Physician-assisted suicide has long been a highly controversial topic in bioethics. In the state of Oregon physician-assisted suicide has been legal since 1998. The Oregon law permits physician-assisted suicide only if the resident has less than six months to live and is mentally competent. They then can request that their physician prescribe them drugs that will cause a very quick and painless death. Yet, many people still argue against this saying it's either intrinsically wrong to kill yourself or for a physician to help you kill yourself. Michael Gill argues against these claims, and I agree with him that physician-assisted suicide should be legal when someone is terminally ill. Contrastingly, Bonnie Steinbock believes that there is not enough evidence for this law and that there are more questions to be asked.
In Michael Gill’s essay, he believes that someone with less than six months to live who is mentally competent can request that a physician prescribe them drugs that will cause a quick and painless death. The counterpoint to Gill’s claim is that it is intrinsically wrong for someone to kill themselves and it is intrinsically wrong for a physician to assist someone in killing themselves (Gill 54). In terms of the argument against killing yourself, Leon Kass’ main claim is that it is unnecessarily tragic. He believes that the person would be destroying that one thing of worth that everyone intended to encourage, which is life. Kass believes that laws allowing physician-assisted suicide destroy our basic autonomy because you can no longer be able to make choices once you have killed yourself since someone who is dead cannot make their own choices (54 Gill).
Another main argument against physician-assisted suicide has to do with the instance where it is legalized for healthy people who are not terminally, or healthy people could justify that they could do physician-assisted suicide based on the autonomy rule. Gill responds to these arguments by saying that the Oregon law is for the promotion of autonomous humans. Meaning that terminally ill patients should be able to have the choice of whether or not they would like to have physician-assisted suicide. Furthermore, when someone is terminally ill, they will not be able to make autonomous decisions in the future anyway since they will end up dead either way. The person who chooses physician-assisted suicide is not making a decision that prevents autonomy in the future. They would simply be choosing to end their life a little bit earlier and in a less painful way (56 Gill).
Additionally, as for the argument that physician-assisted suicide for terminally ill patients does not work because it is fundamentally no different than when a healthy person chooses physician-assisted suicide. Gill argues that a healthy person has a long life to live and has and will have the ability to make autonomous decisions in the future. Whereas the terminally ill patient only has 6 more months of autonomy left and will end up passing away if they do physician-assisted suicide or not (Gill 56). Gill also adds to this claim by mentioning how much pain a terminally ill person can go through. He argues that “progressive bodily deterioration can limit and ultimately eliminate one’s ability to undertake physical activity, and mental deterioration can limit and ultimately eliminate one’s ability to make any kind of decision at all” (Gill 56). Not only do terminally ill patients deteriorate physically and mentally but their autonomy also deteriorates. This can go as far as a patient not being conscious for the last months of their lives. In this case, not only do they not have autonomy in this state but it’s not a great way to live their remaining weeks and months alive. He goes on to argue that “the decision to commit suicide in the final stages of a terminal illness can proceed from a great respect for autonomy, as such a decision can reveal that what a person values about herself is not simply her physical existence but the ability to decide what happens to her” (Gill 56).
Another argument against physician-assisted suicide is that it is intrinsically wrong for a physician to participate in it. This opposition mainly states that it is not appropriate for a physician to make this decision because it puts them in the position of using their own personal ideas instead of medical ones. Medicine’s role is only supposed to be limited to what it can suitably do like promoting health rather than aiding in someone’s death. Gill counterargues that this is not what the physician is doing, and they are only deciding whether the patient requesting physician-assisted suicide has a terminal disease and if they are competent, which would fall under their claims of it having to be a medical determination. As to the point that a physician’s duty is to help patients get healthy, Gill argues that they cannot make a terminally ill person healthy because they are dying and will end up dead either way (Gill 57). Rather, one of the main roles of a physician is to help the patient feel as comfortable as possible, and if they are in a lot of pain sometimes the only option would be physician-assisted suicide.
After reading both sides of the argument I have decided that I agree with Michael Gill’s statement. This is first because of our respect for autonomy. If someone who is terminally ill decides that their pain and life are not enjoyable and want to end it a little short with the help of a physician, they should be able to do so. Respect for autonomy means that we have the obligation to respect the decisions of adults who are competent to make them. Since these are adults who are competent to make these decisions then they should be allowed to. They are not assisting healthy patients who have a long life ahead of them, but patients who, in the near future, are going to lose all of their autonomy. It will also relieve the patient from extreme suffering if there is nothing else the physician can do to make them comfortable. It is also better for them to do it under the supervision of a physician because they can do it in a safe environment that will be painless. Since physicians know what they are doing, they can do it in a way that is completely comfortable and safe. When you are against physician-assisted suicide you are deciding too much for the patient, and it is not fair to force them to stay alive if they are in extreme pain. It has nothing to do with the personal, religious, or spiritual ideas of the physician, it solely is medically helping the patient to be comfortable.
