Argumentative Essay On Right To Die
“The right to choose to live or to die is the most fundamental right there is; conversely, the duty to give others that opportunity to the best of our ability is the most fundamental duty there is” (Aubrey de Grey, 2003). The right to die has always been a controversial topic. This is a question that fueled a modern movement in the 1970’s. With the advancement of technology, it became possible to keep people who had suffered traumatic injuries alive when they would have certainly died in a previous era (McCormick, 2011). While in many cases, these patients made a full recovery and went on to lead productive, fulfilling lives, others who underwent mandatory medicinal treatment, were forced to face a life of significantly reduced quality. These
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circumstances brought to question the moral validity of physician assisted suicide and with it the idea that people have a right to choose whether they want to live or to die.
The movement of the right to die and physician assisted suicide did not end in the 70’s. As time went on the heated debated seemed to only escalate. In 1997, the United States Supreme Court found that the 14th Amendment’s definition of liberty does not include the right to assisted suicide from doctors or otherwise (Westefeld, 2013). During this time, the Supreme Court ruled that decisions on physician assisted suicide would be decided among the individual states. Since this ruling, the States of Oregon, Vermont, Montana and Washington have all legalized physician assisted suicide (Jackson, 2014).
While this paper will focus primarily on the United States views of physician assisted suicide, it is important to note this debate was by no means confined within the borders of the United States. This is a human rights issue not a cultural issue. Physician assisted suicide has been argued around the world. In fact physician assisted suicide is legal, under specific circumstances, in the Netherlands, Mexico, Switzerland, Germany and Luxembourg (Jackson, 2014). This movement has also been extensively deliberated in the United Kingdom. In 2014, a bill of physician assisted suicide came before the British parliament (Jackson, 2014). Like previous bills suggested in 2008 and 2013, the aforementioned bill did not pass. However, arguments continue in favor of legalizing physician assisted suicide in the UK.
While it is most often discussed medically in terms of medical physicians and the terminally ill, this is not strictly a medically ethical question. Medically ill patients who wanted to die were polled for their motives, the list included fear of abandonment, sense of loss of control, loss of dignity, fear of being a burden, and the cost of care (Humphry and Clement, 2000). Many of these concerns coincide with the presentation of Major Depressive Disorder. The DSM- 5 states that those with MDD may present with feelings of worthlessness, feelings of lack of control, irrational and borderline delusional guilt over being sick and the inability to see hope even in evidence-based treatments (American Psychological Association, 2013, p. 163). So are all patients who are willing to participate in physician assisted suicide depressed? By allowing patients to participate in physician assisted suicide are we taking advantage of a vulnerable mentally and physically ill group? If we aren’t, at what point to do we stop forcing psychiatric treatment? Is our acceptance of suicide conditional to being terminally ill?
More than 50% of the general population agrees with the act of physician assisted suicide in the context of a terminal illness (Hendry, Pasterfield, Lewis, et al., 2013). What about the right to die when the quality of life becomes abhorrent but death isn’t imminent, for example, in the case of a degenerative disease? There are ardent arguments on both sides. Tomlinson (2015) did a meta-analytic qualitative thematic study of 16 former care givers whose close loved ones had stage 3 dementia. It was a requirement that all participants had lost their loved ones between 1-5 years ago so that participants could reflect on the entire experience when discussing the right to die. Despite the fact that dementia is not innately terminal, Tomlinson found that approximately 56% of his participants considered ‘right to die’ when caring for their loved ones and would want a physician assisted death if they developed stage 3 dementia. Most stated that they recognized that those who chose suicide in the face of dementia were confronted with a challenging lifestyle and understood if they made that decision, even if they didn’t agree with the choice.
Those adamantly against the right to die suggested there was an inherent risk for abuse.
These participants suggested that if someone had the desire to live but were considered to be in poor condition, they would be medically discriminated against. Further, subjects opposed to right to die suggested that while a dementia patient could have a very negative view of the world, there were still positive aspects in life worth living for. They argued that allowing a patient to participate in a physician assisted suicide while in that negative cognitive state was irresponsible; the patient could change their minds. Participants against right to die also believed that taking someone’s life was murder, regardless of the other person’s desires. Some subjects were against the right to die for religious reasons and believed it was not right for someone to choose how and when they were going to …show more content…
die.
