Proponents of physician-assisted suicide see it as an act of compassion that respects the patient`s choice and fulfills a commitment not to surrender (11). In support of legalization, they also argue that some patients who receive a lethal prescription ultimately do not use it. In addition, some argue that medical assistance in dying already occurs where it is illegal (23), so legalization would lead to standardization, transparency and oversight. It is important to emphasize the rationale for the benefit of the person being assisted in dying, as well-being is a key value in relation to the morality of euthanasia (see Section 3 below). Nevertheless, the defensible nature of the claim that someone can be better dead has been the subject of careful philosophical reflection. Those who claim that a person may be better dead believe that this is true if the life that remains in perspective for that person has no positive value for him (a possibility, for example, by Foot, 1977; McMahan, 2002; Bradley, 2009), while some who consider a person`s life untouchable deny that a person can be better dead (e.g., Keown in Jackson & Keown, 2012). A Kant-inspired variant of the latter position was proposed by Velleman (1999). He argues that a person`s well-being can only matter if it has intrinsic value and that it is therefore impermissible to violate a person`s rational nature (the source of his or her intrinsic value) for his or her well-being. Therefore, he believes that it is inadmissible to assist in dying a person who feels it would be better to be dead and competently requests assistance in dying. The only exception is when a person`s life is so humiliated that they question their rational nature, even if they consider it unlikely that someone in that position would remain competent to request assistance in dying. This position appears to run counter to the established right of a patient capable of refusing life-prolonging medical treatment, at least if further treatment is denied because she feels that her life is no longer of value to her and that further treatment will not restore her value.
(For other reasons for rejecting arguments in favour of the inviolability of a person`s life, including Vellemans, see, for example, McMahan 2002; Jung, 2007; Sumner, 2011.) Despite changes in the legal and political landscape, the ethical arguments against legalizing physician-assisted suicide remain the most compelling. We are aware that ethics is not just a matter of voting. The majority support of a practice does not make it ethical. Medical history provides several cautionary tales of laws and practices in the United States (such as racial segregation in hospital wards) that have been widely advocated but highly problematic. Surveys of individual physicians show that half believe MAID is ethically acceptable in some cases (Cohen et al., 1994). However, professional associations such as the American Medical Association have generally opposed MAID because it undermines the integrity of the profession. The balance between respect for patient autonomy and other principles reflects ethical arguments about the nature of the physician-physician relationship – one that is inherently unequal due to differences in power and the vulnerability of the medical duties of illness and the role of the medical profession in society. A more comprehensive examination of this ethical balance, intent and causality in end-of-life actions, medicalization versus personalization of death, and the ethics and implications of medical assistance in dying is presented in Appendix (16-81). Doctors can influence patients, even in ways that doctors may not appreciate. Patients seeking medical help to commit suicide can ask for confirmation that they are ending their lives. In fact, studies have shown that socially isolated and vulnerable people seek social support and contact through doctor visits (16).
Doctors may influence patients based on their own fear of death and disability (39). There is also evidence that many physicians involved in medical assistance in dying are affected by the experience (40). Some commentators question whether assisted suicide requires medical supervision and whether others could provide help instead (41). The technological interventions of modern medicine have led to the fact that the death time of many people has been extended. Sometimes the extra life it brings is a cause for joy; Sometimes this drags out the period of significant physical and mental decline a person goes through, with the result that life is no longer worth living. Many believe that there is no single, objectively correct answer to the moment when a person`s life becomes a burden, if at all, and therefore undesirable. If they are right, it only shows how important it is for individuals to be able to decide independently whether their own lives retain enough quality and dignity to make life worth living. Others argue that individuals may be mistaken about whether their lives are still worth living (cf. Foot 1977). The conditions referred to in section 2 above are intended, among others, by those proposing them, to protect against such errors. But it should be noted that in the event that a person who thinks he meets these conditions is deemed erroneous by his medical companions as to whether it would be worthwhile to continue living, the likely result is that these companions refuse to provide medical assistance in the event of death. (The evidence below shows that this often happens in jurisdictions where medical assistance in dying has been legalized.) Unless a patient can be placed in the care of other health professionals who accept her assessment, she must rely on her own resources (for example, by refusing nutrition and hydration).
As long as a critically ill person is capable, their own judgment of whether life is beneficial to them should carry the greatest weight in any end-of-life decision-making, whether or not they are in a severely compromised and weakened state. The idea that a competent person`s autonomous judgment about the value of life continues to them should trump others` assessment of their well-being should not be taken as surprising, because exactly the same thing happens when a competent patient refuses a life-prolonging treatment. Silvers noted that a model used for California hospital guidelines specifically requires all patients with disabilities to undergo a thorough consent capacity assessment beyond what is required by California`s euthanasia law. She hopes that, in the same spirit of protection, the additional costs for the disabled patient will be balanced in time and money when such policies are considered. “Suffering from this kind of legally recognized exclusion, having to endure almost every day a socially imposed loss of daily options due to disability, this is my life, and it remains one of the difficulties of living with a disability,” she said. The current approach to legalizing self-government authorization is counterproductive, Silvers concluded, because it forces incurable individuals to prematurely shorten their own lives as physical control deteriorates to preserve their options. While ACP core concerns are based on ethical principles, research suggests there is a “slippery slope” in countries where physician-assisted suicide and euthanasia are legal. In the Netherlands, applications are accepted for patients whose “state of health” is classified as “tired of life”.
Many patients report “loneliness” and “psychological suffering” as symptoms (57). One study found that people who received euthanasia or physician-assisted suicide for psychiatric disorders in the Netherlands were primarily women with complex and chronic psychiatric, medical and psychosocial histories, and disagreements among physicians over patient eligibility were not uncommon (58, 59). In Oregon, referrals for psychiatric examinations were rare (60); In 2014, only 3 out of 105 people who died as a result of the law were referred for formal psychiatric or psychological assessment. In a study carried out in Belgium, deaths by euthanasia fell from 2% in 2007 to 5% in 2013. Similarly, approved requests for euthanasia increased from 55% in 2007 to 77% in 2013 (61). One editorial stated that these trends are “worrisome” and “require that [the concern about the slippery slope] be taken very seriously” (62). Society`s goal should be to make death less numerous, not more medical. Medical assistance in dying is neither a therapy nor a solution to the difficult issues that arise at the end of life. Based on substantive ethics, clinical practice, policies and other concerns, the AKP does not support the legalization of physician-assisted suicide. This practice is problematic given the nature of the relationship between the physician, affects trust in that relationship and in the profession, and fundamentally changes the role of the medical profession in society.
Moreover, the principles at stake in this debate also underpin the responsibility of medicine in other areas and the physician`s duty to provide care based on clinical judgment, evidence, and ethics. Controlling how and when a person died was not and should not be a goal of medicine. However, with quality care, effective communication, compassionate support, and the right resources, physicians can help patients control many aspects of how they live the final chapter of their lives.
