27 July 2014
Physician Assisted Suicide: Giving People the Right to End Suffering
There are an alarming number of people that are living in constant, unrelenting, severe and in many cases unnecessary pain. The advances in medicine and technology have been prolonging people’s lives for decades. People with terminal illnesses included. It is imperative that individuals have the ability to peacefully end their lives when faced with a life-ending illness. Legalizing physician assisted suicide gives a person faced with a debilitating terminal illness the right to end their suffering by taking a prescribed lethal dose of medication. We have the right to refuse treatment but without out the right to end our pain, refusing treatment would be extremely painful. This debate has led to Living Wills, Power of Attorneys for Health Care, and Do Not Resuscitate orders.
In the 1970’s, a man was severely burned in an explosion who pleaded for the ability to end his life. His pleas were denied. Due to the new advances in medical technology he was kept alive. If the accident had taken place just a couple of years earlier the victim would have succumbed to his injuries. Ten years later he was asked if he would have wanted a different outcome. He still would rather have died than suffer as he did (Ekland-Olson & Aseltine 1).
Around the same time a young woman was lying in a persistent vegetative state. Her parents wanted the life support removed. After a court battle, along with religious doctrines, the New Jersey court sided with the parents and the life support was removed. Unbeknownst to all she lived for nine years without the respirator breathing for her (Ekland-Olson & Aseltine 1). Hospice or palliative care is an option available to patients that are at the end of their lives; but for many the medications are not effective. For many years physicians have allowed and even helped patients to die (Ekland-Olson & Aseltine 17). Now with the advancement in pain relieving drugs many agree that we should medicate to alleviate the pain instead of opting for death. The opponents proclaim that not all patients react favorably to pain medication and may not be relieved of their pain and suffering. Dr. Walter Sacket, a medical doctor who was elected as a Florida State Representative, believes that the advances in medicine and technology are costly and inhumane (Ekland-Olson & Aseltine 19). When in office he was an active advocate of “the right to die.” Through his own experience he believed that the advances in medicine in many cases inhumanely prolonged suffering and life (Ekland-Olson & Aseltine 21).
Until the 1990’s when the informed consent was brought into policy, patients did not have a choice as to what treatment they were to receive. They arrived at the hospital and were given the care doctors and surgeons deemed necessary to give them the best chance at surviving. The informed consent allows patients the right to have that doctor or surgeon explain the procedure they are going to undergo. They are informed of the desired outcome, the possible consequences of not having a procedure done, the possible adverse reactions to the procedure, what to expect and are given the chance to ask questions to ensure their understanding. They are also given the right to refuse treatment. The patient, the doctor and a witness sign the consent form before the procedure is performed. When a patient is unable to make the decision on their own due to unconsciousness or other incapacitation the next of kin, or their appointed healthcare advocate make the decisions for them (“Assisted Suicide”).
The cost of keeping someone alive at the end stage of their life is insanely expensive. In 2008, Medicare paid fifty-billion dollars for the doctor and hospital bills alone to keep patients alive for the last two months of their lives. That amounts to approximately fifty-thousand dollars to maintain a patient’s life for two months. The average cost of one day in intensive care is roughly ten-thousand dollars (The Cost of Dying 2009). When a patient is terminally ill it is outrageous to be paying tens of thousands of dollars in medical treatments that are not going to b effectively help him live a happy, healthy, productive or independent life style. Dr. Ira Brock, a team leading physician of advanced illness at Hitchcock Medical Center in Lebanon, N.H., told reporters at 60 Minutes that many patients can spend months in the intensive care unit in the final days of their lives (The Cost of Dying 2009). "This is the way so many Americans die. Something like 18 to 20 percent of Americans spend their last days in an ICU, and, you know, it's extremely expensive. It's uncomfortable. Many times they have to be sedated so that they don't reflexively pull out a tube, or sometimes their hands are restrained. This is not the way most people would want to spend their last days of life. And yet this has become almost the medical last rites for people as they die," Dr. Brock (qtd. in The Cost of Dying 2009).
