Intent and causality are also critical factors in relieving pain or symptoms. Competent symptom control is an ethical duty (9). Patients often fear the prospect of unrelieved pain. Some doctors hold back painkillers because they have a well-founded fear that higher doses may accelerate death by suppressing breath or that the patient may become dependent on the drug. However, adequate pain relief rarely leads to both (51, 52), and patients and families need to understand this (52). Under the double-acting rule, there is strong ethical support for increasing painkillers for terminally ill patients if the intention is to relieve pain, even though it could shorten life (9, 53, 54). The main argument for removing the immoral status of the ADE lies in the patient`s autonomy of will and not circumvented. Therefore, we should recall Dworkin`s thesis that the crudest form of tyranny is to permit the death of the person in a way that justifies another people.27 At the same time, we must keep in mind the well-being of the patient, which is not limited to the perception of his doctor (36). On this basis, we can judge the well-being of the patient, because there are situations in life where, despite the real possibilities of his recovery, a patient wishes to shorten his life, in which it is necessary to limit his autonomy of will. In addition, a patient wants to continue his medical treatment, even if the doctor has diagnosed that death is inevitable. In such cases, the autonomy of the patient will have a dominant character.
The application of euthanasia to this patient would be a violation of all existing ethical principles. Men who, despite a serious illness, simply do not want to hasten his death, whether for religious or non-religious reasons, and thus express their will, which must be respected, and their lives must not be shortened by the application of ADE. No one has the moral right to decide for another person whether their life is worth living or not, because for some their pain may be so unbearable that their life has no value, while for others pain cannot be compared to the values of life. Any decision that involves patience is morally acceptable to him. It must be the same for everyone. Overall, Table 1 shows that physicians were divided on the ethical acceptance of ADR. A slim majority, 56.8%, consider this method ethically unacceptable, while 43.2% opted for a different solution. In addition, 35.2% thought it was completely ethically acceptable, while the remaining 8% considered it ethically acceptable in some cases.
Respondents who considered EDA ethically acceptable in certain situations could not deny its acceptance, as they are aware that the patient`s condition can be extremely difficult. This confirms the initial hypothesis and we have achieved the expected results, not only here, but also almost through the rest of the results. In the Kragujevac region, as well as in most of Serbia, practicing physicians have not yet met with ADE, and therefore their basic opinion about them and ethical acceptance is mostly negative. The Orthodox Church in the region contributes to this view because it sees the ADE and PAS as murder. Controlling how and when a person died was not and should not be a goal of medicine. However, with quality care, effective communication, compassionate support, and the right resources, physicians can help patients control many aspects of how they live the final chapter of their lives. Throughout patients` lives, even when they face death, medicine must strive to give patients the care, respect, and comfort they deserve. Furthermore, the ACP States do not consider neutrality on this controversial issue to be appropriate. The medical profession should not be neutral on issues of medical ethics (9). The PSA is not neutral with respect to practices that interfere with the physician`s relationship and trust in the patient`s profession, such as laws limiting or mandating conversations with patients, or certain recommendations for patients.
According to the American College of Physicians Ethics Handbook, physicians have a duty to clearly state the ethical principles that guide their conduct in clinical care, research, and teaching, or as citizens or collectively as members of the profession. It is crucial that the point of view of a physician in charge be heard when social decisions are made” (9). The legalization and involvement of physicians in assisted suicide would be an explicit and implicit statement that the value and sanctity of life can be weighed in terms of benefit (pleasure) and cost (pain). It is an explicit and implicit statement that suicide can be moral and rational. It is an explicit and implicit statement that life is not sacred and is subject to utilitarian calculation. I refuse to believe it. It degrades the value of human life; it degrades our existence; it degrades our opinion and self-respect; And it degrades our opinion and respect for the lives of others.