Physician-assisted suicide is a topic that has been at the forefront of bioethics for many years now and yet no real consensus has been made on whether it should be a right afforded to all patients. Cases can be made for either side of the argument. For example, most proponents of physician-assisted suicide consider the issue to be ultimately one of patient autonomy and feel that rejecting physician-assisted suicide is just another example of physician paternalism. However, it is naïve to believe that physician-assisted suicide is just an issue of patient autonomy because the autonomy of the doctor must also be considered. For this, reason among others, physician-assisted suicide should not be legalized.
Daniel Callahan’s “Physician-Assisted Dying: Self-Determination Run Amok”, he discusses that the idea of euthanasia as an issue of patient self-determination is incorrect because the responsibility is shared between the patient and physician (p.75). The same logic can easily be applied to physician-assisted suicide as the only difference between providing a patient with the means to kill himself and actually performing the procedure is semantics. While Callahan is quick to differentiate between euthanasia and allowing to die, claiming that the physician is not culpable for the death of the patient if the patient is simply allowed (p.76). I would argue that in the instance of providing a terminal patient with chemicals to kill himself, a physician would be just as culpable as if he personally administered the chemical.
It is unfair to put pressure on doctors to assist in ending the lives of patients whom they have sworn to protect. If physician-assisted suicide was legalized it would directly conflict with everything that doctors have sworn to uphold in the Hippocratic Oath. Violating the sanctity of life of a patient by assisting in his or her suicide would be in direct conflict with virtue ethics which places emphasizes the importance of roles. To ask a physician to betray the oath to which he or she swore by helping a patient end his life prematurely would go completely against everything extolled in virtue ethics.
Callahan argues that physician-assisted suicide should not be legalized because physicians should only be concerned with preserving the health of patients (p. 79). It seems callous to view Callahan’s answer as the only responsibility of physician, but doing so truly protects the interests of both the patients and the physicians. The physician is freed from the burden of making important, unalterable decisions based on a patient’s perceived mental or emotional suffering. The patient is also protected from a law that might lend itself to abuse at the expense of the patient.
For example, Callahan discusses the case in the Netherlands where nonvoluntary euthanasia has occurred, despite the law requiring explicit permission for euthanasia to be performed (p. 78). While physician-assisted suicide is much more difficult to be performed on nonvoluntary patients because it requires the patient to take action in order to end his or her life, nonvoluntary physician-assisted suicide might still occur. Nonvoluntary physician-assisted suicide might occur if a doctor failed to properly inform the patient that a prescribed treatment would result in the patient’s death. Therefore, legalization of physician-assisted suicide, which is often toted as a right of self-determination, might detract from the autonomy of patients in the inevitable abuses of that would occur.
I have already established that the principle of autonomy, often used by proponents for legalization of physician-assisted suicide, does not completely support physician-assisted suicide and in fact, can run counter to it. Physician-assisted suicide also violates the principle of beneficence, doing good, which is one of the core virtues of physicians. As physicians should be concerned with preserving the health of their patients above all else, assisting a patient in taking his or her own life cannot be considered an act of beneficence. Similarly, the principle of non-maleficence, doing no harm, would be violated by the physician in physician-assisted suicide, as providing the patient with the means to kill his or her self, is certainly an act of harm.
The principle of justice is the most difficult to apply to the issue of physician-assisted suicide because it has a different meaning for different. If justice is seen as simply, treating similar people similarly, it is easy to see how legalizing physician-assisted suicide could be difficult to apply in a just manner. Unless physician-assisted suicide was available to any patient who wanted it, restrictions would need to be placed on the law specifying under which conditions a patient should be allowed to receive physician-assisted suicide. The problem comes when deciding which patients fall within these restrictions. A system which treats individual patients with different diseases and ailments seeking the same “treatment” of physician-assisted suicide would be next to impossible to implement because it is impossible for a physician to know exactly what a patient is feeling emotionally, physically, and mentally.
Physician-assisted suicide has captivated those interested in bioethics for quite some time, and will continue to do so. However, I would argue that physician-assisted suicide should not be legalized due to the reasons espoused above. Physician-assisted suicide infringes on the autonomy of the physician by going against the virtues he or she has sworn to in the Hippocratic Oath. Furthermore, legalization of physician-assisted suicide is likely to lead to abuses of the law, which would violate the autonomy of the patient, as well. Allowing the legalization of physician-assisted suicide is sure to lead to breaches in the other 3 principles: beneficence, non-maleficence, and justice, as well and as such legalization should not be permitted.