Those in favor of right to die believed there had to be a sense of autonomy. These subjects stated that having the right to choose to live or die would bring those suffering with dementia a sense of comfort and control. They further argued that people’s lives belonged to themselves and so it was ultimately up to the dementia patient if they wanted to live or die. Participants in favor of the right to die also stated reasons such as unescapable pain, loss or inability to feel pleasure, fear of becoming a burden, disintegration of the brain and over all reduced quality of life to support their stance of pro-assisted death.
These same arguments have been found in multiple studies (Fenn & Ganzini, 1999; Johnson, 2014; Westefeld, 2013). In those studies, the reasons for and against physician assisted suicide were the same for both the terminally ill and those with degenerative diseases. Bruenig (2015) suggested an additional argument of ‘slippery slope’. Bruenig suggests that because physician assisted suicide is less expensive for a money-strapped family and less work for an exhausted doctor, the rates of euthanasia would increase exponentially for the wrong reason. Belgium legalized euthanasia in 2002. Between the years of 2012 and 2013, a period of time defined by financial hardship in the country, rates of physician assisted suicide jumped from 13% to 27% (Bruenig, 2015). These arguments continue to aid the lobbyists against the bill in states that physician assisted suicide is not yet legal.
Even places in which physician assisted suicide has been conditionally legalized, it remains a point of contention. Oregon provides an excellent example of this. The Oregon Death with Dignity Act passed in 1997. This act allows doctors to legally prescribe a lethal dose of medication with the intent that it will hasten the patient’s death. However, patients given this prescription must administer the medicine themselves. Due to the fact that this act is the most progressive motion passed in the United States, it is important to understand what circumstances must be met to make a physician assisted suicide legal. In order to request a prescription for lethal medication, the ODDA requires the patient be:
“at least 18 years or older, a resident of Oregon, considered capable of making and communicating health care decisions, and diagnosed with a terminal illness that is expected to lead to death within 6 months.
Patients meeting these criteria may request a prescription for lethal medication from a licensed Oregon physician. Before the patient is allowed to receive the prescription, he or she must make two oral requests to his or her physician, separated by at least 15 days. The patient must also provide a written request to the physician, signed in the presence of two witnesses. At least one of the witnesses cannot be a relative of the patient by blood, marriage, or adoption; entitled to any portion of the estate of the patient following his or her death; or a person affiliated with the health care facility where the patient is being treated. The prescribing physician may not act as a witness (ODHS,
2006).”
It appears that many of the trepidations anticipated by those opposed to physician assisted suicide are addressed in the ODDA law. First and foremost, there must be safeguards to protect the patient from being taken advantage of as suggested by the ‘witness’ clause. Furthermore, it must be ensured that the person is of sound mind as suggested by the ‘ability to make health care decisions’ clause. The passage that states a 15 day interval between oral requests as well as the requirement for a written request, suggests that it is important to advocates that the patient be sure of their decision. The final clause worth noting is the requirement of a terminal illness that suggests that a patient will not live more than 6 months even without the prescription.
The DREDF (Disability Rights Education and Defense Fund) believes that the safeguards are not protective at all. They have protested and lobbied to ban the bill. The DREDF argues that the ‘death in 6 months’ clause is often misdiagnosed. The DREDF further argues that the clause of ‘sound mind’, which is evaluated by a psychologist, can be sidestepped by simply bouncing from doctor to doctor until one agrees with the patients desires. This option leads to an invalidation of the safeguard and makes it significantly easier to take advantage of this vulnerable group of patients. Furthermore, they argue that the passing of the law has led to worse palliative care in the medical field (DREDF, 2008). They continue to lobby against the bill in all legalized states and discourage the legalization of the bill in states that continue to consider it.
While this law seems to be clear on the role of a psychologist, it is still full of ambiguity and ethical pitfalls for the profession. As the law is written now, psychologists are not to become involved with physician assisted suicide until after the oral request. Once an oral request for a lethal prescription is made, a psychologist must make a competency assessment. This alone raises ethical issues.
