Running head: A REVIEW OF PHYSICIAN ASSISTED DEATH 1

A Review of An Ethical Issue

Alex M Padilla

Los Angeles Pacific University

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Physician Assisted Death

Our healthcare is a very intricate system, we have gone through many decades where we

have adjusted and revamped our system to accommodate for citizens. One issue that we can look

at and review is, the intricacies of physician assisted suicide. There is much discussion and

opinions on the ethics and morals of physician assisted suicide. I believe there will never be a

consensus throughout healthcare on this prominent debate. In the basics of healthcare ethics,

there is normative ethics which his what is right or what is wrong. “In health care, ethical

concepts derived from normative theories, such as autonomy, beneficence, justice, and

nonmaleficence, often guide decision making.” (Morrison & Furlong, 2014) With the

aforementioned ethical issue of physician assisted death highlights many ethical concepts such as

autonomy, beneficence, and non-maleficence.

The process of dying in a healthcare setting is supposed to be not as burdensome and

definitely should not seem to cause controversy. From a professional that has been in the

Emergency Medical Services and now Trauma Services, death among patients always seems to

be a tough pill to swallow. I have witnessed patients that have been chronically ill, and have

succumbed to their illnesses, as well as patients you have an acute injury or illness that takes

their life. Outsiders of the healthcare profession believe that there is getting used to feeling numb

to the death process in patients. “In contrast are the poignant experiences of our own personal

and professional lives that teach us the realities of death and dying—patients, relatives, and

friends who have died from acquired immune deficiency syndrome (AIDS), heart disease,

cancer, or severe traumatic injuries.” (Morrison & Furlong, 2014) Discussing the process of

death is important as we get into ethics and moral beliefs of physician assisted death. As God

wants us to value the gift of life from a Christian standpoint, an individual that cares and respects
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the gift of life would want great medical care and would not prolong a life when death is

imminent. Letting one naturally die is one ordeal but actively assisting someone with a death

would be sinful and morally wrong from the biblical view. “Allowing to die involves

withholding treatment without an intent to cause death. This is a form of beneficence, or

preventing harm to a person. Examples might include removing a ventilator from a grandmother

with no hope of recovery, or choosing to refrain from potentially fruitless chemotherapy.”

(Wurster, 2018)

Organization’s such as the American Medical Association and the American academy of

hospice and palliative Medicine, oppose physician assisted suicide. But there are states in the

United States that have death with dignity statutes. “As of January 1, 2019, California, Colorado,

District of Columbia, Hawaii, Oregon, Vermont, and Washington have death with dignity

statutes. In Montana, physician-assisted dying has been legal by State Supreme Court ruling

since 2009.” (DWD) So we can understand that there are laws in place by a justice system in

regards to PAS, but organizations within the healthcare realm are opposed of this ethical issue.

In terms of autonomy and physician assisted death, could we assume that physician

assisted death is the patients request and choosing to hasten their death, practicing autonomy? In

contrast, clinically having a DNR and withholding treatment such as no further, antibiotics, tube

feedings, etc, is accepted in healthcare. “Withholding or withdrawing life-sustaining treatment is

widely accepted today both in ethics and law as appropriate and compassionate care if the

competent patient is fully informed and freely chooses that treatment option. Some philosophers,

have argued that there is no morally relevant difference between this practice and the practice of

assisted death” (Morrison & Furlong, 2014) How do we draw a line between the accepted

clinical procedures from physician assisted death. One article states “Placing the justification of
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suicide under a medical lens is not only necessary to prevent abuse, but also to ensure

accountability for the practice. As such, it is physicians, not community or family members, who

have the technical skill to facilitate this act, a fact that seems to give more authority to physicians

than the patients.” (Huang, 2015) If we were to completely put our trust into physicians and

allow providers to follow a competent patient request of Physician Assisted Death then it would

not allow for a biblical or public view on ethics of death.

As we look to different views of this ethical debate, there are many ideas on which side

of right and wrong. Physicians want to follow their Hippocratic Oath of fist do no harm Primum

non nocere. From a non biased standpoint I am on the fence of a radical autonomy of allowing

for a competent patient and physician to come to terms on a plan of moving to hasten a death.

