By: Asher Junger  | 

Bioethics in Practice: Assisted Suicide — Physician or Executioner?

“First do no harm.” It is the mantra drilled into the brains of young medical students everywhere. They are taught that as future physicians, they will be responsible to care for human life and their primary priority must be to preserve and protect people at all costs. This includes taking action when required, as well as refraining from taking action when necessary. The philosophy is simple and effective: Every action taken by a doctor must be done with the intent of improving the patient's condition and saving their life.

Medical professionals are taught to think scientifically and objectively. They focus on the practical, observable aspects of life and aim to improve people’s health using the latest technology and medicine. There is a reason doctors are taught this science-based mindset starting at a college age. As a New York Times article put it, “For generations of pre-med students, three things have been as certain as death and taxes: organic chemistry, physics and the Medical College Admission Test, known by its dread-inducing acronym, the MCAT.” This is not random; science is taught because it is effective at producing the desirable outcome of saving lives. There are many forms of alternative medicine available, which are less science-based. Not surprisingly, WebMD cautions against these forms of medicine, stating that while these forms of treatment “sound reasonable and promising... they may or may not be backed up by scientific evidence.”

If doctors are trained to think scientifically in order to achieve the goal of saving lives, what then is the rationale behind physician-assisted suicide? Is it not antithetical to everything they are being trained to do? Do we qualify the practice of saving lives by saying it only applies when the doctor and patient think it ought to apply? Is medicine simply another corporate enterprise where the consumer chooses to purchase healthcare from the provider? These are the important questions that aspiring physicians should be asking. 

MedicineNet defines physician-assisted suicide as “The voluntary termination of one's own life by administration of a lethal substance with the direct or indirect assistance of a physician.” There was a time when people were not so divided over this debate. Suicide was thought of as a terrible, unfortunate event, and the concept of a doctor assisting a patient’s suicide was widely thought of as immoral and illegal. In 1885, the American Medical Association strongly condemned medical euthanasia, calling it an attempt to make "the physician don the robes of an executioner.” Of course, there were still proponents for euthanasia, but this did not reflect a mainstream view. In 1937 Nebraska senator, John Comstock, introduced legislation to Congress calling for the legalization of physician-assisted suicide for the first time in U.S. history. A decade later a committee of 1,776 physicians organized to show support for medical euthanasia. While support for assisted suicide was becoming more mainstream, most people still vehemently opposed its apparent moral absurdity. In the 1950s the World Medical Association voted to condemn assisted suicide under any conditions. At the same time, polls emerged showing that the majority of physicians do not support physician-assisted suicide, and that only 36% of Americans supported its legalization. It was only in the 1990s, after the “Right To Die” movement started gaining popularity, that people’s views started to shift. The California State Bar becomes the first major group to support physician-assisted suicide and polls found that more than half the country supported it as well. Currently there are over 15 countries (including the U.S. in some states) which legalized physician euthanasia to varying extents. As of 2017, 73% of Americans support it.

So what changed? How did support for this issue more than double in less than a century? 70 years may seem like a long time for an issue to evolve and gain popularity, but when one considers what is at stake — life and death —  it is shocking that it only took a couple of decades to sway public opinion on this matter. But public opinion has changed regarding many issues in our current climate. The way we view sex, drugs, money, power, technology, education, religion, fame, family and friends has all changed drastically over the last few decades. Society today operates in a fundamentally different manner than it did a century ago. I am not condemning modernity, nor am I claiming that we should revert back to our old ways. On the contrary, the argument against physician-assisted suicide is only strengthened in light of the technological developments we have had, which enable us to save so many more lives than ever before. I am simply claiming that when it comes to questions regarding life and death, the stakes are so high, and we must carefully examine what is moral and what is not. 

Death With Dignity, a non-profit organization which promotes enacting legislature in support of assisted suicide, makes the claim that, “The greatest human freedom is to live and die according to our own desires and beliefs.” At first glance, it seems to be a pretty morally sound philosophy. It encourages freedom of choice, which is an important value to a modern democratic society like America. Upon deeper analysis, however, this philosophy logically falls short.

