HCA322: Health Care Ethics & Medical Law
Instructor Sarah Howell
April 15, 2013
“Aid in dying” is the most extensive idea of assisting someone to die. One component of this extensive idea is physician assisted death. Physician assisted death includes all of the types of euthanasia such as, active and passive euthanasia, which can be either voluntary or involuntary. A small subset of physician assisted death is physician assisted suicide (PAS). The concept of PAS covers a range of activities. On one end of the spectrum, there is the model used in Oregon; whereas the physician screens those who are seeking to commit suicide and, after determining the mental state, desire, and medical condition of the patient, assists in dying by writing a prescription for a lethal drug overdose. On the other end of the PAS spectrum is the active participation of a physician in assisting the patient by starting an intravenous solution and thereby more directly providing the means by which a patient can initiate the final act of committing suicide (Breitbart, 2012). Though seldom discussed, it is widely understood that the principal role of the physician is to “comfort always,” a role especially important when all hope to benefit from further treatment has faded. This ethic has never included assisting in suicide. When eliminating pain requires large amounts of morphine, unintended death in palliative treatment to provide comfort care raises few ethical, or legal, concerns. Almost certainly, physicians and other caregivers sometimes listen to the pleas of severe pain stricken patients to help them die, or solely from compassionate impulses they occasionally perform involuntary, active euthanasia on a medically hopeless patient who can no longer communicate (Sullivan, 2011). Indeed, both legal counsel and the healthcare administrators that provide advice must understand the legal and ethical implications of issues arising for patients at the end of life. One of the most nerve-racking, challenging issues facing health care providers focuses on end-of-life issues. Although it is established that competent terminally ill patients may refuse life-sustaining treatment, physician-assisted suicide continues to raise much debate. This paper analyzes physician assisted suicide as one element of end of life decision-making and identifies the legal and ethical questions it raises. While it appears that the momentum for legalizing physician assisted suicide has declined somewhat in the United States, the issue is one that necessitates monitoring and thoughtful consideration of institutional policies. To begin with, the history of assisted suicide is neither lengthy nor complex. Aided suicide has origins tracing all the way back to around the fourth century B.C., when scholars estimate the Hippocratic Oath, an ethical vow taken by doctors, was written (Pozgar, 2013). Part of the Oath states, “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan” (Pickert, 2009). According to this statement, doctors are not legally or morally allowed to assist when a terminally ill patient wants to end his life. Within the last thirty years, however, instances of physician assisted suicide have been showing up all over the world. In 1982 in Alkmaar, Netherlands, Dr. Schoonheim participated in aided suicide when she helped a woman take her own life. The woman was Marie Barendregt, a ninety-five year old grandmother who was severely disabled. Initially, Barendregt signed an order which allowed her to refuse potentially “life-prolonging treatment.” With her son’s awareness and the consultation of two other independent physicians, Barendregt decided she did not want to live any longer. Dr. Schoonheim inoculated Marie with a lethal injection, while ultimately ended her life (Pickert, 2009). Moreover, instances of assisted suicide in the United States have not been...