Physician Assisted Death: Claiming the Right to Die versus Tolerating Suicide Essay Sample

Physician Assisted Death: Claiming the Right to Die versus Tolerating Suicide Essay Sample

ABSTRACT

Physician-assisted death had been a widely debated issues as it dealt with human life. The act of taking a person’s life intentionally was something that could not be ignored. At the same time, a person’s suffering could not disregarded. This provided an ethical discussion that provided arguments from different sides of the issue. There was just too much too loose, life and the quality of life that made this issue significantly relevant. Medical ethics, professional integrity, patient and physician values and legislation critically played major factors in the direction of this discussion. Physician-assisted death could not replace the role of physician-assisted living as the physician’s duty and the sanctity of life would always be held most important under any circumstance.

INTRODUCTION

            No one could predict whether or not they would experience facing the dilemma of judging one’s fate of life or death given a painful chronic or terminal disease. Dying individuals, their families as well as their physicians could all fall vulnerable to the stressful psychological forces caused by the prospect of death (Burt 2002). One could not accurately understand what goes through the mind of the patients, physicians and the patients’ families unless they too have undergone illnesses, too painful and costly that would make them contemplate about ending the sick patient’s life.  Contemporary reformist philosophy had claimed that death could be subject to the rational control of the individual in order to tame unruly situation (Burt 2002). According to Judge Richard Posner, a believer of the rationality and freedom that the act of suicide brought said,  “that the availability of physician-assisted suicide increases the option value of continued living” (Burt 2002, p. 106).

There was an increasing debate about the morality of physician-assisted death (PAD), sometimes known as physician-assisted suicide and slightly similar to voluntary active euthanasia (Douglas et al. 1999). On the other hand, the discussion in literature that concerned end-of-life values and attitudes from physicians and patients was not proportionally discussed as it was in the media.  This paper would provide a general discussion about PAD. It would include the Oregon legislation, the Death with Dignity Act that legalized physician-assisted death. It would also cover the ethical debate regarding PAD. The paper would present the different sides of the issue in regards to the morality of physician-assisted deaths. This paper would also related the values of the patients and the physicians in regards to their perspective for PAD as well as a critical analysis of the issue based on the determination of death, professional integrity and the role of the law in the medical process.

REVIEW OF RELATED LITERATURE

Discussion of Physician Assisted Death

            Physician-assisted death referred to the act by which the physician would be the one to provide or to prescribe a patient with a lethal dose of medication upon the patient’s request, by which the patient intends to use it to end his or her life (Braddock & Tonelli 2008). Under a purpose of clarification, PAD was considered to be different from euthanasia. PAD was a practice by which the physician provides the means for death but it would be the patient and not the physician who would administer the lethal procedure through medication. On the other hand, voluntary euthanasia referred to the practice by which it would be the physician who would personally administer the lethal medication, usually through lethal injection, in order to grant the patient’s request to die (Braddock & Tonelli 2008).

            There were different practices that could be considered as physician-assisted suicide. There was terminal sedation by which the terminally ill who was considered competent in his or her choices would allow him or herself to be sedated to the point of consciousness (Braddock & Tonelli 2008).  The patient who was sedated would be allowed to die of her disease as well as starvation or dehydration (Braddock & Tonelli 2008). Another type of PAD was the act of withholding and withdrawing life-sustaining treatments. This was done when a competent patient made an informed decision to refuse all life-sustaining treatment. There was a virtual unanimity under state laws as well as in the medical profession to respect such a decision from the patient’s side (Braddock & Tonelli 2008). There were also pain medications that could be given to hasten death. Usually, patients suffer from unbearable pain that require them dosages of pain medication that would ultimately impair their respiration or have other fatal effects (Braddock & Tonelli 2008).

Death with Dignity Act

            In the state of Oregon, the Oregon Death with Dignity Act (DWDA) was formed as a citizen’s initiative that was passed through vote by the Oregon voters in November 1994 with 51 per cent in favor of it (Oregon 2006). There were efforts in November 1997 that proposed to repeal the DWDA and was placed under general ballot however the voters rejected this measure by a margin of 60 to 40 percent that retained this act (Oregon 2006). Oregon became the first and only state that allowed this medical practice.

