Is judgment of suicidal people impaired by depression or other mental illness? Is there such a thing as rational suicide? Euthanasia is about life or death decisions. It addresses the concern of a person’s right to end their own life (and get help to do so) if they choose. There are many different views towards this issue in today’s society. This is a very controversial topic. Physician assisted suicide has been one of the biggest controversial topics in the last decade.
The Merriam-Webster Dictionary defines medicine as “the science and art dealing with the maintenance of health and the prevention, alleviation, or cure of disease.”As the end of life approaches, the ability of medicine to heal and prolong life comes to an end. Euthanasia is the use of a lethal force, typically a drug, by a third party to end a life. Physician Assisted Suicide (PAS) is the prescription of a lethal means to end life by a physician, however, the patient must administer the drug to themself (Shibata, 2015). This paper will discuss the controversy of these areas, court rulings regarding the topic as well as the moral and ethical principles.
Self determination is one of the central ethical positions of social work. This may lead many social workers to support assisted suicide (Levy, 1992). The social worker should make every effort to support self-determination on the part of the client. Social workers should not exclude their judgement and their values from their work. In most cases of assisted suicide requests, the clients want the assistance, but it is reasonable for the social worker to point out the destructive nature of the behavior and to assist the client with new ways of behaving (Rothman, 1989). Most would think that people who seek assistance in killing themselves are competent in making the decision. Most social workers tend to think that those considering assisted suicide are elderly or terminally ill and that they are not depressed, or psychotic. “Such individuals may be kept alive by artificial means, may be in chronic pain, may have not reasonable quality of life, and may have no hope for a dignified death. These individuals are the basis for the argument in favor of rational suicide” (Callahan, 1994).
A study of 44 terminally ill people showed that only 3 were suicidal or had even thought of suicide and only 7 wished for a premature death that was non suicidal(Brown, Henteleff, Barakat, & Rowe, 1986). The ten people that had wished for death were found to be severely depressed, compared to the 33 non depressed patients (Brown,1986). This study suggests that it is depression rather than terminal illness that leads to the suicidal thoughts. Social workers have found that when working with terminally ill clients that the vast majority are not suicidal (Thal, 1992). Patients who are diagnosed as clinically depressed are typically fully competent. Depression, however, can cause hopeless and helpless feelings.
If a doctor assists in a suicide are they upholding their promise of the Hippocratic Oath? Some may argue that it is acceptable for physicians to assist their patients in committing suicide. One of the main reasons for this argument is that patients that have a terminal illness or are disabled are often in a great deal of pain and suffering. The argument is based on what is the moral right of a physician. It is a physicians responsibility to help patients avoid pain and suffering no matter what it takes to do so. Another argument in favor is that the right to commit suicide should be considered a basic human right. Assisting a human in suicide is said that it reduces the value of human life. There are several religions that don’t allow for assisted suicide these religions believe it be a sin. If doctors or and medical physician could help patients with assisted suicide could place too much control into their hands.
In my opinion, the terminally ill should be allowed to make their own choice regarding the end of their life. It is still important for them to be evaluated properly and the decision cannot be made to hastily. This would also help the family from the pain of watching a loved one suffer. There are many different sides of assisted suicide but people need to meet in the middle. Find a ground that works best for physician assisted suicide. Suicide should not be encouraged and medical physicians should let the patients make their own decisions.
The law does not give someone the constitutional “right to assistance in dying”. The case of Washington vs. Glucksberg, the Supreme Court held that a right to assistance with dying was not protected by the Due Process Clause. The court granted the states the ability to “experiment” with Physician Assisted Suicide and other types of medical care involving assistance in dying. In other words, the laws are limited to the state the individual is living in (Shibata, 2017).
In Vacco vs. Quill, The Supreme Court stated that the states have a legitimate interest in weather or not assisted suicide should be outlawed. “The Fourteenth Amendment does not include the right to kill oneself, or assistance in doing so. In doing this, a rational distinction between a request to end one’s life and a request to withdraw life support was established” Shibata, 2017). People must abide by the rules of their state when choosing their options at the end of life. Vacco vs. Quill found that the difference between a patient refusing treatment and a physician hastening death was not enough to uphold New York’s ban on physician assisted suicide.
One of the most famous cases in assisted suicide would be the case on Jack Kevorkian.
Kevorkian became fascinated by death during his residency at the University of Michigan hospital in the 1950’s. His peers gave him the nickname “Dr. Death” for his unconventional theories regarding using death-row inmates for “painless” medical experiments (Biography.com Editors 2014). In 1986 Kevorkian began a new crusade for assisted suicide, or euthanasia, by lethal injection. Kevorkian was convicted of second degree murder when he “engaged in euthanasia by actively injecting a lethal drug into his patient, assisting in that patient’s suicide” (Shibara, 2017). The Supreme Court in Michigan ruled that it was unconstitutional to conduct euthanasia.
Today, seven jurisdictions now permit physicians to prescribe a lethal dose of medication to adult patients that are deemed mentally competent and terminally ill. Oregon, Washington, Montana, Vermont, California, Colorado and the District of Columbia no engage in this allowance (Buchbinder, 2018). Oregon’s Death With Dignity Act provides benefits for the terminally ill as it gives the terminally ill control and choice. Montana requires 2 physicians certify that the life expectancy is not longer than 6 months and the must assess the patient’s mental capacity. The patient must self administer the medication and doctors have the right not to participate. Montana also requires 2 separate requests to physicians at least 15 days apart and a written request must be submitted in the presence of 2 witnesses (Buchbinder, 2018).
A recent story in The New York Times spoke of a family that was encountering the end of life conversation. In summary, the 83 year old mother was very ill from stage IV lymphoma and atrial fibrillation. The mother sat her adult sons down to discuss her end of life wishes. She did not want extreme measures and did not want to suffer. Although the sons wanted more time with their mother, they respected her wishes and supported the mother’s right to die on her own terms. When the decision was finally made, they were approached by a hospice nurse who was very convinced that she was not dying from the cancer and that she could be treated. Mom then made the decision to undergo the treatment and is still part of the boys lives today. The mother had wanted to “pull the plug” too soon as she became overwhelmed with fear. “Our Ultimate goal, after all, is not a good death but a good life to the very end” (Atul Gawande). The mother is still with the boys today, nearly 3 years later. The end of life conversation is important to both sides-the dying person and the survivors.