Debate: The Right to die VS The Right to Life

Physician-assisted suicide has risen to salience as one of the present day’s most important social, legal and political questions. According to the Pew Research Center sixty to seventy percent of Americans support the legalization of doctor-assisted suicide (Lipka, pewresearch.org). Despite this overwhelming support, assisted suicide is only legal in five American states. In addition to growing public interest, the increasing strain on America’s healthcare resources makes assisted suicide a relevant topic for examination. Although obtaining specific information on PAS patients is difficult due to its generally secretive nature of operations, available data enable us to test arguments both for and against assisted suicide. The right to death is an important extension of the right to liberty because it enables human beings to escape the pain, misery, and indignity of terminal illness; on the other hand, opponents of doctor-assisted suicide argue that it goes against the constitutional right to life and opens the door to unsanctioned killings.
The ‘Right to die’ school of thought argues that it is immoral to compel rational and mentally competent human beings to bear severe pain and indignity at the end of their lives. According to the Human beings should be allowed the autonomy to decide when and how they perish. While many people oppose physician-assisted suicide on ethical or legal basis, advocates of PAS assert that it is improper to argue against a position on personal ethical and religious grounds. Opponents of PAS argue that it creates pressure upon insurance companies and patients’ relations to deny potentially life-saving treatment for pecuniary reasons. Empirical analysis shows no evidence to support this hypothesis. Opponents also believe that PAS enables interested parties to influence patients’ suicide decisions. Yet again, no empirical evidence supports this assertion. The findings of this report are relevant to policymakers and the public as they help illuminate the less straightforward elements of the PAS debate.
Patient autonomy
Patient autonomy is one of the defining elements of the PAS movement. Patient autonomy refers to a patient’s ability to make critical decisions regarding their health and/or course of life without dictation from the state, family, or medical professionals. Advocates of patient autonomy forward the ethical premise that an ailing person should be free to choose the course that he/she deems most suitable for their circumstances. This course may include requesting a doctor to terminate his/her life if the patient deems the costs of continued existence unbearable. In this context, the patient’s exercise of autonomy can be seen as an extension of the construct of informed ‘consent’. Informed consent refers to the provision in medical ethics that a patient is free to refuse treatment even if, in the doctor’s opinion, receiving said treatment is the best course of action available. Inherent in ‘informed consent’ is the notion that the patient has the final word, despite the doctor’s opinion. Informed consent offers patients protection against abuse and misinformation by medical professionals. In the past, physicians were able to use their patients as guinea pigs. For example, physicians misled syphilis patients into rejecting treatment to observe the progression of the disease (Cardozo 126-129). Proponents of PAS argue that the scope of patient autonomy includes the question of life and death itself, allowing patients not just the right to forgo unwanted treatment, but also to forgo life itself. The AMA Code of Medical Ethics further lends weight to the argument from autonomy. In opinion 2.2, it states that where a conflict arises between the duty to preserve life and the duty to respect the patient’s autonomy, the latter shall prevail over the former (Laura & Liang 5-8). In the case of terminally ill patients, this means that physicians should subjugate their life-preserving duties to the preferences of their patients.
Opponents of PAS, while acknowledging the moral integrity of patient autonomy, reject the premise that it should extend to the question of life and death. The Hippocratic Oath, they say, expressly forbids doctors to harm their patients. They contend that physician-assisted suicide runs counter to the Hippocratic Oath and is therefore unethical (Snyder & Sulmasy 214-215). Proponents of PAS counter that the Hippocratic Oath does not preclude PAS. According to them, failing to relieve pain and suffering for terminally ill patients constitutes a form of harm, and is itself a violation of the Hippocratic Oath (Singer 524). Opponents of the patient autonomy argument for PAS also argue that PAS puts too much power in the hands of physicians. Although the decision to terminate the patient’s life is theoretically reserved for the patient, doctors carry immense power to influence patient decisions through direct or indirect manipulation. The asymmetrical information that exists between doctors and patients means that doctors could present misleading or incomplete information to patients, leading them to make decisions that do not tally with the real facts about their health (Cardozo 124). The problem of asymmetrical information is further compounded by the general secrecy within which doctor-assisted suicide takes place. Drawing on the experiences of Oregon- where PAS is legal- Golden & Zoanni (19-21) argue that the secretive environment within which PAS is conducted leaves little room for oversight. Little rigor, for example, is applied toward establishing the mental competence of patients. The authors argue that PAS leaves patients vulnerable to the biases of doctors as well as the machinations of family, relatives, and pressure groups.
