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Currently, Oregon is the only state in the country that permits physician-assisted suicide. The Death with Dignity Act was passed in 1997 after it was approved by the residents of Oregon (Rudden). There are various steps that an individual must take in order to be qualified for assistance in bringing about their own death. In the state of Oregon, patients must make two oral requests, one written request, be terminally ill with less than six months to live, and be judged mentally competent to make the decision by two separate physicians (Rudden). Even though, it requires many qualifications to perform assisted suicide, the ideas of euthanasia and assisted suicide are still questioned by medical ethics, right and freedom of personal choice of autonomy, and finally where it will lead society and humans in the future.
Medical ethics have played a significant role in shaping societies' response to suffering, healing and the choice for life or death. In particular, one of the earliest attempts to construct an ethical code, the Hippocratic Oath, continues to be used as one of the main reasons given as to why doctors should not assist a patient to die. Opponents of euthanasia and assisted suicide include United State's large nonreligious organizations such as the American Medical Association, the American Hospital Association, and the National Hospice and Palliative Care Organization (Foley 3). One of the reasons to oppose is that euthanasia and assisted suicide violates the Hippocratic Oath; the Oath does not say that physicians must continue to treat patients and keep them alive no matter what. The oath says, "I will use treatment to help the sick according to my ability and judgement." This does not mean keep treating until the treatment kills the patient. Also the Hippocrates says that physicians should "refuse to treat those who are overmastered by their disease, realizing that in such cases medicine is powerless," and expressly prohibits euthanasia and assisted suicide, saying "I will not give poison to anyone though asked to do so, nor will I suggest such a plan." Therefore, opponents believe that Hippocrates at least implicitly distinguishes the idea between killing and allowing to die (Parker 26).
Due to the advances in medicine, society has shifted the focus from survival to issues of prevention and quality of life. Thus, the Hippocratic tradition of non-intervention was replaced by a new imperative - to do everything medically possible to increase a person's longevity. In transforming the practice of medicine, it is argued that the scientific advances reduced the relevance of the Hippocratic Oath. Proponents of euthanasia and assisted suicide argue that the oath has many proscriptions that are no longer observed, such as prohibition of surgery, "I will not use the knife - even on sufferers from bladder stone." Surgery is now a specialist and respected part of medical practice, yet it was prohibited by the terms of the Hippocratic Oath because it was too dangerous to even consider. (McLean and Britton 47) This could be same for abortion euthanasia or assisted suicide as well. Furthermore, a same phrase of the Hippocratic Oath can be argued as a different meaning in the medical profession. Proponents argue that the refusal "to treat those who are overmastered by their disease, realizing that in such cases medicine is powerless," is to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their diseases, realizing that in such cases medicine is powerless (McLean and Britton 48).
Maintaining life of any quality is not a morally legitimate end for medicine. Instead, it is frequently argued that when the quality of a patient's life remains permanently below a certain threshold, as is thought to be the case for patients in permanent vegetative state, physicians need not preserve life (Varelius 127). Moreover, the proponents find that the opponents of euthanasia and assisted suicide such as American Medical Association and similar state organizations are disqualified to argue such topics since they do not include or represent all members of the profession. Only about forty percent of all practicing physicians in the United States belong to the AMA, and this number is dropping (McKhann 148). As in the examples of the prohibition on performing surgery or assisting in death, where adherence to its strictest terms leaves a serious gap between contemporary ethics and historical cant. The Oath should be remembered as an ethical framework, but provides neither a solid foundation nor convincing argument against assisting patients to end their own lives.
Opponents argues that one's death choice may be made without full knowledge of options and possibilities, or because of the patient's temporary mental state such as depression, one may be even misdiagnosed by the doctor. According to an editorial written by Wesley J. Smith, "No physician has to report a potential assisted suicide before it happens; no efforts need to be made at suicide prevention, and no family members have to be informed of a pending assisted suicide" (Smith). Opponents of euthanasia and assisted suicide argues that these options enable the individual to make the decision on their own, possibly without any knowledge or support of alternate methods of carrying out their daily lives and letting nature take its own course. Scientific studies reveal that most patients who seek euthanasia are motivated by psychological factors, such as depression, as opposed to trying to escape a death marked by physical suffering that cannot be endured (Emanuel, "The Painful Truth"). In Opposing Viewpoint: Suicide, Pope John II is quoted as saying, "These people are very often isolated by their families and by society, which are organized almost exclusively on the basis of criteria of productive efficiency, according to which a hopelessly impaired life no longer has any value" ("Assisted Suicide Is Immoral"). The patient may be depressed temporarily or may undergo a change of mind. In Oregon, one of the states which euthanasia and assisted suicide is legal, of the thirty-eight persons who in 2005 were assisted in committing suicide, only two had been referred for psychiatric evaluation. Many doctors are not skilled in diagnosing clinical depression (Hentoff 134), and in fact, a misdiagnosis may occur, when in fact a patient is only depressed and not terminally ill. Hence, doctors should never cease or withhold treatment even though the case looked hopeless, if so doing hastened death ever so slightly. However, the suggestion of misdiagnose, some argue, are only theoretical possibilities, but they do not have much bearing on the patient who is dying. By the time a person is dying of a chronic degenerative disease, or pulmonary failure, the correct diagnosis is almost self-evident (Varelius 125). At some point, decision needs to be made whether patients are to be permitted to be the authors of their own destiny or not.
