Is physician-assisted suicide morally justifiable?

Sam asked:

Is physician-assisted suicide morally justifiable?

Answer by Craig Skinner

I think it is.

Let’s take the question bit by bit.

1. Is suicide morally justifiable?
2. If it is, is assisted suicide morally justifiable?
3. If it is, is physician-assistance morally justifiable?

1. Suicide

Suicide was once widely condemned, at least in Christendom, as sinful, and I can recall the days when it was still a crime in the UK. A human life was considered a gift of God, and it was for God, not the person living the life, to decide when to end it.

Kant, in Groundwork for the Metaphysics of Ethics gives avoidance of suicide as an example of a perfect duty to oneself because the maxim ‘from self-love I will shorten my life when the future seems more troublesome than agreeable’ fails his conception test: to self-destruct through self-love would be self-contradictory as a law of nature. However, elsewhere in his writings, he says that martyrdom may be justifiable.

These days, most people feel that a life belongs to the person living it, and many, including myself, think that suicide is morally justified as an alternative to unavoidable, persistent, severe pain or suffering.

2. Assistance

Although suicide is legal in the UK, assistance is still a crime. Although, typically, charges are often not brought these days, or serious punishment meted out, especially if the assistant is a long-standing and clearly loving spouse.

Given that suicide is morally justified, it seems to me that assistance is a service or a kindness to somebody unable to proceed because of, say, paralysis, or ignorance about a suitable fatal drug/dose.

Naturally safeguards are needed. For example, encouragement to go ahead by a greedy relative who stands to inherit a packet does not constitute ‘assistance’.

So I am in favour of a change in the law allowing assistance when this is necessary due to disability or ignorance.

3. Physician-assistance

Given that assistance is morally justified, a physician might be as good an assistant as anybody else.

However, as regards suicide, physicians have two important roles quite separate from assistance.

First, making an accurate diagnosis, sound prognosis, and assessment of treatment options, so that the would-be-suicide knows what he is up against should life go on. Misdiagnosing a treatable disabling condition for one that will progress relentlessly would be unfortunate and often negligent.

Secondly, establishing that the patient is of sound mind and able to make an informed decision. This can be a real problem for dementia sufferers: in the early stages, when still of sound mind, they want to live; by the time the disease has advanced to the point they no longer want to live, no doctor will pronounce them capable of making a judgment as to suicide.

Aside from these standard duties to patients, doctors, in my view, should steer clear of assisting suicide. They are not needed for this. And trust in doctors might be weakened if patients, especially if already feeling themselves a ‘burden’, think doctors are in the suicide business and might even hint to the relatives that they might like to encourage the old dear to consider it. The Dignitas system works well. Doctor only certifies patient as of sound mind and able to freely choose suicide. Suicide assisted (usually in the person’s own home, although foreigners e.g. Brits have to attend a Centre) by escorts/ receptionists who get the client to complete the paperwork, drink the preliminary anti-emetic ensuring that the fatal drink (pentobarbitone) taken half an hour later stays down, and await death after some minutes. The package typically includes cremation and despatch of death certificate to address of choice should the client be unaccompanied.

In summary, I think suicide, assistance with safeguards, and physician-assistance are all morally justifiable, but that the last is best avoided since doctors are not needed for the task, and their participation might weaken doctor-patient trust.

Declaration of interest: I am old, and am a physician.

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