Physician-assisted Suicide

The Ethical Considerations of Physician-assisted Suicide

Madeline Jordan
Department of Biology; College of Arts and Sciences
Abilene Christian University

With respect to physician-assisted suicide, several approaches to adjudicate an

ethical position can be processed from the theories of utilitarianism, Kantian
deontology, and virtue ethics. This paper will explore these three positions with
respect to physician-assisted suicide and the pros and cons of each. In conclusion,
based on my research and Christian beliefs, I will define why I reside with virtue
ethics and why it leads me to a position that is against physician-assisted suicide at
this particular point in my life.

Euthanasia has been a topic under euthanasia. The differences are withholding
debate within our world for many centuries; or withdrawing of medication in order to
but with medicine advancing quicker every allow the patient to die, which is passive; the
day, euthanasia is becoming more of a second is killing the person, which is active.
concern with society and the medical Within each of the passive and active
community as well. It has been a topic of categories of euthanasia, they are further
concern that many different ethical theories broken down into either being voluntary or
have tried to tackle over the years, but non-voluntary/involuntary. Throughout my
remains just as controversial, if not more, research, I have found that many researchers
today. There is not only passive and active use the terms non-voluntary and involuntary
euthanasia but whether each is involuntary, interchangeably; for the remaining length of
voluntary, or physician-assisted as well. the paper, I will use the word involuntary.
This paper begins by describing each Voluntary constitutes the patient verbally
different type of euthanasia. It, then, goes on deciding that he or she wants to die.
to talk more about voluntary active Involuntary constitutes the patient having no
euthanasia as it pertains to physician- choice in the matter of whether they die or
assisted suicide. Once physician-assisted live.
suicide is established, the paper goes on to
discuss the utilitarian, Kantian deontology Examples of Euthanasia
and virtue ethical ideologies on this matter, Since each type of euthanasia has
and the pros and cons of each ethical theory. been broken down, let us now look at an
Finally, based on the research I have found, example of each. Involuntary active
I will explain why I feel that my views euthanasia is the patient being injected with
resonate with the virtue ethical theory. a lethal dosage of drugs by a physician
without having the patient’s consent.1
Types of Euthanasia Involuntary passive euthanasia is the
We must first look at the broad withholding or withdrawing of medical care
category of euthanasia. When narrowing to a patient without consent. Voluntary
down the various approaches to euthanasia, passive euthanasia is where the patient
we see that they break down into two actively consents for the physician to
separate categories: passive or active withhold or withdraw medical treatment in
1
Manning, 1998

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 Physician-assisted Suicide

order to allow the patient to die. Voluntary allows for the patient to have the right to
active euthanasia is the patient’s consent choose what is best for his or her life. In this
given to a physician in order to inject a case, it is whether he or she should live or
lethal dosage of drugs to cause his or her die. Advocates for physician-assisted suicide
death.2 This type of euthanasia will be also believe that no one should have to live
discussed further throughout the paper, and through terminal suffering, and that if the
more specifically within the aspect of physician cannot alleviate the pain any other
physician-assisted suicide. way, then aiding in death is acceptable.5 On
the contrary, people who are against the
Physician-Assisted Suicide actions of physician-assisted suicide believe
We now turn our focus to physician- that it is not in the physician’s job
assisted suicide. In the United States, six description to decide the fate of the patient,
states have legalized physician-assisted even if patient consent is given; they also
suicide; these include California, Colorado, believe that killing is intrinsically wrong.6
Oregon, Vermont, Washington, and Many physicians and people fit their beliefs
Washington D.C. The state of Montana also on this matter within ethical theories. Ethical
has legal physician-assisted suicide through theories help shape a person’s morality and
a court ruling. The law states that this option their behavior and actions in regards to their
is only available to patients who are moral views. In order to understand how
terminally ill or have a specific, limited life many people would determine their position
expectancy.3 So, what is physician-assisted on physician-assisted suicide, we must
suicide and how is it related to voluntary examine some of these ethical theories and
active euthanasia? In physician-assisted determine their positions.
suicide, the physician plays an important
role in enabling the death of a patient.4 Rule and Act-utilitarianism
Although the patient has given the physician The first ethical theory to be defined
consent to help aid with the process by is Jeremy Bentham and John Stuart Mill’s
prescribing the lethal dosage of medicine, utilitarianism. Utilitarianism, in all forms,
the patient is actually the one who will lies on the weight of consequences rather
administer it in order for him- or herself to than rules and it places emphasis on the
die (typically by ingesting a lethal dosage of good and bad rather than what is right or
drugs). Therefore, physician-assisted suicide wrong.7 Though utilitarianism is usually
is a type of voluntary active euthanasia. talked about as one big category, it is often
broken down into many different categories,
Arguments For and Against Physician- and within this paper we will be looking at
Assisted Suicide the categories of rule-utilitarianism and act-
So why is there such controversy utilitarianism. Rule-utilitarianism believes
over the concept of physician-assisted an individual action is morally correct when
suicide and why is it not widely accepted by it sides with the rules or codes that were
everyone? People who argue for the use of already made on a utilitarian basis.8 It says
physician-assisted suicide believe in the that a person should act in agreement with
fundamental principle of autonomy. This the rule that brings about the largest balance