Part of me wants to completely be against physician assisted death but there is medically ways to

make a person comfortable and consult palliative/hospice care at the end of life. As it is accepted

medically and spiritually. Another side argues “I want to argue that physician assisted death does

not demedicalize death; rather it medicalizes suicide; it transforms a private act into a medical

event. Physician assisted death implies not a resistance, but an extension of medical power over

life and death.” (Salem, 1999) There are semantics of medical procedure or private and non

medical benefit in assisted death. Can we deem this a palliative and normal end of life procedure

or as Salem implies an extension of medical power over life and death? Afterall, physicians are

finely educated individuals with residency programs and fellowships. But are they inclined as the

lay person to make ethically charged choices and assist someone with a death? I do not believe

this falls on the physician him or herself but the consensus of the healthcare community and

legislation.
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Those in support may be invested in the requests of the patient, which is understandable

and may even be morally sound if one may be suffering from a terminal illness. “Those

supporting assisted death claim that they are honoring patient integrity by being willing to have

conversations with their patients that are open to discussing all treatment options with the

patient; In support of patient integrity and autonomy, proponents argue that only the patient

knows what constitutes harm and may decide that continued life with severe interminable

suffering is a greater harm than assisted death.” (Morrison & Furlong, 2014)

Psalm 34:17-20 ESV

“When the righteous cry for help, the Lord hears and delivers them out of all their troubles. The

Lord is near to the brokenhearted and saves the crushed in spirit. Many are the afflictions of the

righteous, but the Lord delivers him out of them all. He keeps all his bones; not one of them is

broken.”

As we see this passage and know that God will be by the side of the hurting and the

terminally ill as he urges to not give up the fight. As aligning with a palliative care practice

would be the best option in my opinion. Providing compassion and comfort is a tool for

clinicians to use in end of life as these individuals are trained to deal with end of life and

exemplify the care of a loved one. I would condone hospice/ palliative approach to any one of

my family members or patients that I come across as a healthcare professional. I do not think we

can consider palliative care and physician assisted death the same care. As we look at one

Palliative Physician’s thoughts we can understand that it is not in the same light as one another.

“My work is to provide care with the intention of alleviating suffering and restoring dignity, and

to focus on living while dying. As a palliative care physician, I do not intentionally hasten death,

but approach dying as a normal process and important stage of life. Physician-assisted suicide
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and euthanasia go against the very core of the palliative care approach and have no place within

palliative care.” (Herx, 2015) As I reflect on Dr. Herx’s views, I once thought of physician

assisted death and palliative care in the same light. But we must not forget that hastening death is

impeding a natural process and a process of god.

As we highlighted earlier ones in support be in fully autonomy, and patient request, as the

patient may be the only one that knows what is suffering for him or her. As well as having open

conversations there could be more reasons to be in favor of physician assisted suicide. “Most

terminally ill patients who wish to commit suicide want it accomplished by medical means,

nonviolently — suicide by self-administered drugs is not always easy to accomplish. Failed

attempts can cause greater trauma for the patient and caregivers than the natural course of the

disease itself.” (Gloth, 2003)

A common theme I have heard about death and dying is the suffering from pain.

Supporters bring up a great point in that they do not want a patient no longer suffering, so

hastening the death of a patient would end this suffering. “In fact, the chief argument — that

assisted suicide is needed to avoid the excruciating pain and suffering that may accompany a

terminal illness — is based on a fallacy. But as Dr. Gloth implies that palliative care provides

pain relief and comfort for those in suffering. As we mentioned earlier that the two should not be

looked at in the same light. “Advances in pain management now make it possible to control pain

effectively in dying patients; only rarely is it necessary to induce sleep to relieve pain or distress

in the final stage of dying.” (Gloth, 2003)

I cannot say that physician assisted suicide is completely unethical, morally or even

clinically wrong. But we have highlighted different sides in which point toward that there are

different ways to go about end of life care for a person that may be suffering from a severe injury
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or illness. In biblical terms god has not gave up on us and we should not give on the natural

process of death. As healthcare providers we can provide the appropriate compassion for our

patients by using the correct and effective avenues of palliative care and pain management. I

worry that physician assisted death will be a norm in the future and will lead to abuse of this

“service”. “persons on both sides of this issue agree that a policy of assisted death would pose a

danger to patients and society. Some physicians might abuse this option at the end of life.”

(Morrison & Furlong, 2014).

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References

Death With Dignity (n.d) How Death with Dignity Laws Work. Retrieved from

https://www.deathwithdignity.org/learn/access/#top

Gloth, M (2003) Physician-assisted Suicide: The Wrong Approach to End of Life Care

United States Conference of Catholic Bishops. Washington, D.C

Herx L. (2015). Physician-assisted death is not palliative care. Current oncology (Toronto,

Ont.), 22(2), 82–83. doi:10.3747/co.22.2631

Huang, R (2015) Physician-Assisted Death: A Patient’s Last Plea For Autonomy Berkeley

Political Review, University California, Berkeley.

Morrison, E.E. & Furlong, B. (2014). Health care ethics: Critical issues for the 21st century.

(3rd ed.). Sudbury, MA: Jones & Bartlett.

Salem, T (1999) Physician-Assisted Suicide: Promoting Autonomy or Medicalizing Suicide?

The Hastings Center Report Vol. 29, No. 3 (May - Jun., 1999), pp. 30-36

Wurster, M. (2018) What does the Bible teach about euthanasia and physician assisted suicide?

The Ethics & Religious Liberty Commission ERLC Article Jul.