Where do we draw the line? The high moral aspect of physician assisted suicide draws continuous attention to the matter. Many believe that there is a moral dilemma, but prolonging someone’s life goes against the act of nature also. Keeping someone alive that would otherwise be already dead is morally wrong. If a patient is on respirators, feeding tubes and other life supportive devices, is he or she really being saved or is he or she merely having natural death prolonged? Using tubes and machines to keep someone living is both painful and to a sense unhealthy. When people are put on respirators and surgically implanted feeding tubes a great deal of care is needed. Individuals with gastrointestinal tube become underweight, dehydrated and malnourished. With prolonged use of respirators there is the need for suctioning, the respirator tubes are irritating to the esophagus and individuals can aspirate or choke on mucus.
The United States Conference of Catholic Bishops published several articles on their views of physician assisted suicide where they supply information on the morals of suicide and the need to help the people plagued with the ideas of suicide. Their views against assisted suicide are clearly against the idea; however, they say that people are in fear of life preserving methods that are taken so easily. The stand of the church is that many life preserving methods unnaturally prolong death (Gloth).
The controversy of the right to die could also be extended to the right to live. From a religious aspect the use of life support or other lifesaving procedures like organ transplants could also be against the “Will of God.” We could look at the situation from another of view and say if it is not “God’s will” then why are we blessed with the ability to invent, create and advance in medicine? Which interpretation is the correct interpretation? This remains up to the individual to decide for them.
One very important argument is the one of the elderly and disabled. The aging population is increasing in size with the baby boomers, medical technology and a higher awareness of health maintenance. Opponents of physician assisted suicide worry that many elderly or disabled will be discarded in a sense. They say that family members will decide that the cost of medical technology is too high and will decide to opt for assisted suicide. Opponents also worry that the physically and mentally disabled will be given up on and guardians will end their lives unnecessarily (“Assisted Suicide”). The way the Death with Dignity laws are written makes it hard to infringe on the rights of the disabled and elderly.
Many proponents feel that if we have the right to refuse treatment, which would ultimately end one’s life, we should have the ability to speed up the process. Others worry that people may choose alternate more painful and violent methods of taking their lives (“Assisted Suicide”). The pain inflicted on family members that may find the remains of a loved one that ended their life in more violent ways, would leave a more detrimental and long lasting effects like fear, shock and depression.
In the 1990’s the issue of physician assisted suicide was in headlines all over the world. Dr. Kevorkian was arrested in Michigan for assisting patients to die in excess of one-hundred thirty times (Ekland-Olsen & Aseltine 51). In 1991, Derek Humphry’s best-selling book Final Exit was published. The book was widely discussed and criticized because it outlines numerous ways to take your own life including a list of dos and don’ts, and a complete list of lethal drug dosages (Ekland-Olsen & Aseltine 48). In 1993, according to the New England Journal of Medicine a study of systematic suicide in New York reported that there was more than a 300% increase in deaths by asphyxiation, by using a plastic bag over the head. Many began to wonder if the book by Humphry was the cause of the increase (Ekland-Olsen & Aseltine 49). In 1993 the “Death with Dignity” law was passed in Oregon again causing uproar and controversy.
