Manufacturing Barbiturates; The Suicide Industry

Group 55

The state of Victoria in Australia has recently legalised assisted suicide, stoking debate about whether it is ethically justifiable for patients in certain conditions to end their own lives. A 2015 poll indicated that 82% of British adults and 86% of disabled adults supported the legalisation of assisted suicide. In this article we discuss whether it is ethical for engineers to manufacture drugs for use in assisted suicide. Typically, a lethal dose of barbiturates (a central nervous system depressant) is prescribed, leading to shutdown of bodily systems and a painless death.

FOR

Developing drugs which enable assisted suicide provides an essential alternative for those most in need. From a utilitarian point of view, the key aim of carrying out a certain act is providing the maximum utility, often defined as well-being, for the greatest number of people. Manufacture of the drugs for assisted would only constitute facilitating this action and whether that is moral or not depends on whether assisted suicide itself is moral.

According to Mill, a rational person knows best whether an action will bring them pain or pleasure. In a recent survey of people who wish to undergo assisted suicide, their primary reasons were: losing autonomy — 91.5 percent; less able to engage in activities making life enjoyable — 88.7 percent; loss of dignity — 79.3 percent.

However, it is necessary to consider other people affected by assisted suicide. Ending a suffering person’s life can not only reduce suffering for the patient, but also improve the wellbeing of loved ones by providing essential closure and reassurance that their death was painless. Controlling when you die also gives patients the option of dying at home, with anyone who wants to be present in attendance; in Oregon, 88.6% of assisted suicides in 2018 were at home. Additionally, the money used to provide palliative care to a terminally ill patient could be used for medical research which would bring about additional benefit to society as a whole.

In Kantian ethics, the morality of an act is independent of its consequences; actions must be universal, they must treat other humans as ends rather than as means, and they must respect the right of others to act autonomously. It is important to note here the consequence of the action is deemed irrelevant to it’s ethical validity so if manufactured drugs were abused and the legal system became flawed this should not affect the decision to develop them. While one may be emphatically objected to suicide itself, the manufacture of drugs for assisted suicide is a separate issue. Manufacturing drugs respects the autonomy of patients in making rational decisions and presents no logical contradictions if everyone started making them.

From the view of care ethics, providing the best means for assisted suicide empowers the patient with the choice of what they want to do with their life. It gives them the opportunity to retake ownership of their own life and gives them control they previously lacked. Assisted suicide gives patients the same ability to end their lives as able persons have and they can administer it as a means to end their own suffering.

From an egoist perspective, the manufacture of drugs for assisted suicide can be fully justified. By producing the drugs, the company can make profits and provide work for their employees, attaining the greatest good for themselves and others. The egoistic framework compels people to act in their own self-interest so the ethical nature of assisted suicide and the wellbeing of those it effects is disregarded.

AGAINST

The Utilitarian perspective can also be used to argue against manufacturing barbiturates. Looking beyond just the wellbeing of the patient themselves and to those indirectly involved in the practice.

The main reasons given for those opting for assisted suicide were not due to physical pain but rather the mental suffering associated with the deterioration of the body preventing an enjoyable lifestyle whilst losing dignity and autonomy. These reasons are often more difficult for those to empathise with and while the patient knows best whether an early death is the right choice for them, they cannot possibly know how much pain it would bring to their loved ones. Although some people will take solace in the fact that the patient made the decision rationally, others are likely to experience even greater sadness. It is common for those close to victims of suicide to wonder “was there anything I could have done?”

If the patient was judged to be fully capable of rational decision making, then it stands to reason that their mind could be changed by listening to other perspectives. Anger and guilt are well-known symptoms of bereavement when someone has taken their own life, and the typical advice of “there was nothing you could have done” rings hollow when the decision was made rationally. Beyond the love ones there is also a negative impact on the well-being of the physician who has to prescribe and/or administer drugs that induce death. This is in direct contradiction to their role as a “healer”, as defined by their code of ethics.

Additionally as advances in palliative care are made that allow patients to continue living more comfortably, the marginal gain in utility from ending one’s life early becomes smaller.

