Moral Dilemma - Physician Assisted Suicide

A Moral Dilemma for Physician Assisted Suicide

xxxxxxxxxx

xxxxxxxxxx

xxxxxxxxx

xxxxxxxx

January 30, 2012

Abstract

In order to relieve suffering for those with terminal illness, physician assisted suicide should be legalized for competent persons to allow for autonomy in making end of life decisions. In order to reduce or relieve suffering of animals, medically assisted death is a perfectly acceptable practice today. But when it comes to people diagnosed with untreatable and deadly diseases, they are not afforded the same painless luxury. They are at the mercy of their disease and a medical community that fails to recognize a life without dignity is no life at all.

Physician Assisted Suicide has been legal in the state of Oregon since 1998. The Death with Dignity Act allows Oregon residents who are terminally ill with less than a six month life expectancy to end their lives voluntarily by requesting lethal medications prescribed by a physician. In accordance with the act, a patient must be diagnosed by two separate physicians as being terminally ill, be mentally competent, and serve a 15 day waiting period.

When competent terminally ill persons are given the option of physician assisted suicide, they are given control of how much suffering they have to endure. They would be afforded the opportunity to make their personal decisions and arrangements without intervention in their care and comfort at the end of their life.

Keywords: Physician Assisted Suicide, PAS, Death with Dignity Act

Introduction

The right to end one’s life on one’s terms is a controversial and emotional dilemma. It is difficult to understand why we have enough compassion to use the practice of physician assisted suicide (PAS) to ensure that our pets do not incur undue suffering, yet we do not hold the same concern for members of our own species. The right to life does not mean the right to suffer needlessly from an incurable disease. The states of Oregon, Washington and Montana have addressed this issue legally in an effort to change this manner of thinking. Unfortunately, these are the only states in which the practice is legal and regulated. I feel that in order to relieve suffering for those with terminal illness, more states should consider legalizing physician assisted suicide for competent persons to allow for autonomy in making end of life decisions.

The arguments

In order to reduce or relieve suffering of animals, medically assisted death is a perfectly acceptable practice today. But when it comes to people diagnosed with untreatable and deadly diseases, they are not afforded the same painless luxury. They are at the mercy of their disease and a medical community that fails to recognize a life without dignity is no life at all. Opponents of the practice express views that a physician prescribing lethal doses of narcotics are inconsistent to their purpose of healing the sick (Gill, 2005). If the sick cannot be healed, if a person has an illness that cannot be cured, then what is the role of the physician in that person’s life? Shouldn’t it be to reduce that person’s agony and to make them as comfortable as possible given the untenable circumstances?

This is the question that was posed to voters in the state of Oregon. Physician Assisted Suicide has been legal in Oregon since 1997. The Death with Dignity Act allows Oregon residents who are terminally ill with less than a six month life expectancy to end their lives voluntarily by requesting lethal medications prescribed by a physician. A patient making the request must provide two oral requests of a willing physician and one written request. There is a 15 day waiting period after the first oral request. Once the written request is made, there is a 48 hour waiting period before the prescription is written to the patient. In accordance with the act, a patient must give a fully voluntary and informed decision, be diagnosed by two separate physicians as being terminally ill, and be mentally competent (Lachman, 2010). These safeguards that are written into the Death with Dignity Act are means to prevent coercion of patients to use the Act. It also strictly prohibits mercy killing or other forms of active euthanasia, meaning that medical practitioners cannot be active participants in administering the medications to patients.

Guidelines that ensure the patient is capable of making the decision to end their life protect the patient and the physician that they are making a fully voluntary choice. When competent terminally ill persons are given the option of physician assisted suicide, they are given control of how much suffering they have to endure. They would be afforded the opportunity to make their personal decisions and arrangements without interference in their care and comfort at the end of their life.

The safeguards in place for the Death with Dignity Act currently legal in Oregon are measures that could be used to refute the opposition’s claims that say that legalization of physician assisted suicide could corrupt the medical community to the point where doctors and nurses would do less to sustain life. There is fear that this will lead to involuntary methods of euthanasia. This argument is a fallacy since there is no proof to suggest that euthanasia is a logical succession to physician assisted suicide. “And, in fact, there is evidence that terminal care has actually improved in both Oregon and the Netherlands. After passage of the Oregon law, 88% of those physicians responding to a survey said that they had ‘sought to improve their knowledge of the use of pain medications in the terminally ill “somewhat” or “a great deal” (Dietele, 2007).

The opponents for legalizing physician assisted suicide have produced some arguments with merit. There is fear that there will be abuses of the law. Patients could be pressured by family or insurance companies to seek physician assisted suicide. Vulnerable groups such as elderly, minorities, and indigent persons may be more likely to utilize thinking that they have no other options. There is opportunity for abuses in many social policies. But that shouldn’t hinder enacting laws just on the outside chance that there may be the potential for abuse. The key here is to anticipate where the policy is vulnerable and make sure that there are the proper safeguards in place.

