Physician Assisted Suicide The mission of this hospital is rooted in our emphasis on the individual, and directed toward providing the highest level of autonomy, beneficance, comfort, healing, privacy and respect for the dignity of the patient. With these as our guiding principles, we evaluated Physician Assisted Suicide (PAS) as a possible treatment option at this institution. We have concluded that PAS can be a viable treatment option after making the following considerations: 1. Defing the elements of justified PAS, 2. Consideration of moral justifications, 3. Why personal autonomy is important, 4.
Informed consent, and 5. The benefits of the approach of causitry to issues of biomedical ethics. The elements of PAS are an agreement between a physician and the patient on the treatment option after consideration of all other options, (informed consent) conditions consistant with the Oregon state law and the asurance of the agent choosing this course of action in an autonymous nature. Moral arguements question the validity of PAS as an option. We make the determination that PAS can indeed be considered equivelent to other medical decisions regarding whether or not continue treatment in cases where the prognosis is immenent death, or prolonged intense suffering followed by death.
If for example, a patient with a terminal illness such as lung cancer has a choice between hospice care, and being made comfortable, or PAS, we can not say that the two approaches are inconsistant with eachother. A patient who refuses treatment and accepts death as a consequence has the right self determination by law. If this action is acceptable under law, it is not unfair to consider PAS as an equivelent means to the same end. Therefore, there will be cases where PAS is most certainly a valid option for the patient. To reach our decision, it is important to understand our view of personal autonomy.
We will elaborate on it’s relevance and worth in addressing PAS. Finally, criteria for PAS candidates is intricate, and established. Though we justify PAS as a viable treatment option, we do not take issue with the legal criertia established by the state of Oregon. Personal Autonomy Personal autonomy can be characterized as self-determination or the the extent to which an individual actively participates in in how his or her life is lived. Autonomy, therefore, requires some elements of control and choice.
Defining autonomy in a being that is both rational and passionate can prove complex and problematic. A differentiation of first and second order volitions will help us conclude the what the exact nature of what defines autonomy. First-order desires are those passions to which the agent is subject to as a living being. The desire to live, procreate, feel secure and content are some examples of these desires. While they are certainly expressions of human passions, they do not account for man’s rational capacity, a fundemental facet of human nature.
Second-order desires are wants about wants, or the desire to have certain desires. We will focus, however, on second order volitions, which differ from second order desires. Second order volitions involve the wish of an individual that certain first-order desires will motivate him to action. It is the rational choice of the agent which characterizes this, and therefore we will conclude that second-order volitions represent contemplation of a choice by the agent, which leads to a choice that by virtue of this process, is an indication of his true-self. Therefore, it is through these second-order volitions that we exercise autonymous action.1 The expression of rational choice in relation to a first-order desire is what we will define as the main component of an autonymous action.
There are those who would oppose this view in lieu of other moral considerations. If the agent has a lack information, or choices, the action in relation to the first-order desire is then no longer autonymous. Therefore, we will require that another dimension to autonomy is the range of options availible to the agent. In order to promote autonomy, it is absolutely essential that informed consent is a focal point of treatment. It is the concept of autonomy which is our guiding force in our formulation of a policy on PAS.
PAS as a treatment option has no universal application. In Oregon, where it is legal, two patients with the same doctor, the same illness and the same prognosis can make opposite decisions regarding treatment. If one patient simply chooses to wait for death to occur after stopping treatment, and the other chooses PAS, both of these autonymous actions are therefore equal. They have the same end, and individual considerations of quality of life, and an array of potential first-order desires explain the difference in choices. Therefore, it is the execution of the choice by the informed agent which constitutes the autonymous decision.
With personal autonomy as the primary consideration, the patient then has the right to PAS as a treatment option, and denial is deprivation of self-determination. (Indeed this constitutes deprivation of freedom, which is intrinsically wrong, and contrary to the patients natural right to self determination. PAS in a Clinical Setting In relation to PAS, the agent must act “1) intentionally, 2) with understanding, and 3) without controlling influences that determine their action.”2 As an institution concerned with autonomy as a central right of the patient, we are supporters of requested withdraw of treatment (as well as PAS,) as there is no difference in the matter of allowing to die and killing. Killing is any form of “deprivation or destruction of life”, and allowing to die is “intentional avoidance of causal intervention so that a natural death is caused by a disease of injury,”3 which in itself is deprivation. Therefore, there is no distinction between allowing to die and directly intervening to bring about a patient’s death. Moral Jusifications Compassion is a focal virtue in our practice. Compassion is defined as a feeling of profound sympathy and sorrow for another who is affected by misfortune, accompanied by a strong desire to ease the suffering.
Sometimes in healing the terminally ill suffering from profound pain, assisting the patient in suicide is the only means of alleviating his/her suffering. Those who oppose PAS are not subject to judgement or coercion. PAS is a matter of choice and is not an alternative to be suggested by the physician. It is a procedure which is only regarded among request and acute investigation thereafter. Patients are protected from non-voluntary euthanasia because, again, physicians will only address the option of PAS upon the request of the patient and the physician cannot physically be the cause of the death (euthanasia).
No actions will act out of accordance with such, especially in situations of life and death. It is clear that opposition to PAS is rooted in the execution of normative judgements, which object to the action unequivically and universally. This view neglects the secular and universal standard of self-determination and autonomy in patient care. This is not a criticism of religous institutions which f …