By Max Kerby Henry Edmond, CEO of Epsilon
Nowadays, End-of-life-decision-making is very common in ethical discussions. There are many ethical implications in this debate. One of the concerns is withholding and withdrawing life-sustaining treatment (WLST) (Fisher, 2018, p.287)1. The second one is about assisted suicide and active euthanasia. Now, we call it physician assisted death (PAD) or medical assistance in dying (MAID) (Fisher, 2018, p.287)2. Euthanasia is defined as followed: ‘‘bringing about the death of a person in that person interest.’’ (Fisher, 2018, p.288)3 I strongly believe that patients should be given an option to ask for euthanasia when specific conditions are met because it preserves the invidual’s autonomy and their dignity. Therefore, any adult who has grievous conditions and experiences suffering that is irremediable should have the right to make a voluntary and informed decisions regarding their life. Throughout this text, we will discuss the question of autonomy and dying with dignity.
First, we believe that patients should be given the right to request euthanasia when certain conditions are met because respecting patient autonomy is a key principle in the health care system. ‘‘Respect for patient autonomy (or self-direction) is broadly understood as recognition that patients have the authority to make decisions about their own healthcare’’. (Fisher, 2018, p.35)4 However, some might say that euthanasia is bad because vulnerable people can be forced to do it. In fact, there are many requirements that have to be met for euthanasia to take place :
‘‘ They have a serious and incurable disease; they are in advance state of irreversible decline in capability; that illness or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under the conditions that they consider acceptable; their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining’’(Fisher, 2018, p.293)5. As stated earlier, the adult will be able to take an informed decision and health care professionals are there to discuss with the patient and make sure this decision is made without external pressure. Also, if the adult is unconscious, euthanasia can also be possible if the patient has an advance directive (Fisher, 2018, p.28)6 or a proxy directive (Fisher, 2018, p.28)7 in which a person is designated to make a decision for them when they lack decision-making capacity. Our goal is to respect the autonomy of the patient; therefore, physicians should work in the patient's best interest. A physician’s job is to do beneficence (Fisher, 2018, p.553)8 which is to prevent harm, reduce harm, and do good. Thus, if a patient is suffering from severe pain and the medical system refuses them access to euthanasia, this patient will be suffering continuously, and this is against the principle of beneficence. Also, some people might argue that attention to patient autonomy in the health care system can be a time-consuming business and the demand of identifying patients’ values and preferences are often sacrificed in the face of heavy load and staff shortage (Fisher, 2018, p.36)9. Although this argument is strong and we all know that we have a shortage of staff in our health system, this should be an opportunity to talk about macroallocation. Macroallocation is the fair allocation of a society’s resources for health care under conditions of scarcity. (Fisher, 2018, p.349)10. Therefore, we cannot say that there is a shortage of staff and euthanasia will be a burden for our system because our society has a responsibility to help each person die with dignity. Hence, hospitals should allocate more resources in palliative units because dying with dignity is important because it respects the patient’s autonomy.
Second of all, dying with dignity is a principle that is accepted everywhere in the world. However, some people might say that there is no dignity in killing a patient. They can also say euthanasia is ethically wrong because it rests on a view that has its root in the Hippocratic tradition according to which physicians are healers and must not kill. They also say it is wrong because it intentionally kills the patient. Let’s analyze a hypothetical example. Marie is 70 and she has cancer, and her cancer is spread everywhere in her body. The doctor thinks that this condition is irreversible, and she meets all the conditions mentioned earlier to be eligible for euthanasia. So, are we going to say no to Marie if she asks for euthanasia? What about the woman’s dignity? Marie should have access to euthanasia because the only way doctors can alleviate her suffering is by euthanasia. I must put emphasis on the fact that Marie will not be killed by the doctors as some people like to say. Doctors only respect Marie’s decision to die with dignity. The notion of killing should be analyzed from a philosophical point of view. People that say that the doctors killed Marie make an error of causation, because it is not the doctors that killed Marie but the disease. Daniel Callahan in ‘‘When self-determination runs amok argues that the argument endorsed by people that death is caused by the doctor’s rest on a mistake about causation’’(Fisher, 2018, p.331)11. In the Callahan view, the doctor does not cause her death. Instead, the doctors return the patient to the state of having an untreated disease condition, which causes her death since Marie has cancer. Thus, I Strongly believe physicians act in the patient’s best interest when performing euthanasia because they respect the patient as a human being. Also, there is not one only way of dying with dignity, which is the reason I embrace the concept of cultural relativism that states: ‘‘what is morally right is determined by whatever determined moral standards a culture endorses. So, our goal here is to give the freedom of choice so people can choose to have euthanasia or not’’ (Fisher, 2018, p.3)12. Therefore, saying euthanasia is a bad thing is also not respecting some cultures because the end-of-life decision making is based on one’s culture. Hence, our medical system wants to provide these choices because I do not believe in strong paternalism and interfering with Marie's decision would be a strong paternalism decision for a physician. As previously stated, I argue in this text for autonomy and dying with dignity. Some people might say there is no dignity in giving up and the fact that we allow euthanasia would lead to a painful experience for the relatives of the dying person. I do not deny that the family will face a lot of pain when they know that the euthanasia is imminent death. However, we must look at things not from the family lens but from the lens of the patient. The patient is suffering, and they are in bed, and they ask for euthanasia. Are we going to have compassion and let them die with dignity or are we going to say we will refuse them euthanasia because his family will suffer emotionally. The end-of-life decision making is not an easy subject, so we must do what is ethical and reasonable. I think that allowing euthanasia under certain conditions is ethical because all our decisions should be holistic and the patient should be the winner at the end of the day. In this situation, the fact that we prioritize the autonomy and dignity of the patient shows us that our decision is ethical and reasonable.
Finally, I strongly recommend that patients should be given an option to ask for euthanasia when specific conditions are met. Based on the requirements previously mentioned, I believe that all euthanasia should be performed in the patients’ best interest. Firstly, I believe that patients should be given an option to ask for euthanasia because their autonomy should be respected. Secondly, I believe that our healthcare system should allow all patients to die with dignity. There are also reasons to oppose this view. For example, some people might argue that euthanasia will cause a lot of abuse. I refuted these arguments based on the conditions of euthanasia requirements in place. Also, I believe in the palliative units in all hospitals in Canada, our physicians and nurses have been doing a great job accompanying a lot of people during the end their life. Euthanasia became legal in Canada in 2015 (Fisher, 2018, p.8)13. and the legislation regulating it was passed in 2016. We want a medical system based on compassion. As we see in this class throughout the semester, applied ethics is the application of moral theories, principles, and ideas to specific moral problems. (Fisher, 2018, p.7)14 In this text, we are dealing with End-of-life-decision-making, and we have seen that the patient's interest should always be the center of our decision. I think we should continue with the actual policy we have now in Canada because it prevents people from unnecessary suffering. Also, I do not want to say that our medical system is perfect in terms of evaluating and performing euthanasia, but I think that there is room for improvement. However, I strongly believe that preventing people from having access to euthanasia would cause more harm. Therefore, the status quo in our law regarding euthanasia is the best decision after evaluating the current information we have at our disposal.
Works cited
1- Fisher, Russell, Browne and Burkholder. 2018. Biomedical Ethics, A Canadian Focus (3rd edition) Oxford university press.
2- Ibid 3- Ibid 4- Ibid
5- Ibid
6- Ibid 7- Ibid 8- Ibid
9- Ibid 10- Ibid
11- Ibid
12- Ibid
13- Ibid
14- Ibid
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