What Are the Ethical Arguments Surrounding Medical Aid in Dying?

Medical aid in dying or physician-assisted death is one of the most fervently debated topics in healthcare today. Although most Americans believe that physicians should have the right to help mentally competent, terminally ill adults end their lives, many religious groups and health care professionals are vehemently opposed. Nevertheless, as of this writing, nine states and the District of Columbia have legalized the practice either through legislation or the courts.

The ethical debate over medical aid in dying is, for the most part, divided between those who support the practice and those who oppose it on religious, moral or ethical grounds.

Ethical Arguments in Support of MAID

Those who support the practice of medical aid in dying do so based on the concepts of autonomy, justice, compassion, individual liberty, and honesty and transparency. 

Specifically, they include:

• Respect for autonomy: Competent human beings ought to have the right to decide when and under what circumstances they die. 

• Justice: Justice requires that we “treat all cases alike.” A person who is terminally ill has the right to refuse life-prolonging treatments, such as mechanical ventilation or dialysis. So, in cases where a terminally ill person is experiencing unbearable suffering but does not require life-saving treatments to prolong life, helping them end their lives is a just act. 

• Compassion: Suffering is much more than physical pain. A person may experience horrible suffering due to loss of independence, mobility, control of bodily functions and personal dignity. Sometimes, even the most compassionate care cannot relieve this kind of suffering. In that case, medical aid in dying is the most compassionate act.

• Honesty and transparency: By legalizing and legitimizing medical aid in dying, society encourages open and honest communication between patients and their doctors about end-of-life goals. This may ultimately lead to more compassionate end-of-life care. 

• Individual liberty: Although society has an interest in preserving and protecting life, that interest becomes less compelling when a person is terminally ill and wants to choose when and how they die. In these cases, personal liberty rightfully ought to supersede state interest. 

Ethical Arguments Against MAID

Many of those who object to medical aid in dying do so on moral or religious grounds. Others believe that allowing medical aid in dying is a “slippery slope” that puts vulnerable populations at risk. For physicians, objections may rest on professional integrity and the concept of “do no harm.” 

Specifically, some arguments against medical aid in dying include;

• Sanctity of life: Historically, both religious and secular traditions hold that life is sacred and that deliberately taking a life, even one’s own, is morally wrong. 

• Passive versus active: Although most people agree that withholding life-saving treatment is ethically defensible when a person is terminally ill, it can be argued that withholding treatment and allowing a person to die is not the same as actively helping a person to die. 

• Potential for abuse: Some believe that legitimizing medical aid in dying puts vulnerable populations, such as the poor, the disabled and the elderly, at risk of being pressured to end their lives either to ease the burden on caregivers or to cut costs. (Note: In Oregon, where medical aid in dying has been legal for 20 years, neither of these scenarios has come to pass.) 

• Professional integrity: The Hippocratic Oath, which many (but not all) medical school graduates take upon becoming a doctor, says in part, “I will not administer poison to anyone where asked,” and I will “be of benefit, or at least do no harm.” Many physicians believe this is a proscription against assisting a patient in ending their lives. What’s more, even physicians who support medical aid in dying in theory have expressed reservations about participating in the practice themselves.

• Fallibility: This argument contends that no physician is infallible, and prognoses are often wrong. Lapses in medical care can also occur, which, if rectified, might significantly improve a person’s quality of life. Doctors may also miss a diagnosis of depression in a terminally ill person who wants to end their life. 

Sources

“Assemblymember & NY Alliance for Medical Aid in Dying Question Medical Society of State of New York “Survey”. Compassion & Choices. https://compassionandchoices.org/news/assemblymember-ny-alliance-medical-aid-dying-question-medical-society-state-new-york-survey/