Moral Reasoning in the Context of Physician Assisted Suicide (PAS)

A Statement of Values — Proponents versus Opponents

Collectively, the proponents of physician assisted suicide value personal autonomy and responsibility, the quality of life, and compassion towards others. Proponents of physician assisted suicide feel that by being allowed to choose between life and death as a personal and medical decision, patients are able to exercise personal autonomy, a freedom that they take to be fundamental to the nature of humanity. This autonomy ties directly into their perceptions about quality of life, in that some view life as undesirable or lackluster if they are not able to enjoy activities, events, and relationships that they previously did due to terminal or incurable medical conditions. They do not view life as inherently valuable and worth living, but derive life’s value from its pragmatic and functional elements. When the level and intensity of physical and mental suffering crosses a certain threshold, these proponents value the actions of those who will show compassion and act in accordance with their final wishes. Thus, proponents of physician assisted suicide feel obligated to protect the personal rights of patients as well as to ensure that they are being treated with compassion to alleviate their pain and suffering. Any events or legislation that interfere with those conditions are intolerable.


Meanwhile, the opponents of physician assisted suicide value the inherent sanctity of life, the physician’s right of conscience, and also compassion towards others, especially disadvantaged populations. Opponents of physician assisted suicide view life as inherently valuable, regardless of its form, expression, or content. They also strongly believe that no physician should be forced or required to violate his or her own personal moral beliefs, regardless of the nature of their profession. They do not want the field of medicine to devolve into a business wherein the patient’s demands must necessarily be met at the expense of the physician’s moral well-being. Finally, opponents also value compassion towards others, but they fear that the compassion that is associated with legalizing physician assisted suicide is unequal and will lead to legal and social abuses. They advocate for equal compassion for all, regardless of various social, economic, and corporeal criteria. Thus, opponents of physician assisted suicide feel obligated to protect physicians and patients both from unfair treatment by promoting the inherent and seemingly absolute value of life. Any event or legislation that interferes with a physician’s right of conscience or that prematurely ends the life of a patient is atrocious.

Some Normative Moral Principles

One normative moral principle that proponents of physician assisted suicide endorse is the Principle of Liberty. Derived from the work on Social Contract Theory of Hobbes, Locke, Rousseau and, more recently, Rawls, this normative moral principle holds that each individual should be allowed the maximum amount of personal liberty possible insofar as that liberty is compatible with and symmetrical to such liberty afforded to all other individuals within society. Within the context of the debate over physician assisted suicide, proponents argue that by making physician assisted suicide illegal and punishable by law, the Principle of Liberty is being violated and various patients’ are unable to exercise their liberties to the full extent possible.

Another normative moral principle that proponents of physician assisted suicide advocate is the Principle of Paternalism. This normative principle, drawn from the same philosophical writings and background, claims that a legitimate and, perhaps even necessary, goal of public authority is to prevent or alleviate needless human suffering. This principle finds support within the physician assisted suicide debate concerning arguments about palliative care and treatments. Since, as proponents argue, certain medications and treatments do not alleviate the pain and suffering of the patient, a public authority, in this case the state government, is allowing needless human suffering to occur and thereby violating the Principle of Paternalism.

One normative moral principle under-girding the opponent’s case against physician assisted suicide is the Principle of Ends. Based on the moral reasoning of Immanuel Kant, this normative principle states that human beings should never be treated as a mere means to an end. Put another way, people are not to be used as merely tools or objects to achieve goals or ends that we personally desire or have. As it relates to physician assisted suicide, opponents fear that the family members or friends of patients who are considering PAS as a treatment will pressure the latter into acceptance, perhaps in hopes of receiving insurance money or based on inheritance related grounds. If a family member or friend convinces a patient to accept physician assisted suicide so that the former benefits in some tangible way, then the Principle of Ends is violated.

A similar normative principle embraced by opponents of physician assisted suicide is the Principle of Equality. The Principle of Equality is also drawn from the philosophical tradition of the Social Contract Theory. This normative principle asserts that each individual in society deserves to be treated as an equal and to be shown respect and concern worthy of any and all moral beings. Opponents claim that the Principle of Equality is violated since certain populations such as the undereducated or the disabled or the elderly have been disproportionately singled out and encouraged to accept physician assisted suicide.

Stalemate?

The proponents would like to see an increase in patient autonomy, allowing each individual to decide what is best for him or herself during the last few months of life. The commitment to compassion, combined with the emphasis on quality of life, means that the proponents want patients to be able to alleviate their pain and suffering, especially when daily living seems to be lackluster. Meanwhile, the opponents would prefer to see changes in the medical profession as well as treatment options that would eliminate the need for physician assisted suicide. Opponents would also prefer to see patients exercise autonomy in a manner which holds strongly to the sanctity of all life. Ultimately, it seems that at least some moral questions hinge upon the answer to: “Is life, unconditionally and in all cases, worth living or holding on to?” 

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