Suicide as a right?
Suicide has been a hot topic on the Common Chaos podcast as of late. The discussion originally was brought up in a conversation had between Brandon Hamilton and myself. I had brought it up because I had to write a paper about Physician Assisted Suicide or PAS. I was in support of the controversial life ending procedure, which initially prompted the conversation. As the convo progressed, so did our questions regarding suicide and it’s impact. Aside from it being a hot topic, it is also a complex, delicate, and an important one to have a discussion about.
Regardless of the circumstances, suicide is something that should be discussed, addressed and understood for a multitude of reasons. The most important being prevention. Anyone that may be contemplating suicide could receive the help they need by simply having someone to talk to or to turn to when the stress and pressures of life become to much. It will also help with those who are coping with the loss of a loved one as a result of suicide. Bringing about a better sense of community for those that are affected by it.
Even if it makes you feel weird or uncomfortable, suicide, as ironic as it may sound, is a part of life and unfortunately, in many cases is the reason so many people leave this world too soon.
I wrote the following paper to address Physician-Assisted Suicide. This is a life ending procedure that in some states, is offered to individuals suffering from terminal diseases. The paper was written in support of the procedure, but also with the intent to look at suicide a little differently. In the case of this paper, suicide is looked at in a more passive form, as a treatment meant to help victims and their families cope with what is often times, an unpleasant last few days on earth. I support this as an option patients should have, given other forms of treatment fail or don’t promote an overall quality of life. I look at PAS from a moral and ethical perspective. I also argue that Suicide should ultimately be a human right. (This, being a little more of a controversial topic, I will save for a discussion at a later date). I hope you take something away from the paper and this topic overall. Feel free to leave comments and engage in the conversation yourself.
*Before you begin the paper I must issue this warning. I am in no way supporting suicide outside of the reasons given in the paper. If you or anyone you know may be struggling with suicidal thoughts or tendencies, please do not hesitate to reach out for help. It could save a life*
The suicide prevention hotline is 1-800-273-8255.
Physician-Assisted Suicide: A Moral and Ethical Evaluation
The question of whether or not physician-assisted suicide should be considered morally just is one that may never have a decisive answer. Suicide and the question of whether or not it is permissible under any circumstances, is a topic that has baffled and intrigued philosophers for thousands of years (Cholbi, 2004). Many of which consider suicide to be the most immoral act of all; but what if the reasons for doing so are to eliminate unnecessary suffering and pain? Can it then, under these circumstances be considered justifiable? This is often a question that is regarded by individuals who choose to go through a procedure that will end their own life. The process is known as physician-assisted suicide.
Physician-Assisted Suicide or PAS is a procedure where a licensed medical doctor is legally permitted to administer a life-ending dose of medication to qualifying patients that are terminally ill. This paper will serve to provide a moral and ethical evaluation of PAS. It aims to illustrate a clear understanding of the philosophical and moral struggles regarding PAS. It will also acknowledge some of the objections it faces. Many of which make sense at first glance, but as these issues and reasons get examined more closely, it seems as though this decision is one that ensures an individual the right to eliminate the possibility of pain and suffering, and take their life into their own hands. This decision which some consider a moral right, is one that is the difference between suffering and ease. Physician-assisted suicide should be considered an ethical right and a choice that everyone should be allowed to have.
The Supreme Court ruling of Washington V. Glucksberg, in 1997, declared that denying a person a right to PAS was not considered unconstitutional and it remained a decision that was left up to the states. Since then a variation of the dying with dignity law has been adopted by five states as well as the District of Columbia. Roughly 2700 patients have applied for the procedure, and a little over 2100 have undergone it nationwide (CNN, 2017). These numbers aren't astounding or devastating and in fact, provide some solace for those who are initially against PAS. Seeing how these are qualified patients who have to have specific diagnosis and go through thorough screenings and tests before that are deemed eligible to even apply for the medication or procedure. It is safe to say that this is not a way for people to cheat a system and be given access to life-ending procedures illegally. With that being said, there are still 45 states that prohibit the procedure, so for someone to be able to undergo a process that would result in PAS, they would need to reside in one of the states that recognize the laws. This was the case with Brittany Maynard, a 29-year-old with terminal brain cancer, who chose to end her life under Oregon's "Death with Dignity Act." She had lived in California and moved to Oregon following her January 1, 2014, prognosis to take advantage of the law. Since then California has adopted their own version. (CNN, 2017).
Many factors can determine the way one approaches physician-assisted suicide. These include moral, ethical, and religious beliefs alike. Across either view religious or philosophical, suicide is often times regarded as the ultimate wrong. Though philosophy's roots are deeply tied to religion, the progression of thought over the last century along with new forms of philosophical theories have brought upon a different understanding and approach to morality and ethical reasoning. In the case of suicide, it has been within the last century that it has been able to be better studied and examined, specifically with medical and scientific advancements that have paved the way for better psychological breakthroughs. Through the years we have been able to understand suicide and the mental state of mind of those who seek that as a means to an end. In regards to physician-assisted suicide, however, it has only been a mere twenty years or so that we have seen this as a major topic for debate. For the sake of this paper, we will assume that those who opt to undergo PAS would in no other circumstances choose to take their own-life therefor there won't be a need to question their mental state otherwise.
