Patient Choice and Physician Aid in Dying


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This opinion was originally written for a bioethics presentation.  The argument is by no means comprehensive, but rather is a sampling of the position’s defenses.

The central problem of this paper is whether patient autonomy justifies physician aid in dying.  I will argue that while a patient’s choice in their health decisions is important, it alone does not constitute physician aid in their death as ethical.  The conclusion I reach is that although some autonomy is sacrificed, physician aid in dying is unjustified because it does not provide solid grounds for negating principles of beneficence and nonmaleficence.

Society values autonomy because it identifies a person’s needs and right to those needs, but as such, it can only be valued insofar as it promotes the well being of that person.  Competent patients suffering from terminal illness with no hope for recovery, then, appear justified in any decision to want to die.  Consideration of autonomy alone makes both an incredibly clear and incredibly concise defense of any ‘right to die’ argument.

Any support for physician aid in dying, in the context of active euthanasia or physician-assisted suicide, is grounded both in autonomy and beneficence (1).  A doctor’s practice is an obligation to take care of and promote the life of their patients.  The argument in favor of physician aid in dying is that it both respects a patient’s decision to die, and does good for the person by relieving their suffering (2).  However, the practice of medicine is much larger than a forum for promoting autonomy, and as such, beneficence must be intrinsic to this understanding.  If beneficence entails physician aid in dying, then any support or practice of euthanasia per patient request is de facto also grounds for supporting euthanasia without request.  If physician aid in dying is ethical when a competent patient requests it, the doctor’s role is founded on appeasing suffering (3). Consequently, there is no way to support aid in a competent patient’s death and aiding an incompetent person’s death; both lie in a desire or obligation of beneficence.  Mentally ill, depressed, or disabled people then, fall into great peril, because by beneficence, doctors should relieve their suffering as well.  Offering voluntary physician aid in dying forces its proponents to legally accept the termination of life, without explicit request, which opens dangerous opportunity to disrespect any vulnerable human life.

The principle of nonmaleficence further invalidates any support autonomy has in encouraging physician aid in dying.  Not only should providers work to do good for their patients, they should ensure they also do no harm to them.  Nonmaleficence as part of medicine entails more than not killing; even though physician aid in dying arguably eases suffering, it deprives a patient of the goods of their life (4).  All people, regardless of quality of life, possess a dignity warranting respect for their life in all its circumstances, and supporting any active destruction of life refuses these patients any opportunity for those goods.  Although an autonomous person may want to die, nonmaleficence demonstrates that physicians should not condone or further that decision, regardless of patient competence.

The last flaw in basing physician aid in dying on autonomy is autonomy itself.  Should a physician be responsible for aiding in a patient’s death, they need a way to determine which patients are in sound mind and enough pain, to warrant their help.  But if autonomy of choice is the only indicator of life, then the boundaries defining how to determine physician aid in death become unclear and unexecutable.  At what point is pain great enough to warrant death?  If any competent, dying person has a right to die, then the physician has no right to determine how much suffering is enough suffering to merit aid in death.  Legalizing physician aid in dying would make it impossible to draw a line as far as what amount of suffering constitutes the practice.  This slippery slope concept poses great and incremental threats to human dignity and protection for patient life: it can so easily get to a point where any person who suffers, for any reason, could ask for, demand, and receive, death (5).  We would then have no way to object to any person’s right to die, for any reason.

There is nothing wrong with recognizing and foreseeing death, and there is nothing wrong in trying to ease the process of natural death.  But physician aid in dying is not only unethical in itself; it opens so many gates that violate ethical principles and erode human dignity, and as such is never and can never be ethical.  In such a sensitive field as death, physicians must ease their patients’ suffering in their patients—but hastening it is wrong.

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1. Jackson, Emily, and John Keown. Debating Euthanasia. (United Kingdom: Hart Publishing, 2012), pg. 87

2. Robin Marantz Henig, “A Life-or-Death Situation,” The New York Times, July 17, 2013

3. Gonzales v. Oregon, 546 U.S. 243 (2006), U.S. Supreme Court [Alberto Gonzales, Attorney General, et al., Petitioners v. State of Oregon, et al., Respondents.], Justice Kennedy’s Opinion for the Court. Sect. II-A

4. Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. (New York: Oxford UP, 2013), pg. 154

5. See Beauchamp, pg. 179

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