1 : of or relating to ethics
2 : involving or expressing moral approval or disapproval
3 : conforming to accepted standards of conduct
4 of a drug : restricted to sale only on a doctor's prescription
synonyms see moral
The synonym of moral will bring a whole different dimension as we explore this issue from several points of view. The definition of illegal is fairly straight forward and is listed as: “Not according to or authorized by law.” It should be apparent from our discussion of the terms used in our discourse that some are straight forward and some are more nuanced. Why would a society need such words where there are four definitions for a fairly innocuous word such as ethical?
It would seem that to better review our discourse we would need a better definition of ethical than Merriam Webster can provide. I found that David B.. Resnik, J.D., PH.D has a good explanation of what we can agree is a good frame work to start from when he writes” When most people think of ethics (or morals),
they think of rules for distinguishing between right and wrong, such as the Golden Rule ("Do unto others as you would have them do unto you"), a code of professional conduct like the Hippocratic Oath ("First of all, do no harm"), a religious creed like the Ten Commandments ("Thou Shalt not kill..."), or a wise aphorisms like the sayings of Confucius. This is the most common way of defining "ethics": norms for conduct that distinguish between acceptable and unacceptable behavior.” This definition is in stark contrast with what is illegal is explicitly stated. And this brings up the conundrum that can something be ethical and illegal?
There are several instances of laws that were unethical. The ones that come to mind are the segregation laws in the south, where African-Americans were forced to be segregated from Whites. There were separate bathrooms, water fountains and places to sit on the bus. These legal yet morally bankrupt laws were marched against and protested to the point of their repeal. Prior to that there was the suffragette movement where women protested for the right to vote. Think about that today some people thought it was a good idea that women did not get to vote, how unethical. But that too was changed through protest. Just because it is law does not make it ethically correct.
The AMA is as an organization against doctor assisted suicide and did file a circuit court brief arguing against doctor assisted suicide. The member doctors are much more of a mixed picture. There are however practical reasons to be for assisted suicide from a cost perspective. It is estimated that 25% of Medicaid spending is spent in the last year of a person’s life and 40% in the last 30 days . This creates a very strong argument that reducing care the last 30 days can allow the system to cover more people at a lower tax burden which can increase the quality of life for those who are not ill. For some people the pain they are in is so intolerable that making them stay alive is comparable to cruel and unusual punishment. There is also the financial burden they might be leaving their family. Not everyone has good health insurance. They might be saddling the family with hundreds of thousands of dollars in debt for their few remaining days.
The AMA position is that through proper planning end of life decisions can be made where the patient chooses no feeding, and so on. While this might seem like suicide by starvation the AMA makes a distinction that it does not view not placing feeding tubes in people who do not want to be fed by tube is the natural course of life.
The religious aspect of assisted suicide is fairly clear in the United States where the predominant religions: Christianity and Judaism cover over 80% of the population and assisted suicide is strictly forbidden. In most of Christianity suicide is considered a mortal sin that cannot be forgiven or redeemed. The religious component proposes the idea that everything a religion tells you to do is moral is too stiff a structure for most people in modern life. Legal abortion is the law of the land and yet the Roman Catholic Church is firmly against it. The Pope has ruled that abortion is a sin and immoral yet there are many Catholics who believe otherwise, they do not believe life begins at conception.
The pro-assisted people argue that it is a persons right to choose when they die and not the states right to keep them alive. They would argue “Every person shall have the right to die with dignity; this right shall include the right to choose
the time of one's death and to receive medical and pharmaceutical assistance to die painlessly. No physician, nurse or pharmacist shall be held criminally or civilly liable for assisting a person in the free exercise of this right.” It would seem that we, as a society have not resolved in our collective mind on the idea that the way we die could be our choice. In Europe assisted suicide is generally accepted and not prosecuted; in many cases there are no laws specifically against it.
As we surveyed the various factions on this topic we have discussed the arguments that the various groups have made. Unethical is not as pervasive an argument as would be expected. Patient wishes and money seemed to dominate the discourse more than what is ethical or moral in these cases. The decision of which cases of assisted suicide are unethical and which ones are not does not easily translate to an easy solution. The Ten Commandments is always
a good place to start with societal norms. However that is information delivered in broad stroke and not for a difficult question like this.
There is a good point to the fact that so much money is spent in the last part of people’s lives. Ethically it could be better spent eliminating poverty or providing healthcare for a child that does not have healthcare now. But who is to make
that decision? The idea of choosing who lives and who dies can quickly degenerate into eugenics. Eugenics is the active management of who is allowed to procreate in the belief that through active selection the future generation can be bred to be better and healthier people. It was actively practiced by the German Nazi regime.
It is an odd counter point that while people are prevented from assisted suicide it is something we readily offer our pets. There is no hewn out cry when Mr. Jones has to put his dog down at the veterinarian. It is looked at in this context as humane and ethical. So how can we be kinder to our pets than we our to ourselves?
Context is the point, in some situations assisted suicide can be ethical and in others it can be unethical. The family is the best arbiter of when assisted suicide is appropriate and ethical. The idea that people dying sooner, with assisted suicide, would be a cost saving measure is a very dangerous slippery slope. If we can save the most by taking away the last month, why stop there? It would do something our society has steadfastly avoided, putting a price on life. I know
insurance companies do it but as a society we have not put a price on life. We, as a society realize we are not smart enough to put a price on life, because life is priceless. If we as a society did not take this position our society might look something like the movie Logan’s Run, where everyone is killed at the age of thirty; because this is when people start to get sick and less productive in society’s eyes.
There are however existences that are not living or worth having. Is it ethical to struggle through pain and hardship with no end in sight? I would say no and
understand the desire to end their life on their own terms, it seems like we should all have that right. The religious aspects are not going to change right away. Look at how long it has taken divorce to lose its stigma. But Christianity and Judaism have been around for thousands of years if they did not evolve over the years they would not be followed any more.
In conclusion I cannot definitively say whether assisted suicide is ethical or not. It is currently illegal. As Maine Medical Society's executive VP Gordon Smith put it, "physician-assisted suicide goes against 2,000 years of medical ethics" But just as we discussed how the context gives all of the ethics to the situation. Trying to find a one size fits all solution to a question so fraught with heartache and pain is not practical. Armchair pronouncements do not work well with real life situations. Is it an unethical law like prohibiting women the vote or African-Americans equal access to the economy and the courts? Or is it instead going against our idea that all life is priceless? As is often said in the military some decisions are made above my pay grade. Time will tell which is which.
