The Ethics of Physician Assisted Suicide

Definition of Physician Assisted Suicide (PAS)

• Defined by Merriam-Webster as:
  "Suicide by a patient facilitated by means or information provided by a physician who is aware of how the patient intends to use such means or information."

Distinction Between PAS and Euthanasia

• Physician Assisted Suicide (PAS):

  • Involves the physician providing the patient with the means to end their own life (e.g., prescribing a lethal dose of medication).

• Euthanasia:

  • Involves the physician acting for the patient by administering the lethal component directly.

• The distinction lies in who administers the lethal component: the patient (in PAS) or the physician (in euthanasia).

Legal Considerations of PAS

England and Wales

• Assisting a suicide can result in imprisonment of up to 14 years.

Canada

• Similar laws as in England:

  • Crime to assist in a suicide with potential punishment of up to 14 years imprisonment.

France

• No specific law against assisted suicide.

• Possible prosecution under Article 2,236 of the Penal Code for failure to assist a person in danger.

Mexico

• On April 22, 2008, the Senate voted 70-0 to legalize passive euthanasia.

  • Allows withdrawal of life-sustaining treatment but does not permit the administration of poisons.

Belgium

• The legal framework for euthanasia:

  • The Belgian Act passed on May 28, 2002, legalizing euthanasia for competent adults and emancipated minors.

  • On February 13, 2014, Belgium expanded this law to allow euthanasia by lethal injection for minors without an age limit, provided parental consent is obtained.

  • Concerns about potential pressure on parents and minors regarding this decision.

United States

• Five states have legalized PAS:

  • Oregon (1997)

  • Washington (2008)

  • Montana (2009, following a court case)

  • Vermont (2013)

  • California (2015)

• No federal regulations currently governing PAS.

Ethical Perspectives on PAS

Pharmacist's Viewpoint

• The speaker, as a pharmacist, expresses opposition to PAS:

  • Acknowledges that many believe they have the right to make such decisions.

  • Emphasizes that alternatives exist, such as:

  • Palliative Care: Combination of counseling and pain management to alleviate suffering of both patient and family.

  • Hospice Care: Providing support to patients and families in the final stages of life.

Moral Arguments Against PAS

• Opponents argue it is morally wrong to assist in a suicide, comparing it to killing, which is not justifiable.

• Concerns over possible pressure on terminally ill patients to end their lives, potentially viewing themselves as burdens on their families.

• Physicians, like all professionals, can make mistakes; therefore, the state has an obligation to protect lives and prevent errors associated with PAS.

The Hippocratic Oath

• The Oath articulates a commitment:

  • "Above all, I must not play God."

  • PAS conflicts with this principle by enabling individuals to control their own death.

Personal Reflections of the Speaker

• After over 30 years as a respiratory therapist witnessing suffering from chronic diseases (e.g., COPD, emphysema, chronic bronchitis, terminal cancer):

  • Observes the pain of patients and families, capturing the struggle for breath and dignity in dying.

  • Raises ethical questions about whether a nation can deny patients the right to die with dignity.

Concerns About Discrimination and Pressure

• Arguments against PAS often cite the potential for abuse, especially concerning:

  • The elderly

  • Low-income patients

  • These populations may feel pressured to choose PAS over long-term, expensive treatments.

• Reasonable laws, such as those in Oregon, impose strict requirements to mitigate risks associated with vulnerabilities before allowing PAS prescriptions.

The Speaker's Conclusion

• The speaker asserts that it is not their role to judge the suffering individuals undergo.

• Emphasizes the importance of choice in collaboration with physicians and families regarding end-of-life decisions, recognizing the societal problems surrounding these difficult issues:

  • Acknowledges the depth of suffering that is often unseen until personally experienced, reinforcing the complexity of PAS and euthanasia discussions.