In the early 1990’s Dr. Timothy Quill published Death and Dignity: A Case of Individualized Decision Making which outlines a case in which he assisted a long time patient and friend with assisted suicide. He describes how even with pain control medications the bone weakness and fatigue consumed her life. Dr. Quill felt that assisting his friend helped him realize that he could assist others “that he did not really know or care about,” by taking small risks to help them end their suffering (Ekland-Olsen & Aseltine 51). Dr. Quill was later quoted as saying “If we do not acknowledge the inescapable multiplicity of intentions of most double effect situations, physicians may retreat from aggressive palliative treatment out of fear of crossing the allegedly bright line by allowing patients to die and causing their deaths” (Quill & Greenlaw). In Oregon, the first state to pass the Death with Dignity law, it is clearly defined as to how a patient can choose to end their life. The requirements include a terminal illness with a diagnosis of less than six months to live. A patient opting for physician assisted suicide must ask a doctor for the right to die in writing. The patient must then make the request two weeks later. Once the request is approved the patient is then given the prescription for the lethal dose of medication they are to consume. The patient along with family are given specific directions as to how to take the medication, what to do if they ingest the medication and do not want to follow through with the suicide. They are also instructed as to what to do with the medication in the event that they change their minds and do not want to take the physician assisted suicide route (Ekland-Olsen & Aseltine 6). Many feel believe that physicians are required to uphold the law and order the lethal dose of medication to patients requesting the assisted suicide help. This is not true; physicians have the right to not participate in the physician assisted suicides. He or she has the choice to decide what is morally right for him or her. He or she can opt to participate if he or she feels morally well to handle the idea of helping someone end their lives. The ethical dilemma that a physician may deal with is they are required to investigate the reasons a patient is requesting the death with dignity option (Miles 8). Pharmacists and pharmacies are also given the option to not participate in the death with dignity act. Pharmacists are required to maintain the patient’s dignity and privacy but they have the ability to explore their own beliefs and morals. When a pharmacy or pharmacist opt out the only obligation they have are to post a sign letting the patient know what pharmacy participates in the program (Fass & Fass 11).
When given approval for the right to die in states already having the death with dignity laws in legislature the process is not complicated. The physician prescribes a lethal dose of medication, most often secobarbitol. The medication comes in pill form or liquid. Due to the potency of the secobarbitol needed to ensure the desired effect is met, the dosage of the medication is nine grams in pill form and ten grams in liquid. The medication is bitter and therefore the patient is given instructions to ingest the medication with a sweet fruity drink. The patient is instructed to take the medication on an empty stomach for faster absorption and ultimately a more immediate result. It is also critical for the patient that is going to consume the secobarbitol to take a medication to stop vomiting one hour prior to taking the lethal dose. The pharmacists are required to give specific instructions to the patient as well as the patient’s family for proper ingestion techniques, disposal of unused medication and what to do in case the patient no longer wants the previous desired results after ingestion (Fass & Fass 9). The dosage of medication, proper ingestion and carefully following physician’s and pharmacist’s orders makes it a relatively painless for the patient.
It is imperative that more states legalize physician assisted suicide. We need to allow terminally ill patients to have the option of ending their suffering. I have seen patients and family members that have suffered in their last days, weeks and even months. The pain is many times unrelenting, intolerable and not relieved by high doses of pain relieving medications. I have been told by terminal patients that “they do not want to suffer any longer” or “they have made peace with the fact that they are dying and want to go.” The idea of suffering beyond control is unimaginable. The ability to help these patients is available and relatively painless so let us help them by giving them to option to decide how they want to go.
The laws of physician assisted suicide are clearly defined. There is no more room for error as to the rights of elderly and disabled than there are now. There is always the possibility of a doctor, nurse or pharmacist for that matter to give someone a toxic dose of medication whether on purpose or by accident. Legalizing physician assisted suicide would not change that. Patients already have the right to refuse medical treatment which could ultimately end their life, enacting laws to allow them to die a dignified speedy death would not harm someone who is about to die already.
"Assisted Suicide." Opposing Viewpoints Online Collection. Gale, 2012. Web. 26 June 2014. "The Cost of Dying." N.p., 19 Nov. 2009. Web. 23 July 2014. Ekland-Olson, Sheldon, and Elysian Aseltine. How Ethical Systems Change: Tolerable Suffering and Assisted Dying. E-book. New York: Routledge, 2012. Fass, Jennifer, and Andrea Fass. Physician Assisted Suicide. American Journal of Health Pharmacy 68.9 (2011): 8-12. Print. Gloth, F. Michael, III. "Physician-assisted Suicide: The Wrong Approach to End of Life Care." Physician-assisted Suicide: The Wrong Approach to End of Life Care. United States Conference of Catholic Bishops, n.d. Web. 26 June 2014. Miles, S. H. "The Oregon Death With Dignity Act: A Guidebook for Health Care Providers." JAMA: The Journal of the American Medical Association (2008): Journal. Print.