Dying With Dignity: Physician-Assisted Suicide Debate

Introduction: Two Views on Dying with Dignity

Dying with dignity is a controversy argued from two perspectives by death scholars. Some scholars argue that dying with dignity means expiring without unnecessary physical pain, while others argue that it means dying in socially accepted ways. These arguments emerged in light of changing healthcare demands and diverse cultural practices. The controversy dates back to ancient civilizations, when many Greeks believed that taking one's own life was preferable to enduring endless suffering — a belief that led some physicians to give poison to terminally ill patients. With the advent of Christianity, however, the Hippocratic tradition, which opposed administering deadly drugs, gained considerable acceptance. Consequently, euthanasia — as the practice came to be called in the fifteenth century — was regarded as suicide and therefore immoral. Over time, euthanasia was reintroduced into public discourse and has since gained broad acceptance in various medical institutions.

Physician-Assisted Suicide: Definition and Justifications

From the perspective that dying with dignity means dying without unnecessary physical suffering, doctors developed the practice of physician-assisted suicide (PAS), also referred to as physician-assisted death. It is the voluntary ending of one's life by taking a lethal substance prescribed by a physician. Supporters of physician-assisted death argue that patients have the right to receive aid in hastening their death, and that it is the most humane and dignified way to treat terminally ill patients who are competent to choose how they wish to die. It is thus considered a measure of last resort. According to members of Compassion & Choices, medical paternalism is a coercive practice that results in life-prolonging interventions that are insensitive to patient autonomy. As Beauchamp and Childress (2009) note, autonomy refers to an individual's ability to make decisions for themselves.

According to Beauchamp and Childress (2009, p. 183), several criteria justify physician-assisted suicide. These include: a voluntary request made by a competent patient, which is persistent and preferably repeated twice within a fifteen-day period; an ongoing patient–physician relationship; well-informed decision-making in which the physician consults another healthcare provider before proceeding; the patient's expression of a durable preference for death even after being offered the option of palliative care; the patient's experience of unacceptable suffering; and the physician's use of a method that is painless and as comfortable as possible for the patient.

Advantages of Physician-Assisted Suicide for Patients and Families

Although physician-assisted suicide is considered unethical by many, it has gained wide acceptance because of the benefits it offers to both patients and their families. Once a competent patient requests it, PAS can be administered to end a prolonged stay in an Intensive Care Unit — an experience that is often demoralizing and dehumanizing for patients and their families alike. Intensive care is also expensive due to the technological facilities and medications involved; therefore, the option to end a terminally ill patient's suffering also helps reduce the financial burden on the family. Additionally, terminally ill patients sometimes choose physician-assisted suicide to end their dependence on others. According to Gentzler (2003), many people associate dependency with indignity and therefore prefer to end their lives in order to preserve their dignity.

Conclusion: Decision-Making, Competence, and Patient Autonomy

While determining who should live, it is essential for the physician to recognize that the patient's quality of life is equally valuable as the quantity of their life. Therefore, adequate education and open communication between healthcare providers and their patients should be ensured. Physicians should also seek opinions from other healthcare providers, which helps both physician and patient make sound decisions and proceed with confidence and peace of mind.