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There is a large number of articles written about different aspects of assisted dying. For this work, the article by Malpas & Owens (2016) was carefully examined. The authors discuss the doctor’s role in the physician-assisted dying process and consider the arguments for and against PAD’s legalization (Malpas & Owens, 2016). The article states that the evidence against the doctor’s participation in the PAD is unwarranted, and therefore, the grounds may be insufficient to prohibit this practice in health facilities.
It is noted that several countries and the US states have accepted a particular form of physician-assisted dying under certain conditions. According to their jurisdictions, assisted suicide and euthanasia are compatible with the doctor’s role. Here, these practices are regarded as other practices such as abortion and sterilization, which are acknowledged in modern society (Malpas & Owens, 2016). In addition, countries and states where PAD is prohibited have witnessed some cases where a doctor agrees to hasten the death of their patients. It provides further evidence in favor of PAD and proves that practitioners do not see a contradiction between such practices and their function.
However, the authors exclude the doctor’s participation in the death penalty from the cases when assistance in dying can be justified. The doctor’s role in capital punishment and assisted suicide cannot be regarded similarly as there is no connection between these two practices (Malpas & Owens, 2016). It is also worth noting that the term “physician-assisted suicide” is often considered as an inappropriate description of the practice because the word “suicide” evokes wrong associations with mental disorders (Malpas & Owens, 2016). As such, to prevent unnecessary debates over the terminology, different forms of assisted dying will be referred to here as physician-assisted dying, or PAD.
This review will not explore the ethical, moral, or religious aspects of the subject, and academic works on these issues will not be included. It will focus on the doctor’s role in PAD, and it will not examine the function of other health care providers in the process. The purpose of the review is to determine whether physician-assisted suicide is permissible in medical practice. The arguments for or against the practice will also be provided.
Researchers in this field classifies euthanasia as active and passive; however, the authors of the reviewed article state that there is no fundamental distinction between the two types. They argue that it does not matter who takes or gives the lethal amount of medicine as the practice involves a mutual decision of a patient and a doctor (Malpas & Owens, 2016). The only difference between active and passive euthanasia is who acts the last.
The article raises the issue of the patient’s right to make decisions by themselves. Malpas & Owens (2016) assert that the patient’s interests should be taken into account, even if it is a desire to end life. Terminally ill patients should have the option to die decently if life quality is unacceptable and unbearable for them. For instance, the official permission to hasten the death given to patients who are expected to die soon would relieve their suffering (Malpas & Owens, 2016). Several states in the USA allowed their citizens assisted dying, and several individuals have already taken advantage of this opportunity.
Countries, where PAD is illegal, have reported several cases when a physician violated the law and helped their terminally ill patients to die. It is evident that in such cases, a doctor is guided by beneficence and had good intentions. It also shows that physicians may resort to this practice when it is the only possible way to alleviate the patient’s suffering and proves that PAD can be justified in certain situations.
Some commentators argue that the doctor’s involvement in assisted dying breaks the Hippocratic oath principles. They claim that a doctor’s role is incompatible with PAD, and it violates the fundamental principles of medical practice. Nevertheless, these ethical principles also include beneficence and respect for the patient’s independence in making decisions. In this perspective, PAD may help a practitioner fulfill their duty and adhere to medical principles. In some cases, assisted death is equal to care and appreciation of the patient’s autonomy. Furthermore, in the modern world, some of the rules have already been violated when abortion and sterilization were implemented in medical practice care (Malpas & Owens, 2016). It means that some of the Hippocratic oath principles are already outdated and may be changed.
The reviewed article examines the PAD’s influence on other medical areas if it were legalized. One of the concerns is connected with the reduction in other caregiving services provided when a patient faces a life-threatening illness and experiences unbearable suffering. Several researchers claim that governments will spend less money on palliative care if PAD becomes legal. According to them, it is cheaper to prescribe a lethal dose of medicament once than to maintain a terminally-ill patient by supplying them with pain medicaments for a long period. Hence, governments will choose a cheaper alternative and give priority to it in all medical cases.
However, practice shows that these concerns are unjustified; hence they should not serve as a reason to prohibit PAD legalization. In countries where assisted dying is permitted, it is regarded as the last resort. Here, a doctor has the right to use it only when they have considered all other options, including palliative care. Furthermore, Belgium and the Netherlands have not seen a decline in the accessibility of palliative care services since euthanasia was legalized, on the contrary, the governments have invested even more money into the service (Malpas & Owens, 2016). This example provides strong evidence that the concerns about the negative influence of PAD on other medical areas are not reasonable.
Another argument against assisted death legalization lies in the fact that practitioners will lose credibility in society if the practice becomes legal. It is stated that providing PAD means that a physician has surrendered in the fight for a patient’s life and has chosen an easier option. Nonetheless, studies show that patients believe that doctors always have the best intentions and cannot inflict harm (Malpas & Owens, 2016). Moreover, people consider that PAD’s permissibility would increase trust in medicine (Malpas & Owens, 2016). Thus, the fear that end-of-life practices could undermine the doctor’s authority has no basis.
The article also considers the etymology of the word “patient,” which has Latin roots and describes a person who suffers. Here, a practitioner acts as a healer who is to mitigate the patient’s affliction. The sense of the term suggests that assisted dying does not contradict a doctor’s role as a healer, and they can resort to the practice in exceptional cases.
Certain forms of physician-assisted dying are permitted in several countries and states in the USA. Here, a patient and a doctor act together in making decisions about their further treatment plan, and if a patient expresses a wish to end life, a practitioner has the legal right to assist them. For example, a person can ask their physician to remove them from ventilator support if they cannot bear the suffering. It should be mentioned that PAD is regarded here as an extreme measure, and all other options, such as palliative care, should be considered first.
A practitioner’s involvement in PAD is a highly controversial issue. The most obvious argument against their participation in the practice is that a doctor’s role lies in saving lives and mitigating suffering. Some authors offer a counterargument to this claim and state that, in some cases, the only way to help a patient is to allow them to die with dignity. Here, PAD does not contradict a doctor’s role but implies fulfilling their duty.
Taking into consideration all the arguments suggested by the reviewed article, one can conclude that PAD may be permissible in certain cases. The authors refer to the lack of evidence against the practice and note that those which are proposed by some commentators may have insufficient grounds and can be refuted. However, further research is needed in this area as the doctor’s involvement in assisted dying is still a debatable issue. Some arguments against PAD’s legalization are present in a scientific discussion but the majority of them have proved to be unwarranted. Though, there are other points of view concerning the permissibility of assisted dying in medical practice, which is not covered in this work and needs consideration.
References
Malpas, P. J., & Owens, R. G. (2016). Given that physician-assisted dying is ethical, should it be part of a doctor’s role?. Mortality, 21(4), 295-304.
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