Since the implementation of The Suicide Act 1961, it has been a subject of controversy and debate, as to whether physician-assisted suicide (PAS) should be permitted in the UK. The National Health Service (NHS} website states – ‘Assisted suicide is the act of deliberately assisting or encouraging another person to kill themselves’ and according to Section 2 of the Suicide Act 1961, Doctors will be liable for conviction if they encourage or intend to encourage the suicide of another person. In this essay, I will firstly examine Slippery slope arguments, along with existing positive practices such as Palliative Care, that are currently in place, as my arguments against the legalization of PAS.
In addition, I will consider the role of medicine as another argument against the reformation of PAS. Afterward, I will finally critically examine the problematic arguments surrounding free will in favor of PAS. As a conclusion to these arguments, I will proceed to give an overall reason as to why I believe that Section 2 of The Suicide Act 1961 should be not reformed in order to permit physician-assisted suicide, due to the many complications that would arise as a result of such legalization.
This essay will primarily focus on slippery slope arguments, originally proposed by Keown in 2002 which have been interpreted differently when discussing the legalization of PAS. The term slippery slope is commonly used in moral debates in order to exemplify the reasons as to why the legalization of PAS would incur adverse consequences for society. Thus, as a result, creating a downwards spiral of events that could effectively snowball into chaos.
Such consequences may include doctor’s abusing their powers and belittling minority groups such as those with disabilities, which may lead to a society which is synonymously akin to Nazi Germany, with a population filled with passively complicit citizens, unwilling to help those who wish to better their lives through various processes of empowerment such as palliative care (which will be discussed later in this essay).
If Section 2 of The Suicide Act 1961 is reformed in order to permit PAS, then mentally competent adults with illnesses would likely and voluntarily be able to choose whether to proceed with PAS or not as they are deemed to have the capacity to take matters into their own hands. However, limiting PAS to patients suffering could be extremely prejudicial towards those who are mentally incapacitated, which is clearly a violation of equal protection. This is due to the reason that, those who lack mental capacity or insight may be more susceptible to vulnerability resulting in a physician choosing to end the life of a patient which is involuntary and may not be the outcome that the patient wants. Article 3 of The Human Rights Act 1998 includes the prohibition of torture and inhumane treatment, therefore the legalization of PAS would breach this proceeding if involuntary assisted death occurs, which is inhumane and wrong as each person, whether mentally competent or incompetent deserves to live the life they choose and not have someone dictate them. This also clearly violates the idea that we are all seen as equals thus, also violating the Human Rights Act article 14 which indicates that no matter who we are, we should all have access to and enjoy the same human rights as each other. Not one person should be able to voluntarily pick or choose PAS if another cannot.
For, example a new baby with a congenital deformity should not have another human being terminating their life. There will be new Medical and Surgical breakthroughs including possible gene therapy that will bring new cures and treatments. If section 2 of The Suicide Act 1961 is reformed, it may lead to society seeing those with disabilities, whether physical or mental, as inferior and unworthy of life. Due to this, the legalization of PAS could have extremely unethical consequences when it comes to minorities within society, hence the legislation should not be reformed as it also breaches elements of the Human Rights Act 1998 and the breach of these elements may pioneer the path for others to breach such elements, leading to a society of unlawful behavior.
This mentality of the argument also leads down a psychological slippery slope, whereby individuals may become desensitized to the idea of killing another, which may inevitably lead to a passively complicit society, akin to that of Nazi Germany. It could be that once physicians become completely desensitized to PAS, they may naturally feel freer and more willing to practice assisted suicide, by which they encourage patients to end their lives, even if they are not suffering from a terminal illness. This may be because PAS would be the quickest and the so-called ‘easy way out’ for suffering patients, regardless of whether they can find other means to increase their motor and mental capacity. This idea is significantly detrimental to the meaning of human life as it may be that doctors are killing off the so-called weak just because it is the easiest and cheapest option, rather than promoting the lives and health of patients. This is the complete opposite of what a doctor should be promoting as it is most commonly argued that the norms of medicine are set out in order to prevent a doctor from ever acting with intent or trying to aid a patient to kill themselves and therefore the legalization of PAS would undeniably go against the norms of medicine, giving it no purpose and so, therefore, the legalization of PAS should never be permitted.
