Pharris Livingston
Physician Assisted Death
Physician assisted death is the practice of a physician giving a terminally ill patient the means to end his or her life. Physician assisted death has been a controversial medical topic for many years. The opposing sides of the debate are a fantastic representation of the long standing medical dilemma of balancing patient autonomy with a physician’s paternalism and traditional role as a healer. An article by Charlotte Huff discusses the history of this debate and outlines each side of the argument. Huff begins her article by describing some statistics originating from the state of Washington, who had just legalized physician assisted death just over a year before the article was published. She explains that this makes Washington the 2nd U.S. state to legalize physician assisted death as Oregon legalized it as early as 1994. Huff transitions this description of what was the current political state of physician assisted death to the more general aspects of the moral dilemma. She explains how the physicians opposed to physician assisted death generally hold the view that it violates the physician’s core responsibility to heal and comfort. On the other hand, supporters argue that patients have a right to decide how they will die, especially considering that these patients are already terminally ill.
The statistics that Huff includes from Washington were that, in total, 63 people requested and obtained the lethal medication. Of these 63, 47 died, but only 36 did so as a result of taking the medication. Huff explains that “in expressing their end-of-life concerns, all reported fearing loss of autonomy. Other common concerns were loss of dignity, reported by 82%, and loss of the ability to participate in enjoyable activities, reported by 91%” (Huff). Similarly, of the 460 people who underwent physician assisted death in Oregon from 1998 to 2009, 91% stated that “loss of autonomy was the leading concern” (Huff). Inadequate pain control and financial implications of treatment were also points of inquiry, but, when compared to loss of autonomy, they were significantly less prevalent. The main takeaway from this data is that autonomy is of utmost importance to patients when considering physician assisted death.
The Stanford Encyclopedia of Philosophy defines paternalism as “the interference of a state or an individual with another person, against their will, and defended or motivated by a claim that the person interfered with will be better off or protected from harm” (Dworkin). Paternalism is relevant to physician assisted suicide because withholding the option of physician assisted death from patients is a paternalistic act that does not respect patient autonomy, so the question as to the justification of this paternalistic act is what the debate on physician assisted death largely hinges on. The articles “Medical Paternalism – Part 1” and “Medical Paternalism – Part 2” by Daniel Groll discuss the moral validity of medical paternalism. Groll finds that two accounts of paternalism hold the most moral weight: the authority account and the beneficence account. Groll explains that the authority account is when “a clinician acts paternalistically when, for her patient’s good, she usurps his decision-making authority,” and the beneficence account is when “a clinician acts paternalistically when, for her patient’s good, she acts only or overridingly out of concern for his good” (Groll 1). The main difference between these accounts is that the beneficence account characterizes a physician’s act as paternalistic because the choice to disregard a patient’s autonomy is based on the physician’s belief that the act is for the patient’s own good. This is different from the authority account because the authority account does not take the physician’s motivation to act for the patient’s own good into account. Groll argues “for a conception of paternalism according to which a person acts paternalistically to the extent that she acts in a way that is only or overridingly motivated by concern for another person’s good. In the context of medicine, this is often appropriate since for many patients – i.e. those that are not competent to make their own decisions – the only (or at least primary) consideration that is relevant for the surrogate decision maker is the patient’s good” (Groll 8). With this definition of paternalism established, Groll recognizes that the well-being of the patient is not the only factor that must be taken into account as the patient’s right to dictate his or her own treatment is also important. The conflict arises when what the physician views as preferable for the patient’s health contradicts what the patient desires (Groll 8). Groll concludes that because the authority account trumps the beneficence account, “acting paternalistically (at least when it comes to competent patients) is presumptively impermissible” (Groll 1).
When placing the issue of physician assisted death in the context of this conclusion, it appears that restricting patient access to physician assisted death is not justifiable as it is a paternalistic action that does not allocate patient’s with the freedom to choose if they want physician assistance in their death. One counterclaim that could be made against this conclusion is the idea that patient’s who are not mentally fit to make decisions about their treatment could request physician assisted death. In this scenario, Groll explains that it is morally permissible to make decisions for a patient that is unfit to make his or her own decisions: a belief that is well established across medicine (Groll 8).
When reading the article by Huff regarding the history and ongoing debate of physician assisted death, I believe that the side of the argument that a reader would take would be largely based on the reader’s own perceived preferences for his or her own death and the likelihood that he or she would be open to utilizing physician assisted death if the possibility presented itself. I would assume that the readers that fear a loss of autonomy, being a burden, or suffering greatly in their final moments are generally more likely to support the legalization of physician assisted death because they would actually consider using it. Conversely, readers that would not consider physician assisted death are more likely to support the restriction of it. Another factor that would likely affect how readers perceive the issue would be how strictly they believe doctors must abide by their traditional role as a healer. Readers who believe that doctors must stay extremely loyal to their obligation to heal patients are more likely to be against physician assisted death while readers who do not feel that this traditional role is binding or should have any tangible authority over real world issues are more likely to support physician assisted death.
Works Cited
Dworkin, Gerald. “Paternalism (Stanford Encyclopedia of Philosophy).” Stanford.edu, 2020, plato.stanford.edu/entries/paternalism/.
Groll, Daniel. “Medical Paternalism – Part 1.” Philpapers.org, 2014, philpapers.org/rec/GROMPP. Accessed 10 Oct. 2023.
Groll, Daniel. “Medical Paternalism – Part 2.” Philpapers.org, 2014, philpapers.org/rec/GROMPP. Accessed 10 Oct. 2023.
Huff, Charlotte. “Doctors Debate the Ethics of Assisted Suicide.” ACP Internist, 1 July 2010, acpinternist.org/archives/2010/07/suicide.htm.