HPPA 514 – Biomedical Ethics – Summer 2021 – Ethical Argument Essay
Every day, patients around the country exercise their right to autonomy when making decisions about their medical care. Included in this right is the ability for patients to make the conscious choice to not receive treatment. Today, one of the most debated topics within the medical community is whether or not this right should include a patient’s choice to end their own lives. Physician-assisted suicide, also referred to as aid-in-dying (AID), occurs when “a physician provides “the necessary means and/or information” to facilitate a patient’s choice to end his or her life.” (Dugdale, Lerner, & Callahan, 2019). While some states and countries have begun to legalize this practice, many still oppose the idea as it conflicts with a physician’s duty of nonmaleficence along with the risk of abusing this practice with individuals looking to end their lives. As medicine continues to advance and patients are living longer than ever before, I believe that under particular circumstances, a patient is within their rights to decide when they wish to die and no other opinion should trump this autonomy.
As we have learned, the four core concepts of biomedical ethics include patient autonomy, beneficence, nonmaleficence, and justice. As medicine has shifted from a paternalistic model to shared-decision making model, the patient’s right to autonomy has become a center focus when it comes to an individual’s level of treatment. When the conversation surrounds aid in dying however, many feel that a physician has an obligation to deny any request of the nature. I do not believe that medical ethics should have the ability to set limits on a sound-minded patient’s autonomous request. If a competent patient were to develop an illness for which there was no cure and only leads to agony and suffering, the patient should be allowed, and within their rights to end life on their own terms. Making this decision alleviates the patient of the agony and suffering their illness will create for them, reduces the use of resources within the healthcare system, reduces the financial hardship that is ultimately passed on to the individual’s family, and most important, allows the patient to die with dignity while they can still recognize themselves. Before any execution however, I believe the caring physician must utilize the resources available to them to ensure that this patient is of sound mind, free from any illnesses that can affect one’s judgement.
Clinical ethics shows that the respect for autonomy is a subset of a larger principle known as respect for persons. One implication of respect for persons is acknowledging the “moral right of every competent individual to choose and follow his or her own plan of life and actions.” (Jonsen, Siegler, & Winslade). And while a physician’s recommendation aligns with a patient’s request a majority of the time, where is the line drawn where the physician’s moral compass should decide whether or not a patient will live and suffer as opposed or die in peace. If the patient is capably making this request, I would argue that the physician is in fact practicing beneficence as opposed to nonmaleficence as the patient is looking for a way out of the suffering.
Arguments against the aided death practice range from moral and ethical to pragmatic. One line of the Hippocratic Oath, one of the most well-known Greek texts which states, ‘I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan…’ In the practice of aid in dying, some view the core concepts of autonomy and nonmaleficence are in direct conflict but, under the circumstances, feel that the latter can override the former. In this conflict, why should the principle of nonmaleficence take priority solely because it aligns with the physician’s moral compass? If our patient completely understands the nature of what they are requesting, as explained by the physician, this no longer is posed as an illusionary conflict between the two core concepts.
An individual’s unalienable rights are to life, liberty, and the pursuit of happiness. I believe one’s right to die should be protected under our 14th Amendment. Taking away this right is limiting a mentally competent patient’s right to exercise autonomy. This practice is not a true issue of autonomy versus nonmaleficence as individual’s are making educated and reasonable requests to their physicians in an effort to escape potential harm, pain, or suffering. If a provider truly upheld their duty to nonmaleficence, one would not allow their personal moral dilemmas conflict with an ill patient’s wishes towards seeking peace.
- Dugdale, L., Lerner, B., & Callahan, D. (2019 Dec). Pros and Cons of Physician Aid in Dying. Yale Journal of Biology and Medicine, 92(4): 747-750.
- 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.
- Shinall Jr, M. C. (2018). The Evolving Moral Landscape of Palliative Care. Health Affairs, 37:4, 670-673.