The ethical principle of autonomy, also known as the patient’s right to self-determination, is the principle which indicates that decisions must be made by those who are most affected by the decision. In other words, this principle focuses on the importance of individuals making decisions for themselves and on their own about their care or matters related to their care. While the desire from healthcare professionals to help and treat individuals may be strong and innate, it may not always translate to a strong manifestation of the principle of autonomy, especially where the individuals being treated become dependent on the healthcare professionals for their care including decisions related to their care. This principle also highlights that after being informed by the healthcare professional of the risks and benefits related to his care and possible interventions for his illness or disease, the decision to accept treatment can then be made by the patient. In this case, the patient is well-informed before he makes his independent and autonomous decision regarding his care.
Another ethical principle is respect for people. This respect highlights how all people have intrinsic value and such value has to be respected and acknowledged by others including health professionals. The respect owed to an individual has to be based on his individual qualities, including his preferences, his culture, his religion, and his physical attributes. For some individuals, their personal preferences and decisions regarding their care may be based on cultural or religious beliefs. In this case, the healthcare professionals must make the necessary adjustments in the way they carry out interventions. A Muslim woman for instance can only be examined in a private examination room by female attendants only. This is a cultural and religious consideration as Muslim women cannot be seen in their underclothes by men other than their husbands. For health practitioners, adjustments made in relation to cultural or religious considerations is very much in accordance with the principle of respect for people.
In relation to physician-assisted suicide or PAS, the principle of autonomy or self-determination implies that where a patient decides in favor of PAS, such decision should be allowed. However, this decision must be made following a thorough discussion with the patient about his/her options (Landry, Foreman, & Kekewich, 2015). The mental and spiritual capacity of the patient must also be fully assessed by the healthcare givers in order to ensure that the PAS decision is being made with the full awareness and mental faculties of the patient intact. Such mental assessment has to indicate that the patient is fully aware of the consequences, the meaning, and the impact of his decision on himself and his family (Landry, Foreman, & Kekewich, 2015). The healthcare giver also has to encourage the patient to discuss the decision of PAS with his/her family, with the latter being fully made aware of the intention and the consequences of the decision (Landry, Foreman, & Kekewich, 2015).
After the assessment reveals that the patient is fully aware of the consequences and of the meaning of his decision, the decision of the patient to have physician-assisted suicide has to be respected and allowed. Preferably, the physician who would be undertaking the process for the PAS would be the patient’s attending physician, even if that physician is against the decision of the patient (Gostin & Roberts, 2016). However, physicians refusing to carry out the procedure may also refer the same to another physician. Different states have different policies on physicians wanting to opt-out of the PAS (Gostin & Roberts, 2016). What is important in this case is that patients have the right to PAS and this right should be granted based on the principle of self-determination and autonomy.
While the principle of self-determination and autonomy would provide ethical support for physician-assisted suicide, the ethical principle of respect for people does not (Landry, Foreman, & Kekewich, 2015). Respect for people emphasizes and recognizes how each individual has intrinsic value. In allowing a patient to have PAS, the health practitioner is practically discarding his patient’s intrinsic value. Respect for people also implies that while a decision may be good for one group of people or one community, it may bring harm to others. In the context of PAS, while the decision to consent to physician-assisted suicide may be good for the patient, mostly in relieving him from pain and suffering, it may not be good to other people like the physicians who may be asked to assist in the suicide. It may also not be beneficial to the family who do not support their family member giving up on life.
In reconciling these two ethical principles, it is important to always consider the patient. The patient is the one who is experiencing the symptoms of the disease and is likely suffering untold pain from the disease ravaging his/her body (Landry, Foreman, & Kekewich, 2015). The role of healthcare givers is to fully evaluate the patient and his decision, ensuring that the patient is fully aware of the meaning and consequences of his decision. Ultimately, both principles can actually be used to support the patient in his physician-assisted suicide (Landry, Foreman, & Kekewich, 2015). The principle of self-determination calls for healthcare givers to respect their patient’s autonomy while the principle of respect for people calls for the healthcare givers to also respect the patient’s preference and beliefs regarding his care.
- Gostin, L. O., & Roberts, A. E. (2016). Physician-assisted dying: a turning point?. Jama, 315(3), 249-250.
- Landry, J. T., Foreman, T., & Kekewich, M. (2015). Ethical considerations in the regulation of euthanasia and physician-assisted death in Canada. Health policy, 119(11), 1490-1498.