When reviewing the production of barbiturates under the scope of care ethics, it can be seen why some people disagree. One may view the production of barbiturates as the most caring option as it provides possibility to end people’s hopeless suffering. However, it is just as feasible that others may view it as a complete abandonment of care and see it as fundamentally giving medical professionals the tools to abort palliative care. The option provided by enhanced availability of barbiturates may seize the advancements of palliative care, and the lack of progress may results in a higher number of patients seeking barbiturates.

It is difficult to know the certainty with which doctors can say a patient is of sound enough mind to decide whether they should live or die. How certain can we be that, with enough effective therapy, someone suffering from an illness won’t decide life is still worth living despite the hardships they endure? It can be argued that the purpose of therapy is to alter the mind-set of patients and if done effectively emotional pain can be reduced to make the patient want to extend their lives.

CONCLUSION

Based on the discussion above, we believe that the development of drugs which enables people the assistance of suicide is morally justifiable and a perfectly ethical career path.

44 thoughts on “Manufacturing Barbiturates; The Suicide Industry

  1. I think this is a good topic and I really liked the section arguing the case ‘for’. However, the case against seems weak because it (to my thinking) confuses suicide with assisted suicide. In the cases of assisted suicide the patient/victim most likely discusses the course of action they wish to take with their loved ones, and they (most probably) make their decision based on those discussions.

    In cases of natural death, the dying person lets go of all attachments and says goodbye to loved ones. Assisted suicide seems to be the same process.

    1. Dear Dr Smith,
      Thank you for your comment, I would say the differentiator between a natural death and an assisted suicide death is that for those who love the patient assisted suicide deaths can feel premature and difficult to emphasize with. Particularly in cases where the patient is suffering from mental rather than physical illness.

  2. Interesting article. However, I disagree that the manufacturer can claim no responsibility as to how their product ends up being used and the potential for it to be abused. I think if there is a chance of this, they should ensure that the regulations are in place before making the option available.
    I agree that in making the active decision to end someones life would complicate the grieving process and could result in overwhelming feelings of guilt or regret. Or potentially the opposite, if they denied their loved one the opportunity to take their own life then watched the alternative process dragged out and ultimately wished they had allowed them to ease their own suffering.
    I think their is a concern that undue pressure could be put on someone to end their life if the option was available, especially if it was financially more viable (from the hospitals view) or eased the burden on family members.
    In some cases I think assisted suicide is a much kinder option and should be facilitated, but I think great care needs to be taken to regulate its use.

    1. This is very true. Assisted suicide is only legal in a minority of areas and those where it is legal to have serious grey areas which need to be addressed. Though it goes against Kantian ethics it is dangerous to ignore the possibility of the drugs being miss used for unethical practice.

  3. This is a very well though out article, and both sides were well argued. I would agree that it is morally justifiable for a company to manufacture barbiturates to be used in assisted suicide. However, I would emphasise that the manufacturer does have a responsibility to fully assess the mental and physical state of the patient. I think that this should be a deliberately long and well-thought process, which allows full assessment of the patient and the time would also give the patient a chance to fully consider the implications of the choice, and even allow them to change their mind.
    I would also argue that proper counselling should be provided by the manufacturer to the family/friends of the patient, or at the very least, a clear sign-posting should be offered on how the family/friends can access a counselling service.

    1. Thanks for your comment, unfortunately, the producers of the drug are rarely responsible for administering or deciding who is administered by the drug. This withdrawal of responsibility presents a dilemma and in a sence, a level of trust needs to be placed that the system in order to argue production is an ethical practice

  4. The challenge with this argument is that it does not articulate with enough specificity the exact criteria or conditions that might need to be met in order to justify the freedom of assisted suicide. The mental state in which the drugs might be used are critical to the argument for manufacture and should simultaneously be articulated in detail to justify the manufacture as states of mind vary significantly over periods of time.

