Physician-Assisted Suicide/Physician-Assisted Death/Voluntary Euthanasia
(*henceforth PAS/PAD/VE)

In what follows, I will present a brief typology of some of the various arguments that are commonly raised against PAS/PAD/VE. This typological sketch will proceed in broad strokes. The general categories that I used to group these various arguments are: methodological arguments, consequentialist arguments, legal arguments, epistemological arguments, and moral arguments.

To the Five Burroughs (Methodological, Consequentialist, Legal, Epistemological, and Moral)

Methodological arguments deal with the logistics, common practices, and general material or medical conditions involved with PAS/PAD/VE. To give an extended example, arguments that explore the topic of palliative care, an alternative treatment to PAS/PAD/VE, would fall under this category. Within this family of methodological arguments for palliative care, there is the argument that palliative care is capable of relieving the pain and suffering of (almost) all terminal patients who may be seeking PAS/PAD/VE. There is also the argument that current life-shortening or life-ending drugs prescribed by physicians to their patients may actually cause more pain and suffering in the process. Moreover still, there is the argument that physicians may lack the proper education and experience to have compassionate yet professional discussions with their patients who may be seeking PAS/PAD/VE. Several other methodological arguments have been formulated (both on this topic and numerous others), but suffice it to say that this type of argument ultimately asserts that the manner in which PAS/PAD/VE, or at least a crucial aspect of it, is carried out/operates is problematic in some important way. As a result of this recognized problematic feature, PAS/PAD/VE should not be utilized and it should not be legalized.

Consequentialist arguments state that the legalization of PAS/PAD/VE results in (or will result in) substantially negative consequences that ought to be prevented/avoided if possible. For example, the classical argument against PAS/PAD/VE, that its legalization will result in the disproportionate number of deaths within the disabled, senior, and/or lower socioeconomic populations in society, is one of several consequentialist arguments raised by critics. Another common consequentialist argument is that PAS/PAD/VE will irreparably damage the special physician/patient relationship by eroding the sense of trust between the two. Yet a third consequentialist argument is that PAS/PAD/VE will cause society as whole to devalue or undervalue human life in general. Critics appealing to consequentialist arguments attempt to show that PAS/PAD/VE will bring about outcomes that are either illegal, immoral, ineffective, or a combination of all three in order to deny the viability of its legalization.

Legal arguments are a subset of both methodological and consequentialist arguments in the sense that they either address a problematic aspect of how PAS/PAD/VE is carried out/operates or the potential (or actual) illicit consequences of PAS/PAD/VE. Legal arguments, as such, aim to point out a genuine conflict between the law that legalizes PAS/PAD/VE and another law. This conflict, these arguments aim to show, will not only be illegal but also have detrimental consequences for those involved.

Epistemological arguments challenge the assorted knowledge claims of PAS/PAD/VE. This skepticism, if successful, raises doubts about PAS/PAD/VE’s legalization. Epistemological arguments may target a patient’s self-knowledge (e.g. how does the patient know that he/she truly wishes to terminate his/her own life and is not, say, struggling with depression or another mental illness that actually is curable?), a patient’s autonomy (e.g. is the patient medically competent to make life-ending decisions?), a source or area of deep professional disagreement (e.g. how can two (or more) physicians have a widely divergent diagnosis for the same patient?), or a plurality of other related topics. The goal is to show that what proponents of PAS/PAD/VE claim to know, they actually do not know, either because the claim or fact is unknowable or simply false (perhaps incomplete).

Moral arguments are those which criticize PAS/PAD/VE for ethical reasons. Most often, moral arguments involve an explicit description of a relationship (e.g. social, biological, professional, personal, etc.) and the relevant expectations held by those who are directly involved in the relationship. For instance, Leon Kass argues that, by the very nature of their profession, physicians have a professional obligation (i.e. the modern Hippocratic Oath) and duty to their patients to do no unnecessary harm. Thus, cutting off a tumor-riddled appendage or removing an infected organ from a patient’s body is a harm (it involves pain and loss), it is not unnecessary because it leads to a greater goal of health and well-being for the patient (at least ideally). But PAS/PAD/VE is not like the example above because death neither allows for the pursuit of health or well-being nor the measure of their progress. It is a definitive end-point and thus, some argue, constitutes a harm. This is just one example of a moral argument against PAS/PAD/VE, but there are others that target the sanctity of life, the essence of human nature, and so on. These moral arguments typically rely on a pre-existing moral, social, or metaphysical framework to ground them.

A Couple of Closing Qualifications

It is worth noting that these categories are not comprehensive. I am sure that if we sat down for a bit and really reflected, we could think of other relevant categories (depending on our purposes and goals). Regardless, the important thing to keep in mind is that this work is meant to be a typological sketch of the various arguments raised against PAS/PAD/VE. Moreover, these categories are not mutually exclusive. That is to say, certain arguments raised against PAS/PAD/VE can be classified or described in a plurality of ways. As a result, it would be a misunderstanding to think that these arguments can all be accurately described by a singular label.

In a future post, I will articulate some of these arguments in their strongest forms and then analyze them from a bioethical perspective. For now, I will leave things as a typological sketch of where the discussion currently stands.

Tagged: Autonomy, Bioethics, death, Do No Harm, Duty, Euthanasia, Hippocratic Oath, Leon Kass, Obligation, PAD, PAS, PAS/E, Physician Assisted Death, Physician Assisted Suicide, Voluntary Euthanasia