The hippocratic oath

This is the scenario: You are terminally ill, all medical treatments acceptable to you have been exhausted, and the suffering in its different forms is unbearable. Because the illness is serious, you recognize that your life is drawing to a close. Euthanasia comes to mind as a way of release. The dilemma is awesome. But it has to be faced. Should you battle on, take the pain, endure the indignity, and await the inevitable end, which may be days, weeks, or months away? Or should you take control of the situation and resort to some form of euthanasia, which in its modern-language definition has come to mean “help with a good death”? (Humphry, 1) The aforementioned circumstance is one that millions of people meet in the United States each year; despite the world’s advanced medical technologies, no one has discovered cures for diseases such as cancer or AIDS. Euthanasia is when a doctor intentionally kills a person by the administration of drugs at that person’s voluntary and competent request. Physician assisted suicide is when a doctor intentionally helps a patient to commit suicide by providing drugs for self-administration at that person’s voluntary and competent request. The euthanasia of humans probably dates back to the beginning of time but the earliest mention of it can be noted in the Hippocratic Oath. The use of the Hippocratic Oath has continued since it was adopted by those in the medical profession but not all types of euthanasia are openly linked to doctors. Uses in colonial America, Europe during the Holocaust, and even most cases in modern society today do not involve direct contact by a doctor.

The Hippocratic Oath was written between 400 and 300 B.C. The exact date is not known because the work is likely not that of Hippocrates; many professors and higher scholars who taught in that era took the works of their pupils and submitted them as their own. This oath is only mentioned in accordance when speaking about euthanasia because it is the first document essentially discerning the act of euthanasia. Hippocrates stated “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.” In the modern version of the Hippocratic Oath, this has been translated to “I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness, I will guard my life and my art.” Around the 1970s, many medical schools in America and other countries chose to abandon the use of the Hippocratic oath as part of their ceremony for graduation so many doctors who treat patients now have no idea what the oath is comprised of. “The old Hippocratic Oath is no longer suitable for modern times and is, therefore, subject to a variety of interpretations. Depending on the individual, such oaths may be perceived critical to the way in which a particular physician perceives himself or herself, or it may be seen as another rite of passage, important in form but unimportant in detail. Even, however, if it is believed to be merely a symbolic rite of passage that does not become a part of what an individual thinks he/she is, it does constitute a public avowal and a public pledge. These oaths almost invariably promise, above all, fealty to one’s actual or potential patients and to work for their good regardless of religion or lack thereof, race, ethnicity, gender, party or socioeconomic considerations. It is said to be “freely” taken and not to have been coerced” (Loewy, 1). This being said, most doctors assume that it is morally wrong to kill a patient no matter their medical history or the oath they took at the time of their completion of medical school.