By participating in physician assisted suicide do psychologists violate Standard 3.04 of the Ethics code: to Avoid Harm (APA, 2010)? If it is not deemed harmful to take part in a physician assisted suicide and there for not ethically wrong, what if the psychologist believes it is morally wrong and they are still called upon to do the competence evaluation? Does this not lead to a violation Standard 3.06 Conflict of Interest (APA, 2010)? If these violations are not an issue, can we be sure that the psychologist is up to the task of a competency evaluation? In 1999, Oregonian psychologists were surveyed regarding the issue of physician assisted suicide. 33% of the aforementioned psychologists felt that a competence evaluation of physician assisted suicide would fall outside their area of training and practice; regardless, approximately 60% of those same psychologists reported that they would be willing to perform the evaluation (Fenn & Ganzini, 1999). This would be a violation of Standard 2.01 Bounds of Competence (APA, 2010).
The APA has published a single edict acknowledging physician assisted suicide. This edict was called the APA Resolution on Assisted Suicide. The assisted suicide resolution “takes a position that neither endorses nor opposes assisted suicide” (APA, 2001). This lack of position leads to a lack of guidelines. Thusly, all aforementioned concerns are ethical issues that have not been addressed by the APA. There are no specific guidelines or even suggestions for how psychologists should handle physician assisted suicides (Johnson, 2014). Due to this, physician assisted suicide remains morally and ethically ambiguous in legalized states. Currently unless practicing in a state in which physician assisted suicide is legal, contributing to physician assisted suicide is a prosecuted offense.
Physician assisted suicide is an important human rights issue. Its arguments come down to autonomy versus the value of life. It’s legalization in the present will lead to even bigger, more ambiguous questions in the future. Should the day come in which physician assisted suicide is generally accepted throughout the country, where will the line be drawn? After all in countries where it has been legalized, laws on euthanasia have become increasingly loosened (DREDF, 2008). Belgium now even allows children to be euthanized with the consent of parents and expressed desire of the child (Bruenig, 2015). The question in psychology will come down to this: if a practicing psychologist or counselor becomes aware of a client’s suicidal thoughts; is it morally or ethically right to force psychiatric treatment upon them and force them to live, whether they are terminally ill or not?
circumstances brought to question the moral validity of physician assisted suicide and with it the idea that people have a right to choose whether they want to live or to die.
The movement of the right to die and physician assisted suicide did not end in the 70’s. As time went on the heated debated seemed to only escalate. In 1997, the United States Supreme Court found that the 14th Amendment’s definition of liberty does not include the right to assisted suicide from doctors or otherwise (Westefeld, 2013). During this time, the Supreme Court ruled that decisions on physician assisted suicide would be decided among the individual states. Since this ruling, the States of Oregon, Vermont, Montana and Washington have all legalized physician assisted suicide (Jackson, 2014).
While this paper will focus primarily on the United States views of physician assisted suicide, it is important to note this debate was by no means confined within the borders of the United States. This is a human rights issue not a cultural issue. Physician assisted suicide has been argued around the world. In fact physician assisted suicide is legal, under specific circumstances, in the Netherlands, Mexico, Switzerland, Germany and Luxembourg (Jackson, 2014). This movement has also been extensively deliberated in the United Kingdom. In 2014, a bill of physician assisted suicide came before the British parliament (Jackson, 2014). Like previous bills suggested in 2008 and 2013, the aforementioned bill did not pass. However, arguments continue in favor of legalizing physician assisted suicide in the UK.
While it is most often discussed medically in terms of medical physicians and the terminally ill, this is not strictly a medically ethical question. Medically ill patients who wanted to die were polled for their motives, the list included fear of abandonment, sense of loss of control, loss of dignity, fear of being a burden, and the cost of care (Humphry and Clement, 2000). Many of these concerns coincide with the presentation of Major Depressive Disorder. The DSM- 5 states that those with MDD may present with feelings of worthlessness, feelings of lack of control, irrational and borderline delusional guilt over being sick and the inability to see hope even in evidence-based treatments (American Psychological Association, 2013, p. 163). So are all patients who are willing to participate in physician assisted suicide depressed? By allowing patients to participate in physician assisted suicide are we taking advantage of a vulnerable mentally and physically ill group? If we aren’t, at what point to do we stop forcing psychiatric treatment? Is our acceptance of suicide conditional to being terminally ill?
