Physician Assisted Suicide

[muad'dib]

I am curious as to others feel about this issue; please explain your reasoning.

[muad'dib]

I myself vote no because I believe physician assisted suicide (PAS) is a direct violation of the Principle of Double Effect and Natural Law.

[rakuenso]

I vote yes because humans no longer follow Double Effect nor Natural Law

[john5746]

I vote yes. Suffering, terminally ill people shouldn't continue to suffer for our morality.

[muad'dib]

I vote yes because humans no longer follow Double Effect nor Natural Law

 

 

Do you mean that the Principle of Double Effect and Natural Law are now defunct as moral principles, because if that is what you mean that's not true; or do you mean so many people violate them that we should just ignore them and they don't matter? Do you mean something else by that?

 

Pain medication and hospice care do a lot in terms of relieving suffering. Just because physician assited suicide isn't available doesn't mean that terminally ill patients suffer. Granted there are many out there that don't have the money or family required for them, it is a very imperfect system, but physician assisted suicide could most likely lead to a much more imperfect system.

[Mokele]

Principle of Double Effect and Natural Law

 

What exactly are these two things?

 

 

IMHO, having a right to live your life as you please (basic freedom) also incorporates a right to end your life as you please.

 

Mokele

[Bald Wonder]

Yes. To explain why I'll draw a quick analogy:

 

If abortion were still illegal we would have many women using coat hangers to perform their own abortions (like they still do in many places). This is why we have physician-assisted abortion in the US.

 

Humans are free to choose when and if they want to end their life. Due to lack of knowledge, a large percentage who attempt suicide are unsuccessful and botch the job. Not only do they now continue to live, but they do so with whatever additional deformity has resulted from their failed attempt.

 

Human beings are always going to choose to commit suicide. Why should we continue to deny them access to assistance from knowledgable professionals in performing this task?

[muad'dib]

The Principal of Double Effect is a guideline that judges whether certain actions that produce both a desired effect (good) and undesired effect (bad), are moral or immoral. There are four guidlines that judge whether the undesired effect is acceptable. The first is that the action itself is not immoral, the second that the undesired effect cannnot be a means to the desired effect. Thirdly the undesired effect is not directly intended and the fourth is that the desirable effect has to produce a great enough amount of good to be at least proportional to the desired.

 

Natural Law states firstly that the basic instinct of humans is self preservation/survival, it is built into us. If this is true then we have the right not to be killed because if we instinctly want to survive our life must be good. If we have a natural right not to be killed then we must have a natural duty not to kill others. The presumption of this is in favor of keeping ourselves and others alive.

[muad'dib]

.

 

Human beings are always going to choose to commit suicide. Why should we continue to deny them access to assistance from knowledgable professionals in performing this task?

 

 

Are you saying in all cases when people choose to commit suicide or just the terminally ill? It seems as if you're implying in all cases even if it's just a depressed teenager.

[LucidDreamer]

Yes. To explain why I'll draw a quick analogy:

 

If abortion were still illegal we would have many women using coat hangers to perform their own abortions (like they still do in many places). This is why we have physician-assisted abortion in the US.

 

Humans are free to choose when and if they want to end their life. Due to lack of knowledge' date=' a large percentage who attempt suicide are unsuccessful and botch the job. Not only do they now continue to live, but they do so with whatever additional deformity has resulted from their failed attempt.

 

Human beings are always going to choose to commit suicide. Why should we continue to deny them access to assistance from knowledgable professionals in performing this task?[/quote']

Are you only referring to people with terminal illness or are you saying that anyone that wants to commit suicide should be assisted?

 

Damn you Paul Atradis, you beat me to the punch!

[Bald Wonder]

Not all cases, I guess I should have been more clear. I am only talking about those dealing with 'end-of-life' issues, e.g. terminally ill.

 

However, you do bring up a very good point. Legalizing PAS would definitely create a slippery slope.

[muad'dib]

Damn you Paul Atradis, you beat me to the punch!

 

haha....I'm glad to see someone else thought the same thing when they read that

[muad'dib]

Not all cases' date=' I guess I should have been more clear. I am only talking about those dealing with 'end-of-life' issues, e.g. terminally ill.

 

However, you do bring up a very good point. Legalizing PAS would definitely create a slippery slope.[/quote']

 

 

Okay just checking. I think the slippery slope argument is what's keeping PAS from being legalized in a lot of places; if a perfect system were gauranteed then it would probably be legal in a lot more places than the Netherlands and Oregon. I do agree that if, like abortion, people are going to do it they should have the guidance of a professional like you suggest. Then some people might ask should that professional be a physician who is devotedto preserving life, or do we create a new profession where there might not be a conflict?