2 6
ibid. Uhlmann, 1998
3 7
Yao, 2016 Ashcroft, Dawson, Draper, & McMillian, 2007
4 8
Degrazia, Mappes, & Brand-Ballard, 2011 Mandal, Ponnambath, & Parija, 2016
5
ibid.

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 Physician-assisted Suicide

of good over evil for everyone involved would feel that the killing rule is better to be
within the situation.9 Act-utilitarianism is broken in order to bring about the better
sometimes referred to as a type of situational consequences for everyone involved. When
ethics. This means that a certain kind of applying both of these categories of
action can be wrong within one setting but utilitarianism, we see that, more than likely,
right within another. This situation is either most people who find that they agree with
right or wrong considering which side brings both theories agree with physician-assisted
the greatest amount of good for everyone suicide.
involved.10
Pros of Rule and Act-Utilitarianism
Rule and Act-Utilitarianism in Regards to Rule-utilitarianism and Act-
Physician-assisted Suicide utilitarianism bring about strong points. In
Consider a patient who is terminally regards to rule-utilitarianism, a valid belief
ill and in a lot of pain. He or she wants a the theory presents is asking individuals to
physician to help speed up his or her death make their decisions based off of rules that
by prescribing a lethal dosage of drugs. A exemplify morality. Act-utilitarianism looks
rule-utilitarian, in this situation, would at all sides of a situation before the decision
consider raising the possibility of a justified is made. This is in order to maximize the
exception to the rule of “do not kill.”11 In utility of all people involved in, which is
most rule-utilitarian’s eyes, killing in self- good since they are not trying to maximize
defense is seen to be a justifiable exception the utility of just themselves. Therefore, in
to the rule of “do not kill.” Therefore, the the case of physician-assisted suicide, the
rule-utilitarian that advocates for physician- physician would look at all who were
assisted suicide believes that if the involved before consenting with the patient,
terminally ill patient would be able to escape rather than just deciding based on the
a prolonged painful death, others involved patient’s belief.
would benefit as well. The hospital and
physicians would benefit from not using Cons of Rule and Act-Utilitarianism
unnecessary money that could go to another Though there might be pros to both
patient who would ultimately live. The rule and act-utilitarianism, arguments can be
family involved would benefit by not made for cons as well. With act-
watching their loved one suffer anymore. utilitarianism, one is allowed to break a
The patient should be allowed to be the moral rule, such as the case with physician-
administration of the lethal dosage of a drug assisted suicide. However, there must be a
since the consequences will bring about the reason to believe that breaking the rule will
greatest balance of good over evil. cause maximum utility, or the perfect
The act-utilitarian would agree with balance between good over evil for all
the rule-utilitarian on this matter as well. involved. With this brings about the problem
They agree that “do not kill” is a moral rule of a person taking one’s interest more into
that should be followed, but if the terminally consideration over everyone else involved
ill patient is in terrible pain, wishes to die, along with the breaking of a moral rule.
and everyone else who is involved would Similar to act-utilitarianism is the rule-
benefit as well, then physician-assisted utilitarianism, which says that moral rules
suicide is justifiable. An act-utilitarian are subject to exception if the exception has

9 11
Op. cit. ref. 4 ibid.
10
ibid.