In addition to this particular slippery slope argument, the Netherlands along with few other places legalized the practice of PAS in 1984 and coming from this legislation, a famous quote arose from a Dutch physician in reference to euthanasia and PAS stating ‘The first time you do it, euthanasia is difficult, like climbing a mountain’. This quote implies that once one helps assists with the death of another, one is more likely to become desensitized to the practice as he may have ‘climbed to the top of the mountain’ and the process all of a sudden became worth it with a clear view at the top. It also implies that once conducting PAS for the first time, the process becomes easier: Could this mean that physicians would become desensitized to the ethics and morality of assisted dying? If so, this is not the mentality that any society should be adopting as it is an ideology that was seen in Nazi Germany prior to and during the Second World War, which resulted in the mass extermination of many innocent Jews at the time. This came about due to the abuse of power that the Nazis possessed over the German population at the time and Nazi doctors would euthanize those who were deemed as being ‘physically’ and ‘mentally’ weaker on a regular basis. This, in turn, leads to those with disabilities to live in fear of constant extermination. This in terms of the slippery slope argument in relation to the legalization of PAS, the same outcome would be very much likely. This may be because once doctors become desensitized to PAS as ‘climbing the mountain’ after the first step supposedly gets easier, doctors may use PAS as a first result option when having to act on behalf of those who are deemed as being mentally or physically impaired, which may create fear amongst those who these characteristics apply to. Thus, PAS should not be legalized in case our society becomes parallel to Nazi Germany in terms of ideology and a mass fear is created amongst people as they may fear being at risk of being euthanized if deemed as being mentally or physically impaired.
Palliative care is concerned with improving the quality of life of patients with incurable diseases that will eventually cause that patient to die. Through Palliative Care patients can positively utilize the last few months of their lives, which means they can die with dignity having symptoms improved/treated, rather than ending their lives unnaturally through PAS. Many doctors and nurses that work within the field of palliative care along with dying patients reject that The Suicide Act of 1961 should be reformed in order to permit PAS, and given that they have years of clinical practice in helping patients die with dignity, their views, and clinical experience should be taken into account.
Legalizing PAS may mean that individuals feel a sense of hopelessness and see no value in their lives anymore and so wish to end their lives to relieve not only physical but mind-related suffering, which as a society we should encourage the fulfilment of living the best life one can live given the years that patient has left, focusing on improving quality of life. However, we must ask ourselves, is suffering ever fully relieved? The answer to this is likely to be no. How can we ensure that a patient’s family is relieved of all suffering? And how can we be so sure that a good death is achieved for the patient by which the patient is fully satisfied? Again, we cannot simply relieve all suffering. Despite this, palliative care aims to provide the patients with the means to explore and exercise their moral autonomy which is the given right of an individual to exercise full power over his life, which is morally satisfying, as many patients feel as if they have no self-control once being deemed as chronically ill. This also allows the patient to feel a sense of relief and in my opinion, this is a good way to die as the parties involved and the individual affected will be less likely to suffer as it is a more peaceful and empowering way of dying. Therefore, PAS should not be legalized as the UK is fortunate enough to allow patients to access palliative care, as a means of relieving suffering rather than using PAS, which doesn’t help all parties involved.
However, although palliative care is a good practice as a way of helping patients towards the end of their lives, it is also important to note that palliative care is not often available to everyone. This raises an issue as the legalization of PAS may be more desirable as it would be a quicker process and much more accessible. Palliative care also focuses on the mental aspects of suffering as opposed to just the physical suffering which often gets overlooked for those suffering from physical illnesses. However, despite the limited access available to palliative care, it may be useful in the future to provide more funding for this practice rather than fund PAS, in order to help satisfy the needs of patients.