            DWDA came with certain requirements for the patients for PAD to be legal. It allowed terminally ill Oregon residents to obtain and use such prescriptions for self-administered and lethal medications (Oregon 2006). Oregon law did not consider this procedure to be suicide. It was considered as legal and free from any immoral judgment from the law. DWDA specifically prohibited voluntary euthanasia wherein it was the physician or another person administering the lethal medication (Oregon 2006). Other requirements were the capability of the patient to make their own health care decision. The patient must be 18 years of age or above. Terminal illnesses must lead to diagnosed death within six months or less in order to be eligible to request for the prescription to lethal medication from a licensed Oregon physician. It was basically like getting a license to end one’s life. In 2007, there were 85 prescriptions for lethal medications by which 46 patients took the medications, 26 died of their disease and 13 were still alive at the end of 2007 (Oregon 2008). There were 45 physicians who were responsible for those 85 prescriptions. Since 1997, there were already 341 patients who had died under the terms of DWDA (Oregon 2008).

Terminal Illness

            Terminal illness was a concept that could be considered elusive. There were some groups that debated the requirement for terminal illness and the right to have a physician-assisted death (Gunderson & Mayo 2000). There had always been a difficulty in the definition of terminal illness that provided much heat to it as a requirement to PAD. There were objections to this requirement because they did not see any moral difference whether the patient was terminally ill or not when it came to PAD (Gunderson & Mayo 2000). The issues of compassion and autonomy were still present and the argument of fairness found the need to expose the moral arbitrariness of the line between a non-terminal and a terminal illness requirement (Gunderson & Mayo 2000).

Overview of the Ethical Debate for PAD

            It was important to take at the two sides of this debate. Physician-assisted death was considered unethical when it was considered as helping a patient commit suicide. Suicide, especially under a spiritual or religious standard, was considered as immoral. On the other hand, there was a question as to the ethical argument of providing the patients’ dignity by releasing them from their suffering caused by their disease.  Under such an argument, allowing patients to suffer with death as a prognosis was seen to be more immoral.

Patient Rights: Relief from Suffering and Loss of Dignity

            Physician-assisted death was considered to be ethical because it must be left to the rational decision of the patients when it came to their choice to choose death. It was also seen as the physician’s duty to alleviate suffering even if it was up to the point of providing assistance to end a life (Braddock & Tonelli 2008). Arguments for this side focused mainly on the respect for autonomy. There was personal decisions involved because it included the time and circumstances of death. Competent people were seen to be given the right to choose death. There were many debates about a person’s constitutional life to die (Palmer 2000). In this case, there were arguments that were worse things than death and that included a life of suffering unbearable pain and major physical incapacity. Competent individuals must have the right to determine their own fate, especially in matters that were important to them. Illness could seriously compromise a the quality of life for a person and such were the basis for asking if life was still worth living (Gunderson & Mayo 2000).

            There was also the argument for justice. Justice would move that all cases should be treated equally. Thus, while competent and terminally ill patients were allowed to hasten death by treatment refusal other patients’ death would not be hastened just by it. Their only option was PAD. Justice should grant them the same option as those who were terminally ill (Braddock & Tonelli 2008).

            There was also the case for compassion. Suffering meant more than physical pain; it involved psychological, emotional and even financial burden as well. It was not always possible to relieve suffering thus PAD was a compassionate response to such unbearable form of suffering (Braddock & Tonelli 2008). The patient’s dignity was also upheld by this argument because it was evident that the person suffers massive loss of dignity as brought about by the disease. The control of how the patient would die was a compassionate manner by which dignity could at least be restored.

            The physician must also be regarded as the patient’s friend (Palmer 2000). After informing the patients of their case and giving them their options for treatment as well as exposing the risks and chances for survival, he or she must respect the patient’s decision to refuse treatment. At the same time, still in the role of the patient’s friend, relieve the person’s suffering for requesting for an assisted death if the case was unbearable already.

