A Conversation on the implications of Death

Oregon State Hospital

Physician-assisted suicide (PAS) is a controversial topic in the political world and in popular culture. Questions range from whether individual states should be allowed to legalize the practice, or if doctors should have to provide the service. All these concerns at their root return to the philosophical question of the ethical nature of the practice. It is important to ask what the implications of allowing or preventing someone from taking their own life would be. By looking at the specifics of the procedure, understanding the underlying reasons we so value life and review the remaining arguments against PAS it will be clear that it, rather than giving cause for concern, we are ethically obligated to allow this freedom.

In this discussion, it will be important to clarify what form of PAS will be argued for. Rather than arguing for anyone to be able to take their life, or for doctors to be able to take the life of a person for them, we will instead be arguing from the perspective of PAS for those capable of taking their life and within six months of death due to an illness. This limits the scope of patients greatly and with current protections as enacted in US state laws requiring multiple doctors to confirm diagnoses and ensure the patient is not affected by some mental illness that would push them toward suicide, the practice is less likely to be abused.

With an understanding of just what sort of PAS is to be argued for, we can discuss the ethical questions surrounding it. The first subject to explore is what about life makes it necessary to protect, and by inference is endangered by allowing PAS. Life is made up of a multitude of experiences that, in aggregate, are seen by many as positive. When considering the future the same generally positive outcome is assumed, resulting in our designation of that future as something good. It’s claimed that this good is then threatened by practices such as PAS which some argue devalue the lives of others. (Singer, 529)

This argument against PAS along with many others will interact with this central value of life claim and can be answered by returning to it. The confusion comes from thinking that the good that we assign to future experiences is still maintained by someone who is six months from death. In that situation, the evaluation of the future must change because of the assured pain and suffering this person will experience. By recognizing that the future for these people is radically different from that of any other person, and understanding how that changes the way we place value on life, it becomes clear that someone taking the option of PAS is doing so for the same reasons we make the decision in normal life to continue living. While we evaluate future experiences and see a net benefit, they see a medically assured negative. This alone upsets the claim that allowing PAS devalues life and will be the underlying response to most other arguments against PAS.

The first of those arguments is that it’s possible the disease will be resolved. Either through miraculous remission or a sudden breakthrough in science, there is potential for the person to be taking their own life when a better solution lies just around the corner. This argument ties back into the argument about the value of life discussed above, as if this is the case then life suddenly stretches out ahead and the patient is losing those highly valued experiences. These possibilities, however, are simply that, highly unlikely potential scenarios that will unfortunately never happen for many of those placed in this position. As such it is a judgment call about the odds of the solution coming just in time, or the disease to continue unabated causing unbearable pain. This, like the decision to take chemotherapy instead of hoping that some cancer might go into remission by itself, is a decision that should be left up to the patient. If they find the chance slim they ought still to have the option of PAS. (Singer, 537-538)

There is also the argument that if we allow for PAS patients will be pressured into the practice or a slippery slope will be found at the end of which all suicide is legalized (Singer, 538-541). This, however, is less a philosophical argument and more an argument easily addressed with facts. Several studies have been done on PAS in both the Netherlands and Oregon. The most recent report on the Netherlands looked at two decades of data from the time since the law was passed to 2009 and found that, “A last important lesson that can be learned is that the legalization of euthanasia in the Netherlands did not result in a slippery slope for medical end-of-life practices . . . Our studies show no evidence of a slippery slope. The frequency of ending of life without explicit request did not increase over the studied years” (Rietjens, J. A. C., et al. 2009). 

Furthermore in a study comparing the Netherlands and Oregonian laws on PAS found that “a smaller percentage of older people received assistance in dying than of younger patients; gender ratios were slightly higher for males over time; and assistance was not more common among uninsured. Socioeconomic data of intermediate strength, usually inferred from other, more robust data, also suggest similar pictures in the two jurisdictions: recipients of assistance in dying were likely to be of equal or higher educational status and were less likely than the background population to be poor” (Battin, et al. 2007). These reports all point towards the conclusion that no heightened risk appears for any in vulnerable groups, nor does it show that over time people are euthanized without consent. The facts simply do not bear out the slippery slope argument that many people attempt to draw from PAS laws. 

Finally, there is the argument that physicians should not be asked to prescribe such medication. The first oath a doctor takes is to do no harm, and many have argued that this is one of the reasons PAS should not be permitted. The assumption underlying such a claim, however, is that to do no harm is defined as preserving life for as long as is humanly possible. This fails to speak to the value or experience of that life. By doing no harm do we really mean, attempt to preserve the best possible life for a person, rather than prolonging any existence at all. Surely under such a view taking a patient off of life support would be just as problematic, but that clearly isn’t the case. This comes back again to how we value life, a person on life support does not have the potential to experience anything that we determine to make life good or worth continuing.

It is clear that PAS is not going to deteriorate down a slippery slope, and by virtue of understanding why we truly value life we know that simply allowing the practice will not make life worthless, violate Hippocratic oaths, or that we should force those so close to death to value life in the same way others do. Allowing physician-assisted suicide for those with only six months left to live is unambiguously the correct conclusion.