    1. Hi Elizibeth,
      The difficulty is that from a producers perspective the input into what and how legislation regarding assisted suicide (AS) is imposed is limited so rather than allowing specific criteria a wider for a more personal case by case basis a wider recognition of what the sociatal effects of AS are needs to be employed. You are correct in saying mental states vary over time, this may be seen as a strong argument against assisted suicide in itself.

  5. Very interesting points in this article! I had never before thought about the impact on palliative care improvements on the validity of barbiturates in this industry. Would it be safe to assume, however, that the effects of these are enough to actually negate a decision to commit suicide? Would patients not still suffer from the same mental strains which come with nearing the end of their lives?

    1. Hi Sacha,

      Interestingly palliative care has been shown to be very effective at relieving physical pain associated with terminal illnesses, allowing for increased overall wellbeing. Furthermore, Palliative care often entails a great deal of emotional care for both the patient and their families.

  6. Both sides of the argument have been well put foward here, using a utilitarian framework to look at the wide reaching impact of the use of barbiturates. The article debates the ethics of the production of barbiturates, not the administration of the drugs. However, in this case, engineers must navigate the same ethical minefield that doctors deal with on a day to day basis. We just take into account the deep and deceptive nature of patient psychology. Due to this it is almost impossible to know wether or not it is moral to produce these drugs as we can not truly know if the patients are in sound mind or have made the right decision to end there lives.

    1. This is a very well written point. The deceptive nature of patients physcology does cast into doubt the ethical validity of AS and the production of the drugs for AS. If you believe that it is impossible to know the overall morality of the circumstance is it sensible to err on the side of caution and not produce these drugs?

  7. Nice article. A few points I’d raise:
    1) Can you guarantee that the patient is making their decisions rationally? One can imagine scenarios in which a family might place pressure on a patient to opt for assisted suicide, or where the patient themself feels that they are an emotional or financial burden to their loved ones, and hence is making the decision for the wrong reasons.
    2) Linked to the above point – have you considered the legal frameworks that need to be put in place to stop this, and which would help oversee best practice when there are grey areas. Many patients who might opt for assisted suicide would be vulnerable adults – how do we safeguard them?
    3) I’d also just say not to underestimate the value of palliative care in providing a good death for patients, and indeed how much families appreciate the work of palliative care teams. Death is a natural part of life and I’d worry that a move towards assisted suicide and possibly euthanasia would further medicalise and change society’s attitudes towards death.

  8. I think that this article raises a number of interesting points, which require on-going debate, but unfortunately the title itself is misleading and the content does not entirely link with the conclusion.
    In addition, it is worth noting some aspects of medication design , manufacture and use.
    The title limits itself to barbiturates, but the article relates to all medications that can be used to end life in a planned way – this is an important distinction to make.
    Secondly, medications used to terminate life are designed for other uses – in the case of the title, barbiturates were originally designed to treat mental illness and provide sedation for anaesthesia, the later use for ending life was not their original intent.
    Medications used for terminating life currently (as the article alludes to in the conclusion) include painkillers, anaesthetic drugs, medications for heart conditions and medications for mental illness, all of which are perfectly justifiable uses.
    The issue, therefore, is not limited to manufacture, but to use of a particular medication.
    Appropriately, the article rightly moves to focus on providing the means for assisted suicide, and this ,of course is a moral and ethical argument, not a chemical one or manufacturing one.
    There will always be means available for a person to terminate their own life, and one could argue that having the option of a reliable uncomplicated means is simply meeting a demand of society.
    If another person is involved in assisting suicide then there would need to be the appropriate safeguards in place regarding a person’s mental capacity to make such a decision.
    One could argue that having a reliable means forces debate regarding the ethics, and for that reason this article is to be commended.
    However, the final comment of this being potentially ‘a perfectly ethical career path’ is unnecessarily provocative and demeans the rest of the article.

    1. Hi Mark,
      The points you make here certainly have merit. With no clarification on the additional benefits of a particular drug, it becomes difficult to make an informed decision. It should be assumed in the case of this argument that the drugs are being made primarily for the use of AS. Isolating the individual uses of a product is further a useful exercise in making an ethical decision. The argument describes a situation where one is producing drugs they know are going to end someone’s life however they do have the confidence that the drugs will be prescribed through lawful means. The problem is multifaceted and simplification of it requires unique and often unjustifiable assumptions.

