The Morality of Physician-Assisted Suicide and Voluntary Euthanasia (PASE)

Ethics

The teachings of the Roman Catholic Church would absolutely reject any form of assisted suicide or euthanasia claiming human life is made in the image of God, so purposefully ending life is a sin. On these grounds, suicide is also unethical. Thomas Aquinas, widely acknowledged as the greatest Catholic theologian and philosopher, summarised this in “It is not lawful for man to take his own life that he may pass to a happier life, nor that he may escape any unhappiness”[1] .Similarly, most religion traditionally rejects assisted suicide and euthanasia due to the principle of the sanctity of life (the idea that all human life is sacred, or holy, and so should not be violated), and the idea that the separation of the soul and body should be a natural process.

However, most major religious doctrines also reject abortion, the use of contraception and stem cell research, yet these processes are generally accepted in the UK as norm. Perhaps this is because it is questionable, by even religious philosophers, if these traditional views are too outdated to apply to today’s society. Further, even if religion does condemn PASE, this doesn’t mean it should be illegalised and taken away as a choice for others. More modern, or secular ethical theories may then be more applicable and useful today. For example, Joseph Fletcher’s situation ethics, states that PASE can be acceptable if it maximises agapeic (Christian) love. Aristotle’s virtue ethics also supports that PASE can be ethical as it involves the virtue of compassion[2] .However major questions about the morality of PASE still remain.

Is there a difference in morality between physician assisted suicide and voluntary euthanasia? It could be argued that in assisted suicide the patient self-administrates the barbiturate, so has more responsibility and the physician has less, compared to euthanasia when the physician is administrating. There is also less of a risk in lack of consent with assisted suicide than in voluntary euthanasia.

Right to death

Do people have a right to death? Suicide is legal, suggesting that people do. It seems unfair that people with health problems that prevent them from being able to commit suicide do not have the same rights as a person who can. Why shouldn’t people with a physical health problem be able to make an autonomous decision about their death, when people with psychiatric problems can? Patients currently have the right to refuse life-sustaining treatment, and to proportionate palliation, even though it may hasten death, so why don’t the right to death. Y. Tony Yang argues that “the ‘right to die’ is a euphemism for the putative ‘right to have a physician help me kill myself’, which he believes “is never justifiable”[3]. Another criticism of the ‘right to die’ argument is that suicide cannot be rational, so it would be irrational to allow PASE. However, Héctor Witter proves that “anyone arguing that doctors may not assist in suicide in any way because suicide is essentially irrational is arguing for a thesis for which no plausible justification can be found”, because someone who is burdened with both physical and mental illness is still capable of making a logical and well thought out decision[4].

Attitude of the Public

The public attitude on PASE is difficult to assess, as support varies greatly depending on how the question is phrased, and if additional information such as prognosis, age and symptoms are given. See table below[11]:

However, generally research has concluded that in Europe there is a East/ West divide where most of Western Europe is becoming more permissive to PASE and most of Eastern Europe is becoming less permissive[6]. The British Social Attitudes Survey, one of the most reliable surveys of public opinion, has conducted several questionnaires on the issues of assisted dying and voluntary euthanasia[7]. The results find that the majority of the public support assisted suicide and voluntary euthanasia, particularly if it is conducted by a physician, and the patient’s illness is terminal.

2005 BMA survey

 

 


Attitude of Doctors

Voluntary euthanasia tends to be supported more than physician assisted suicide.[8] The consensus of doctors is equally important in the discussion of legalising PASE. Research concludes that physicians generally oppose both physician-assisted suicide and voluntary euthanasia, generally on the basis that it is not compatible with the role of a doctor. Even physicians who supports the legalisation of PASE are less likely to be willing to participating in the process. In 2014 Medix held a survey to research the views of 600 UK doctors on physician-assisted suicide and euthanasia[9]. 58% said that they would not support a change in the law for physician-assisted suicide, and 54% said that they would not for euthanasia either. Only 29% said they were in favour of both being legalised[10].

 

References:

[1] Thomas Aquinas, 1485, Summa Theologica, II-II, Qu.64, Art.5

[2] John Frye (2017) AQA A-level Religious Studies Year 1: Including AS. Hodder Education. Pg 119-204

[3] Y. Tony Yang (2016) Why physicians should oppose Assisted suicide. Journal of the American Medical Association, 315(3), 247-248

[4] Héctor Wittwer (2013) The problem of the possible rationality of suicide and the ethics of physician assisted suicide. International Journal of Law and Psychiatry, 36, 419-426

[5] Ezekiel J. Emanuel, Bregji D. Onwuteaka-Phillipsen, John W. Urwin, Joachim Cohen (2019) Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada and Europe. Journal of the American Medical Association, 316(1), 79-90

[6] Joachim Cohen, Paul Van Landeghem, Nico Carpentier, Luc Deliens (2014) Public acceptance of euthanasia in Europe: a survey study in 47 countries. International Journal of public health, 59(1) 143–156

[7] Ruth Campbell, Jacqueline Connolly, Judith Cross, Martin Davies, Fay Davies, Veronica English, Gail Grant, Daniel Hodgson, Lucy Merredy (2015) End-of-life care and physician-assisted dying. British Social Attitudes, 20(1), 82-83

[8] Clery E, McLean S, Phillips M “Quickening death: the euthanasia debate”, in Park A,

Curtice J, Thompson K et al. (eds.) (2007) British Social Attitudes: the 23rd Report –

Perspectives on a changing society. Sage: London. p.41

[9] Ruth Campbell, Jacqueline Connolly, Judith Cross, Martin Davies, Fay Davies, Veronica English, Gail Grant, Daniel Hodgson, Lucy Merredy (2015) End-of-life care and physician-assisted dying. British Social Attitudes, 20(1), 90-92

[10] Medix (2014) “Euthanasia & Physician-assisted-suicide – a summary of results”.

[11] Ezekiel J. Emanuel, Bregji D. Onwuteaka-Phillipsen, John W. Urwin, Joachim Cohen (2019) Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada and Europe. Journal of the American Medical Association, 316(1), 79-90

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