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.

12 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.

  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?

  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.

  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.

  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.

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