In Bonnie Steinbock’s essay, she discusses two cases that are important for the discussion of physician-assisted suicide. She starts off by saying that this controversial topic of physician-assisted suicide should be looked at in a broad sense. Instead of looking at singular cases, we should start looking at how important and how much we need physician-assisted suicide. We should compare these ideas to the risks which include mistakes and abuse. The first case she talks about is the case of Kate Cheney who was an older woman who was diagnosed with inoperable stomach cancer. Her daughter helped her ask for physician-assisted suicide. The first doctor dismissed her, and the second doctor wanted to have her get a psychiatric evaluation. She met with two psychiatrists and the first one concluded that Kate lacked the competency they were looking for to go through with this and the second one thought that she did. Additionally, both psychiatrists thought that she was being influenced (Steinbock 238). The doctors then decided that she was competent and went along with it, and she died with her family from lethal medication. This case concluded lots of questions which includes, “what level of capacity does the Oregon law require?” (Steinbock 238).
The second case that she talks about was Michael Freeland who was diagnosed with terminal lung cancer. He called the Physicians for Compassionate Care which is an anti-suicide group. “He seemed distraught, and told the volunteer who answered the call, Catherine Hamilton, that he saw no purpose in undergoing chemotherapy. He also said that he lived alone and that he did not want to tell his daughter about his diagnosis, because she was moving to another state to start graduate school” (Steinbock 239). After the phone call, he tried to kill himself and was put into a psychiatric hospital where he made two more attempts. He ended up undergoing chemotherapy and radiation treatment. After a year of finding out about his diagnosis, he received a lethal prescription from a physician but was brought to the hospital where he was diagnosed with depression and much more. It was also revealed that his home was not livable and that other relatives had suicidal ideations. He ended up not taking the lethal medication when he got home and towards the end of his life he was in a lot of pain until he was switched to a more suitable medication which was a morphine pump. He died two weeks later and was able to say goodbye to his friends and family (Steinbock 239).
Steinbock wants us to conclude from this essay that we should look closer at the abuse aspect of physician-assisted suicide. With just these two cases it does not provide much evidence for abuse that could go on if it is legalized. “For all these reasons, I remain conflicted” (Steinbock 240). She believes that there are many more issues and questions to be discussed before we make it a universal law and that so far it seems unproven. I disagree with Bonnie Steinbock's opinion of physician-assisted suicide. I believe that these two patients should have the right to choose just like Kate Cheney did. She was able to die peacefully around her family and without any pain. I believe this case is a perfect example because she was told by a doctor that she was fully competent, and she had a terminal illness. She knew she was going to be in pain, and she just wanted to be surrounded by her family when she died. She did not have to go on living in pain especially when it was against her wishes. I believe that this is the right way to go about it and it follows the law in Oregon. As for the second case of Michael Freeland, it is a little bit different. He did not have full competence and his depression was getting in the way of deciding whether he wanted to undertake physician-assisted suicide. But this would go against Oregon law because he was not fully competent when making this decision and it worked out for him because he got other medications that helped alleviate his pain. Furthermore, not everyone would have access to medications that would adequately relieve their pain and they might want to be able to autonomously choose to be with friends and family as Kate Cheney did. I believe the issues and questions around these laws have been adequately addressed and the counterarguments stem from personal biases.
In conclusion, physician-assisted suicide is a very controversial topic that can be argued against based on religion, physicians being healers, not choosing autonomously, and many other reasons. However, I believe that in the case of physician-assisted suicide the pros outweigh the cons. Some of the pros include that we are autonomous beings, not wanting to suffer, have the aid of a safe medical practitioner, and many more. I, therefore, conclude that physician-assisted suicide is appropriate in the case of terminally ill patients that have demonstrated competence in making such a difficult decision and it’s a matter that we should very much consider.
Works Cited
Steinbock, B. “The Case for Physician Assisted Suicide: Not (Yet) Proven.” Journal of Medical
Ethics, vol. 31, no. 4, 2005, pp. 235–241., https://doi.org/10.1136/jme.2003.005801.
Gill, Michael B. “A Moral Defense of Oregon's Physician-Assisted Suicide Law.” Mortality, vol.
10, no. 1, 2005, pp. 53–67., https://doi.org/10.1080/13576270500031055.