A case where there was suspected coercion of an elderly patient was treated with the measures that were put in place in the Oregon law. “PAS opponents have used a case involving an 85 year old woman dying of terminal cancer to argue that the system has been abused. In 1999, Kate Cheney requested a prescription for lethal medication. Her physician arranged for her to undergo a psychiatric evaluation, to make sure that she was competent to make the decision to end her life. ‘The psychiatrist noted that although assisted suicide seemed consistent with Kate’s values throughout her life, “she does not seem to be explicitly pushing for this” The psychiatrist’s evaluation concluded that Ms. Cheney did not have the level of competency needed to make the decision” (Dietele, 2007). There are no guarantees that family coercion or other outside pressure will not take place in requesting physician assisted suicide. The possibility does exist for those with agendas to coerce or put undue pressure on a terminally ill patient in order to convince them to seek physician assisted suicide. By legalizing physician assisted suicide, it could have a corrupting influence on the medical community. Doctors and nurses may not try hard enough in performing life-saving measures and could result in a decline in health care. Current trends in Oregon, where the law is currently enacted do not bear out that there is pressure from insurance for patients to seek physician assisted suicide. There is slight inconclusive evidence involving family pressure on a terminally ill patient. Vulnerable groups showed no signs of increase in terminating their lives due to the legalization of physician assisted suicide. “Between 1998 and 2004, 208 people died after ingesting a lethal dose of medication prescribed under Oregon’s Death with Dignity Act. Of those 208 people, 74 (36%) cited ‘burden on family, friends/caregivers’ as one of their reasons for seeking PAS. But this statistic can be misconstrued. It does not show that the family actually put pressure on the patient; it merely shows that the patient did not want to be a burden to the family” (Dietele, 2007). Another possible abuse that the opposition to physician assisted suicide is concerned with is that vulnerable groups, consisting of minorities, the elderly, and the poor may be more susceptible to choosing it based on discriminatory practices. Again, this allegation appears to have no merit. “In Oregon, terminally ill younger range of the 208 people who died after ingesting a lethal medication prescribed under Oregon’s Death with Dignity Act between 1998 and 2004 was 25–94, with only 16 (8%) over the age of 85. The median age was 69 and 203 of the 208 patients were white and 5 were Asian. These patients were not poor or uneducated and 61% of them had at least some college. The statistics on those seeking PAS parallel the statistics on those who actually died after ingesting the lethal medication and 97% were white and the median age was 68” (Dietele, 2007). According to the current data collected by the state of Oregon, there is no evidence in the argument that family and insurance pressure can coerce terminally ill patients to seek physician assisted suicide. Nor is there any evidence that vulnerable groups are more likely to terminate their life. Data collected from the Netherlands actually show that there, physician assisted suicide is more common in those that have higher economic status. (Dieterle, 2007). Conclusion It is easy to understand why the opponents of physician assisted suicide would be fearful of the abuses that could take place with its use in public policy. There have been many public policies that have shown potential for abuse. From welfare to farm subsidies programs, laws put in place to help those in need are manipulated and contorted into something that is barely recognizable from what it was initially supposed to achieve. But none are as final as enacting physician assisted suicide. But, it is important to improve current end of life care. In all 50 states, competent patients can decline treatment in order to hasten death, but the problem with that is that the anguish continues until nature takes its course. In order to relieve the anguish for those individuals with terminal illnesses, physician assisted suicide should be legalized for competent persons to allow for autonomy in making end of life decisions.

References:

Gill, M. (2005). A moral defense of Oregon 's physician-assisted suicide law. Mortality, 10(1), 53-67.

Dieterle, J. (2007). Physician assisted suicide: a new look at the arguments. Bioethics, 21(3), 127-139.

Rose, T. (2007). Physician-assisted suicide: development, status, and nursing perspectives. Journal Of Nursing Law, 11(3), 141-151.

Lachman, V. (2010). Physician-assisted Suicide: compassionate liberation or murder?. MEDSURG Nursing, 19(2), 121-125.

References: Gill, M. (2005). A moral defense of Oregon 's physician-assisted suicide law. Mortality, 10(1), 53-67. Dieterle, J. (2007). Physician assisted suicide: a new look at the arguments. Bioethics, 21(3), 127-139. Rose, T. (2007). Physician-assisted suicide: development, status, and nursing perspectives. Journal Of Nursing Law, 11(3), 141-151. Lachman, V. (2010). Physician-assisted Suicide: compassionate liberation or murder?. MEDSURG Nursing, 19(2), 121-125.