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Ethical and Legal Considerations of Physician-Assisted Suicide
Introduction
The ethical considerations related to death have been at the center of the discussion of philosophers, policy-makers, health care providers, and other representatives of the involved spheres for many years. On the one hand, death is perceived as a phenomenon that does not depend on a person; on the other hand, it is considered by many to be a subject of human will and occurs when desired if one deals with their own life. Such ambiguity in views is influenced by the differences in human values, needs, religious affiliations, and culturally constructed beliefs. The concept of the voluntary ending of life is considered a tabu on a general scale. However, it becomes more plausible when applied to individuals whose existence has become complete suffering either due to lethal medical conditions or very old age. In order to meet the needs and respect the rights to the free will of such individuals, several countries of the world have enacted specially designed laws that enable the voluntary ending of life in the form of physician-assisted suicide.
In this literature review, the current viewpoints on the ethical considerations behind the legality of physician-assisted suicide will be discussed and critically analyzed. The paper argues that physician-assisted suicide should be a legal procedure for specific groups of people, whose desire to end their lives voluntarily is influenced by medically approved reasons. To define the scope of research, one should state that the concept of physician-assisted suicide will be at the center of research, disregarding a broader concept related to the end of life, which is called euthanasia. The ethical validations of physician-assisted suicide as an action performed by an individual under the guidance of a physician will limit the scope of this research. Therefore, the scope of literature under review will include scholarly materials investigating the issue of ethical considerations behind the legality of physician-assisted suicide published within the past five years. This review will not include articles on end-of-life issues other than physician-assisted suicide. Because suicide travel has intensified in the past decade, the issue of physician-assisted dying is of great relevance and must be viewed from an evidence-informed perspective.
Literature Review
The debate between the supporters and opponents of the voluntary ending of life has been an ongoing issue in scholarly and legal circles. The scope of literature available on the topic is very broad and includes the investigations of various types of assisted dying. To clarify the concepts involved in the subject area of life-ending, scholars provide definitions of the terms. Indeed, Yu et al. (2020) and Goligher et al. (2017) specifically oppose physician-assisted suicide to euthanasia, the two terms which have long been used interchangeably without particular identification of the differences between them. Euthanasia is considered to be a means of relieving a person from pain and is administered by a doctor who deliberately causes death to the patient. Importantly, euthanasia might be performed voluntarily, involuntarily, or non-voluntarily (Goligher et al., 2017). It means that under euthanasia, a persons consent is not always a necessary requirement because the ending of life might be performed with the consent of a patient, against their will, or without either, depending on the circumstances.
However, physician-assisted suicide, as the title implies, consists of an individuals completely voluntary actions aimed at ending their life. This process occurs under the supervision of a physician who prescribes a lethal drug for a patient to intake by themselves ( Data reveal knowledge gaps on physician-assisted suicide, 2020; Malpas & Owens, 2016). In such a manner, the decision to commit suicide by physician-assisted means depends merely on the patient and with the consent of the family. The quantitative survey study conducted by Gaston et al. (2018) investigates the perception of physician-assisted suicide through ethical and professional considerations of end-of-life social workers. The study found that the probability of assisted suicide legislation to expand from four US states to the whole country is high and that the majority of social workers supported physician-assisted suicide. The article demonstrates that the ethical, legal, and professional considerations in the disposal of the individuals who directly perform the procedure validate the legality of assisted suicide for terminally ill patients. Thus, the article is a credible and highly comprehensive piece of evidence that contributes to the scope of literature.
The ethical principles and morality of assisted dying are explicitly researched by Goligher et al. (2017). This article presents a thorough two-side description of the common opinions on both sides of the debate around the legality and morality of physician-assisted suicide. The authors investigate the harm and benefit of death under the circumstances of a terminal illness, the morality of the physicians role in the procedure, as well as the management of conscientious objection (Goligher et al., 2017). Although the descriptive presentation of the ideas does not provide a definite conclusion, the article facilitates the open discussion of the importance of physician-assisted suicide. Importantly, this literature source incorporates the perspectives of both physicians and patients as the two directly involved parties. The limitation of this source is the lack of empirical data that could illustrate the realistic state of affairs related to the debate.
The recent exploratory study conducted by Yu et al. (2020), uses the perspective of tourism to interpret the perception of physician-assisted suicide by the general public. The study aims to explore the ways the general public perceives physician-assisted dying. The methodology used for the research is non-randomized sampling with data mining and text analysis of users comments to assisted dying-related videos on YouTube. Indeed, the selection of this online video platform allows for collecting realistic information as per the general publics opinions. The most common medical conditions that force individuals to end their life voluntarily include neurological problems, rheumatic disease, cancer, and chronic respiratory disease (Yu et al., 2020, p. 2). Since only three countries, namely, Switzerland, the Netherlands, and Belgium, have legal means for conducting the ending of life, people who require such a service have no other choice but to engage in a one-way trip. The consideration of the topic of travel within the context of assisted suicide allows for limiting the scope of investigation on the issues related to the scarcity of resources available to people who need such kinds of services.
