Physician assisted suicide (PAS) and active euthanasia has been an ongoing battle for many years now. Some countries have accepted parts of these “end of life” techniques and some have accepted both techniques. There are also countries, like the U.S., that have not accepted either of these techniques but have administered a right to die technique that allow the withholding and withdraw of treatment to terminally ill patients. Two recent court decisions made the various states in the U.S., within their jurisdictions, the first governments in history to officially sanction PAS.
In the United States, “allowing to die” has become a normal practice. A 1998 study found that 85% of deaths in the U.S. occurred in health care institutions; 70% of which involved electively withholding some form of life sustaining treatment. A 1997 study showed that between 1987-88 and 1992-93, recommendations to withhold or withdraw life support prior to death increased from 51% to 90% in intensive care units. Studies of cancer patients have shown that over 50% suffer from unrelieved pain, which accompanied by feelings of hopelessness and untreated depression, is a significant factor for suicide. The U.S. actually does permit the use of double effect uses of high dose opiates, and terminal sedation which is conceived as “allowing to die”. Terminal sedation uses high doses of opiates to sedate the patient into unconsciousness while artificial nutrition and hydration are withheld allowing the patient to die a painless death.
Opponents of PAS and active euthanasia condemn both practices as immoral and violate the moral rule against killing the innocent or they object the fact that physicians are being asked to act in a way that would undermine their role as healers and kill the patient intentionally. There is a third group of opponents that states that either PAS or active euthanasia is not always morally wrong. They believe that in rare cases, the release from a painful or degrading existence might prove as an important exercise of personal autonomy for the patient. Autonomy is the right to self determination in matters that profoundly touch religious themes as life, death, and the meaning of suffering. There is also the view that once accepted, we could start on a slippery slope. There are three arguments based on the slippery slope hypothesis. One argues that PAS and euthanasia would be impossible to keep within its boundaries once implemented. What would be considered unbearable pain or terminally ill? The second view on the slippery slope argues about the likelihood of abuse, neglect, and mistake. Would we be able to establish a system that would be reliable at reporting all cases in order to monitor these cases and respond to abuses? There is also another slippery slope argument that shows the highly predictable failure to reliably diagnose and treat reversible clinical depression in the elderly population. Would clinical depression be considered a reason to use one of these “end of life” techniques? All three of these arguments are a possibility in the U.S. because we are a country where contact with a personal physician is decreasing, risk of malpractice action is substantial, many medical practices are not covered by insurance, medical decisions are based off of financials, racism remains high, and we have not been in direct contact with Nazism or similar totalitarian movements. This makes the U.S. untrustworthy for PAS and euthanasia. We can also predict that in many cases, all reasonable alternatives will not be exhausted and any reporting system would not be able to adequately monitor all PAS and euthanasia cases.
Supporters of PAS and active euthanasia argue that PAS and euthanasia are merciful acts that deliver terminally ill patients from painful and protracted deaths. We should treat human beings at least as well as we treat our pets by putting them out of their misery when they