The Quality of life and the Right to Die
Proponents of PAS posit that the right to life includes the right to death as a necessary corollary. Just as the right to speak must include the right not to speak, and the freedom to practice of religion must include the freedom to forgo all religious practice, so too must the right to life include the right to forgo life. It is outside the proper province of government to compel individuals who wish not to live to continue living (Allmark 255-257). Proponents also argue based on the constitutional right to liberty. Individuals should be free to pursue any action they desire so long as they do no harm to other unconsenting parties (Singer 525). PAS, according to its proponents, is the logical destination of the constitutional right to liberty. The appellate court of California upheld the right to die in Bouvia v. Superior Court. The court held that a patient reserved the right to take actions that were certain to end his/her life, even if medical opinion conflicted with this decision. In its ruling, the appellate court affirmed the notion that the quality of life, not just its temporal extent, was an important metric for human life. The right to self-determination, the Court argued, subjugated the state’s interests in the case of patients who wished for death (Laura & Liang 2-5). Opponents of the Right to Death argument counter that the constitution and the Bill of Rights do not contain a right to death provision. The right to death, they contend, is not only absent in the constitution and the bill of rights, but also a contradiction in terms, as it necessarily involves an irreversible repudiation of all rights henceforth. The right to life, according to opponents of PAS, can be abridged neither by the individual nor by a competent physician. Other opponents, while not disputing the right to death, argue that looking after patients’ quality of life is outside the scope of medical practice. Snyder & Sulmasy (212-216) argue that while alleviating human suffering is a morally compelling object, it falls outside the tasks of the medical profession. The profession’s task is to alleviate the conditions that afflict human beings, and maintaining patients’ quality of life is secondary to addressing these conditions. Opponents also reject the right to liberty argument, arguing that PAS does in fact carry consequences to third parties. Dore (308-313) argues that PAS opens the door to the widespread abuse and homicide of elderly people by setting up intractable moral hazards within the healthcare industry. Examining the legal frameworks of Washington and Oregon- in both of which states PAS is legal- Dore demonstrates that numerous loopholes exist that compromise the independence of patient decisions relating to PAS administration. Not only are the criteria used to gauge the competence of individuals too liberal, there is insufficient supervision of the PAS procedure. These loopholes, she postulates, provide latitude to physicians and family of terminally ill patients to pressure people into PAS against their will. Dore notes that elderly affluent people are more likely to choose PAS than other demographic categories (Dore 318). Dore concludes that in the final analysis, PAS is about applying pressure on terminally ill patients rather than about self-determination.
Utilitarian arguments
Utilitarianism refers to the doctrine that human action should be appraised on the basis of its consequences, rather than its deontological merits or demerits (Singer 523-524). According to utilitarians, an action is moral if it carries benefits (or lessens pain) for the greatest number of people. Proponents of utilitarian arguments invoke the hardship that terminal illness brings to patients as well as their families and the state. Caring for terminally ill patients is expensive, as it uses up vast amounts of resources. These resources could be employed to better serve other individuals, rather than terminally ill individuals with little to no hope of recovery. PAS enables terminally ill patients to mitigate the financial burden that their families and the state are compelled to bear. In addition, they are able to escape the pain and indignity of a slow and vegetative death (Singer 522). According to this utilitarian viewpoint, PAS maximizes gain for the greatest number of people, and is therefore morally permissible. According to Singer (524-525), denying a mentally competent individual the right to choose death over life is morally unjust. Counterarguments to this position come from both within and outside the utilitarian tradition. Goel (216) offers a non-utilitarian rebuttal of the utilitarian argument, postulating that it is impossible to quantify the value of human life in terms of money prices. He states that reducing human life to money prices cheapens it. Non-utilitarians also argue that taken to its logical conclusion, utilitarianism would permit involuntary euthanasia, so long as it maximized the gain of the greatest number of people. For example, a person’s family could- on utilitarian grounds- end the life of a curably sick patient if their gain was greater than the patient’s loss. Utilitarianism is therefore an invalid ethical framework within which to examine the question of PAS (O’Neill, Manchester.edu).