[Bald Wonder]

Then some people might ask should that professional be a physician who is devotedto preserving life, or do we create a new profession where there might not be a conflict?

Another great point! The primary argument of the AMA and other groups is that PAS violates the Hippocratic principle of 'Do no harm.' Although I believe that a physician's responsibility to alleviate pain and suffering should be primary. Besides, many would argue that we are already violating this principle by providing abortions.

 

Any of the other medical professions not bound by the Hippocratic oath could actually perform the assisted suicide.

 

I guess it should be pointed out that PAS and euthanasia are two different things. In euthansia the physician is the direct agent; in PAS the patient is the direct agent. So in PAS, the physician simply gives the patient the injection but does not administer it. PAS is legal in Oregon, not euthanasia.

 

Whether most people are aware of it or not, euthanasia happens all of the time in the hospital. If a patient is near death and suffering, the physician can give a large dose of morphine on the premise that they are alleviating suffering. They do this knowing the patient will die. However, it is not illegal based on their motivational premise.

 

I've done this personally. Have I violated Double Effect and Natural Law? Am I a murderer?

[Mokele]

The Principal of Double Effect is a guideline that judges whether certain actions that produce both a desired effect (good) and undesired effect (bad), are moral or immoral. There are four guidlines that judge whether the undesired effect is acceptable. The first is that the action itself is not immoral, the second that the undesired effect cannnot be a means to the desired effect. Thirdly the undesired effect is not directly intended and the fourth is that the desirable effect has to produce a great enough amount of good to be at least proportional to the desired.

 

Interesting, but, in my opinion, flawed. I, personally, think the first guideline is useless, as I don't believe there is any absolute morality (unless it refers to the person's individual ethical/moral code). The second means that working out at the gym is immoral, since the pain and effort are undesirable, but are tolerated in order to aquire the desired effect. The third guideline also falls afoul of that example. The fourth seems less like a moral/immoral guideline and more like an index of "are you wasting your time doing this?"

 

Natural Law states firstly that the basic instinct of humans is self preservation/survival, it is built into us. If this is true then we have the right not to be killed because if we instinctly want to survive our life must be good. If we have a natural right not to be killed then we must have a natural duty not to kill others. The presumption of this is in favor of keeping ourselves and others alive.

 

But isn't that the naturalistic fallacy? Just because it's found in nature, or our natural course of action, it's good? Murder comes very naturally to some people, does that make it good for those individuals to murder? Infanticide also appears to be an instinctual reaction, triggered by certain stimuli, as can be seen by it's widespread practice. Does that make it acceptible? A thousand other things, like selfishness and mate-stealing, are also natural instincts.

 

Legalizing PAS would definitely create a slippery slope.

 

But would it, necessarily? If it's legal only when x number of physicians along with a few psychologists have gone over the person's case, then that should prevent anyone but the genuinely terminally ill who make the decision while in sound mind from receiving PAS.

 

Also, would the slippery slope really be that bad? The ending would just be making suicide legal, and why is that such a bad thing? Sure, people will make mistakes and kill themselves over things like their girlfriend dumping them, but freedom connotates freedom to err, even if that error has lethal consequences.

 

-----

 

I just find it slightly hypocritical that a society can say "You are free to live your life as you wish (providing that it doesn't infringe on the rights of others to do the same)", but then turn around and say "But you aren't free to end your life on your own terms in accordance with your own wishes, even if doing so does not infringe the rights of others."

 

Freedom to do something how you want logically includes the freedom to not do it at all, even if the "something" is "living".

 

Mokele

[muad'dib]

I guess it should be pointed out that PAS and euthanasia are two different things. In euthansia the physician is the direct agent; in PAS the patient is the direct agent. So in PAS' date=' the physician simply gives the patient the injection but does not administer it. PAS is legal in Oregon, not euthanasia.

 

Whether most people are aware of it or not, euthanasia happens all of the time in the hospital. If a patient is near death and suffering, the physician can give a large dose of morphine on the premise that they are alleviating suffering. They do this knowing the patient will die. However, it is not illegal based on their motivational premise.

 

I've done this personally. Have I violated Double Effect and Natural Law? Am I a murderer?[/quote']

 

There are two types of euthanasia, active and passive. Active euthanasia is actively killing someone by giving them an injection. PAS is a form a active euthanasia because the physician provides the means and the intention is that the patient will kill themselves. There are other forms of active euthanasia that are illegal like "mercy killing." Passive euthanasia is legal everywhere; removing someone from life support, removing feeding tubes, and giving someone a large dose of drugs with the direct intention of alleviating pain (not killing them) although the drugs may hasten death due to suppressed respitory function, are considered forms of passive euthanasia.