More than 50% of the general population agrees with the act of physician assisted suicide in the context of a terminal illness (Hendry, Pasterfield, Lewis, et al., 2013). What about the right to die when the quality of life becomes abhorrent but death isn’t imminent, for example, in the case of a degenerative disease? There are ardent arguments on both sides. Tomlinson (2015) did a meta-analytic qualitative thematic study of 16 former care givers whose close loved ones had stage 3 dementia. It was a requirement that all participants had lost their loved ones between 1-5 years ago so that participants could reflect on the entire experience when discussing the right to die. Despite the fact that dementia is not innately terminal, Tomlinson found that approximately 56% of his participants considered ‘right to die’ when caring for their loved ones and would want a physician assisted death if they developed stage 3 dementia. Most stated that they recognized that those who chose suicide in the face of dementia were confronted with a challenging lifestyle and understood if they made that decision, even if they didn’t agree with the choice.
Those adamantly against the right to die suggested there was an inherent risk for abuse.
These participants suggested that if someone had the desire to live but were considered to be in poor condition, they would be medically discriminated against. Further, subjects opposed to right to die suggested that while a dementia patient could have a very negative view of the world, there were still positive aspects in life worth living for. They argued that allowing a patient to participate in a physician assisted suicide while in that negative cognitive state was irresponsible; the patient could change their minds. Participants against right to die also believed that taking someone’s life was murder, regardless of the other person’s desires. Some subjects were against the right to die for religious reasons and believed it was not right for someone to choose how and when they were going to …show more content…
die.
Those in favor of right to die believed there had to be a sense of autonomy. These subjects stated that having the right to choose to live or die would bring those suffering with dementia a sense of comfort and control. They further argued that people’s lives belonged to themselves and so it was ultimately up to the dementia patient if they wanted to live or die. Participants in favor of the right to die also stated reasons such as unescapable pain, loss or inability to feel pleasure, fear of becoming a burden, disintegration of the brain and over all reduced quality of life to support their stance of pro-assisted death.
These same arguments have been found in multiple studies (Fenn & Ganzini, 1999; Johnson, 2014; Westefeld, 2013). In those studies, the reasons for and against physician assisted suicide were the same for both the terminally ill and those with degenerative diseases. Bruenig (2015) suggested an additional argument of ‘slippery slope’. Bruenig suggests that because physician assisted suicide is less expensive for a money-strapped family and less work for an exhausted doctor, the rates of euthanasia would increase exponentially for the wrong reason. Belgium legalized euthanasia in 2002. Between the years of 2012 and 2013, a period of time defined by financial hardship in the country, rates of physician assisted suicide jumped from 13% to 27% (Bruenig, 2015). These arguments continue to aid the lobbyists against the bill in states that physician assisted suicide is not yet legal.
Even places in which physician assisted suicide has been conditionally legalized, it remains a point of contention. Oregon provides an excellent example of this. The Oregon Death with Dignity Act passed in 1997. This act allows doctors to legally prescribe a lethal dose of medication with the intent that it will hasten the patient’s death. However, patients given this prescription must administer the medicine themselves. Due to the fact that this act is the most progressive motion passed in the United States, it is important to understand what circumstances must be met to make a physician assisted suicide legal. In order to request a prescription for lethal medication, the ODDA requires the patient be:
“at least 18 years or older, a resident of Oregon, considered capable of making and communicating health care decisions, and diagnosed with a terminal illness that is expected to lead to death within 6 months.