            There were certain misconceptions that were said to be regarded with physician-assisted death. One myth was that it was the advances of biomedical technology that had created an unprecedented public interest in PAD (Emmanuel 1997). There was seen to be the emergence of a right to hasten one’s death as a consequence of advances in medical sciences.  PAD had been a practice that confronted doctors ever since Western medicine emerged for more than 2000 years ago (Emmanuel 1997).  It was not medical advancements that influenced PAD interest.

The Case for the Physician Assisted “Suicide”

Many had argued that PAD was unethical was rightfully called physician-assisted suicide (PAS). The practice of PAS was said to directly counter the duty of the physician in his responsibility to preserve the life of his patients (Baddock & Tonelli 2008). The oath the doctor had taken when he or she had become a physician was to find ways to save a person’s life. The act of assisting a person in his or her death could not be considered to be any way close to this responsibility. It would be more of an act of betraying one’s duty or making sure the patients live.

Legality of PAS would enabled abuses to take place. Poor patients or elderly ones would be pressured to chose PAS over spending a fortune for medical treatment. The option for PAS may not be easily granted however; the systems would always have cracks wherein people could easily fall into. People fall into the cracks of the system everyday, the risk for PAS was greater than any other because it dealt with life and it was considered to be valuable under the constitution and under any other standard.

The sanctity of life was an issues that strongly reflected by religious and secular perceptions against taking one’s life (Baddock & Tonelli 2008). There could never be any argument that could sufficiently counter this point. It would remain something that would be seen to be valued over everything else. Even as compassion for the patient under unbearable pain seemed to be the counter-argument, there was always the possibility of hope for healing through natural causes or medical advancements. Preserving life must be done at all costs. PAS did not seem to uphold this principle. There was also the emphasis on the distinction between actively “killing” a patient versus passively letting one die of his or her disease. PAS was considered to be an active act of killing oneself and was not justified (Baddock & Tonelli 2008). There was a huge difference between the manners by which the patient dies. Active “killing” through PAS was considered to be participation in the manner of ending a person’s life that could cause heavy psychological and mental implications on the physician as well as the family left behind.

There was also the argument for the fallibility of the profession wherein physicians have a margin for error and diagnosis and prognosis could be wrong thus causing one’s life because of such mistakes (Baddock & Tonelli 2008). Physicians were still only human. They, even in the level of their competence, were bound to make mistakes. It was only natural for this to happen. There was too much to loose from such error and that was a person’s life, it was the patient’s life by which they had sworn to protect as they took on the duty to be physicians. They were health care providers, not death-providers.

In an ethical discussion, fatal actions were seen to be worse than fatal omissions (Manning 1998). In the case of PAS, if the doctor administered a large dose of morphine to ease the pain and in the process unintentionally hasten the patient’s death it was acceptable. However, omissions were when the doctor failed to treat a person’s disease because of assisting in a person’s death instead. Allowing a patient to die was the act of stepping out of the way of the disease and letting “natural forces bring a life to its natural end” (Manning 1998, p. 47). On the other hand PAS was not the same. The disease or nature did not do the killing; it was people (the patient and the physician), therefore it was suicide (Manning 1998).

Values that Influence Patient’s Inclination towards PAD

            According to Oregon statistics from it 2007 summary, patients who participated under the DWDA were between 55 to 84 years of age, 98 per cent were white, they were well educated and 86 per cent of them had terminal cancer (Oregon 2008). More than half of the patients who died under DWDA had private insurance while 35 per cent had Medicare or Medicaid. Most of their end-of-life concerns included the loss of autonomy (100%), their decreasing ability to have an acceptable quality of life (86%) as well as loss of dignity (86%) (Oregon 2008).

In a the study, “Primary Care Physician Attitudes and Values Toward End-of-Life Care and Physician-Assisted Death,” they were able to point out the different values that influenced the patients’ inclination to opt for PAD. Values included their fear of being a burden to their family, physically and financially (Douglas et a 1999). It was not only that they did not want their families to seen them in pain and in tubes. They also did not want to spend their life savings for medical expenses that would only prolong their lives and not really save it (Douglas et a 1999). They also want to communicate and think clearly to enable them to communicate with their family before they died (Douglas et a 1999). They wanted to make their own health care decisions as well as to be free of pain when they die. It was those who had strong religious affiliations that were seen to stand out against PAD and to highly influence the manner by which they die; they were the ones who would choose to die a natural death that was free from any human intervention (Douglas et a 1999).

