Medical Ethics

Physician-assisted suicide refers to the physician acting indirectly in the death of the patient -- providing the means for death. The ethics of PAS is a continually debated topic. The range of arguments in support and opposition of PAS are vast. Justice, compassion, the moral irrelevance of the difference between killing and letting die, individual liberty are many arguments for PAS. The distinction between killing and letting die, sanctity of life, "do no harm" principle of medicine, and the potential for abuse are some of the arguments in favor of making PAS illegal. However, self-determination, and ultimately respect for autonomy are relied on heavily as principle arguments in the PAS issue.

Daniel Callahan, author of When Self-Determination Runs Amok, is against any social policy that would allow for PAS to be practiced. Callahan believes that the argument for PAS does not have a firm foundation, because self-determination and mercy, the two principles that are in support of PAS, may become separated (711). If mercy is seen as a core element in support of PAS, why restrict PAS only to those who can ask for it -- don't the unconscious or incompetent deserve mercy also?

Callahan is in opposition to the belief that the essence of human dignity is the notion that a person should be free to choose how and when they want to die. Callahan questions the absolute nature of autonomy and self-determination and the extent to which these values can be applied. Self-determination by definition entails human freedom of action and respect for persons but those in support of PAS want it to be restricted to those who are terminally ill. Human suffering and an individual‘s outlook on the quality of their life, are, in Callahan’s opinion, subjective and there is no one standard to compare individual suffering. If we just focus on autonomy/self-determination, why restrict PAS only to those who are terminally ill and competent? Are the incompetent less deserving of relief from suffering than the those competent individuals? If physician-assisted suicide is legally permitted yet restricted to the terminally ill adult with full decision-making capacity, it will certainly raise legal concerns about discrimination. PAS will probably broaden to include incompetent, non-consenting, and non–terminally ill persons. The final extreme of the slippery slope argument is that PAS will be abused, run amok and ultimately become involuntary euthanasia.

Physician-assisted suicide refers to the physician acting indirectly in the death of the patient -- providing the means for death.