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Physicians, particularly those in the field of palliative care, will be faced with a request for assistance in dying. It doesn’t matter where clinicians stand ethically and morally on the permissibility of this practice, and no matter whether these practices are legally permitted or prohibited in a given country. Clinicians have to carefully consider and decide how they will respond to these requests.
Over the past few decades, assistance in dying has drawn intense public attention and controversy. It is also a concern for physicians as well. An open ethical argument supporting or opposing assisted dying is needed to solve the controversy and to know the boundaries of a physician’s role in assisting death for a terminally ill patient. The argument/debate must be on the basis of 4 core ethical principles: Autonomy, Beneficence, Non-maleficence, Justice.
Firstly, Autonomy is the one that justifies a patient asking for assisted dying as it means honouring the patient’s preference in accepting or not accepting medical care. Thus, to respect their autonomy it is their choice by weighing their personal values to decide to end their lives. But some argue that the above argument fails to take the limitations of Autonomy into account. The main challenge is the possibility of autonomy and its limitation by the harm principle (i.e. is doing no harm) as ending one’s life may cause harm to others like loss of support, grief, etc. They even argue that accepting their wish to die is more like accepting suicide.
Secondly, Principles of mercy, nonmaleficence, and beneficence also support assisted dying. In cases of terminal illness, living creates more pain and suffering than death so by accepting the condition of such patients it is justified to permit assisted dying. It is also found that assuring patients about the option of assisted dying even it Is not used benefits patients in the aspect of relieving the sense of anxiety about future pain and suffering. But some people raise the point that adequate palliative care and hospices would relieve most pain and suffering. But even with optimal end of life care, patients may still suffer uncontrolled pain and suffering.
It is also important to know the attitude of the public by taking their opinion and conducting surveys regarding their point of view on assisted dying. Some people even raised how ethical is assisted dying on a social and religious basis. Physicians when asked about assisted dying must also consider alternatives to assisted dying like Palliative care and Hospice care.
Competing interests:
No competing interests
12 May 2019
Dr. Vishal Busa
INTERN
Dr. Chaitra Janga
King George Hospital (KGH), Andhra Medical College.
Re: Assisted dying should be discussed openly
Physicians, particularly those in the field of palliative care, will be faced with a request for assistance in dying. It doesn’t matter where clinicians stand ethically and morally on the permissibility of this practice, and no matter whether these practices are legally permitted or prohibited in a given country. Clinicians have to carefully consider and decide how they will respond to these requests.
Over the past few decades, assistance in dying has drawn intense public attention and controversy. It is also a concern for physicians as well. An open ethical argument supporting or opposing assisted dying is needed to solve the controversy and to know the boundaries of a physician’s role in assisting death for a terminally ill patient. The argument/debate must be on the basis of 4 core ethical principles: Autonomy, Beneficence, Non-maleficence, Justice.
Firstly, Autonomy is the one that justifies a patient asking for assisted dying as it means honouring the patient’s preference in accepting or not accepting medical care. Thus, to respect their autonomy it is their choice by weighing their personal values to decide to end their lives. But some argue that the above argument fails to take the limitations of Autonomy into account. The main challenge is the possibility of autonomy and its limitation by the harm principle (i.e. is doing no harm) as ending one’s life may cause harm to others like loss of support, grief, etc. They even argue that accepting their wish to die is more like accepting suicide.
Secondly, Principles of mercy, nonmaleficence, and beneficence also support assisted dying. In cases of terminal illness, living creates more pain and suffering than death so by accepting the condition of such patients it is justified to permit assisted dying. It is also found that assuring patients about the option of assisted dying even it Is not used benefits patients in the aspect of relieving the sense of anxiety about future pain and suffering. But some people raise the point that adequate palliative care and hospices would relieve most pain and suffering. But even with optimal end of life care, patients may still suffer uncontrolled pain and suffering.
It is also important to know the attitude of the public by taking their opinion and conducting surveys regarding their point of view on assisted dying. Some people even raised how ethical is assisted dying on a social and religious basis. Physicians when asked about assisted dying must also consider alternatives to assisted dying like Palliative care and Hospice care.
Competing interests: No competing interests