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 Physician-assisted Suicide

better consequences than the moral rule believes that this includes suicide, and that
without the exception.12 Both theories suicide is not acceptable under any situation.
believe that if the consequences of the In Jecker, Jonsen, and Pearlman’s work,
results to exception are better than the moral they quote Kant saying, “…a system of
rule itself, then the action is justifiable. So, nature by whose law the very same feeling
with each individual that wants to undergo whose function is to stimulate the
physician-assisted suicide, if their particular furtherance of life should actually destroy
situation, in their eyes, has better results by life would contradict itself and consequently
proceeding with the physician’s assistance, could not subsist as a system of nature.”16
then it is justifiable to do so. Since the Killing oneself is seen to go against Kant’s
individual within the situation decides which moral principle of the categorical
action produces the better consequences, imperative, and, therefore, is never to be
shouldn’t there be a stipulation with each broken. Kant deontology also expresses the
individual on what constitutes what a better duty of beneficence, which lies within the
consequence entails? “imperfect duty to others” category. He
believes that we are not only to treat people
Kantian Deontology with respect but we are to further the
The next ethical theory to be happiness of others as well, but never at the
discussed is Kantian deontology that was expense of a perfect duty.17
developed by Immanuel Kant. Kant believes
that the categorical imperative is the Kant in Regards to Physician-assisted
fundamental principle that is the basis of all Suicide
moral responsibilities.13 The categorical In regards to physician-assisted
imperative is based on two formulations, but suicide, based off of Kant’s duties as
we will only be addressing one of these explained above, it would seem that Kant
formulations. The one that is most would believe that there is no justification
prominent within the context of this paper is for this particular action. Since Kant’s
the second formulation, which says, “…treat perfect duties to others and self seem to say
humanity... never simply as a means, but that no matter the situation killing is wrong,
always at the same time as an end.”14 Kant it would seem that Kant would not ever be
furthers this formulation by breaking it in agreement with physician-assisted
down into four different duties. Of the four suicide. However, through the duty of
duties, “perfect duties to others,” “perfect beneficence, the physician would be creating
duties to self,” and “imperfect duties to happiness for the patient who wants to die.
others” are the three that are relevant to our This, however, still goes against Kant’s
topic of physician-assisted suicide. The categories of “perfect duties to others” and
perfect duties to others include respecting “perfect duties to self”, which are to never
others. Examples include not killing be broken according Kant’s belief in the
innocent people, keeping promises, and not categorical imperative.
lying. There is no exception, like utilitarian,
in breaking these duties. They are simply off Pros of Kantian Deontology
limits. With “perfect duties to self,” you are Kantian deontology brings about
not to disrespect yourself either.15 Kant strong points when Kant points out that we

12 15
ibid. op. cit. ref. 4
13 16
ibid. Jecker, Jonsen, & Pearlman, 1977, p. 136
14 17
op. cit. ref. 6 op. cit. ref. 4

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 Physician-assisted Suicide

must respect not only ourselves, but others described previously, is not action-based. It
as well. Kant believing that the notion of is concerned with becoming a good person
respecting others and not treating a person rather than acting a certain way. Virtue
strictly as a means to an end is a key point in ethics is looking to achieve what is humanly
morality. This philosophy seems to be excellent rather than looking to maximize
beneficial to everyone involved, not just the utility or consistently performing duties.
patient.18 Another valid point that Kant Virtue theory does not care whether or not
brings to the table is individual rights for the action brings about harm or benefits to
everyone, and in this way he describes them the individual or a society, but it cares about
as perfect duties to others in which a person, the person performing the action showing
for example, is not to kill, which in turn virtuous behavior.22 It believes that actions
causes you as an individual to not be killed show our inner morality and virtues are what
either.19 So any source of suicide or killing help shape that morality within us.23
is strictly forbidden, no matter the Therefore, a virtuous person carries
circumstance. out the right action, and the right action
describes a virtuous person. So, this brings
Cons of Kantian Deontology up the question, what does virtuous behavior
Just like utilitarianism, Kantian entail? Virtues are characterized by traits
deontology critics argue that it brings about that are morally valued, which include, but
some difficulties as well. Critics believe are not limited to, truthfulness, compassion,
that often this ethical theory thinks too much courage, and sincerity.24 Virtue theory also
about the individual and not enough about takes little consideration into rules and
the community to the effect that the principles. This theory believes that
community is often non-existent.20 Everyone cultivating enduring traits like honesty and
is different and each person lives a different loyalty through education and role models
life, but Kant does not believe this to be are a more reliable basis for a morally
true. Kant believes that no matter what the correct action than from knowledge of
situation a person is in, everyone should principles or rules.25 It often asks the
come to the same conclusion when it comes questions of “Who am I?”, “Who ought I
to specifically killing and suicide. We can become?”, and “How ought I get there?”26
come to this same conclusion with In conclusion, virtue theory relies heavily on
physician-assisted suicide as well. This the individual person rather than a group or
clarity is often misleading to some because what is best for everyone within a situation.
it denies the role of the social experience in
which this dilemma may occur.21 Virtue Ethics in Regards to Physician-
Assisted Suicide
Virtue Ethics In regards to physician-assisted
The last ethical theory that will be suicide, I believe the theory would view this
discussed is the virtue theory as seen to action as going both ways. If the physician
emerge from Aristotle. The virtue theory, is virtuous, which means that he or she
unlike the other two ethical theories acquires the virtues as listed above, they are

