Conceptual, Legal, and Ethical Considerations in Physician-Assisted Suicide: An Overview
DOI:
https://doi.org/10.32890/uumjls2024.15.2.12Keywords:
Assisted suicide, legal perspective, ethical consideration, end-of-life practicesAbstract
Physician-assisted suicide (PAS) remains a contentious and highly debated topic within medical, legal, and ethical spheres. The complex issue of (PAS) raises significant inquiries regarding patient autonomy and societal norms. Ambiguities in conceptual, legal, and ethical aspects impede policy formulation, leading to unequal access and apprehensions about patient welfare and confidence. This article provides a thorough examination of assisted suicide, exploring its legal, ethical, and medical dimensions. It aims to facilitate informed dialogue and stimulate further investigation into the legal framework and ethical considerations surrounding this contentious issue. Through a library-based research approach and qualitative analysis of existing literature, this study delves into the diverse facets of assisted suicide. The article begins with a definition and contextualisation of assisted suicide, distinguishing it from related end-of-life practices. It then delves into the legal landscape, discussing different legal frameworks and regulations across various jurisdictions, and significant legal cases that have shaped the current discourse. From an ethical standpoint, this article explores the ethical considerations involved in assisted suicide, including autonomy, dignity, and the sanctity of life, and presents the perspectives of different stakeholders. The medical perspective examines the role of healthcare professionals, the criteria for assisted suicide, and empirical research on its effectiveness and safety. Realworld case studies are presented to illustrate the complexities of assisted suicide. Furthermore, this article analyses public opinion and ongoing debates on the topic. Ultimately, this analysis aims to provide readers with a comprehensive understanding of assisted suicide, fostering informed discussions and encouraging further exploration of this contentious issue.
References
Akdeniz, M., Yardimci, B., & Kavukcu, E. (2021). Ethical consider-ation at the end-of-life care. SAGE Open Med, 9. https://www. ncbi.nlm.nih.gov/pmc/articles/PMC7958189/
AMA Council on Ethical and Judicial Affairs. (2014). AMA Code of medical ethics’ opinions on assisted reproductive technology. AMA Journal of Ethics, 16(1), 30–33. https://doi.org/10.1001/ virtualmentor.2014.16.1.coet1-1401
Appel, J. E., & Van Wijngaarden, E. J. (2021). Older adults who ex-perience their lives to be completed and no longer worth living: A systematic mini-review into used terminology, definitions, and interpretations. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.734049
Ashford, J. (2021, September 22). Countries where euthanasia is le-gal. The Week UK. https://www.theweek.co.uk/102978/coun-tries-where-euthanasia-is-legal
Asscher, E. C. A., & Vam de Vathorst, S. (2020). First prosecution of a Dutch doctor since the Euthanasia Act of 2002: What does the verdict mean? Journal of Medical Ethics, 46(2), 71–75. https://doi.org/10.1136/medethics-2019-105877
Bakewell, F. (2016, June). Medical Assistance in Dying (MAID). Ca-nadiEM Online Community of Practice for Canadian EM Phy-sicians. https://canadiem.org/medical-assistance-dying/
Barrow, J. M., & Khandhar, P. B. (2023, August 8). Deontology. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/ NBK459296/
BBC. (2014). BBC – Ethics Guide – Euthanasia: Anti-euthanasia arguments. BBC. https://www.bbc.co.uk/ethics/euthanasia/ against/against_1.shtml