  9. Interesting arguments here. Both sides are argued well with support from very suitable theory. Just would be interesting to here more about the potential exploitation of the system. For example, vulnerable people are often subjected to people trying to exploit them financially and legalization of assisted suicide would provide perfect means to do so. So I was just wondering who would you suggest have overall say in administering the barbiturates, as family members may not always have the patient in their best interest? If doctors were given overall say, then it would be such a grey area and be may dictated by emotion, not logic. If it were the patient, irrational decisions could be made due to the stress of the situation.
    Overall, I really enjoyed this article and it was interesting to read both sides of the story.

    1. Thanks for your comment. This is definitely an issue with the legality of manufacturing barbiturates. The issue with the administering of barbiturates is the grey area it poses, as there can not be fixed guidelines as each case and individual is unique.

  10. Well argued piece for both sides, especially considering the different ethical disciplines, however I think an interesting point for further discussion could be the discussion of the hazy placement of ‘the line’ when it comes to who is administered these drugs and who isn’t. An important consideration is to what level of suffering is deemed ‘enough’ to warrant the termination of life, and what about the situations in which an individual may not be able to communicate the pain that they are in – especially if the consideration of assisted suicide would then have to be made by someone else as proxy.

    In addition I feel that the production companies should not shoulder the responsibility of the misuse of these drugs, as was stated before, that these drugs typically have alternate uses, and by ceasing production due to its misuse will then negatively impact those who require it for its intended use, such as the overdosing of anesthetic for suicide. As such it is the distribution of this product that must be carefully monitored and controlled, but again this brings about the discussion of who ‘qualifies’ for the drugs and assisted suicide. Overall great piece!

    1. The difficulty with the already hazy placement of the line is that it is somewhat out of control of the drug producer. The Manufacturer does, however, have a choice of whom they sell these drugs too. Therefore it is possible to not sell a drug to those intending to use it for the purpose of AS whilst still retaining the other, less morally problematic, uses. If you are producing the drug in a way so that you can only economically support production through selling to the AS market that becomes problematic in itself.

  11. Orla and I both read it, comments below are very much from Orla. Not set to Arthur, as settings on my WhatsApp are not set up properly yet.
    Where does this then end? The against argument is referring to the patient having no quality of life, you could then argue that people with non terminal illnesses such as depression have no quality of life and then they should also be allowed to take these drugs, allowing these tools to aid assisted suicide is a slippery slope also because in some cases the terminally ill person may have a few years left and feel pressure by the family as stated it “would also improve the well being of loved ones”

    1. Hi Tony, thank you for reading our article. The slippery slope argument is certainly one that must be considered. The regular reavaluation of the concluding decision, in this as in any other moral argument, is important. A decision must be made on the current state of play, how likely do you think it would be that we as a generally compassionate society will allow for AS to become a mainstream option.

  12. Interesting article. How can you ensure the mental health and well-being of care providers and doctors who have to administer the drugs, as well as family members who might consider the ‘what if?’

    1. Thanks for the comment. Mental well-being is definitely an issue with assisted suicide. This is one of the key problems with the manufacturers of barbiturates, as they are likely to reap great profits whilst being detached from the consequences, leaving others to deal with the issues that come along with it.

  13. Some good arguments here. Its interesting to think how detachable the manufacturers of barbiturates would be to the whole issue. Are they cashing in on people’s death or just filling a whole in the market that would be filled by someone else if not them?

    1. Thanks you for commenting. This is a key issue with the legality of manufacturing barbiturates for this purpose. From an egoist point of view you could agree with the fact that they are simply cashing in on a hole in the market. However, it can be considered that they are very detached from the issues that they are enabling, so as the article states, this is a very grey area.

