack Kevorkian, vote on grounds that empathy and compassion takes precedence over the letter of the law antithetically; should the juror take the conventional or legalist perspective and enforce the law as not allowing room for such compassion. Is it morally permissible for individuals to end their lives when they no longer wish to go on living or suffering? This central question of assisted suicide directly relates to the worries of how society would be impacted if Euthanasia were to be legalized. In addition to the societal impact of legalizing such a procedure, does this violate the ethical codes of the practice of medicine? These are some of the obvious and reoccurring questions in the controversial ethics pertaining to Euthanasia.
The controversial issues of Euthanasia have direct relevance to the field of psychology in the judgment of whether or not an individual is competent to make such a determination to end their life. For an example, clinical and counseling psychologists often are consulted by physicians regarding DNR-Do Not Resuscitate-orders to examine the psychological stability of the patient to make a life ending decision. Additional parallels that relate psychology to Euthanasia are an individual’s moral development and how it affects their decision making process in relation to moral dilemmas in the law. Everyone is put in situations where they are forced to form an opinion that potentially goes against an accepted or legal policy.
Psychology examines and theorizes how people may react in such a situation as well as analyzes the varying factors that may lead up to an individual’s decision in such a predicament. Examples of this, relevant to Euthanasia, would be jurors sitting on an assisted-suicide case. In this situation, the jurors were faced with the psychological decision to either declare that it is wrong to assist in one’s death, because it is legally prohibited. Or, on the contrary, the suffering and the pain of a terminally ill patient was ended allowing the patient to die in a peaceful manner; delineating that the action should be deemed honorable due to its inherent value rather than its consequences. There are various types of Euthanasia that must be explained before further discussing the topic. If the act is undertaken at the explicit request of a competent patient, it is defined as voluntary Euthanasia. On the other hand, involuntary Euthanasia is when this action is carried out without the explicit request of the individual, also known as murder. Those who argue against physician-assisted suicide primarily base their justification on the moral decency of the medical profession. There are many worries that go along with the legalization of Euthanasia. . In fact, Euthanasia is commonly practiced legally throughout the Netherlands.
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In the Netherlands, Euthanasia has already been legalized and been practiced. Some of the frequent concerns are the possible pressuring of patients into consenting; especially those without health insurance or financial support. Economic and financial hardships could potentially play a major factor with the unjust persuasion of an individual into such a procedure. The Netherlands, indeed, find itself having an alarmingly high rate of involuntary Euthanasia, which is indisputably impermissible. Euthanasia is also seen as being a serious disturbance to physicians and others in the medical field because of the potential luring of doctors away from the improvement of pain control, suffering, and terminal care. In addition, frequent practice of Euthanasia could very well negatively affect the trust entailed in the patient-physician relationship with doctors who are known to actively practice assisted-suicide. All practitioners in the medical field take the Hippocratic Oath stating the following; I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is harmful and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel. The Hippocratic Oath strongly implicates that participating or approving of physician-assisted suicide could very well destroy the legitimacy of the medical practice with direct regard to the value and the sacredness of life. Additional views against such procedures claim that most pain and suffering in terminal illnesses are controllable using current medical technology; thus suggesting the non-necessity of Euthanasia.
There are many dangers that can be presented by the misuse of assisted-suicide. Without proper guidelines and precautions established, Euthanasia could easily become a dangerous hazard. A misunderstanding could easily transpire in regards to what level of pain the patient should be in for assisted suicide to be offered. Moreover, guidelines must be set as to determine whether or not the patient is psychologically competent to make the decision to end their life. I feel that there is a crucial difference in the manner that Euthanasia should be permitted. I feel that a physician should not convince an individual the worthiness of life; however, I feel that Euthanasia should be allowed because of its respect for a person’s judgment on his or her own quality of life provided that all other medical options have been considered. One of the greatest dangers is to ignore or deny lessons learned from world history.
Nazi Germany actively had programs to eliminate the weak and vulnerable; moreover in this movement Euthanasia was frequently meditated. Hitler focused on this topic and legalized the assisted-suicide for all those who were mentally retarded as well as anyone who was incurably sick by medical examination. By 1941, Nazi Germany had euthanized 70,000 patients in mental institutions. For Hitler, this act was merely an advancing step towards a better social hygiene. The power of the State rather than the empowerment of the individual with respect to Euthanasia displayed the danger of such practice. What the Nazi’s did was purely murder for the good of the State; however, the possibility for legalized Euthanasia to once again become such a hazard must be recognized. There are five commonly excepted ethical reasons for those against physician assisted-suicide. The first is that the American Medical Association has ruled out any mercy killing, which is defined as the intentional termination of the life of one human being by another. They argue that a physician’s duty is to prevent medical suffering in the first place as laid out in the Hippocratic Oath, an oath that all physicians take upon completion of medical school. Western medicine has regarded the killing on patients, even on request, as a profound violation of the deepest meaning of the medical vocation. Neither legal tolerance, nor the best bedside manner can ever make medical killing medically ethical.
The next argument recognizes the slippery slope that could easily develop as did with Hitler in Nazi Germany upon the legalization of assisted-suicide. The opposition also fears that more and more physician’s will become insistent in their roles with assisted-suicide and begin to offer and urge it on patients who have become not only depressed about their circumstances, but also a burden to themselves and to others-even an economic burden. They also feel that the doctor-patient relationship depends solely on trust, and if the public begins to distrust the profession of medicine, because of its unhealthy participation in death-dealing, then the profession of medicine itself will suffer irreversible losses. They also see the potential for physician’s having the ultimate power of life and death in their hands as being mastermind to breach and control over an individual’s life.