BBC. (2020, October 14). Netherlands backs euthanasia for termi-nally ill children under-12. BBC News. https://www.bbc.com/ news/world-europe-54538288
BBC. (2022, January 1). New law allowing assisted suicide takes ef-fect in Austria. BBC News. https://www.bbc.com/news/world-europe-59847371
Blackwell, T. (2011) 67% of Canadians support legalizing assided suicide: poll. Toronto Sun. https://torontosun.com/news/ canada/67-of-canadians-support-legalizing-assisted-suicide-poll
Braun, E. (2022). An autonomy-based approach to assisted suicide: A way to avoid the expressivist objection against assisted dying laws. Journal of Medical Ethics, 49(7). https://doi.org/10.1136/ jme-2022-108375
Breitbart, W. (2012). The physician’s role in physician-assisted sui-cide. Palliative and Supportive Care, 10(4), 237–239. https://doi.org/10.1017/s1478951512000752
Brenan, M. (2018, May 31). Americans’ strong support for eutha-nasia persists. Gallup. https://news.gallup.com/poll/235145/ americans-strong-support-euthanasia-persists.aspx
Chan, B., & Somerville, M. (2016). Converting the “Right to Life” to the “Right to Physician-Assisted Suicide and Euthanasia”: An analysis of Carter v Canada (Attorney General), Supreme Court of Canada. Medical Law Review, 24(2), 143–175. https://doi.org/10.1093/medlaw/fww005
Childress, S. (2012, November 13). The evolution of America’s right-to-die movement. Frontline. PBS. https://www.pbs.org/wgbh/ frontline/article/the-evolution-of-americas-right-to-die-move-ment
Chu, M. (2023). Malaysia seeks to decriminalize suicide attempts. Reuters. https://www.reuters.com/world/asia-pacific/malaysia-seeks-decriminalise-suicide-attempts-2023-04-04/
Clark, D. (2016, March 30). Palliative care or assisted dying? We just need to start talking more about “the right to die well”. The Conversation. http://theconversation.com/palliative-care-or-assisted-dying-we-just-need-to-start-talking-more-about-the-right-to-die-well-56258
Clay, R. (2018). The cultural distinctions in whether, when and how people engage in suicidal behavior. American Psychological Association, 49(6), 28.
Colburn, B. (2019). Autonomy, voluntariness and assisted dying. Journal of Medical Ethics, 46(5). https://doi.org/10.1136/me-dethics-2019-105720
Cook, C. C. H. (2014). Suicide and religion. British Journal of Psychiatry, 204(4), 254–255. https://doi.org/10.1192/bjp. bp.113.136069
Davis, N. (2019, July 15). Euthanasia and assisted dying rates are soaring. But where are they legal? The guardian. http://www. theguardian.com/news/2019/jul/15/euthanasia-and-assisted-dying-rates-are-soaring-but-where-are-they-legal
Dugdale, L. S., Lerner, B. H., & Callahan, D. (2019). Pros and cons of physician aid in dying. The Yale Journal of Biology and Medicine, 92(4), 747–750. https://pubmed.ncbi.nlm.nih. gov/31866790/
Edgman-Levitan, S., & Schoenbaum, S. C. (2021). Patient-centered care: Achieving higher quality by designing care through the patient’s eyes. Israel Journal of Health Policy Research, 10(1), 1–5. https://doi.org/10.1186/s13584-021-00459-9
Eleftheriou-Smith, L.-M. (2014, November 5). “Goodbye world” writes terminally ill Brittany Maynard as she chooses to end her life. The Independent. https://www.independent.co.uk/ news/people/brittany-maynard-dead-terminally-ill-cancer-pa-tient-ends-life-by-assisted-suicide-9834808.html
Erdek, M. (2015). Pain medicine and palliative care as an alater-native to euthanasia in end-of-life cancer care. Linacre Q, 82(2), 128-134. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4434784/