 

Giving someone large doses of drugs to alleviate suffering does not violate Double Effect or Natural Law. The action itself, giving someone who is in pain painkillers is not in and of itself immoral. The point is to relieve suffering by killing the pain, not by killing the person and thus relieve suffering, so the undesired effect is not a means to the desired. The death is not directly intended, and the relief of a tremendous amount of suffering outweighs the shortening of life by a few days or weeks. If the drugs are given to someone with the intention that they will overdose to purposely kill themselves to end the pain then it would violate Double Effect.

 

(I should mention that when I said Double Effect judges whether certain actions are moral or immoral, I was off a little bit. Double effect is used to judge whether a bad result is acceptable when both good and bad effects are present)

 

Giving someone large doses of drugs with the intention that they are to alleviate pain does not violate Natural Law because no one is directly killing anyone or intending to kill anyone.

[Mokele]

does not violate Double Effect or Natural Law

 

Why should we care about either of these? As I just showed above, both are horribly flawed and thus should not used as a litmus test of the desirability of this or anything else.

 

Mokele

[muad'dib]

Interesting' date=' but, in my opinion, flawed. I, personally, think the first guideline is useless, as I don't believe there is any absolute morality (unless it refers to the person's individual ethical/moral code). The second means that working out at the gym is immoral, since the pain and effort are undesirable, but are tolerated in order to aquire the desired effect. The third guideline also falls afoul of that example. The fourth seems less like a moral/immoral guideline and more like an index of "are you wasting your time doing this?"

 

 

 

But isn't that the naturalistic fallacy? Just because it's found in nature, or our natural course of action, it's good? Murder comes very naturally to some people, does that make it good for those individuals to murder? Infanticide also appears to be an instinctual reaction, triggered by certain stimuli, as can be seen by it's widespread practice. Does that make it acceptible? A thousand other things, like selfishness and mate-stealing, are also natural instincts.

Mokele[/quote']

 

 

 

If morality isn't absolute then how do you suggest we judge whether an action is moral or immoral. If everyone was allowed to live according to their own moral code, like say serial killers, or pyromaniacs many people could be hurt because of what is moral to them.

 

Going to the gym can be supported by Double Effect. First there are many simple actions which few would disagree upon their morality, like going to the gym, doing the dishes, breathing; it's neutral, it isn't necessarily moral or immoral. Secondly the desired effect of going to the gym is better health in most cases and the means to doing that is lifting weights, running on the treadmill, etc, not causing pain. Thirdly I don't think most people go to the gym with the direct intention of causing themselves pain. There is a problem with the fourth, because of course no theory or principle is without flaws (at least in ethics). It is very subjective to ask if a desired effect produces enough good to outweight the undesired effect, different people have different opinions. In your example of the gym though there would probably be few people disagreeing if better health over a period of years does outweigh a few hours of discomfort or pain per week in the gym.

 

As to Natural Law: You have to take into account that humans have the natural ability to inhibit many of the things you mentioned (maybe an instinctual ability to inhibit them why else would most of what you mentioned be considered wrong); it's part of what makes us human, we have rational thought and reason.

 

Natural Law is a product of western civilization so you're right when you say there may be people in other cultures (is that what you mean, or do you mean individuals?) to whom murder is natural, but in what sense? Do you mean killing someone for any reason or self-defense and war? I think it's safe to say that in almost all cultures murdering someone based on emotions is taboo.

 

Please tell me where in human civilization infanticide is in widespread practice. I don't know of anyplace or culture so I'm curious as to if one exists if you could tell me where.

[muad'dib]

Also' date=' would the slippery slope really be that bad? The ending would just be making suicide legal, and why is that such a bad thing?

 

 

Mokele[/quote']

 

I don't believe suicide is illegal anywhere; assisting in a suicide is illegal.

[rakuenso]

Are you saying in all cases when people choose to commit suicide or just the terminally ill? It seems as if you're implying in all cases even if it's just a depressed teenager.

 

 

I doubt any sane physician will help a teenager suicide.

[muad'dib]

I doubt any sane physician will help a teenager suicide.

 

 

It's happened in the Netherlands, plus read what I was replying to when I wrote what you quoted.

[Mokele]

If morality isn't absolute then how do you suggest we judge whether an action is moral or immoral.

 

Why does external judgement matter? Why should I care whether society as a whole thinks I'm moral or not, so long as I believe I am?

 

Just because it'd make things easier doesn't mean it's true.