Some utilitarians also reject the foregoing arguments for PAS on the grounds that although its immediate consequences may pass the utilitarian test, its unseen and systemic consequences produce decidedly undesirable consequences. The first of these consequences is the diminution of the incentive to find cures for terminal illnesses. When PAS is accepted as a solution for terminal illness, the incentive to find cures for terminal illnesses is significantly diminished. This lessens the possibility of producing legitimate cures for terminal illnesses. PAS may also lead to a diminished respect for human life that prompts the legalization of involuntary forms of Euthanasia. Most consequentially, legalizing PAS may cause disadvantaged people such as the disabled, minorities, and elderly people to be pushed into euthanasia against their will. Beresford (21) reports that a study in the Netherlands- where PAS is legal- showed that there had been 22 mercy killings of children below the age of twelve, even though PAS is only permitted for people older than sixteen. Golden & Zoanni argue that in a profit-driven healthcare system, legalizing PAS creates a dangerous incentive on the part of insurance companies and medical institutions. Without coercing patients to take PAS, healthcare providers could simply delay treatment or withhold it, pushing helpless patients to opt for PAS. Although this is patently an immoral action, it would be virtually impossible to prevent it in a regime where PAS was legal (19-22). Almagor & Hartman (45-49) disagree with this premise. In their review of Oregon’s PAS framework, they affirm that they find no evidence that PAS disproportionately affects underprivileged people or minorities. Patel (416) likewise finds no evidence to corroborate the claim that vulnerable groups are victimized by PAS.
Death with Dignity
The question of a dignified death is at the center of the PAS debate in the United States and elsewhere. Proponents of PAS contend that terminally ill patients should have every right to die with dignity. Patients should not be compelled to endure the indignity of debilitating illnesses such as cancer, cerebral palsy, and ferocious autoimmune disorders that vastly diminish the quality of life. In Bouvia v. Superior Court., the California Appellate Court ruled that the quality of life was a significant metric to consider. Proponents of ‘Death with dignity’ contend that life is not an end in itself, but a means to an end. The quality of life is an important metric for individuals in choosing whether to retain or relinquish life (Aungst 20-21). Terminally ill patients suffer indignities such as being incapable of communication, incontinence, dependency, and immobility. Proponents of ‘Death with Dignity’ argue that it is inhumane to compel a person to suffer such indignities against his will. They argue that people should be permitted to escape the indignities of debilitating illnesses by voluntarily ending their lives through PAS. Golden & Zoanni (19-30) reject the ‘death with dignity’ argument for PAS. The authors state that in every state, people who wish to escape the pain and suffering of terminal illness have many options available to them, including refusing medication. PAS is therefore unnecessary to mitigate suffering. Painkillers and palliative sedation are some of the legal options available to people in distress. Golden & Zoanni (20-24) posit that the primary reason why people go for PAS is not pain or suffering, but the perceived indignities of debilitating illness. Quoting personal anecdotes, they posit that the discomfort of being physically incapacitated underlies most PAS decisions. The authors conclude that this creates a dangerous perception of disability that hurts those living with disability. The notion that being physically incapacitated is a form of indignity, they argue, is misleading and harmful (21-23). Disability is not an indignity, less still a reason for people to terminate their lives. PAS fuels the perception that physical incapacity is something to be ashamed of, even to the point of preferring death instead.