  14. A well balanced and thought out argument. I found the point about the possible neglect of palliative care interesting and was something I had never considered. The article makes you appreciate both sides of the argument thoroughly

    1. This is certainly worth noting. Fortunately, the market is now, in general, well regulated, and in this context, we believe the presumption should be that these drugs are being used solely for the purpose of AS, which is, in itself a difficuilt moral argument.

  15. Just wondered about the mental strain possibly placed onto the doctors who have to administer the drugs, would you suggest mental support or just expect it to be ‘part of the job’?

    1. Thank you for commenting. Of course doctors will have a lot of mental strain based on decisions like this an mental support should be provided. However, it should be mentioned that doctors deal with decisions that could lead to death on a daily basis and this could simply be another one of those decisions.

      1. Just to clarify I am not disregarding the stress doctors go through by making these decisions, just saying that if other decisions like this are made regularly then assisted suicide could be considered just part of the role of a doctor/carer.

  16. I was surprised initially at the number of people who supported the legalisation of assisted suicide. Would you not be inclined to think that access to barbiturates could get out of hand/be abused? It’s hard to know where to draw the line and in a high proportion of cases it can be argued that therapy would provide a means to solve emotional pain.

  17. Thank you for your comment, this is definitely an issue. These are currently prescribed for only very small numbers however statistics have shown that a large percentage of those prescribed the drugs never actually take them leaving room for them to fall into the wrong hands. Therapy is intrinsically important and it is rarely argued that AS is anything other than the last option to prevent irreversible suffering.

  18. i believe that if society accepts the reasoning of those who are suffering and think their life is not worth living then they have the right to make that decision. However one questions are we in danger of contradicting our preventative actions towards suicide in general?

  19. This question is very important, by accepting the reasoning of those think that they are a burden on the society we are accepting that people can be a burden on society and therefore that they should give up and die. The worth of a person is intrinsic. We may set a dangerous precedent if we support mainstream assisted suicide in this case.

  20. As a Christian it is my solemn belief that the sanctity of life should always be respected, I believe suicide is playing God and humans should always strive to preserve and prolong the gift of life. Despite the views in the article going against my beliefs, I enjoyed viewing the matter from another perspective. I think the arguments were well presented and backed up.

    1. Religious beliefs are an ethical frame work and those who follow such belief systems are entitles to those beliefs. Although, those who choose not to follow a clearly defined judgement regarding suicide may argue they have the authority to determine the outcome of their own life and death.

  21. An interesting article. In the case of assisted suicide over normal suicide, the subjectivity surrounding someone’s desirability for death creates further debate. How can a family or friend assuredly prescribe the use of this drug with assurance in fulfilling the patients wishes?

    1. That is something touched on it the article, in terms of the emotional impact on the loved ones of those deciding they desire assisted suicide through the use of barbiturates. There is little evidence regarding the effect of therapy or anti-depressant medication on those who desire assisted suicide, suggesting there is no means of proving patients mind are set or if can be changed during the decision process of choosing to go through with assisted suicide.

  22. Religious beliefs are an ethical frame work and those who follow such belief systems are entitles to those beliefs. Although, those who choose not to follow a clearly defined judgement regarding suicide may argue they have the authority to determine the outcome of their own life and death.

  23. This is a really interesting argument. For the most part, I agree with your conclusion and do not see any major ethical concern for engineers to manufacture barbiturates. However, I wonder whether the production of barbiturates could be unethical for if they are sold illegally on the black market (I.e. are not administered through a doctor). Would this undermine the ethical basis you position yourself on?

  24. The ethical problems discussed here seem to focus more around the ethical concerns with the idea of the act of assisted suicide as opposed to the manufacturing and regulating of the drug itself. I think the most important point raised was mentioned in the For section, that assisted suicide gives the same option to those not physically able to end their lives as those able to. Denying assisted suicide, denies those physically less able the same right of an able bodied person to choose to end their life. Without the ethical/moral/religious debates surrounding the broader topic of suicide, on a basic level of human rights for those less able assisted suicide seems like a fair option.

  25. Very interesting article, with a strong argument for the for side. In regards to the against side, what factors would determine whether the individual in question would be of sound mind for decision making? Would this be better decided on a case-by-case basis?

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