Physician-Assisted Suicide

Should physician-assisted suicide (PAS) be permitted for a competent, non-terminally ill patient experiencing chronic, incurable pain, with a low quality of life? Suggesting a possible response to this question requires an examination of various concepts. One must have an understanding of notions such as rational thought, pain, and suffering. An examination should be made of the alleged rights of the patient, such as the “right to die”, as well as the patient’s competence and the specific circumstances of his situation.

With respect to a discernable definition of rational thought, Battin posits that there are two necessary components to a person’s ability to reason:

“(1) that in moving from the premises from which he or she begins to the conclusion reached, he or she maintains good logical formâÂ?¦ and (2) that the person can see the consequences of the positions he or she adopts or of the actions he or she plans to take.” (Ethical Issues in Suicide. Prentice Hall, New Jersey, 1995.)

As for the definitions of “pain” and “suffering”, pain is used to refer to physical harm which isn’t long-term. While suffering is a similar concept to pain, it has some important differences. Suffering refers to an extended state of physical or emotional harm, either of which could be caused by physical or emotional circumstances. In this specific case, for the patient to consider suicide a possibility, that would indicate that the patient is not only suffering physically, but emotionally, as a result of the physical pain caused by the chronic, incurable medical condition.

Supporters of physician-assisted suicide, regardless of circumstance, often advocate an individual’s alleged “right to die”. This right, though often seen as separate and distinct, can be explained as an extension of the right to refuse life-sustaining treatment, including refusal to accept medical assistance, which historically has been supported legally. While this extension may seem natural, since removal of treatment for terminally-ill patients seems no different from choosing to die, this extension of rights has not been supported legally.

There are a couple notable counter-arguments to a patient’s right to die, and specifically to the further extension of this right to non-terminally ill individuals. First, the historical and philosophical origins of the concept of individual rights go against the right to die. Rights originated from the desire to be freed from the command of another entity, such as the government or a slave-owner. This freedom is not seen to extend to the ability to do whatever one wants, and so it is not a natural right to be rendered inanimate.

A reply to this first counter-argument further examines the origins of rights. The desire to be freed from others’ commands is more accurately seen as a wish to be freed from being forced to follow their choices. This freedom involves allowing an individual to make his own choices regarding events that impact his life. As long as the individual’s choices do not negatively affect another, he should be allowed to make any decisions regarding the molecules which have been allocated from the inanimate and defined as himself, in the same way that a tattoo or pacemaker becomes part of that individual. In the case of a non-terminally ill patient considering suicide, this choice is being removed from those who have control over the patient, such as doctors, family, or the government, and given to the patient. Having a doctor assist in the suicide is an emotional appeal to make sure the suicide is successful and that it is done with as little additional pain or suffering as possible.

A second, more direct counter-argument is against the specific extension of the right to refuse life-sustaining treatment to non-terminally ill patients: whatever treatment the patient is receiving is not life-sustaining; the patient can live without the treatment, and so the whole argument of extension breaks down. In reply to this, the reply given for the first counter-argument seems sufficient, as does an appeal to compassion on the part of the doctor for the patient to die with dignity rather than in pain and anguish.

As for the patient’s competence and ability to think rationally, it seems unclear whether his desire for death is illogically skewed because of the constant pain and suffering, especially since his medical condition is non-terminal. The patient could argue that, if he wants the pain to cease, the only way this can be done would be to no longer remain in a conscious state. Because the patient would no longer be taking an active part in society, his long-term “vegetable” state could then be seen as a low quality of life. This argument appears rational, but whether it leads to the choice of death is still unclear. Therefore, although a patient’s right to death may exist, it should probably be the last option. Provided that it can be shown that no medical treatment will leave the patient in a conscious, non-suffering state, and that the patient understands the consequences of his death and its impact on others (the 2nd of Battin’s requirements for the ability to reason), physician-assisted suicide for non-terminally ill patients should be considered a valid possibility.

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