It is important to understand that the ability to choose is not an inherent virtue. Choice and freedom to choose are great things when they pertain to morally sound choices. Choosing a profession, a community, which flavor ice cream to eat, these are choices that do not infringe on moral dilemmas. Whether one chooses to live in New York or California, eat chocolate or vanilla ice cream, those are equally acceptable choices from a moral standpoint. Therefore every individual should be free to make such choices for themselves and infringing on an individual's right to make such choices is wrong. As a society, we begin to limit people’s choices when one or more of the outcomes is morally wrong. We do not grant people the freedom of choice when it comes to rape, murder and theft. This is because those are not choices with two equally virtuous outcomes; rape is wrong, consensual sex is right. In this sense, it is a logical shortcoming to base the reason for supporting physician-assisted suicide, solely on the fact that it is a choice. Establishing euthanasia as a choice does absolutely nothing to promote the morality of the issue. If having a doctor end a patient’s life is not morally acceptable, then choosing to engage in this practice does not help make it a moral.

From a legal perspective, the claims for assisted suicide stand on shaky ground. In 2005 a Japanese man named Hiroshi Maeue used the internet to connect with three people who consented to having Hiroshi strangle them. The victims had consented to being killed, but Hiroshi was still sentenced to death. If choosing to die makes the act of homicide okay, why then was this man sentenced to death? His victims consented to their murders. Surely according to the proponents of physician-assisted suicide, consensual homicide should be legal. If the basis for physician-assisted suicide, as claimed by the Death With Dignity movement, is that people ought to be able to choose the terms of their own death, then Hiroshi Maeue should be innocent, not a murderer. 

The difference between assisted euthanasia and the case of  Hiroshi Maeue is obvious. Assisted suicide discusses cases of terminally ill people experiencing great amounts of pain, while the story of Hiroshi Maeue is a rare and disturbing murder case. But the point of the Hiroshi Maeue story demonstrates something very powerful; consent does not confer morality to murder. 

Even if there was a way to somehow circumvent the moral issues pertaining to physician-assisted suicide, there is an even greater issue at hand. Granting people the right to terminate their own lives represents one level of moral corruption. But the euthanasia lobby wants physician-assisted suicide to be a mainstream treatment option. If medical euthanasia became legal across the board, and it became commonplace for patients to choose if and when they wanted to end their lives, eventually doctors would be forced to engage in these practices. As medicine becomes more industrialized, doctors increasingly work for large medical corporations. When operating under the authority of such a corporation, doctors become subject to their rules and practices. If physician-assisted suicide becomes a mainstream treatment option, all of the big hospitals will eventually offer this service. This will result in doctors being forced to engage in physician-assisted suicide or else risk losing their jobs. Forcing doctors to engage in practices which they regard as immoral is wrong. Doctors who oppose euthanasia (as they should), should not be forced to act against their moral inclinations just because society decided to ignore moral reasoning. 

Aside from moral, legal and logical issues with assisted suicide, there is the intuitive argument that life is precious and deserves to be treated accordingly. In an interview, an anonymous physician discusses this aspect of assisted suicide, saying, “Patients facing a terminal illness often experience a wide range of emotions, including hopelessness, depression and fear. The desire for suicide before a natural death likely indicates the patient is afraid of what is to come or doesn’t view his life as having value.” Death is scary and filled with unease and emotions. Presenting patients with the option to end their lives validates it as a legitimate solution to dealing with one's issues. 

The physician continued saying, “Every human being is terminal; at some point all of us will die. Suicide eliminates the ‘what if’ possibilities that may occur: The discovery of a new treatment or cure, the realization of an incorrect diagnosis, or the opportunity to have one last kiss or touch from a loved one.” Essentially he is making the argument that death is permanent; there is no going back. Once someone's life is over there is no more possibility of choosing to undo it. If life does not seem worth living at the moment, surely it is worth living for the possibility of improvement. As Phil Donahue once said, “Suicide is a permanent solution to a temporary problem.”

All things considered, there are many reasons for young medical professionals to consider being opposed to physician-assisted suicide. On the most basic level, it is antithetical to everything they are taught as physicians. It would be a shame to spend a decade studying the science of saving lives, and end up being responsible for death. When considering euthanasia, doctors should consider all of the moral parameters to the issue before deciding to support it. It is also important to consider the consequences of being on the wrong side of this issue. If euthanasia is, in fact, morally acceptable then by not engaging in it, the doctor failed to provide the best possible medical treatment for their patient. If, however, physician-assisted suicide is immoral, like I propose it is, then engaging in it makes a doctor guilty of murder. The distinction may seem semantical, but it is not. When Roman gladiators tore people apart for sport, it was acceptable in the eyes of the law, but that did not make it any less of a murder. Similarly, if society adopts the practice of physician-assisted suicide and decides it should be legal, that does not make it any more morally acceptable. Physicians should turn to logic and reason when deciding their stance on an issue as sensitive as physician-assisted suicide.

Photo Caption: Support for physician-assisted suicide has increased in recent decades. 
Photo Credit: Pixabay