Demonstration Moral Reasoning
To have PAS make sense from a philosophical perspective, we must first align it with a theory. We will look at physician-assisted suicide through two different lenses; utilitarianism and deontology; both have foundations based on actions that result in some form of a greater good (Mosser, 2003). Deontology focuses on the act itself, for example, murder. In the case of deontology, murder is never permissible even in self-defense. Utilitarianism, on the other hand, is a form of consequentialism and focuses on the outcome of the act, hoping to provide the best possible outcome for the highest amount of people. In the case of murder, it would be permissible if it was in self-defense and you were protecting your family. With these theories presented, assigning PAS to one specifically may seem difficult. Each of them has different variables and circumstances as well as pros and cons (Jordan, 2016). The one that seems most appropriate regarding the moral and ethical basis would be utilitarianism.
John Stuart Mill, who is widely considered the most prominent mind in utilitarianism explains; "the basis of morals is utility", and holds that, "actions are right in proportion as they tend to promote happiness, wrong in proportion as they tend to produce the reverse of happiness" (Mill, 2008). Clearly, suicide and assisting someone with suicide doesn't promote happiness But again, we are meant to look at this with situational circumstances. In the case of PAS, we have a patient or patients who may spend their remaining days in pain and suffering. For them to have autonomy and the ability to make a decision that will bring about a happiness that is more desirable than being alive, given the state of their health is deteriorating; seems without question the proper action to take. Some utilitarian views hold that we have a moral duty to maximize happiness, even in the case of suicide (Mill, 2008). From which it follows that; when an act of suicide will produce more happiness than will remaining alive, then that suicide is not only morally permitted, but morally required (Cholbi, 2004).
Objection and Response
From another perspective we have deontology. The deontological theory is a theory of ethics that focuses on the right and wrong in actions. It does not focus on the right and wrong of the consequences of the action like consequentialism would (Mosser, 2003). Deontologists believe that morality is a matter of duty. We have moral duties to do things which it is right to do and moral duties not to do things which it is wrong to do. Whether something is right or wrong doesn't depend on its consequences. Rather, an action is right or wrong in itself (Kant, 2008). one of the more prominent minds in deontology, Immanuel Kant said, "act in such a way that you always treat humanity, whether in your own person or in the person of any other, never simply as a means but always at the same time as an end." (O'Neil, 1993). Essentially he is saying that we should treat those we come into contact with, with good intentions and never as a part of a scheme, or as he refers to it, "a mere means" (O'Neil, 1993). In regards to physician-assisted suicide, the theory of deontology would be one that would focus on the action of assisting in the suicide as well as committing the suicide itself. Both, from a Kantian deontology perspective, serve as moral wrongs. In regards to suicide specifically, he stated In his Lecture on Ethics that, taking your own life "robs you of your person" which according to him is "contrary to the highest duty we hold towards ourselves, for it annuls the condition of all other duties" (Denis & Sensen, 2015).
Kant's views on sacrificing one's life for the sake of a greater good are permissible to an extent, but suicide for the sake of ending an existence is "never permissible" (Dennis & Sensen, 2015). The argument here is that suicide is never to be looked at as an escape or a way out. In the circumstances surrounding PAS, however, we are dealing with people, whose remaining life will be that of suffering and agony. Again, these are terminally ill patients whose health often quickly deteriorates. Their final days are not happy ones enjoying life; they are often spent succumbing to drugs that merely mask the pain. Even in the case of Palliative care, there is only so much that can be done to make the patients and their families comfortable. Their choice of PAS isn't one that removes them from a life of opportunity and duty; it removes them from a life that may otherwise be unbearable.
Another objection that stands against PAS is the involvement of the Physicians assigned to the patients that are terminally ill. Doctors worldwide have taken an oath to serve citizens and uphold standards in regards to health and medicine. Often times it is the Hippocratic Oath, which has seen many variations since it's initial version between 300 and 500 B.C. Even with this oath or set of standards in place, the topic of PAS is still largely debated. This debate holds weight. Some medical physicians have moral and ethical beliefs that will not allow them to participate in the procedure. Understandably so, a doctor must heal and prolong the life of a patient. However, the standards that are the basis for both utilitarian and deontology could be used as catalysts for assisting in PAS. The greater good and the duty to others respectively. No question being the one that helps end the life of another must be severely complicated. These objections don't come with scrutiny, as no one should be asked or expected to assist in ending someone's life regardless of the circumstances or their role (the same can be said for those that carry out executions or who are left with the decision to end life support of a loved one).
However, there is an argument that doctors, when at a certain point are left with no other options in terms of care for a patient must do whats right by the patient. When this point has come, is it permissible to follow the requests of a patient that wishes to no longer endure suffering? This is a question almost as difficult to provide an answer for, like the one that was initially posted. There are, however doctors that will take that responsibility, carry that burden so the speak. Whether it be there own moral reasonings or their duty to the patient, there are those who will partake in PAS. If that is the case, and it is the will of the patient, then it seems completely reasonable that PAS should be considered as a viable method for the terminally ill.
When revisiting Kant's Lecture on Ethics, he states "those who advocate suicide seek to give the widest interpretation of freedom" (Denis and Sensen, 2015). It's that very sentence that provides the argument of PAS with enough substance to give it moral justification. Freedom! Freedom of choice for ourselves and our lives as human beings should be the one thing that should be without question. Without dissecting the different interpretations of freedoms, it should go without saying that the freedom over ourselves should be something we as human beings have without any overseeing authority to tell us otherwise. In the case of a terminal illness, something that threatens to deteriorate and diminish a person's quality of life. Physician assisted-suicide, should be an ethical right that we as people and as human beings, have the freedom to make.