It is widely accepted that when a person is diagnosed with a terminal illness, depressive episodes may follow which may impair an individual from keeping up with their daily activities along with maintaining relationships. One may find that they lack enjoyment in activities that used to pleasure them, or even find that they are hopeless in aspiring for greater things in the future. All the above can lead to clinical depression or exacerbate existing depression, which may, in turn, make terminally ill patients have a lack of will to live. This may result in them wanting to use PAS to end their suffering mentally. Depression often makes patients feel like they have no way to fully live a life of being autonomous and make their own decisions rationally. Seriously ill people often suffer from undiagnosed depression or other mental illnesses that can impair their ability to make an informed decision. Research has also shown that when a patient is mentally ill e.g. suffering from masses of stress, the symptoms of the terminal illness often deteriorate. As a result of this, a more ethical approach would be to enroll a terminally ill patient in cognitive behavioral therapy (CBT), which could help relieve the stress of the patient and make their depression subsidize which may make the patient feel less inclined to end their life, change their mind about undergoing PAS and feel more empowered as a result to engage with palliative care and live their remaining life to the fullest.
In addition to this, medical diagnoses can be inaccurate, and patients are often misdiagnosed with illnesses. This may mean that a patient may opt for PAS, should it be legalized, and die even though they had no illness to justify their assisted dying. As a result, PAS, should not be legalized, or it should not be permitted until the medicine is more advanced to ensure that testing is 100% accurate, in case patients are wrongly diagnosed and partake in PAS for no apparent reason.
Despite, the Slippery slope arguments, along with the role of palliative care and medicine, it is important that this argument is considered when deciding on whether PAS should be legalized. As humans, it is important that we should fully exercise and conduct our rights of autonomy and free will, by making decisions to ensure that we govern ourselves. This links to the debate as to whether PAS should be legalized as many argue that autonomy and free will would be exercised by the legalization of PAS. However, the issue with this argument is that free will and autonomy would be empowered through palliative care, as it aims to promote a patient’s free will into helping them make and live by decisions that will add to the value of their lives. Therefore, legalizing PAS is not the only way a patient can exercise their free will, as palliative care exists in order to ensure that free will and autonomy are in the hands of those who are terminally ill.
‘Dying people are not suicidal – they do not want to die, but do not have the choice to live, when death is inevitable, suffering should not be’. This quote implies that the key issue facing ‘dying people’ is that of suffering. Again, palliative care and the practices of CBT would very much help to relieve the suffering and change the mentality of those who are ill, and so arguing that PAS should be legalized in order for one to feel fully autonomous is absurd as other practices exist which help promote autonomy and the free will of a patient.
After critically analyzing the leading arguments for and against the legalization of PAS, my argument leads to the conclusion that the Suicide Act of 1961 should not be reformed to legalize PAS. Although patients who are terminally ill, seek to find a painless way out, adequately funded palliative care services should be the main way forward as it helps promote the free will and autonomy of a patient. Along with this, as a society we should be protecting individuals against prejudice, as certain members of the populace, live in fear of being killed off if deemed as being weak which is akin to the ideologies of Nazi Germany and would breach Article 3 and 14 of the Human Rights Act 1998.
It is also important that we as humans never devalue the aspects of life and should encourage all to live life to the fullest, given whatever time a patient has left to live. The field of medicine is also a factor to consider when debating the legalization of PAS due to the inconsistencies within diagnosis’s and along with the aspects of depression, which can improve with support, that one is likely to have as a result of becoming chronically ill, which all in all leads to my decision that The Suicide Act of 1961 should not be reformed in order to permit PAS. This is due to severe problems that would arise from such legalization, and incur a slippery slope that could potentially harm our society and prejudice members living with illnesses’.