 

If everyone was allowed to live according to their own moral code, like say serial killers, or pyromaniacs many people could be hurt because of what is moral to them.

 

This is where the governmental code of rights comes into play. I feel the late Supreme Court Justice Oliver W. Holmes said it best: "My right to swing my fist ends where the other man's nose begins".

 

So long as you don't infringe on other's rights to live life as they see fit, you should be able to live your life as you see fit.

 

First there are many simple actions which few would disagree upon their morality,

 

Meaningless. The number of people who believe something has no bearing on it's actual veracity or lack thereof.

 

Secondly the desired effect of going to the gym is better health in most cases and the means to doing that is lifting weights, running on the treadmill, etc, not causing pain. Thirdly I don't think most people go to the gym with the direct intention of causing themselves pain.

 

The second states, according to you, that the desired effect cannot be acheived by means of an undesired effect. Working out does no good unless you work until your muscles burn. The pain is required and a direct consequence that is unavoidable without lots of steroids.

 

The third, well, ever hear the phrase "no pain, no gain"? People go to the gym to do things that are exhausting or painful, in hopes of a later benefit.

 

------

 

Of course, leaving aside specific examples, why should I not be able to do something that causes pain or other negative effects in pursuit of a positive effect, if I'm the only one who suffers? Isn't that my choice?

 

You have to take into account that humans have the natural ability to inhibit many of the things you mentioned (maybe an instinctual ability to inhibit them why else would most of what you mentioned be considered wrong); it's part of what makes us human, we have rational thought and reason.

 

However, that doesn't mean the actions I described *aren't* the product of instinct. In fact, the second most deeply rooted instinct in all of life (aside from reproduction) is selfishness. Infanticide is basically an example of this pre-programmed selfishness, and is found throughout the animal kingdom. If your genetic and energetic investment in young cannot pay off, terminate the investment rather than spending more on it. Just be glad we aren't like most other species; they often eat their young after killing them.

 

I think it's safe to say that in almost all cultures murdering someone based on emotions is taboo.

 

War is just that, on a grand scale.

 

Please tell me where in human civilization infanticide is in widespread practice.

 

Rural China. If we include the past, then most of civilization. "Exposing" (aka abandoning) infants was common practice in ancient Greece, for example, and they're basically the root of western civilization.

 

The fact is, you can't claim that something is automatically moral based on our natural inclination towards it, as we have plenty of natural inclinations that contradict most moral systems. Selfishness, war, mate-stealing, infanticide, stealing, discrimination, all of those are *natural*, instinctive responses.

 

Mokele

[muad'dib]

Why does external judgement matter? Why should I care whether society as a whole thinks I'm moral or not' date=' so long as I believe I am?

 

Just because it'd make things easier doesn't mean it's true.

 

This is where the governmental code of rights comes into play. I feel the late Supreme Court Justice Oliver W. Holmes said it best: "My right to swing my fist ends where the other man's nose begins".

 

So long as you don't infringe on other's rights to live life as they see fit, you should be able to live your life as you see fit.

[/quote']

 

I've never said that people shouldn't be free to live their life as they see fit, they should be. I personally feel that the government, or society, should not be allowed to keep people from being immoral if that's what they wish (as long as it doesn't infringe upon another's rights). Just because I think it is immoral for a physician to assist in a suicide doesn't mean I think it should remain illegal. The reason I think it should remain illegal for now is that the guarantee of a perfect system is not possible at this time. The Netherlands is a perfect example where depending on where you get your facts, in 12 months 1000 cases of PAS were found to not have had patient consent. This is where your quote from Justice Holmes comes into play.

 

The point of this thread was to discuss whether it is morally acceptable for a physician to assist in a patient's suicide, not whether you have the right to end your life as you please. Is it moral for a physician to give a patient drugs and say "I'm giving this to you so you can kill yourself and this is how you do it."

 

 

 

 

The second states' date=' according to you, that the desired effect cannot be acheived by means of an undesired effect. Working out does no good unless you work until your muscles burn. The pain is required and a direct consequence that is unavoidable without lots of steroids.

 

The third, well, ever hear the phrase "no pain, no gain"? People go to the gym to do things that are exhausting or painful, in hopes of a later benefit.

[/quote']

 

Again walking on a treadmill is a means to better health; causing pain is not a direct means to better health. Walking thirty minutes a day five days a week is enough to drastically lower the risk of heart attack but it does not cause pain to the average person. If someone decides to go to the gym and work hard and make themselves "feel the burn" then is pain really an undesired consequence?

 

The principles I mentioned are usually used in moral dilemas, not any scenario you can think of (like going to the gym), maybe that's where some of their faults lie.

