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.
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.
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.
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.