Lastly, the opposition feels that more often than not, Euthanasia would be offered before all moral; political; and social ramifications have been considered. On the contrary, there are many that argue in favor of Euthanasia and assisted-suicide. Euthanasia can be easily seen as a method of allowing an individual to die peacefully and painlessly if they are suffering from an incurable sickness. In 1991 an estimated 516,170 Americans died from cancer. If 5% of these people died suffering with severe pain, this surmounts to 25,809 people dying a painful death that could have been eased with assisted-suicide. This statistic clearly proves that there are a considerable number of people that are suffering painful deaths in areas that the medical field has been able to remedy. If a patient is physically and emotionally competent and able to coherently understand their dainty condition, the option of Euthanasia and a peaceful death should rightfully be presented. For patients that are suffering from terminal cancer and other incurable sicknesses, pain is by no means the only cause of their suffering. Other common symptoms of terminally ill patients are weakness, pain, anorexia, dyspnea, nausea vomiting, confusion, pressure sores, fecal incontinence, as well as offensive odors.
Dr. Jack Kevorkian, a publicly well-known advocate and practitioner of assisted-suicide argues that in the current state of law and medicine, individuals with degenerative diseases must decide either to take their own life during the stage of their impairment when they are still capable, or suffer the harsh realities of an enduring decline. Individuals deserve the right to have control over their lives and to the autonomy they are entitled to. Those in favor of Euthanasia agree that it is an individual’s constitutional right to be offered a painless cure to their suffering. The principle of respect for autonomy tells us to allow rational individuals to live their lives according to their own autonomous decisions without any interference. If rational individuals independently chose to die, then proper respect for autonomy will allow physicians to assist them in doing so.
The goal of medicine is to address the suffering of patients. As the suffering increases difficulty to relief, if requested by the patient, the medical field should offer euthanizing relief if no other options are available. This by no means delineates that a person should be forced into assisted-suicide regardless of their social, political or economic stature. Assisted-suicide should merely be an option mentioned to the patient; moreover would be permissible to execute upon a patients request. Supporters also argue that the responsibility for technology should exist for these individuals as well. Medical technology has made efforts to gain terminally ill patients some additional time; likewise, medicine must recognize when they are unable to further help such patients. Scientific research for cures in these areas should continue. However, in the mean time, technological methods to relieve the pain for those via lethal injection should be offered. Furthermore, when science is able to find a cure, there will be no need for the assisted-suicide. Euthanasia is not trying to replace scientific research, but it offers a relief to the incurable pain and suffering that research has not yet corrected. Addition concern should be devoted to the individual’s autonomy. The personal decision to end one’s life-whether it is because of terminal pain or merely faced with old age-should be honored, however, firm criteria for this must be established to prevent abuse.
Here are some guidelines: the patient must fully understand their current medical condition and must be mentally aware that assisted-suicide is an irreversible action. Moreover, the patient must request assisted-suicide on their own will. The suffering patient must also be validated by a physician as not being caused from inappropriate care. A second, non-affiliated physician should make consultation, thus ensuring that the patient’s judgment is not distorted. The rise of patient’s rights in current medical ethics debates will undoubtedly bring Euthanasia closer to being legalized in the United States. Those who support autonomy in biomedical ethics have been promoting the right for patients to ask for assistance in death.
The supporters of assisted-suicide have established numerous reasons as to why Euthanasia is a morally and legally legitimate practice. These supporters have also instituted particular safeguarding procedures preventing against abuse. Specific committee review boards have been devised to examine the patient’s competence, the voluntaries of the request, and the terminal condition in which the patients suffer from. The Euthanasia committees would consist of interdisciplinary panels of clinicians, ethicists, lawyers, as well as laypersons. With a diversified professional panel, the committee will effectively be able to analyze the patient’s competency levels as well as the severity of the individual’s suffering. Corresponding interviews will be conducted assuring the patient’s genuine desire to carry out the procedure, and that he or she is not suffering from a mental or psychological impairment. The committee’s purpose is not to agree or disagree with the patient’s decision in whether or not to proceed with assisted-suicide, rather it determines the patient’s psychological ability to make such a decision. This does not impose Euthanasia, but it morally and legally sanctions the procedure because it is of the individuals own will.
Now that both sides to Euthanasia’s opinions have been described, I feel that I am prepared to present my perspective on this issue. As an undergraduate student, I am an ardent supporter of medical research to find cures for terminal diseases as well as more effective methods to relief pain in such patients. In situations where medicine is presently unable to treat or relief an illness, I feel that it is an individual’s autonomous right to end their life if the suffering has reached an unbearable level. I see physician assisted-suicide as being a legitimate option if there is no further medical assistance can relief a person’s illness.
By no means am I discrediting medical research! However, in cases where no medical help can be provided, I feel that Euthanasia should be an option upon request. An individual should not be pressured into the procedure; however, it is a person’s constitutional right to end their terminal suffering. I believe that assisted suicide should be available upon request by licensed practitioners regardless of the individual’s social, economic, or political status. I feel that Euthanasia should only be legalized under very specific guidelines. I agree that there should be an established committee that analyzes the competency of the patient’s mental status; thus assuring that the patient is fully able to make such an irreversible decision. I see Euthanasia as being a justifiable procedure concluding that the patients are not forced into doing anything they do not desire, and there is an assurance that patients will be capable to make such a decision. With the proper safeguarding against abuse, physician assisted-suicide is a moral option to those in need of a way out of their terminal suffering. In Pennsylvania at this time Euthanasia was and still is against the law. It is also against the Doctor's Code of Ethics to take a life. I feel that a patient should be kept informed as to the severity of their medical condition and should be given all the information about their chances for survival. The patient should also be informed of the severe pain and suffering involved, what treatments are available also how effective they are. This way the patient can, while still in a proper state of mind, make an informed decision about using Doctor assisted-suicide as an option.
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