Patients meeting these criteria may request a prescription for lethal medication from a licensed Oregon physician. Before the patient is allowed to receive the prescription, he or she must make two oral requests to his or her physician, separated by at least 15 days. The patient must also provide a written request to the physician, signed in the presence of two witnesses. At least one of the witnesses cannot be a relative of the patient by blood, marriage, or adoption; entitled to any portion of the estate of the patient following his or her death; or a person affiliated with the health care facility where the patient is being treated. The prescribing physician may not act as a witness (ODHS,
2006).”
It appears that many of the trepidations anticipated by those opposed to physician assisted suicide are addressed in the ODDA law. First and foremost, there must be safeguards to protect the patient from being taken advantage of as suggested by the ‘witness’ clause. Furthermore, it must be ensured that the person is of sound mind as suggested by the ‘ability to make health care decisions’ clause. The passage that states a 15 day interval between oral requests as well as the requirement for a written request, suggests that it is important to advocates that the patient be sure of their decision. The final clause worth noting is the requirement of a terminal illness that suggests that a patient will not live more than 6 months even without the prescription.
The DREDF (Disability Rights Education and Defense Fund) believes that the safeguards are not protective at all. They have protested and lobbied to ban the bill. The DREDF argues that the ‘death in 6 months’ clause is often misdiagnosed. The DREDF further argues that the clause of ‘sound mind’, which is evaluated by a psychologist, can be sidestepped by simply bouncing from doctor to doctor until one agrees with the patients desires. This option leads to an invalidation of the safeguard and makes it significantly easier to take advantage of this vulnerable group of patients. Furthermore, they argue that the passing of the law has led to worse palliative care in the medical field (DREDF, 2008). They continue to lobby against the bill in all legalized states and discourage the legalization of the bill in states that continue to consider it.
While this law seems to be clear on the role of a psychologist, it is still full of ambiguity and ethical pitfalls for the profession. As the law is written now, psychologists are not to become involved with physician assisted suicide until after the oral request. Once an oral request for a lethal prescription is made, a psychologist must make a competency assessment. This alone raises ethical issues.
By participating in physician assisted suicide do psychologists violate Standard 3.04 of the Ethics code: to Avoid Harm (APA, 2010)? If it is not deemed harmful to take part in a physician assisted suicide and there for not ethically wrong, what if the psychologist believes it is morally wrong and they are still called upon to do the competence evaluation? Does this not lead to a violation Standard 3.06 Conflict of Interest (APA, 2010)? If these violations are not an issue, can we be sure that the psychologist is up to the task of a competency evaluation? In 1999, Oregonian psychologists were surveyed regarding the issue of physician assisted suicide. 33% of the aforementioned psychologists felt that a competence evaluation of physician assisted suicide would fall outside their area of training and practice; regardless, approximately 60% of those same psychologists reported that they would be willing to perform the evaluation (Fenn & Ganzini, 1999). This would be a violation of Standard 2.01 Bounds of Competence (APA, 2010).
The APA has published a single edict acknowledging physician assisted suicide. This edict was called the APA Resolution on Assisted Suicide. The assisted suicide resolution “takes a position that neither endorses nor opposes assisted suicide” (APA, 2001). This lack of position leads to a lack of guidelines. Thusly, all aforementioned concerns are ethical issues that have not been addressed by the APA. There are no specific guidelines or even suggestions for how psychologists should handle physician assisted suicides (Johnson, 2014). Due to this, physician assisted suicide remains morally and ethically ambiguous in legalized states. Currently unless practicing in a state in which physician assisted suicide is legal, contributing to physician assisted suicide is a prosecuted offense.
Physician assisted suicide is an important human rights issue. Its arguments come down to autonomy versus the value of life. It’s legalization in the present will lead to even bigger, more ambiguous questions in the future. Should the day come in which physician assisted suicide is generally accepted throughout the country, where will the line be drawn? After all in countries where it has been legalized, laws on euthanasia have become increasingly loosened (DREDF, 2008). Belgium now even allows children to be euthanized with the consent of parents and expressed desire of the child (Bruenig, 2015). The question in psychology will come down to this: if a practicing psychologist or counselor becomes aware of a client’s suicidal thoughts; is it morally or ethically right to force psychiatric treatment upon them and force them to live, whether they are terminally ill or not?