Medical Ethics: The Right to Die

“Primum non nocere.” First, do no harm. This line from the Hippocratic Oath dates back to the fifth century B.C.E. While many medical schools have adopted more modern versions of this classical medical creed, the Hippocratic Oath still maintains a notable presence in the consciousness of the world of medicine and, more specifically, in medical ethics. They are the guidelines upon which the practice of medicine is grounded and represent a sphere of important discussion. In fact, Stuyvesant High School has its own Medical Ethics course available for students to take as an elective.

Medical ethics is an important part of the medical world, as it defines and constitutes the regulations, rules, and beliefs that doctors are expected to abide by. But the world of medicine has changed dramatically since the time of Hippocrates. With new innovation and advancement come new challenges and points of contention. One particularly prominent issue that has faded in and out of the sphere of discussion has been the policy and legal conditions surrounding physician-assisted death, or, as coined by the proponents of its legalization, "the right to die." The locus of the controversy surrounding this issue centers on terminally ill patients who experience immense suffering in their daily lives, and the question of whether physicians should be allowed to perform physician-assisted death upon a patient’s request.

The goal of legalizing physician-assisted death is the fulfillment of patients’ right to decide for themselves how they wish to live the remainder of their lives and what their wishes are. Not only is this a necessary right to uphold for patients, but it is also in alignment with those who ascribe their medical ethics to the Hippocratic Oath. While doctors should first seek to do no harm, this is an extremely simplistic heuristic that falls apart quickly when one considers common scenarios for terminally ill patients. What exactly does it mean to do harm? If prolonging the suffering of an individual who will inevitably succumb to their illness is not harm, then why would physician-assisted death constitute harm inflicted by the medical provider?

Upholding the Hippocratic Oath does not necessitate a tradeoff with patient self-determination. In fact, one could argue that the United States is already partway there. The passage of the Patient Self-Determination Act in 1990 required healthcare facilities to provide information regarding advance directives. This ensured that patients were cognizant of all possible options in their state regarding their rights with regard to how they chose to be treated and that health care institutions recognized and followed patients’ advance directives. The act ensured that patients were made knowledgeable of their choices, and the legalization of physician-assisted death ensured that terminally ill patients had the choice if they wanted to.

Though the majority of states in the U.S. have not legalized physician-assisted death, the practice is legal in the District of Columbia and nine states. Expanding this option to all Americans should be a priority. Terminally ill individuals should not be subject to the decisions of lawmakers and politicians with regard to whether they wish to endure further pain. This upholds individual autonomy, which is crucial for any free society that wishes to maintain a modicum of integrity. The idea of legalizing physician-assisted death is also popular among the American population at large. According to a 2018 Gallup poll, 72 percent of Americans believe that if a terminally ill patient requests for physician-assisted death, doctors should be legally allowed to cooperate.

While some may argue that physician-assisted death depreciates some inherent value of life itself, it's a question of the relationship between the value of life and one's personal autonomy when one is terminally ill. A phrase often heard among proponents of the right to die is that physician-assisted death allows individuals to “die with dignity.” While this phrase may clash with the cultural frameworks of some societies and beliefs, the individual patient should not be forced to be held to those standards and values. This issue is ultimately about self-determination, autonomy, and the belief that each person has the capacity to govern their own individual self as long as it does not harm others.

It should be noted, however, that there are valid concerns regarding this legalization, particularly in regards to misuse and coercion. Necessary safeguards need to be packaged with broad federal legalization of physician-assisted death. Many of the laws that have legalized the practice in states like California and Montana already have many of these measures in place. A good model for a federal legalization law would be Oregon’s Death with Dignity Act. The law has succeeded in ensuring that it is used only as needed for its purpose, and it has effective measures to protect against manipulation or abuse of patients. There is a comprehensive process that checks for the requesting of a patient's mental competence, voluntariness, prognosis, and other important pieces of information to ensure that the patient is making the decision independently and with full understanding of what the choice they are making entails. Federal legislation that can successfully implement such a system will be able to advance patient rights concerning autonomy while continuing to uphold the integrity of the practice of medicine.

Though Hippocrates had virtue when he created his oath, antiquated sayings fit antiquated times. The modern world of medicine is evolving rapidly and we need to consider the serious ethical implications of new methods. Sometimes, what is considered “harm done” depends on the patient themselves. And as medicine evolves, the practice of medicine must evolve as well. The right to die is an integral part of reforming the ethics that govern the medical discipline today.