When confronted with the concept of human euthanasia, countless people would say that they would want their family member alleviated of pain when in the process of death, so why not provide a catalyst in the process of dying by early euthanization instead of letting them experience misery for a longer period? The main question when speaking of physician assisted suicide, or even suicide for medical reasons, is: should it be conducted? From The Arguments for Euthanasia, “Past U.S. and British advocates typically adduced the same four arguments used today to justify euthanasia: 1) It is a human right born of self-determination; 2) it would produce more good than harm, mainly through pain relief; 3) there is no substantive distinction between active euthanasia and the withdrawal of the life-sustaining medical interventions; and 4) its legalization would not produce deleterious consequence. As Eugene Debs and Dr. Millard claimed in 1913 and 1931, respectively, patients have a right to control the manner of their death and, more specifically, terminally ill patients have the right to a quick and painless death with physicians’ help” (Emanuel, 3). Overall, Eugene Debs and Dr. Millard were correct in their beliefs at the time but as the world has become industrialized, so have the reasons developed for which euthanasia should be legalized. As stated before, the natural extension of patient rights and alleviation of suffering of terminally ill patients are key points; however, now we can see reasons such as minimization of health care costs when it does not aid in the betterment of the patient. Emanuel brings up another great factor in his Arguments for Euthanasia passage when he mentions a passage from A. Bach-Medico-Legal Congress, “There are also cases in which the ending of human life by physicians is not only morally right, but an act of humanity. I refer to cases of absolutely incurable, fatal and agonizing disease or condition, where death is certain and necessarily attended by excruciating pain, when it is the wish of the victim that a deadly drug should be administered to end his life and terminate his irremediable suffering” (Emanuel, 3). Many people have written letters and provided in depth stories as to why they think suicide by the terminally ill is justified. Before Carol Bernstein Ferry took her own life in 2001, she wrote a letter explaining her decision in the hopes that it would contribute to an understanding of euthanasia. “That is why I am writing this letter, explaining why I choose to take active steps to end my life rather than waiting for death to come gradually. With his letter I also want to make it clear that, although I have the support and tacit agreement of my children and close friends, no one but myself will take the steps that cause death. If is unfortunate that I must say this; our laws are at a destructive point just now, so if anyone other than myself actually causes my death, that person will be liable to conviction as a felon. What an absurdity! To help someone facing a time-whether short or long-of pain and distress, whose death coming bit by bit can cause major sorrow and anxiety to family and friends, not to mention the medical help, quite useless, that must be expended in order to maintain a bearable level of pain-that this sensible deed can be construed a crime is a blot on tour legal system and on our power of thought” (Ferry, 8). Many in government either feel very negatively towards Ferry’s attitude or are afraid to express their true feelings on the subject as the opposite spectrum of the euthanasia debate-negatives of legalization-is broached. Any of the types of physician assisted suicide, whether it be direct (as in the doctor being present) or indirect (as in the doctor prescribing enough medication to overdose) can be construed as homicide, although it would technically be hard to tell in the case of indirect assistance since many of the amounts of medicine that terminally ill patients take can cause an overdose simply by accident. “Much weight is placed on the Hippocratic injunction to do no harm. It has been asserted that sanctioning physician-assisted suicide ‘would give doctors as license to kill,’ and physicians who accede to such requests have been branded by some as murderers. This is both illogical and inflammatory. Withdrawal of life-sustaining treatment-for example, disconnecting a ventilator at a patient’s request-is accepted by society, yet this requires a more definitive act by a physician than prescribing a medication that a patient has requested and is free to take or not, as he or she sees fit. Why should the latter be perceived as doing harm when the former is not” (Rogatz, 31)? When articulating on the subject of euthanasia, most people present the fact that advanced medical technology has made it possible to increase human life span and treat patients in pain as in The Ethics of Euthanasia, “It is argued that requests for assisted suicide come largely from patients who haven’t received adequate pain control or who are clinically depressed and haven’t been properly diagnosed or treated. There is no question that proper management of such conditions would significantly reduce the number of patients who consider suicide….However, treatable pain is not the only reason, or even the most common reason, why patients seek to end their lives. Severe body wasting, intractable vomiting, urinary and bowel incontinence, immobility, and total dependence are recognized as more important than pain in the desire for hastened death” (Rogatz, 31). This stated, the more dependent people become upon their family or people employed to care for them, the more they know that their lives are ready to be over. At this point in time, many people who wish to die can simply have themselves removed from whatever machines may be extending their lives though this rarely leads to an immediate death and causes numerous patients to suffer if doctors will not prescribe medication for pain treatment. “It is argued that requests for assisted suicide are not frequent enough to warrant changing the law. Interestingly, some physicians say they have rarely, if ever, received such requests, while others say they have often received requests. This is a curious discrepancy, but I think it can be explained: the patient who seeks help with suicide will cautiously test a physician’s receptivity to the idea and simply won’t approach a physician who is unreceptive. Thus, there are two subsets of physicians in this situation: those who are open to the idea of assisted suicide and those who aren’t” (Rogatz, 31). This seems to be a trend among authors who loom along the offenses of being protagonists in the line of PAS because Humphry and Clement also mention the decline of the doctor-patient relationship early in their book. “Societal changes and discretionary abuses within the medical community have led to a distrust of the medical profession and a decline in the doctor-patient relationship. This deterioration of confidence is yet another force of activism that has propelled PAS to its current mainstream status. The elements of trust that existed before World War II were strong enough to legitimize a paternalistic attitude on the part of the doctor. But when trust diminished, so did the public’s willingness to accept the doctor’s authority. Patient autonomy, spurred on by the rights culture of the 1960, increased, and with it came further acceptance of the right-to-die movement…Opinion surveys have, over the years, inquired into the degree of confidence that Americans have in various institutions including congress, the press, universities, and the medical profession. The declines have been dramatic and nowhere more pronounced than in medicine. Looking at confidence in medicine from 1966-1994, the numbers speak for themselves: seventy-three percent (1966), forty-three percent (1975), thirty-five percent (1985), and twenty-three percent (1994)” (Clement, 35). Granted the studies are quite a bit dated, this was the most up-to-date information when the book was published, and is still the most correctly represented data used today. It is often argued that once we open the door physician-assisted suicide, we will find ourselves on a slippery slope