On the other hand, the positive aspect of euthanasia or assisted suicide is the fact that an individual can choose to end their life instead of suffering from a terminal illness for an extended period of time. The right to die is an integral part of human's right to control one's own destiny so long as the rights of others are not affected (McLean and Britton 102). The choice should rest with the only person who is experiencing the intolerable agony that cannot be relieved. Dignity and quality are important values right up to the end of life, and autonomy is the way of protecting them. Personal autonomy is the liberty to make decisions for oneself. Justice Benjamin Cardozo declared, "Everything human beings of adult years and sound mind has a right to determine what should be done with his own body" (Russell 174). The ultimate extension of autonomy is to control the time, place, and circumstances of dying. A patient with liver cancer said, "If you commit suicide, you're not losing your autonomy, you're using it. You lose it when you get stuck in a hospital and they fill you full of all kinds of stuff that's not going to do any good anyway" (McKhann 34). If life seems meaningless due to suffering, patient autonomy dictates that physicians should grant their requests for assisted suicide (Foley 9). Claiming the right to control our bodies and out lives is characteristically American. Each of us comes to the end of a unique life and dies his or her death. The desire to claim one's death as part of one's life choices is one of the most compelling and frequently used arguments in favour of permitting choice at the end of life.
The argument of autonomy does not justify the legalisation of voluntary active euthanasia. Euthanasia advocates consistently confuse the notion of autonomy with 'satisfying preferences'. They argue that a person with intractable suffering should have the autonomous right to choose to end of one's own suffering. The autonomy of an individual requires that the conditions for the exercise of autonomy are not compromised, and the killing of someone to end suffering does just this. Autonomy requires that the individual lives according to rationally conceived decisions, and the free conditions by which these decisions or plans are made are compromised by the act of euthanasia (Mayo 53). Individuals cannot voluntarily and irreversibly surrender the conditions necessary for autonomy. For example, in the modern world we have universally rejected the notions of voluntary slavery. This is because in both of these situations the individual commits to remove one's autonomy irreversibly.
However, opposition to assisted dying are concerned about a slippery slope, where patient's choices could be abused. Beyond the opposition to assisted dying based on concerns about potential abuse is the threat of the so-called slippery slope. According to opposition's theory, legalization of euthanasia and assisted suicide would be followed by non-voluntary euthanasia, involving patients whose current personal desires could not be evaluated due to pressure from family or financial circumstance or believe that patient is burden on society. From there it would be a short step to involuntary euthanasia, where death is forced upon people who understand the circumstance and do not want to die. This practice may permit even the most limited forms of assisted suicide; eventually be killing the handicapped, the poor, the elderly, abnormal babies, and anyone else who becomes inconvenient or a burden. (Kass 23)In this extreme form it is surely groundless, given the values that prevail in our society. As Ezekiel Emanuel puts it, "Euthanasia and assisted suicide are socially disastrous. They are not containable by placing legal limits on their practice. Arguments to the contrary, the slippery slope is an inescapable, logical, psychological, historical and empirical reality" (Emanuel, "Physician-Assisted Suicide").
Fear of the slippery slope should not prevent some steps to help those in severe situations, as long as there are strict controls on its use. "The steps that could be taken to prevent abuse are so numerous that it is possible too many safeguards could be implemented" (McKhann 178). Compassion and benevolence demand that we legalize assisted death for the sake of the afflicted and those who love them. The most powerful argument in favor of physician-assisted death comes from the families of those who have witnessed loved ones die in extreme agony. When medical science has done all it can and death has not yet brought merciful relief, family members suffer a sense of powerlessness and despair as they watch in horror someone they love dearly writhe in torment as they wait and hope for a quick end to their awful suffering. That these extreme cases are rare is indeed fortunate, but it does not render less important the appalling plight of whose who must live - hopeless and helpless - through such distress. It would benefit people who choose death in hopeless, intolerable situations are allowed under defined circumstances that prevent abuse. (Varelius125)
Deciding what is right or wrong is especially difficult and test moral wisdom when the permissibility of deliberately ending a human life is involved. The ideas of euthanasia and assisted suicide continue to debate whether it is ethically and acceptable to society. Proponents claims that euthanasia and assisted suicide is acceptable based on fact that it is suitable in terms of medicine goal and ethics, right to provide freedom to choose individual's autonomy, and it will not lead to a slippery slope under strict restrictions. Opponents argue that euthanasia and assisted suicide violates medicine goal and ethics, the choices may be made under psychological influences and the freedom of autonomy is limited to a certain point and finally will lead to a slippery slope and be a harm to society and human beings. Through thoroughly examining both sides of this contentious debate, it is clear that life has been given to human as a gift to be lived fully to its potential and overcome many challenges. All human beings are born through pain and may end with pain. It has been said that one should not bring about their own death just because of physical or emotional hardships. Doing so would be considered taking the easy way out, instead of facing life's challenges head on. It is nearly impossible to monitor a patient's true intentions when they are in the process of considering an assisted suicide or euthanasia. Even though being diagnosed by a terminal illness can be easily proven by a person's physical state, a mental illness may not be as easy to detect. In fact, euthanasia and assisted suicide may not lead to slippery slope under strict restrictions, but just the fact of opting to kill one's soul to escape the tribulations of reality should not be considered as an option at all. The human body was created to endure pain and to learn trivial life lessons by losing ones we love. Ending a life by penetrating a lethal injection into one's arm is hardly a "death with dignity," but rather a death without faith and potential meaning of life.