Annotate Bibliography: Euthanasia and Physician-Assisted Suicide
Euthanasia and Physician-Assisted Suicide
Euthanasia and physician-assisted suicide (PAS) are two emotive and controversial issues. While these practices are legal in some American states and a few countries across the world, they remain illegal in most parts of the globe. Debates regarding the practices often revolve around ethical issues. This paper reviews some of these ethical issues and evaluates them using Kantian ethics. Additionally, it provides an annotated bibliography of relevant articles that give more insight into the topic.
Personal and Communal Ethical Factors
There are certainly personal and communal ethical factors that may be involved in determining the moral position of either side in that debate. First, there is autonomy. This refers to the ability of an individual to make an informed decision without being coerced or under the influence of desires. Second, there is capacity. This refers to an individual’s competence or his/her ability to comprehend and do something. Finally, there is the law. This refers to the set of rules that regulate or govern the actions of society. These three factors are vital in determining the morality of PAS and euthanasia. A person must have the autonomy and capacity to make a sound decision regarding ending his/her life. If he/she is incapacitated, his/her family and physicians must have the capacity to decide on his/her behalf (Cipriani & Di Fiorino, 2019). In both cases, the action of ending life must only occur if the law allows it.
Articulation and Evaluation of the Ethical Positions Using Kantian Ethics
The Categorical Imperative from Kantian ethics applies to the ethical issues described above. The Categorical Imperative states, “Act only according to that maxim by which you can at the same time will that it should become a universal law” (Rachels & Rachels, 2019). Therefore, when determining whether euthanasia and PAS are morally acceptable, the concepts of autonomy, capacity, and the law must be considered. However, Kantian ethics takes a relatively rigid approach to issues. Therefore, based on the Categorical Imperative, the support for euthanasia and PAS can either be fully supported or completely ignored. There is no flexibility for some people to use it and others not to use it.
Cholbi, M. (2015). Kant on euthanasia and the duty to die: Clearing the air. Journal of Medical Ethics, 41(8), 607-610.
In this article, Cholbi (2015) presents an argument against two radical views, which apply Kantian ethics to support the morality of suicide. Both of these views on suicide focus on patients with “dementia” and the “duty to self.” “Dementia” refers to the loss of thinking abilities, problem-solving capacity, and memory to the extent that one can no longer carry on daily-life activities effectively. “Duty to self” refers to the preservation of one’s own life with the objective of maintaining his self-respect and abilities. The first radical view asserts that individuals with dementia should commit suicide before the disease eradicates their status of being moral agents. Cholbi (2015) argues against this point by stating that this view “wrongly assumes that rational agents’ duty of self-preservation entails a duty of self-destruction when they become non-rational” (p. 607).
The second radical view asserts that any person with present or future dementia should be forced to commit euthanasia. Cholbi (2015) argues against this point by stating that this view “neglects Kant’s distinction between duties to self and duties to others” (p. 607). I agree with the assertions of the author because the radical views make a wrong assumption by perceiving the lack of dignity or assistance is a reason that makes one obligated to commit suicide. This article is important because it reveals how society has an indirect duty to make moral decisions on behalf of an individual who is no longer rational. This is because Kantian ethics is about adopting laws, which one would want to be universal.
De Lima, L., Woodruff, R., Pettus, K., Downing, J., Buitrago, R., Munyoro, E., … & Radbruch, L. (2017). International association for hospice and palliative care position statement: Euthanasia and physician-assisted suicide. Journal of Palliative Medicine, 20(1), 8-14.
In this article, De Lima et al. (2017) discuss the responsibility of health professionals in facilitating euthanasia and PAS in “palliative care.” “Palliative care” refers to the specialized healthcare given to individuals with serious or terminal illnesses. In the article, De Lima et al. (2017) note that in the territories that have legalized euthanasia and PAS, there are no provisions to exclude health care practitioners who do not support these practices from taking part in them. To this end, De Lima et al. (2017) argue that “palliative care units should not be responsible for overseeing or administering euthanasia and PAS” (p. 8). Instead, the authors feel that the relevant regulations should have special provisions, which allow healthcare practitioners who do not support euthanasia and PAS to excuse themselves from participating in such practices.
I disagree with the authors’ arguments in this regard. I feel that all healthcare practitioners should be subjected to the same regulations and laws. Creating special provisions to excuse others from taking part in euthanasia and PAS will create other problems in the future. For instance, when it comes to abortion, healthcare practitioners who do not support this practice on moral grounds will also want to be excused from the practice. This article is important because it reveals the moral dilemma that healthcare practitioners face when carrying out their duties and have to carry out practices that they do not support. It also shows the need to tighten regulations to ensure euthanasia and PAS are guided by strict regulations that cannot be easily abused.
Jordan, M. (2017). The ethical considerations of physician-assisted suicide. Dialogue & Nexus, 4(1), 1-12.
In this article, Jordan (2017) gives a comprehensive discussion about PAS in the context of three ethical points. First, there is “utilitarianism,” which refers to the philosophy of maximizing happiness and pleasure while minimizing unhappiness and harm. Second, there is “Kantian deontology’” which refers to strict adherence to moral rules in a manner that likens it to universal law. Finally, there is “virtue ethics,” which define a moral person through his/her good habits.
