Questions and Answers

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• Islam    The Islam is against physician aid in dying. All human life is sacred because it is given by Allah, and Allah chooses how long each person will live. Human beings should not interfere in this. Aid in dying is, therefore, forbidden. Physicians must not take active measures to terminate a patient’s life.
• Roman Catholic    The official position of the Roman Catholic Church is strict: killing of a human being, even by an act of omission to eliminate suffering, violates divine law and offends the dignity of the human person. However, many Catholics—particularly in the United States—cite various quotations by Pope Benedict XVI as a source for continued disagreement and controversy regarding controversial issues.

• Buddhism    The teachings of the Buddha don’t explicitly deal with assisted dying, but the Buddha himself showed tolerance for suicide by monks. Buddhists are not unanimous in their view of physician-assisted dying. In Buddhism, the way life ends has a profound impact on the way the new, reincarnated life will begin. So a person’s state of mind at the time of death is important: their thoughts should be selfless and enlightened, free of anger, hate or fear. This suggests that suicide is only approved for people who have achieved enlightenment and that other people should avoid it.

• Judaism   In 2000, Rabbi Bleich, Jewish Law Professor, stated that “Judaism places the highest importance on palliation of pain, particularly in the case of terminal patients,” and that “Judaism teaches that suicide is an offence against the Deity who is the Author of life.” Conservative and Reform leaders have called for increased discussion of end-of-life issues, but have not issued official positions on assisted dying.

Advance care planning is a process aimed at extending the rights of competent adults to guide their medical care through periods of decisional incapacity. The process, when accomplished comprehensively, involves three steps:(1) thinking through one’s values and preferences, (2) talking about one’s values and preferences with others, and (3) documenting them.

Competence is the ability of an individual to be responsible for his or her own decisions in a specific matter. Decisional capacity is a form of competence. This is the ability of an individual to make a rational choice in his or her own best interest. Someone can be competent on a specific matter, while being incompetent on another matter.

Informed consent is the term for the permission given by a patient to a physician to conduct a medical procedure, after the patient is made fully aware of the facts, implications and consequences of the procedure.

Some ethicists have argued that what will begin as a right of patients to request aid-in-dying from their physicians under specified conditions will eventually become a duty. Autonomy works for both patients and physicians. Physicians should not be required to assist in dying, just as they are not required to perform other surgical procedures they are morally opposed to.

An argument frequently used against changing the law, which states that it is impossible to set secure limits. Under this argument, it is claimed that (voluntary) euthanasia would eventually and inevitably lead to non-voluntary or even involuntary euthanasia.

Those who argue that assisted dying is ethically justifiable offer the following sorts of arguments:

• Respect for autonomy : Decisions about time and circumstances of death are very personal. Competent person should have the right to choose death.
• Justice: Justice requires that we “treat identical cases alike”. Competent, terminally ill patients are allowed to hasten their death by refusal of treatment. For some patients, such refusal will not suffice to hasten death; only alternative is suicide. Justice requires that we should allow assisted death for these patients.
• Compassion: Suffering implies more than pain; there are other physical and psychological burdens. It is not always possible to relieve suffering. Thus, PAS may be a compassionate response to unbearable suffering.
• Individual liberty vs. state interest: Though society has strong interest in preserving life, that interest decreases when a person is terminally ill and has a strong desire to end his life. A complete prohibition on assisted death excessively limits personal liberty.
• Openness of discussion : Some would argue that assisted death already occurs, although in secret. For example, morphine drips ostensibly used for pain relief may be a covert form of assisted death or euthanasia. That PAS is illegal prevents open discussion, in which patients and physicians should engage. Legalization of PAS would promote open discussion.

Those that argue that assisted dying should be/remain illegal often offer arguments such as these:

• Sanctity of life: This argument concerns the strong religious and secular traditions against taking human life. It is argued that assisted suicide is morally wrong because it contradicts these beliefs.
• Passive vs. active distinction : The argument here holds that there is an important difference between passively “letting die” and actively “killing.” It is argued that treatment refusal or withholding treatment equates to letting die (passive) and is justifiable, whereas PAS equates to killing (active) and is not justifiable.
• Potential for abuse: Here the argument is that certain groups of people, lacking access to care and support, may be pushed into assisted death. Furthermore, assisted death may become a cost-containment strategy. Burdened family members and health care providers may encourage option of assisted death.
• Professional integrity: Here opponents point to the historical ethical traditions of medicine, strongly opposed to taking life. For instance, the Hippocratic oath states, “I will not administer poison to anyone where asked,” and “Be of benefit, or at least do no harm.” Furthermore, major professional groups (AMA, AGS) oppose assisted death. The overall concern is that linking PAS to the practice of medicine could harm the public’s image of the profession.
• Fallibility of the profession: The concern raised here is that physicians will make mistakes. For instance, there may be uncertainty in diagnosis and prognosis. There may be errors in diagnosis and treatment of depression, or inadequate treatment of pain. Thus the State has an obligation to protect lives from these inevitable mistakes.