 

Of course, leaving aside specific examples, why should I not be able to do something that causes pain or other negative effects in pursuit of a positive effect, if I'm the only one who suffers? Isn't that my choice?

 

Go for it, it is your choice, nobody disputes that. What some may dispute is the morality of it.

 

 

 

However' date=' that doesn't mean the actions I described *aren't* the product of instinct. In fact, the second most deeply rooted instinct in all of life (aside from reproduction) is selfishness. Infanticide is basically an example of this pre-programmed selfishness, and is found throughout the animal kingdom. If your genetic and energetic investment in young cannot pay off, terminate the investment rather than spending more on it. Just be glad we aren't like most other species; they often eat their young after killing them.

[/quote']

 

We aren't talking about other species. Generally if we do find something in nature happening it is good. Male lions killing the offspring of other lions to ensure the survival of their own genetic lines is a moral thing in nature, in a sense (I don't think nature has morals).

 

 

 

Rural China. If we include the past' date=' then most of civilization. "Exposing" (aka abandoning) infants was common practice in ancient Greece, for example, and they're basically the root of western civilization.

 

The fact is, you can't claim that something is automatically moral based on our natural inclination towards it, as we have plenty of natural inclinations that contradict most moral systems. Selfishness, war, mate-stealing, infanticide, stealing, discrimination, all of those are *natural*, instinctive responses.

[/quote']

 

Are the examples of infanticide that you listed above due to natural inclinations or due to social circumstances? In China I believe it's social circumstances. I'm assuming that the Greeks often abandoned infants that were deformed in some way. Given the time period I can see why they would do that, the reasons aren't the same as you listed for the animal kingdom. Now that we now why an infant is deformed and that we can take care of them abandoning them is seen as wrong. That is part of nature in a sense. We are a product of nature and our ability to gain knowledge should be considered part of that.

 

Why do those natural inclinations contradict moral codes if there is not a natural inclination against them?

 

Again the point of my starting this thread in the first place was to see a persons reasoning behind what they think about the morality of PAS. You know mine, what is yours? I know you believe people should have the right to end their life as they please, but why do you believe that it is morally acceptable for a physician, devoted to preserving life, to help a person kill themselves? I'm not trying to say you're wrong and I'm right, I'm curious.

[Milkman]

It all depends on the situation. For example, if a person has cancer and knows that they are going to die, PAS should be permitted. It is the individual's choice whether they want to continue living, and that choice should be respected.

 

In an another instance, say a person is depressed and doesn't want to live anymore, the physician should provide some guidance and possibly refer the patient to a psychiatrist. PAS should not be an option because the patient might get out of the depression and change their mind.

 

PAS is morally acceptable when the patient requesting it is going to die in the near future from an illness, but should not be performed when the patient is only suffering from psychological problems (depression, etc...).

[Drug addict]

I just noticed this thread and wanted to add my views.

 

In my view, PAS is acceptable when a patient has a terminal illness. In a law and ethics lecture I had recently it was mentioned that "doctors should not hasten death, but may take actions that coincidentally have this effect." Also consider that it is acceptable to withdraw treatment from a patient. What is the difference between this and taking action to hasten death?

 

Any of the other medical professions not bound by the Hippocratic oath could actually perform the assisted suicide

 

The Code of Ethics for pharmacists in the UK states '... pharmacists must act in the best interests of patients... and seek to provide the best possible health care... Pharmacists must respect patients' rights to participate in decisions about their care...'

 

To me this is more flexible than the Hippocratic oath, however the problem remains that a Doctor needs to sign the prescription.

 

Palliative care has improved, however there are some concerns, both from patients and doctors, over prescribing of opiod analgesics such as morphine because of the risk of dependency. This should not be an issue because the patient is terminally ill.

 

I am somewhat fortunate in that I have both the knowledge and access to drugs to commit suicide in a painless way, which definately wouldn't involve paracetamol (acetaminophen). Most people do not have this knowledge and so are reliant on medical professionals, who are not (as the law stands at present in most places) in a position to help them. It is depressing when we treat pets better than we do humans.

 

To me, the most depressing case would be suffering from a muscular dystrophy type disease (i.e. the case of Diane Pretty) where I was mentally competent and reached a decision that I wanted to end my life with dignity, but was physically unable to do so.

 

 

*edit*

 

This was published in the BMJ and may be of some interest: http://bmj.bmjjournals.com/cgi/content/full/329/7472/939-b?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=physician+assisted+suicide&andorexactfulltext=and&searchid=1103331470751_16656&stored_search=&FIRSTINDEX=0&sortspec=date&resourcetype=1