According to the American Academy of PA’s the values of the PA profession is to uphold the tenets of the patient’s autonomy, beneficence, non-maleficence, and justice. Not just PA’s, but nurses, doctors, and other healthcare professionals’ core-values align with respecting patients’ autonomy, and their ability to make their own medical choices like refusal of a treatment. One of the most debated topics today is Physician-assisted suicide, also referred to as Physician-Assisted Dying (PAD) or voluntary active euthanasia. This is the practice where a physician provides a terminally ill patient, with a prescription of a lethal medication at their own request. As states, and countries have started to legalize the patients right to die, PA’s and other healthcare professionals are faced with a conflict, as one of the core principles of a PA’s duty is nonmaleficence. I believe that under certain circumstances a patient is within their rights to decide if they wish to die, and as practitioners we must respect a patient autonomy regardless of our personal belief.
The principle of medical ethics revolves around five main ideas, autonomy, beneficence, confidentiality, nonmaleficence, and equity. Healthcare professionals don’t have issues with respecting a patient refusal to treatment, but when it comes to patient assisted suicide, three of these five principles come in conflict with physicians’ ability to perform their duty to the patient, such as autonomy, non-maleficence, and beneficence. Because of these conflicts the physicians will deny the patients request for PAD. I disagree that these principles come into conflict with PAD. Firstly, we must have respect for patient self-determination, this includes patients having control of how and when they die, secondly, we must present them with any beneficial treatment, and finally we must not prolong any suffering for the patient.
I believe that if a patient is sound and facing terminal illness, they have every right to deice their treatment even if it means ending their life. By denying the patient’s own ability to choose PAD we are prolonging the patients suffering, adding more pain every day, and the primary duty of medicine is to end suffering. By denying PAD we are essentially taking away the patient’s autonomy, and respect away. Patients who chose PAD do it to preserve dignity, and not lose who they are before the illness takes over. I’m not arguing that every patient should be presented with PAD or any patient who is seeking PAD have their request granted. PAD is not to be taken lightly. Every other option should be exhausted before presenting PAD.
Another principle that justifies PAD is beneficence which requires a doctor to act in ways that best promote the welfare of patients. Patients’ interests are best served by a doctor who will respect the patient’s autonomy, is understanding of the patients pain, and is willing to work with the patient, and meet their needs, especially since medicine is best practice when it is patient-centered. In cases of terminally ill patients, who are in unbearable pain then ending that patient life is the most merciful act. For the patient death is imminent, and the doctor is presented with two choices let the disease take over until the patient is no longer functional, and in severe pain or end the patient life. The first view achieves nothing other than we let the patient suffer. The second view fulfills the doctor’s duty of beneficence to the patient by ending the patient’s pain and respecting his or her autonomy.
Furthermore, we may cause other grievances that are not medically related. Our current healthcare system is not free, and certain medications, treatment, and life supporting equipment can become a financial burden to the patient, family, and society. This has a negative impact on society on a large scale, because cost will go up, our healthcare system gets more clogged up with appointments, and quality of medical service goes down. For example, two twin brothers from Belgium who were born deaf, were going blind, and decided to be euthanized as neither the twins could endure the suffering that would take place if they went blind. They were terrified about the idea of not being to see each other, and the inability to communicate with one another. Instead, they wanted to die with dignity and within their own terms, as becoming blind would’ve made it difficult for them to carry on day to day and subjected them to suffering. Becoming blind would’ve added more stress for them and would’ve made it more difficult for them to navigate the world. In addition, the cost of learning to read braille, the help they would need to get around, would have been a great financial cost to society. The brothers weren’t terminally ill, but their quality of life would have been reduced significantly, and under the ethical framework of autonomy, and beneficence, the physician had an obligation to fulfill their wish of voluntary euthanasia.
The advancement in medical technology has found ways to improve, and prolong life of ill patients, often beyond the point of where they can derive joy and live a pain free life. For those patients who chose to voluntary end their life, we as a practitioners have a duty under the ethical framework our profession has been founded on to respect the wishes of our patients. PAD and voluntary active euthanasia are supported by the ethical framework of autonomy, beneficence, and nonmaleficence, and by acting on it we are fulfilling our oath to our patients. If we deprive a patient right to die, under their own circumstances when all avenues have been exhausted, we are committing a far greater crime, we are taking way their liberty, dignity, and subjecting them to pain.
References:
Jonsen, A. R., Siegler, M., & Winslade, W. J. (n.d.). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine 8th Edition. 2015: McGraw-Hill Education
Dugdale LS, Lerner BH, Callahan D. Pros and Cons of Physician Aid in Dying. Yale J Biol Med. 2019 :747-750.
Margaret, B & Thaddeus P Physician-assisted dying https://www.uptodate.com/contents/physician-assisted-dying?search=Physician-assisted%20dying&source=search_result&selectedTitle=1~17&usage_type=default&display_rank=1 Published March 25th, 2022, Accessed June 12th, 2022
Greenwood, F Deaf Belgian Twins euthanized after discovering that they are going to go blind. https://theworld.org/stories/2013-01-14/deaf-belgian-twins-euthanized-after-discovering-they-are-going-blind. Published January 14th 2013, Accessed June 12th, 2022
Bernadette S, Ethical Justifications for Voluntary Active Euthanasia, 3 Rich. J.L. & Pub. Int. 71
