The public is warming to the idea of physician-assisted suicide.
What are the arguments against it?
by Mark B. Blocher
Standing before television cameras, twice-acquitted "Dr. Death," Jack Kevorkian declared, "I now consider [physician-assisted suicide] to be a legitimate medical service." We might question what standing an unemployed, unlicensed pathologist has to make any declarations about legitimate medical services, except that a majority of Americans seem to agree with him.
In light of such support, what arguments may be made that might prove to be of sufficient public potency to reverse the current momentum? What case can be made against the practice of physician-assisted suicide? Here is a brief overview of some of the main arguments against the practice.
Physician-assisted suicide perverts the doctor-patient relationship and undermines the purpose of medicine.
The role of a physician in the life of a patient is that of a healer and an advocate. His medical training and skill is there to relive pain, to treat disease and otherwise be an advocate for his patient's physical well-being. The role of the physician is a limited one, focusing primarily on physiology. He is to act in the best interest of his patient and for the person's benefit.
In physician-assisted suicide, the physician and the patient must share the view that death is preferable to continued existence, (i.e., that death is a benefit and remaining alive a burden). However, such judgements are not purely medical ones. Other influences play a substantial role in such a conclusion. The conclusion that deliberately causing the death of another person on grounds that such a life is not worth living requires that a physician becomes more than a physician. He must become a philosopher/theologian. However, this shifting of roles forces the physician out of his area of expertise. Just because he is a physician does not make him and expert on death, nor on what lies beyond death's door. Even Kevorkian admitted under cross- examination that he could not be sure that death results in the end of pain and suffering.
Physician-assisted suicide re-introduces into society the practice of private killing.
All civilized societies seek to reduce occasions in which one person can be killed by another. Personal disputes can no longer legally be settled by dueling. Revenge killings are still prosecuted under homicide statutes. The standards for using deadly force in the protection of one's home, property or person remain quite high in order to discourage probate killing.
An ordered society will strongly resist the notion that private agreements can be reached which allow one person to take the life of another to serve the interests of one or both of the parties. The proposal to legalize physician-assisted suicide is an attempt to add a new category of acceptable killing - a proposal that seemingly contradicts other national trends aimed at limiting occasions where human beings are killed (e.g., gun control).
Legalizing physician-assisted suicide distorts the principle of personal liberty.
The movement to decriminalize physician-assisted suicide rests on two premises: self-determination and the obligation to relieve suffering. The first premise, self-determination - or more accurately, self-sovereignty - springs from democratic ideals of liberty. The essence of self-rule is the individual's indigenous authority to make his own decisions. The proponents of physician- assisted suicide contend that rendering "aid in dying" to those who request it demonstrates respect for self-sovereignty.
However, do we undermine the principle of self-determination by acting on a choice that eliminates the capacity for self- determination? Isn't this the reason there is no such thing as "voluntary slavery?" We do not allow people to make an autonomous choice to sell themselves into slavery because it contradicts the notion of freedom. Why should society permit a similar contradiction in the choice to have one's life ended? You cannot transfer your right of self-determination without contradicting it.
Physician-assisted suicide won't be limited to competent, conscious, terminally ill patients.
Upon what moral grounds can physician-assisted suicide be limited to those who are terminally ill? If one has the right to die and it is moral for a physician to assist in fulfillment of an autonomous request for "aid in dying." What moral ground remains for denying such a request from a healthy individual?
If the right to die is among the inalienable rights granted individuals, why must a person be conscious and competent to exercise it? If we are obligated to relieve suffering, why limit the option of rendering "aid in dying" to only those who can request it" In fact, there is no principled reason for rejecting such logic if autonomy and suffering are the criteria for accepting the morality of physician-assisted suicide.
The right to die will ultimately require a duty to kill.
If it is the physician's duty to relieve suffering and respect his patient's autonomy, on what ground can a physician refuse a request for assistance in dying? How can a physician set aside such weighty responsibilities by appeals to conscience or personal values? If we accept the premise that a physician has a duty to eliminate all of a patient's suffering, then his moral life and integrity are encompassed in an action that ends that patient's life. What sensitivities must be part of his character? Must he embrace wholeheartedly the notion that a self-chosen death is the only rational way to deal with suffering in order to obtain a medical license?
Physician-assisted suicide will negatively affect efforts to improve palliative care.
There is no question that improvements in the care given terminally-ill patients are needed. In particular, pain management can be vastly improved with better physician training and minor changes in the laws governing controlled substances.
Evidence is growing in The Netherlands, however, that as assisted suicide is more widely practiced, the level of comfort care offered to terminally ill patients deteriorates. If a quicker, painless death is available, what incentive remains for a physician to provide costly medical care for someone who wants to live as long as possible?
Legalized physician-assisted suicide will lead to a "duty to die" mentality.
Asserting that the right to die encompasses the right to have another person end one's life places in jeopardy another right - the right to remain alive without having to justify one's existence. All of the arguments that make physician-assisted suicide into an acceptable moral act can be used to argue that it is irrational for anyone to remain alive if they are in pain, suffering or terminally ill. The indignity of prolonged dying, the loss of quality of life, the stress and burden placed on family, the financial burdens, etc., are all given as reasons for decriminalizing physician-assisted suicide.