Euthanasia in Belgium, the Netherlands and Luxembourg. (2013). Prescrire International, 22(143), 274–278. https://pubmed. ncbi.nlm.nih.gov/24427846/
Fontalis, A., Prousali, E., & Kulkarni, K. (2018). Euthanasia and assisted dying: What is the current position and what are the key arguments informing the debates? J R Soc Med, 111(11), 407–413. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6243437/
Ganzini, L., Nelson, H. D., Schmidt, T. A., Kraemer, D. F., De-lorit, M. A., & Lee, M. A. (2000). Physicians’ experiences with the oregon death with dignity Act. New England Jour-nal of Medicine, 342(8), 557–563. https://doi.org/10.1056/ nejm200002243420806
Gerson, S. M., Koksvik, G. H., Richards, N., Materstvedt, L. J., & Clark, D. (2019). The relationship of palliative care with assist-ed dying where assisted dying is lawful: A systematic scoping review of the literature. Journal of Pain and Symptom Manage-ment. https://doi.org/10.1016/j.jpainsymman.2019.12.361
GOC. (2016, June 16). Medical Assistance in Dying. Government of Canada. https://www.canada.ca/en/health-canada/services/ health-services-benefits/medical-assistance-dying.html
GOC. (2016). Introduction - Brief Summary of Carter v. Canada. Government of Canada. https://www.justice.gc.ca/eng/rp-pr/ other-autre/ad-am/p1.html
GOC. (2021, March 17). Canada’s New Medical Assistance in Dy-ing (MAID) law. Government of Canada. https://www.justice. gc.ca/eng/cj-jp/ad-am/bk-di.html
Goligher, E. C., Ely, E. W., Sulmasy, D. P., Bakker, J., Raphael, J., Volandes, A. E., Patel, B. M., Payne, K., Hosie, A., Churchill, L., White, D. B., & Downar, J. (2019). Physician-assisted sui-cide and euthanasia in the ICU. Critical Care Medicine, 45(2), 149–155. https://doi.org/10.1097/ccm.0000000000001818
Grove, G., Lovell, M., & Best, M. (2022). Perspectives of major world religions regarding euthanasia and assisted suicide: A compara-tive analysis. Journal of Religion and Health, 61(6). https://doi.org/10.1007/s10943-022-01498-5
Guarascio, F. (2016, September 17). 17-year-old is first minor to be granted euthanasia in Belgium. Reuters. https://www.reuters. com/article/us-belgium-euthanasia-minor-idUSKCN11N09P
Guillod, O., & Schmidt, A. (2005). Assisted suicide under swiss law. European Journal of Health Law, 12, 25-38. https://www.jstor. org/stable/45442698
Hetzler, P. T., Nie, J., Zhou, A., & Dugdale, L. S. (2019). A report of physicians’ beliefs about physician-assisted suicide: A national study. The Yale Journal of Biology and Medicine, 92(4), 575–585. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6913834/
Ho, H. (2020). Suicide prevention in Brunei. BJPsych Internation-al, 17(2), 40-42. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC7283118/
Hofstra, E., Van Nieuwenhuizen, C., Bakker, M., Özgül, D., Elfed-dali, I., De Jong, S. J., & Van der Feltz-Cornelis, C. M. (2019). Effectiveness of suicide prevention interventions: A systematic review and meta-analysis. General Hospital Psychiatry, 63, 127-140. https://doi.org/10.1016/j.genhosppsych.2019.04.011
Huffman, J. C., & Stern, T. A. (2003). Compassionate care of the ter-minally Ill. The Primary Care Companion to the Journal of Clinical Psychiatry, 5(3), 131–136. https://doi.org/10.4088/ pcc.v05n0305
Kamalruzaman, M. S., Jafri, N. I., Nuing, D. B. (2022). Euthanasia and advanced Medical directives in the perspective of ethical, moral, religious and legal issues in Malaysia and under com-mon law. Current Legal Issue, 4, 97-121. https://journalarticle. ukm.my/18547/1/ARTIKEL%208.pdf
Keown, J. (2005). Euthanasia, ethics and public policy: An argument against legalisation. Cambridge University Press.
