TOPIC GUIDE: DM Israel: Assisted Suicide
"Physician assisted suicide should be legalised"
PUBLISHED: 11 Mar 2016
AUTHOR: Anwar Oduro-Kwarteng & Maria O'Connor
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On 8 June 2014, MK Ofer Shelah proposed an addition to the ‘Law for the Terminally ill Patient: Death by Physician’s Prescription’, with The Ministerial Committee on Legislation approving the motion by eight votes to two – reigniting the debate about assisted physician suicide in Israel [Ref: Ynet news]. As well as this, the issue was brought to a head in 2015, when the Tel Aviv District Court allowed a patient with terminal ALS to end his life, something which some argue “advanced the rights of an individual vis-a-vis his life and death, above and beyond the 2005 Dying Patient Law” [Ref: Ha’aretz]. For supporters of physician assisted suicide, the proposed legislation would put Israel at the forefront of “enlightened countries”, because: “The bill respects the patient’s right of control over his body” [Ref: Ynet news] and allows them to maintain dignity in death. Critics however suggest that legalising physician assisted suicide would lead to a decline in respect for the value of life, and the creation of a ‘slippery slope’ towards euthanasia as practised in countries such as Belgium. Opinion on this emotive subject is sharply polarised, with important moral questions of individual autonomy, dignity and choice, clashing with concerns about the wider societal consequences of formally involving the State and doctors in the suicide of individuals. Will legalising assisted suicide for the terminally ill mark the top of a slippery slope, and set a precedent with worrying consequences for us all? Or is it an enlightened and compassionate attempt to give choice to the dying, allowing them to end their lives with dignity and without pain? Should we legalise physician assisted suicide?
DEBATE IN CONTEXT
This section provides a summary of the key issues in the debate, set in the context of recent discussions and the competing positions that have been adopted.
What would a change in law mean?
As it stands, the current 2005 ‘Dying Patient Law’ achieves a delicate balance of allowing a terminally ill patient a degree of autonomy, whilst not permitting doctors to aid their death in any way [Ref: The Dying Patient Law 2005]. As a result of this ruling: “When a competent terminally ill patient does not want his life prolonged, his wish should be respected and his medical treatment withheld” [Ref: The Dying Patient Law 2005]. However, the law is clear that the aim is not to assist in the patient’s death, and any action that could be seen as contributing directly and knowingly to their death is prohibited. The new assisted suicide bill proposes an extension to this - it would formally allow doctors to prescribe a lethal dose of anaesthesia to terminally ill patients who have less than 6 months to live, provided they have been an Israeli citizen for at least 5 years and are of sound mind [Ref: Israel Hayom.com]. This proposal marks a huge cultural and ethical shift, with supporters and critics debating what effect this could have on Israeli society.
Sanctity of life Vs dignity in death
Israel is not the only country to be considering a law on assisted suicide. Last year, the UK Parliament rejected proposals for a law very similar to that being discussed in Israel [Ref: BBC News], and at the end of 2015 the American State of California approved ‘The End of Life Option Act’ [Ref: L.A Times]. In all of these cases, much of the argument for physician assisted suicide focusses on choice, dignity and autonomy of the individual. And the majority of the proposed Israeli bill is based on the ‘Death with dignity Act’ in the American State of Oregon [Ref: Oregon.Gov], which is often seen by advocates as a model of how legislation on this difficult issue can work. During the debate on the UK assisted suicide bill, supporter Desmond Tutu argued that a change in the law would not degrade the sanctity of human life, but instead, would recognise the right of individuals to have, “autonomy and dignity” in death [Ref: Guardian]. Furthermore, other advocates say that ultimately, it is about choice – giving those who want the option to end their lives when they are terminally ill, the ability to do so. Echoing these sentiments, Professor Avrinoam Reches concludes that, “there is no principle or belief that can coerce a person to continue to suffer without hope.” [Ref: Ha’aretz] Others are critical of these claims however, asserting that to legalise assisted suicide would be to legitimate the idea that some lives are of less value than others. Academic Dr Kevin Yuill for instance compares the ethical implications of the death penalty with physician assisted suicide, and suggests that morally they are no different – both diminish the sanctity of life. He argues that: “If we are to place value on even the most wretched of human lives – an important marker of civilisation – neither the death penalty or assisted suicide can be justified.” [Ref: Independent] In addition, Justin Welby Archbishop of Canterbury, questions whether assisted suicide is truly compassionate, arguing that instead of relieving people of suffering, compassion is actually, “a commitment to sharing in the suffering of others….(and) offering hope, even in the darkest of circumstances” [Ref: The Times]. These views are supported by one Jewish writer who notes that: “While advocates for physician assisted suicide argue that a life of pain and suffering is not worth living, our tradition teaches us that even the last few moments of life are of immeasurable worth.” [Ref: Jerusalem Post] Some also worry about the role of doctors in the process of physician assisted suicide, with UK writer Melanie Phillips arguing that a change in the law would potentially, “turn doctors into executioners” [Ref: The Times].