The credibility of the results is validated by the explicit description of the data collection and analysis process and the non-randomized sampling method applied. The relevance of the research is also intensified by the multiple themes discussed in association with assisted suicide. However, there are several limitations to the reviewed source of literature. The choice of videos influences the character of comments and might not illustrate the real situation. In addition, the collected data cannot be analyzed against the characteristics of the participants, such as age, gender, nationality, marital status, or other. Therefore, the results portray only general implications and lack evidence-based justification of the opinions expressed by the participants. Finally, the exploratory nature of the investigation does not allow for obtaining comprehensive conclusions, which is why further research is encouraged.
The study found that the majority of commenters support suicide travelers in their attempt to end life. The main themes discussed in the comments were a humane act, human rights, religious considerations, legislation, and religion (Yu et al., 2020). The authors conclude that the immaturity of the research on the topic causes peoples lack of knowledge about it. The journey to a different country helps them to acquire the necessary information and understanding, which is crucial in making the ultimate decision.
Indeed, the lack of information about physician-assisted suicide is a considerable concern. The article posted by Relias Media reveals the findings of a study conducted at Yale University ( Data reveal knowledge gaps on physician-assisted suicide, 2020). It was found that the majority of US physicians support the legality of physician-assisted suicide but are misinformed about the reasons for patients decisions, which is why doctors are commonly reluctant to perform the procedure. Indeed, 49% of surveyed physicians think pain is the reason most patients seek physician-assisted suicide, while, in reality, the loss of autonomy and dignity is the main reason ( Data reveal knowledge gaps on physician-assisted suicide, 2020, para. 4). This source of literature amplifies the implications stated by Yu et al. (2020) about the lack of knowledge in both patients and doctors about the procedure. The article provides credible and specific findings, which are important information assets for the research.
Similarly, the role of doctors in the process of assisted dying is tackled from an ethical perspective by Malpas and Owens (2016). The authors of the article provide well-developed insights into historical, professional, and ethical realms of the physicians profession and question whether a doctor should be responsible for performing the role of an assistant in suicide. As the discussion of these realms unveils the possible opinions, Malpas and Owens (2016) state that there is no argument against the doctors role in assisted dying. It is validated by the ethical considerations that prioritize patients benefits of continuous living; however, if suffering obstructs dignified living, death is a more desired benefit. This piece of scholarly literature is well-reasoned and logically constructed, although it is strictly descriptive and lacks comprehensive statistical data to illustrate the assumptions. It contributes to the evidence concerning the ethical side of the research and might be used as a solid ground to argue for the legality of physician-assisted suicide.
Conclusion
In summation, the debate on the legality of physician-assisted suicide is characterized by ambiguity in opinions. Both supporters and opponents of the idea that this procedure should be legal validate their point of view by their ethical, cultural, and religious considerations. The literature review conducted on the topic allows for concluding that the amount of research in this subject area is scarce and requires evidence-based, comprehensive research. The findings of the literature review suggest that the majority of people think that physician-assisted suicide should be legal in all countries of the world. Also, it was revealed that doctors, as well as patients, do not have sufficient knowledge about it to make an informed decision about the legality of physician-assisted suicide. This idea is justified by the increased number of cases of suicide travel, as well as the ethical reasonability of the triggers behind the decision to commit suicide. The most common ones include such medical conditions as cancer, neurological problems, and other terminal illnesses that cause unbearable suffering and physical pain.
Despite its informative and highly realistic character, the reviewed literature lacks a comprehensive context and justification of participants opinions about their background. To argue for or against physician-assisted suicide, a researcher should obtain relevant data about a particular setting, which should be comprised of the dominant cultural, religious, and historical values of a given society. Moreover, the ethical considerations behind the legislation should be studied. Overall, the analyzed literature provides a substantial ground for considering the topic of physician-assisted dying, an issue of great significance to contemporary society. The identified limitations validate the reasons for further research of the topic, which needs to be based on mixed methods usage and comprehensive evidence collection and interpretation. It is important to conduct questionnaires and surveys with the representative of the countries where physician-assisted suicide is legal and where it is illegal to compare the perception of the issue. The results of such research will contribute to the scholarly discussion of the under-addressed topic of assisted dying and allow for arguing the need for making physician-assisted suicide a legal procedure.
References
Data reveal knowledge gaps on physician-assisted suicide. (2020).
Gaston, N. R., Randall, J. M., & Kiesel, L. R. (2018). Physician-assisted suicide and Midwest social workers: Where do they stand?. Journal of social work in end-of-life & palliative care, 14(1), 73-92.
Goligher, E. C., Ely, E. W., Sulmasy, D. P., Bakker, J., Raphael, J., Volandes, A. E., Patel, B. M., Payne, K., Hosie, A., Churchill, L., White, D. B., & Downar, J. (2017). Physician-assisted suicide and euthanasia in the intensive care unit: A dialogue on core ethical issues. Critical Care Medicine, 45(2), 149.
Malpas, P. J., & Owens, R. G. (2016). Given that physician-assisted dying is ethical, should it be part of a doctors role?. Mortality, 21(4), 295-304.
Yu, C. E., Wen, J., & Yang, S. (2020). Viewpoint of suicide travel: An exploratory study on YouTube comments. Tourism Management Perspectives, 34, 1-8.
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