Jordan (2017) perceives the topic of PAS through her Christian beliefs. Consequently, she takes a position against PAS by using virtue ethics to assert her position. She feels that Kantian deontology and utilitarianism have certain qualities, which do not align with her Christian beliefs. This is why she supports virtue ethics by stating “As a Christian, I believe that our virtues cause us to act, and I believe that these virtues are given to each of us from God in the form of the Holy Spirit” (Jordan, 2017, p. 6). I disagree with the author’s conclusion since her beliefs make her biased. She acknowledges that she is inclined to support virtue ethics because it supports her beliefs. Nevertheless, this article is important because it reveals the pros and cons of the three ethics theories concerning the topic of PAS.
Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., … & Janke, R. (2020). Nursing and euthanasia: A narrative review of the nursing ethics literature. Nursing Ethics, 27(1), 152-167.
In this article, Pesut et al. (2020) conduct a comprehensive literature review of various articles with ethical arguments on the issue of euthanasia. The objective of the review is to find out how ethical arguments relate to nursing practice. One vital element explored by the authors is the “nurse-patient relationship,” which refers to the interaction between a client and a nurse to improve the well-being and healthcare outcomes of the former. In the article, Pesut et al. (2020) assert that “many of the arguments reviewed were not nursing-specific, but rather are relevant across healthcare disciplines” (p. 153). The authors perceive this as a problem since issues to do with euthanasia should consider the nursing context when discussing morality and ethics because nurses hold the primary responsibility of taking care of patients during palliative care.
I agree with the author’s conclusion. I feel that in the debate regarding the ethics and morality of euthanasia, more argument and research should be made with a focus on the nature of nurse-patient relationships. Nurses are at the forefront of facilitating healthcare services to patients. They are the ones who form deeper bonds with the patients compared to other healthcare practitioners. Therefore, when discussing the issue of euthanasia, their perceptions on the issue should be given careful consideration. This article is important in revealing the current gaps in the literature with regards to the debate on the morality of euthanasia. It is informative as it gives a new dimension to the debate and encourages more research to be conducted on the topic.
Snyder, L., & Mueller, P. S. (2017). Ethics and the legalization of physician-assisted suicide: An American College of Physicians position paper. Annals of Internal Medicine, 167(8), 576-578.
In this article, Snyder and Mueller (2017) discuss the issues of ethics and legalization of PAS in the context of the American College of Physicians. There are two vital aspects of this discussion. First, there is “autonomy,” which refers to the ability of an individual to make an informed decision without being coerced or under the influence of desires. Second, there is the “patient-physician relationship,” which refers to the interaction between a client and a healthcare practitioner to improve the well-being and healthcare outcomes of the former. Snyder and Mueller (2017) argue against the legalization of PAS by asserting that assisted suicide is problematic since it “affects trust in the patient-physician relationship and the profession, and fundamentally alters the medical profession’s role in society” (p. 576).
I disagree with the authors’ opinion because I feel that their position is one-dimensional. It only focuses on the comfort of the physicians and ignores the wishes of the patients. It checks on the negative aspect of PAS on the patient-physician relationship while ignoring the autonomy of the patient. However, this is an important article because it reveals the difficulties that physicians go through when carrying out PAS.
Cholbi, M. (2015). Kant on euthanasia and the duty to die: Clearing the air. Journal of Medical Ethics, 41(8), 607-610. https://www.citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.829.4850&rep=rep1&type=pdf
Cipriani, G., & Di Fiorino, M. (2019). Euthanasia and other end of life in patients suffering from dementia. Legal Medicine, 40, 54-59. https://www.researchgate.net/profile/Gabriele_Cipriani1/publication/334645744_Euthanasia_and_other_end_of_life_in_patients_suffering_from_dementia/links/5d3807f3a6fdcc370a5a3fa2/Euthanasia-and-other-end-of-life-in-patients-suffering-from-dementia.pdf
De Lima, L., Woodruff, R., Pettus, K., Downing, J., Buitrago, R., Munyoro, E., & Radbruch, L. (2017). International association for hospice and palliative care position statement: Euthanasia and physician-assisted suicide. Journal of Palliative Medicine, 20(1), 8-14. https://www.liebertpub.com/doi/pdfplus/10.1089/jpm.2016.0290?cookieSet=1
Jordan, M. (2017). The ethical considerations of physician-assisted suicide. Dialogue & Nexus, 4(1), 12. https://digitalcommons.acu.edu/cgi/viewcontent.cgi?article=1049&context=dialogue
Pesut, B., Greig, M., Thorne, S., Storch, J., Burgess, M., Tishelman, C., & Janke, R. (2020). Nursing and euthanasia: A narrative review of the nursing ethics literature. Nursing Ethics, 27(1), 152-167. https://journals.sagepub.com/doi/pdf/10.1177/0969733019845127
Rachels, S., & Rachels, J. (2019). The elements of moral philosophy (9th ed.). Mcgraw-Hill Education.
Snyder, L., & Mueller, P. S. (2017). Ethics and the legalization of physician-assisted suicide: An American college of physicians position paper. Annals of Internal Medicine, 167(8), 576-578. https://www.acpjournals.org/doi/full/10.7326/M17-0938