Kletečka-Pulker, M., Völkl-Kernstock, S., A Atanasov, Doppler, K., Eitenberger, M., Gabriel, M., Klager, E., Klomfar, S., Teufel, A., & Ruf, A.-K. (2022). Views on assisted suicide and reli-gious beliefs. OMEGA - Journal of Death and Dying. https://doi.org/10.1177/00302228221133895
Lewis, P. (2015, October 6). Assisted dying: What does the law in dif-ferent countries say? BBC News. https://www.bbc.com/news/ world-34445715
Matthews, S. (2022, May 11). An evidence-based approach to As-sisted Dying. King’s College London. https://www.kcl.ac.uk/ news/spotlight/an-evidence-based-approach-to-assisted-dying
McMorrow, T. (2018). MAID in Canada?. Debating the Constitu-tionality of Canada’s new medical assistance in dying law. Queen’s LJ, 44(1), 69. https://papers.ssrn.com/sol3/papers. cfm?abstract_id=3318824
McQuillan, S. (2020, September 16). Arguments for and against phy-sician-assisted suicide. psychology today. https://www.psy-chologytoday.com/us/blog/cravings/202009/arguments-and-against-physician-assisted-suicide
Mroz, S., Dierickx, S., Deliens, L., Cohen, J., & Chambaere, K. (2021). Assisted dying around the world: a status quaestionis. Annals of Palliative Medicine, 9(6), 57–57. https://doi.org/10.21037/ apm-20-637
Muhammad, N., & Baihaqy, H. (2021) MIB and Islamic education in Brunei Darussalam: An overview. Globalisation, Educa-tion and Reform in Brunei Darussalam, 85-103. https://doi.org/10.1007/978-3-030-77119-5_5
National Cancer Institute. (2021, November 1). Palliative Care in Cancer. National Cancer Institute https://www.cancer.gov/ about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet
National Council on Disability. (2019, October 9) Federal study finds nation’s assisted suicide laws rife with dangers to people with disabilities. NCD.gov https://www.ncd.gov/2019/10/09/ federal-study-finds-nations-assisted-suicide-laws-rife-with-dangers-to-people-with-disabilities/
National Health Service. (2020, July 28). Euthanasia and Assisted Suicide. NHS. https://www.nhs.uk/conditions/euthanasia-and-assisted-suicide/
Oregon Health Authority. (2010). Oregon Health Authority: Oregon Revised Statute: Oregon’s Death with Dignity Act: Death with Dignity Act: State of Oregon. Oregon.gov. https://www.oregon. gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALU-ATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/ors. aspx
Pereira, J. (2011). Legalizing euthanasia or assisted suicide: The il-lusion of safeguards and controls. Current Oncology (Toronto, Ont.), 18(2), e38-45. https://www.ncbi.nlm.nih.gov/pmc/ar-ticles/PMC3070710/
Pesut, B., Thorne, S., Greig, M., Fulton, A., Janke, R., & Vis-Dunbar, M. (2019). Ethical, policy, and practice implica-tions of nursesʼ experiences with assisted death. Advances in Nursing Science, 42(3), 216–230. https://doi.org/10.1097/ ans.0000000000000276
Pew Research Centre. (2006, February 1). Supreme Court’s Decision in Gonzales v. Oregon: High Court Rejects Federal Regula-tion of Physician-Assisted Suicide. Pew Research Center’s Religion & Public Life Project. https://www.pewresearch.org/ religion/2006/02/01/supreme-courts-decision-in-gonzales-v-oregon-high-court-rejects-federal-regulation-of-physician-as-sisted-suicide/
Pew Research Centre. (2013). Religious Groups’ Views on End-of-Life Issues. Pew Research Centre’s Religion & Public Life Project. https://www.pewresearch.org/religion/2013/11/21/religious-groups-views-on-end-of-life-issues/
Picón-Jaimes, Y. A., Lozada-Martinez, I. D., Orozco-Chinome, J. E., Montaña-Gómez, L. M., Bolaño-Romero, M. P., Moscote-Salazar, L. R., Janjua, T., & Rahman, S. (2022). Euthanasia and Assisted suicide: An in-depth review of relevant historical aspects. Annals of Medicine and Surgery, 75, 103380. https://doi.org/10.1016/j.amsu.2022.103380
Purvis, T. E. (2012). Debating death: Religion, politics, and the or-egon death with dignity act. The Yale Journal of Biology and Medicine, 85(2), 271–284. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3375669/
Rathnor, M. Y., Shahar, M. A., Abdul Rani, M. F., Che Abdullah, S. T., Jamalludin, A. R., Mohamad Shah, A. S., & Omar, A. M. (2014). Attitudes toward euthanasia and related issues among physicians and patients in a multi-cultural society of Malaysia. Journal of Family Medicine and Primary Care, 3(3), 230-237. https://doi.org/10.4103/2249-4863.141616