Mercy and Compassion
Supporters of PAS postulate that mercy and compassion call for allowing people to put an end to the misery and immense physical and emotional suffering that attends terminal illness (Cardozo 123-127). Denying people this opportunity is cruel and inhumane. PAS is held up as a merciful way of allowing pain-wracked individuals repose in death. Golden & Zoanni challenge this assertion on practical grounds, demonstrating that PAS is not the only way to show mercy and compassion to individuals in great suffering. Painkillers and palliative care are legal and effective alternatives to PAS (Golden & Zoanni 19-22). The authors also focus on the incidental costs of PAS, which they argue outstrip the imagined benefits of PAS. Ideologically, opponents contend that the right to life surpasses every compassionate consideration. Ending suffering, they state, is an insufficient reason to justify taking life (Louanna 110).
Physician-assisted suicide is a live topic of discourse in America’s political arena and academic circles. Although as many as seventy percent of Americans support PAS, it is only legal in five states. Sympathizers of PAS argue that individuals should have the right to decide how they die, and the circumstances under which they die. The right to death, they argue, gives individuals the ability to chart their destinies. Opponents refuse, asserting that the right to death is a contradiction in terms. PAS proponents also submit that it is utilitarian, compassionate and a dignified action. Opponents reject the foregoing arguments, countering that PAS creates moral hazards in the profit-driven healthcare industry, further stigmatizes disability, and creates moral hazards in healthcare delivery. Disagreement reaches across the empirical elements of the debate as well, with proponents of PAS arguing that no evidence exists to support the charge that PAS victimizes marginalized groupings. Opponents argue that trends in the Netherlands and American states where PAS is legal show that certain vulnerable groupings are victimized by PAS. The question of PAS is patently still far from resolution. However, the increasing support for PAS suggests that voters are increasingly leaning toward PAS rather than against it.

Works Cited
Allmark, Peter., “Death with Dignity.” Journal of Medical Ethics 28, 2002: 255–257. Print.
Almagor, Cohen., & Hartman, Monica., “Oregon’s Death with Dignity Act: Review and Proposals for Improvement.” Journal of Legislation 27(2), 2001. Print.
Aungst, Heide. “Death with Dignity.” Geriatrics 63(12), 2008: 20-22. Print.
Beresford, Stuart., “Euthanasia, The Right To Die and The Bill Of Rights Act.” 2003. Web. 24 December, 2015.
Cardozo, Juan., “The Moral Claim Justifying Physician-assisted Suicide.” Journal of International Law 2(7), 2001. Print.
Dore, Margaret K., “Death With Dignity: A Recipe for Elder Abuse and Homicide (Albeit Not by Name).” Marquette Elder’s Advisor 11(2), 2010. Print.
Goel, Vaibhav., “Euthanasia – A dignified end of life!” International NGO Journal 3(12), 2008. Web. 15 December, 2015.
Golden, Marilyn., & Zoanni, Tyler. “Killing us Softly: The Dangers of Legalizing Assisted suicide.” Disability and Health Journal 3, 2010. Web. 15 December, 2015.
http://users.manchester.edu/acstaff/SSNaragon/Online/texts/201/O’Neill, Kant.pdf
Laura, Lin., & Liang, B., “Bouvia v. Superior Court: Quality of Life Matters.” Virtual Mentor 7(2), 2005. Web. 24 December, 2015.
Lipka, Mitchele., “California legalizes assisted suicide amid growing support for such laws.” 2015. Web. 24 December, 2015.
Louanne, Mary. “Physician-Assisted Suicide: Death with Dignity?” Journal of Nursing Law 14(3), 2011: 110-116. Print.
O’Neill, Regan. “A simplified account of Kant’s ethics,” in Matters of Life and Death, 411-415. 1993. Web. 24 December, 2015.
Patel, Kant. “Euthanasia And Physician-Assisted Suicide Policy In The Netherlands And Oregon: A Comparative Analysis.” Journal of Health and Social Policy 19(1), 2013. Print.
Singer, Phillip. “Voluntary euthanasia: A utilitarian perspective.” Bioethics 17(5/6), 1993:526- 541. Print.
Snyder, Lois., & Sulmasy, Daniel., “Physician-assisted Suicide.” Annals of Internal Medicine 135(3), 2001. Print.

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