A slippery slope?
Critic Melanie McDonagh maintains that physician assisted suicide proposals amount to, “an open door, waiting to be pushed open further” [Ref: Spectator], a worry that many opponents of any proposed law have. Some point to the recent law which legalises euthanasia for children in Belgium, 11 years after the same law was passed for adults [Ref: Telegraph] as evidence of where legislation in this area can eventually lead to. Others are anxious about the message it sends out to the disabled or mentally ill, with one campaigner outlining that in time, it could be used to justify the assisted suicide of other vulnerable groups [Ref: Huffington Post], because the new law suggests that: “Life that doesn’t meet certain conditions, is worthy of no respect at all” [Ref: The Times]. However, although supporters caution that: “Gradualism…is warranted” [Ref: Economist], they nonetheless disagree with the slippery slope arguments employed by critics. Professor Raymond Tallis cites the American state of Oregon which passed the Death With Dignity Act 17 years ago, and yet the proportion of overall deaths which are physician assisted has never been more than 0.25% [Ref: Independent], showing that the law hasn’t opened the ethical floodgates, but has offered those who wish to choose it, an option to end their lives on their own terms. Columnist Polly Toynbee, states that arguments about the uncertainty of where physician assisted suicide could lead are used inappropriately, because: “In the end, our bodies are our own, our lives are our own, and it threatens no one else to shorten the time of our dying.” [Ref: Guardian] So, are critics right that legalising physician assisted suicide “brutalises society” [Ref: The Times], ultimately changing the way in which we view death and dying? Or would legalising physician assisted suicide be an expression of compassion and enlightenment, recognising the dignity and autonomy of the individual, because, “any meaningful right to life entails the right to choose how we die” [Ref: Huffington Post]?
It is crucial for debaters to have read the articles in this section, which provide essential information and arguments for and against the debate motion. Students will be expected to have additional evidence and examples derived from independent research, but they can expect to be criticised if they lack a basic familiarity with the issues raised in the essential reading.
A.Steinberg & C.L.Sprung Israel Medical Association July 2007
Avinoam Reches Ha'aretz 6 January 2015
Economist 19 July 2014
Carol Midgley The Times 16 July 2014
Desmond Tutu Guardian 12 July 2014
Kevin Yuill Independent 18 July 2014
Tim Stanley Telegraph 12 July 2014
Melanie Phillips The Times 7 July 2014
Shimshon Hakohen Nadel Jerusalem Post 18 June 2014
Definitions of key concepts that are crucial for understanding the topic. Students should be familiar with these terms and the different ways in which they are used and interpreted and should be prepared to explain their significance.
Useful websites and materials that provide a good starting point for research.
Patrick McGreevy L.A Times 19 January 2016
Polly Toynbee Guardian 7 November 2014
Pavan Dhawali Huffington Post 18 July 2014
Kieran Turner-Dave Huffington Post 17 July 2014
Tanni Grey-Thompson Telegraph 17 July 2014
Raymond Tallis Independent 17 July 2014
Simon Stevens Huffington Post 15 July 2014
Justin Welby The Times 12 July 2014
Melanie McDonagh Spectator 12 July 2014
Jon Holbrook spiked 3 July 2014
Matthew Parris The Times 1 August 2009
Links to organisations, campaign groups and official bodies who are referenced within the Topic Guide or which will be of use in providing additional research information.
IN THE NEWS
Relevant recent news stories from a variety of sources, which ensure students have an up to date awareness of the state of the debate.
BBC News 11 September 2015
BBC News 22 October 2014
Ynet News 6 August 2014
BBC News 18 July 2014
Israel Hayom 9 June 2014
Telegraph 12 February 2014
Ynet News 12 July 2005
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