Chidi's Choice

 

For week 2 of bioethics, we're looking into requests to die. The chapter we were asked to read in the textbook was long, but offered interesting background on some of the arguments surrounding past cases and legislation in countries (and US states) where physician-assisted death is legal. This is a difficult issue, and isn't one that is often discussed. Not that it needs to be part of everyday conversation either, but maybe it would be less taboo and easier to talk about if it were brought up more often than just in a collegiate bioethics course. 

Before diving into my thoughts about the ethics of physician-assisted death, I want to address something that I see as a major error on the part of the publishers of the textbook. There was a section in this chapter that spoke explicitly about various methods of suicide and what can happen as a result of an unsuccessful suicide attempt and/or the state of the survivor after a suicide attempt. This chapter, or that section at the very least, needed to have some sort of warning. Any mention of suicide can be incredibly triggering for anyone who has had suicidal thoughts/ideation or who has survived an attempt. I knew that the chapter was going to discuss medical cases and the ethics behind physician-assisted death, but there was no warning as to the depth of the discussion about personal suicide attempts and methods. I have received professional training in suicide prevention and it was still difficult for me to read. 

Moving past that blatant error...

When it comes to heavy and potentially convoluted ethical questions, there is a lot to consider. 

I'm going to highlight here some of the information presented that I agree with. My initial stance on this issue hasn't really been shifted after reading the chapter, but rather I saw it strengthened by some of the arguments presented in it. 

One overarching theme of the chapter is that of consent and autonomy. Jean Davies is quoted as saying, "[just as] rape and making love are different, so are killing and assisted suicide" (Pence 49). If you actively take away the life of someone who did not ask for it, one could argue that you have taken away that person's right to choose and right to life. But where this issue is different, as the above quote suggests, is in the consent given. To that, we can add that it should be informed consent. Margaret Battin claims that physicians don't discuss end of treatment/end of life options with dying patients (Pence 44), which also takes away their ability to actively choose what they want their care to look like. And at the end of the day, it is the patient alone who fully understands the pain (physical, psychological, etc.) that they are experiencing. The biggest issue under the umbrella of making autonomous decisions then, is whether the quality of life is acceptable to the person who is living it, and the fact that that decision can only be made by the person who is experiencing it (Pence 43). 

This is not something that should be available to everyone in every case, but that could be utilized to end or prevent suffering in terminal patients. If it is extended as an option to every patient deemed legally competent, it quickly becomes an extreme case of the slippery slope argument. What is the value of one life? And what life, or lives are worthy to be lived? If a physician can justify the killing of one patient (or letting them die), then where is the line drawn between them and the next patient? What is the reasoning used here? In empirical slopes, the claim is made that when a moral change occurs, the ability to reason and maintain once strongly-held standards will be lost. A conceptual slope is based on the idea that once a small change is made in a moral rule, other changes will soon follow because, "reason demands consistency in treating similar cases similarly" (Pence 51). Either (or both!) of these slopes could come into play when considering the issues surrounding physician-assisted death, which is why arguments concerning human life must be taken seriously.

The title of this post is "Chidi's Choice" so that it fits within the theme of using episode names from "The Good Place" as titles, but ultimately, every person should have the ability to make a series of choices and have control over their care. Physician-assisted death is not something to be treated lightly or a procedure, or power, that should be abused or run unchecked. Rather, it should be considered as an option for terminally ill patients who desire to have more control over their treatment and choices for the end of their life. 

Textbook reference: 

Pence, Gregory. Medical Ethics: Accounts of Ground-Breaking Cases. 9th ed., McGraw Hill, 2021.