18 23
op. cit. ref. 4 ibid.
19 24
op. cit. ref. 4 op. cit. ref. 4
20 25
Garrett, Baillie, & Garrett, 1993 op. cit. ref. 4
21 26
ibid. Rozier, 2016
22
Koçyiğit & Karadağ, 2016

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 Physician-assisted Suicide

able to use their virtues of compassion and that they are doing it out of their virtuous
mercy to help understand the pain that the behavior? I think that it is difficult to exactly
patient is in. These virtues help guide the know the motivations of a physician and
physicians in their decision-making and whether or not we can distinctly say that he
actions in regards to helping their patients. or she is acting out of virtue. If our moral
This theory would view that, in some compass were to be learned by education or
physician’s eyes, aiding in the death of a a role model, like the virtue ethics theory
patient, under which he or she could not live suggests, it would be difficult to know who
anymore, to be a respectful, compassionate, the physician’s role model was.
and benevolent response to a patient’s
suffering.27 However, other physicians could Conclusion
have these same virtues, and believe that Before I started this paper, I
physician-assisted suicide is wrong. It’s understood very little of what euthanasia or
difficult to draw conclusions on whether or even physician-assisted suicide entailed. I
not this theory believes that physician- knew that there was major controversy
assisted suicide is okay since it is strongly concerning this topic, but I had never looked
based on the individual person and the way at each topic in light of the various ethical
that he or she pursues his or her virtues. theories. In regards to the ethical theories
presented within this paper, I find that I can
Pros of Virtue Ethics accept parts of each of the theories in
In favor of virtue ethics, we can see particular circumstances when it comes to
that the other two ethical theories presented the topic of physician-assisted suicide.
above often fail to face the fact that we often However, I also find that I can see the
look at the character and motivation of a downside of each of these arguments as
person and not just their actions. Another well. I cannot discount that each ethical
point that is valid is virtue ethics does not theory presented within this paper, at least at
just go along with a set of principles, but some point, has made me question my own
rather learns from personal experience what beliefs on the matter, but it has also
is morally correct. It has no clear cut rules furthered my knowledge on this particular
that it should follow, which allows issue. Based on my research of the ethical
individuals within this theory to have a little theories investigated, I find that I reside
bit more space in his or her decision making. more with the virtue ethics aspect of being
However, theory does call for the physician against than for physician-assisted suicide at
to use the virtues that he or she has learned this particular point in my life. As a
in order to help with the patient at hand, Christian, I believe that our virtues cause us
rather than all of the people who are to act, and I believe that these virtues are
involved in the situation. given to each of us from God in the form of
the Holy Spirit. On the matter of Christianity
Cons of Virtue Ethics and physician-assisted suicide, Lammers
Though we are able to see the and Verhey state, “We need not glorify or
upsides of this theory, how are we to know seek suffering, but we must be struck by the
that the motivation of a physician in the case fact that a human being who is a willing
of a physician-assisted suicide is actually sufferer stands squarely in the center of
virtuous? Are we to trust that if the Christian piety. Jesus bears his suffering not
physician agrees to aid the patient in dying because it is desirable but because the Father
27
Huxtable, 2002

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 Physician-assisted Suicide

allots it to him within the limits of his and think in a different way. The reason why
earthly life.”28 God nor Jesus said that we I am hesitant to be fully against physician-
were never meant to suffer within our assisted suicide is due to instances where I
human life, so I believe that this is where I could understand it being open for
have to lean toward disagreeing with discussion, such as a patient with
physician-assisted suicide. With this belief, I amyotrophic lateral sclerosis, or ALS.
also state that I have no doubt that there are However, I feel that much more research
holes within my argument, and that I believe and thought is needed before we can agree
the Holy Spirit may give each of us some of with certain situations being acceptable in
the same virtues but causes each of us to act regards to physician-assisted suicide.

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28
Lammers & Verhey, 1998, p. 659

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