The principlist approach to biomedical ethics is understood on the basis of two central theses. The first thesis is that moral principles are non-absolute and that they do not occur in a determinate order of precedence. This means that every single principle is prima facie. These prima facie principles are; beneficence, respect for autonomy, non-maleficence and justice. The second central thesis, usually called the global applicability thesis, posits that the four prima facie principles derived from common morality make principlism universally applicable.
Analysis of ethical questions based on the biomedical principles of ethics is central to moral reasoning while at the same time respects exigencies of circumstance and liberates pluralism (Beauchamp & Childress 14; Herissone-Kelly 65). Since this application of ethical principles is sensitive to moral beliefs encountered in everyday lives, it forms the basis of ethics in biomedical practice. It acts as a guide to action even though the four principles do not operate in a determinate order of precedence.
In attempting to discern the ethics of physician assisted suicide one central question comes into mind. Is assisted suicide morally justified? In a nutshell, assisted suicide or more specifically, physician assisted suicide, refers to a case where the patient has ended his life either with a lethal dose or any other medically provided instrument after the patient requested for the lethal dosage from the physician who provided the dosage for the specific reason of ending the life.
The difference between euthanasia and assisted suicide is that in the case of euthanasia, it is the physician who administers the lethal dose or withdraws the life support system because the patient in question is unable to administer the same to him/herself. Thus, the difference lies in the difference in who makes the action that precedes death. In assisted suicide, it is the patient who acts last. The choice of taking the lethal dosage or pushing the button that will terminate life solely rests with the patient and they have the capacity to alter their decision before their actions become irreversible.
Even though the physician plays a causal role in both; the patient kills him/herself in assisted suicide while in the latter, it is the physician who kills the patient. This difference creates an intrinsic moral difference between the two. This brings into question the principle of respect for autonomy. The moral principle of respect for autonomy refers to a patient’s freedom of liberty or choice interests. However, it should not be confused with an all-for-nothing phenomenon. Gradations of autonomy and its interpretation in different circumstances are variable.
A patient’s autonomy can be interfered with when there is excessive control (too much interference with the patient’s decisions) or when there is too little interference (neglect of the patient). Respect for an individual’s autonomy is also threatened in cases where an individual’s right contravenes another individual’s freedom of choice and their actions (Brent 40). With respect to assisted suicide, the patient in question having satisfied the qualifications of making an informed consent can request the causal assistance of the physician to carry out actions that directly lead to their death.
In such a case, professional codes of ethics bind physicians to respect the patient’s rights to self determination by unobstructing the conditions for the operation of an autonomous action such as: intentionality, understanding, and the complete absence of any controlling influence. In a situation where all these conditions are met and the physician dutifully performs their causal roles, physician assisted suicide is ethically correct. This is so because so long as the patient’s rights are supported it automatically follows that ethical permissibility of assisted suicide is also granted (Weir 89; http://www. deathreference.
com/). In cases whether the patient is suffering from a treatable clinical depression or dementia which impair the decision making capacity of the patient, the right to self determination do not apply (http://www. inclusiondaily. com/). The moral principle of Non maleficence hold that a person should not do harm. It specifically holds that one should have the capacity to discern actions that are morally harmful. However, there is controversy as determining the intention behind an action. At the same time, determining whether an intentional or unintentional action refrains from action harms or puts the subject at a risk of harm.
The moral principle of beneficence entails the following obligations: to prevent harm, to eliminate harm, and to do good. These three conditions characterize the measures taken by medical practitioners to balance the components of risks, harms and benefits. Beneficence therefore encompasses professional, personal and societal obligations (Brent 41). The principle of beneficence largely builds on the foundational principle of non maleficence. In this case assisted suicide is ethically permissible on the basis of an individual’s well being.
It can be argued that in such a case, to promoting and protecting the patients well being may be contradictory to the patient’s right to self determination. However, this is not so. Life is often is perceived as being good and its value is a product of our pursuit of goods within life itself. In an assisted suicide scenario, a person who is fully competent to reach a decision decides that life sustaining treatments no longer has any benefit but has become a burden. Most of these patients are often critically ill, dying or in a very debilitated and severely compromised state.
If such patients request the means to end their lives, it is in line with non maleficence or beneficence because such an act is value to the patient’s life. Unless if the patient is unable to reach a competent decision and the dictatorial authority transferred to a surrogate, the right of self determination stands and is not in contradiction to the principles of non maleficence and maleficence(Weir 90). Moreover, such a decision is only ethical if it does not infringe on the moral and professional values of the physician. Additionally, assisted suicide is an act of compassion that eliminates further suffering and pain.
Refusal to grant the patient their claim or entitlement is akin to putting them to unbearable suffering. Finally, the moral principle of justice simply refers to fairness. It is the act of receiving one’s due; entitlement or claim. Distributive justice concerns itself with how fairly benefits can be allocated and distributed. Basically, four considerations guide moral justice. For instance, an equal share, according to a persons need, according to a person’s effort, and lastly, according to societal contribution (Brent 42).
Physician assisted suicide is supported by the moral principle of justice in the context of “treat like cases alike” (http://depts. washington. edu/). When competent but terminally ill patients request lethal dose medications or refuse life sustaining treatments with the sole purpose of hastening death, it is only just that they should be granted their claim. However, these arguments are only suitable when the ethics of assisted suicide is analyzed on a basis of the biomedical ethical principles. Works Cited BBC News. Assisted suicide ‘danger’ claim.
April 20, 2009. http://news. bbc. co. uk/2/hi/uk_news/scotland/8008736. stm Beauchamp, Tom L, & Childress, James F. Principles of biomedical ethics. Oxford University Press, 2001; 1-23 Brent, Nancy J. Nurses and the law: a guide to principles and applications. 2nd Edition. Elsevier Health Sciences, 2000; 40-47 Reynolds, Dave. Assisted Suicide’s For Mental Illness, Too, Swiss Court Rules. Euthanasia, Assisted Suicide, Eugenics, Bioethics. Inclusion Daily Express. February 5, 2007. http://www. inclusiondaily. com/archives/07/02/05/020507sweuth.
htm Encyclopedia of Death and Dying. Bioethics. http://www. deathreference. com/A-Bi/Bioethics. html Harrison-Kelly, Peter. The Principlist approach to bioethics, and its stormy journey overseas. in, “Scratching the surface of bioethics”, By Matti Hayry, Tuija Takala. Rodopi Press, 2003; 65-72 Physician-Assisted Suicide. Ethics in Medicine. University of Washington School of Medicine. http://depts. washington. edu/bioethx/topics/pas. html Weir, Robert F. Physician-assisted suicide. Indiana University Press, 1997; 86-97