Week 4 - learning about the ethics of physician-assisted suicide

Sheeeesh.  Its all very well me going to these talks, listening and digesting all the information.  Granted its all compelling and I'm taking it all in retrospectively but then it sits there somewhere in a drawer in the vast cavity of my brain, normally not to be thought of in much detail again. But, its another story entirely when I actually have to verbalise my thoughts and opinions on what I've heard.

This one, then, is a humdinger and a subject I had no real concept of how much of a can of worms it actually is.  The extent of my opinion was such that, I think it is wrong to not allow euthanasia, specifically for terminally ill people to not be able to end their lives on their terms and with dignity.  This was the reason I wanted to go to a talk about the ethics of physician-assisted suicide as I really wanted to hear all sides of the argument.

There was a small issue with the talk and that was that the American speaker, Professor Browne Lewis had a very thick Southern accent and I struggled to keep up with what she was saying.  I also wasn't aware that she was going to be talking very specifically about the different laws in America - doctor-assisted suicide is actually legal in five States.  So, I had to battle, not only through her incredibly thick drawl but also through all the different processes and legalities pertaining to each state.  That being said, the ethics are ultimately the same anywhere and we all have the same feelings wherever we are in the world, so I still gained a lot.

But, oh my, there is so much to think about with this topic and its actually ever-changing with advances in technology, the fact that we're all living longer etc.  It even comes down to semantics in the first instance.  For example, many people who are opponents of physician-assisted suicide (PAS) are very clear to use the term "suicide" because it has a negative connotation and opponents want to create the image in people's minds that a doctor is physically helping the patient to commit suicide.  Whereas proponents of PAS would rather it be called "physician-assisted dying" - their objective is to see the doctor as a comforter who is helping the patient to die with dignity.   So is it aiding a death or helping with a suicide?  We could think of it this way: a life support machine is used to prevent death and yet anywhere, regardless of the law, a family member can choose to take someone off that life support machine, which will invariably mean they will die. Could that be seen as aiding a death?

So it is great that there are some States where PAS is legal (FYI Oregon, Washington, Vermont, California and Montana).  Naively though, I didn't really think for a minute that there could be a whole load of ethical concerns coming into play with it being legal.  A lot of people would argue that the current legal system of PAS does not protect terminally-ill patients who are vulnerable because of factors other than their illnesses, including age, disability, race and economic status.
So for example, the elderly may feel some sort of duty to die and that they are a burden to their family or vice versa they may have family who pressure them into choosing PAS.  Certainly in the Western world, we do live in an ageist society where people over a certain age get a bit over-looked.
Take someone who is very disabled.  Again, they might be pressured into PAS either from family members who don't want to look after them or by insurance companies who are not willing to cover their medical expenses but will pay for lethal medication.  The same could be said for someone who has a very low income but might need huge amounts of money to cover costs of a treatment - the insurance companies are very willing to suggest PAS as an alternative.  
These are all ongoing problems that are associated in the States where PAS is legal.  But, these problems are universal and why it is so hard for our government to make any key decisions.

Lets say that PAS is legal here.  Well, it can't just be granted to anyone. You actually have to work bloody hard to get it.  In the States the conditions are that you have to be eighteen or over, you have to be of sound mind (capable of making decisions and communicating those decisions), you have to be a resident of the State and you have to be diagnosed with a terminal disease that is incurable and irreversible.  You then have to put in a request in writing and it be witnessed by two people (one of whom does not know you).  Ok yes, it is important that it can't just be granted to anyone - thats the whole point, life is precious and we can't play God.  But surely people can see if someone is suffering, unhappy, in pain and quite clearly does not want to carry on as is.  These conditions are all too stringent and as everyone knows, life is messy and different and complicated.  Not everyone fits into a box.
If everybody abided by these rules then it would mean that two groups of people are totally banned from PAS and that is people under the age of eighteen and people who don't have terminal illnesses (put another way, people who are predicted to live for more than six months).  So does that mean that people under the age of eighteen don't suffer pain or are incapable of communicating their suffering?
What about someone who has a progressive, irreversible brain disorder that destroys their memories and abilities to learn, reason and make decisions?  They can survive for a long time and so aren't recognised as being terminal.

Clearly there is a lot of work to be done on this subject and yes, this talk made me realise that it isn't as easy as 1,2,3 to just go ahead and legalise PAS or euthanasia but all I know is that if someone is in constant pain, unhappy, has very little to live for and is unable to do things for themselves, I truly believe that if they want to end their life, they should be able to do that with dignity, with family and in the comfort of their own home.  Why should they have to fight and fight through all the other trauma just to make that happen?  This is not a law that is black and white like murder or rape or stealing where if you commit those crimes you should be punished.  This is a law with a million shades of grey and as such, should be looked at on an individual basis.  Like I said, life is precious and if we have a choice for how we leave that life, it should be studied with careful consideration.