Rietjens, J. A., Raijmakers, N. J., Kouwenhoven, P. S., Seale, C., van Thiel, G. J., Trappenburg, M., van Delden, J. J., & van der Heide, A. (2013). News media coverage of euthanasia: A content analysis of Dutch national newspapers. BMC Medical Ethics, 14(1). https://doi.org/10.1186/1472-6939-14-11
Rome, R. B., Luminais, H. H., Bourgeois, D. A., & Blais, C. M. (2011). The role of palliative care at the end of life. The Och-sner Journal, 11(4) 348-352 https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3241069/
Ruijs, C. D., Van der Wal, G., Kerkhof, A. J., & Onwuteaka-Philipsen, B. D. (2014). Unbearable suffering and requests for euthanasia prospectively studied in end-of-life cancer patients in primary care. BMC Palliative Care, 13(1). https://doi.org/10.1186/1472-684x-13-62
Salihu, S, I., Yusof, Y., & Halim, R. (2017) Legal application of the offence of murder and euthanasia in Nigeria. UUM Journal of Legal Studies, 8, 113-132. https://e-journal.uum.edu.my/index. php/uumjls/article/view/uumjls.8.2017.4646
Sathya, C. (2013, December 2). Docs offside on physician-assisted suicide: Majority of doctors do not want to take part in eu-thanasia. CBC News. https://www.cbc.ca/news/health/docs-offside-on-physician-assisted-suicide-1.2448089
Scopetti, M., Morena, D., Padovano, M., Manetti, F., Di Fazio, N., Delogu, G., Ferracuti, S., Frati, P., & Fineschi, V. (2023). As-sisted suicide and euthanasia in mental disorders: Ethical po-sitions in the debate between proportionality, dignity, and the right to die. Healthcare, 11(10), 1470. https://doi.org/10.3390/ healthcare11101470
Shoichet, C. E. (2014, November 3). “Death with Dignity” advocate dies at 29. CNN. https://www.cnn.com/2014/11/02/health/ore-gon-brittany-maynard/index.html
Sjöstrand, M., Helgesson, G., Eriksson, S., & Juth, N. (2011). Auton-omy-based arguments against physician-assisted Suicide and euthanasia: A critique. Medicine, Health Care and Philosophy, 16(2), 225–230. https://doi.org/10.1007/s11019-011-9365-5
Smith, W. J. (1999, February 15). The Profit of Hemlock. Washing-ton Examiner. https://www.washingtonexaminer.com/weekly-standard/the-profit-of-hemlock
Sultana, A., Tasnim, S., Sharma, R., Pawar, P., Bhattcharya, S., & Hossain, M. M. (2021). Psychosocial challenges in palliative care: Bridging the gaps using digital health. Indian Journal of Palliative Care, 27(3), 442–447. https://doi.org/10.25259/ ijpc_381_20
The Government of the Grand Duchy of Luxembourg. (2012, Sep-tember 4). Information on Requesting Euthanasia or Assisted Suicide, Information on requesting euthanasia or assisted sui-cide. Guichet.lu. https://guichet.public.lu/en/citoyens/sante/ fin-vie/euthanasie.html
Tseng, P-E., & Wang Y-H. (2021). Deontological or utilitarian? An eternal ethical dilemma in outbreak. International Journal of Environmental Research and Public Health, 18(16), 8565. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391290/
U.S. Supreme Court (1990). Cruzan v. Director, Missouri Department of Health. West’s Supreme Court reporter, 110, 2841–2892. https://pubmed.ncbi.nlm.nih.gov/12041283/
Van Niekerk, A. (2016, October 25). We have a right to die with dig-nity. The medical profession has a duty to assist. The Conversa-tion. http://theconversation.com/we-have-a-right-to-die-with-dignity-the-medical-profession-has-a-duty-to-assist-67574
Veenhoven, R. (2010). Greater happiness for a Greater number: Is that possible and desirable? J Happiness Stud, 11, 60-629. https://doi.org/10.1007/s10902-010-9204-z
Vilpert, S., Bolliger, E., Borrat-Besson, C., Borasio, G. D., & Maurer, J. (2020). Social, cultural and experiential patterning of atti-tudes and behaviour towards assisted suicide in Switzerland: Evidence from a national population-based study. Swiss Medi-cal Weekly, 150 2526. https://doi.org/10.4414/smw.2020.20275
WHO. (2020, August 5). Palliative Care. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/palliative-care
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