Physician Values and Perception of PAD

            A significant number of physicians also had strong values against PAD that were also drawn from their personal values either from professional integrity or religious affiliations (Douglas et al 1999). If the physician was a Catholic or a Protestant, they were more likely to opposed PAD. On the other hand Jewish physicians or those who did not have religious affiliations supported PAD. Value-based beliefs widely influenced their convictions towards end-of-life care. They were also seen to hold frank discussions with their patients regarding their beliefs.

CRITICAL ANALYSIS

Determination of Death

            It was seen to be a critical question as to when a person should terminate treatment or when a person should decide to die. It was also a slippery slope by which under what circumstance can a surrogate decision maker could make a constitutional decision for a patient’s life to live (Palmer 2000). While courts respect the patient’s right to refuse life-saving procedures, physicians had been observed to ignore these rights. For example, patients were unwilling to undergo a treatment like resuscitation after a cardiac arrest, but physicians would still have this procedure done. There were a lot of inconsistencies when it came to the idea of patient autonomy. There was also more debate when other people would be left accountable for deciding for the patient. It was still an area of discussion that was encompassed with vagueness.

Professional Integrity

            There was also the issue of professional integrity. A standard for this was reflected in this statement: “Our argument is that moral integrity in science, medicine, and health care should be understood primarily in terms of the principles, rules, and virtues that we have identified in the common morality” (Miller and Brod 1995, p. 8). More than the issue of moral justification, PAD must be critically analyzed if it was even permissible for a physician to assist a patient’s death (Miller and Brod 1995). Professional integrity represented what it meant to be a physician in terms of the values, norms, and virtues that were distinct to physicians. There was a certain identity tied to that role and it was their commitment to upholding the medical ethics. Majority of the arguments held PAD to be incompatible with the morality of medicine that was to be upheld by professional integrity (Miller and Brod 1995). Simple enough, doctors have a duty to protect life and not to assist in killing patients.

Medicine was basically a healing enterprise and should never be about helping patients die.

Role of the Law in PAD

            Legislation played a significant role in physician-assisted death. It was very important to consider the different consequences of legalizing PAD despite the fact that there were restrictions that were upheld by the law. PAD could be considered a bad public policy, as there still could not be enough ground to allow giving birth to a constitutional right to die (Palmer 2000).

            Dying was a different subject all together from other “right-to-life” debates that included pro-creational choices and abortion issues. Legal arguments for dying were separate and critically important to analyze. The argument that physicians could be authorized to assist patients in killing themselves was something that went beyond “constitutional rights” (Palmer 2000).  However, despite the supposed commitment of the law to preserve life, courts were seen to be in the forefront of blurring the lines for the patient’s rights to die by allowing patients to decline medical treatments (Palmer 2000).Legislatures were seen to be more vocal about placing regulatory schemes by which physicians could participate in death-dispensing practices for the patients (Palmer 2000).

            There were still disagreements as to the nature of this “constitutional right to die.” Physicians did not need to be exempted when it come to the Constitution’s role in protecting individual rights (Palmer 2000). Life was still considered more valuable. The quality of life caused by illness and suffering could always change as long as there is life. While when there is no life, nothing could be altered or improved. Legislature must encourage physician-assisted living instead of PAD by modifying laws and regulations that allowed for PAD cases to fall into the cracks and prevent doors that allow PAD procedures to become legally accepted and encouraged from opening.

CONCLUSION

            Physician-assisted death had been the subject of active debate because life and the quality of life were important issues to humanity. PAD was mostly an issue of medical ethics, professional integrity and morality. Legislation has the power to prevent PAD from being implemented. While respecting treatment refusals were acceptable, physicians should never participate in any practice that deviates them from performing their duty of protecting human life. Physicians must always fight for the quality of life of the individual and prevent suffering through their medical competence, they could only do this when the patient is alive

References

Braddock, C.and Tonelli, M. (2008). Physician-assisted suicide. University of Washington School of Medicine. Retrieved on April 26, 2006, from http://depts.washington.edu/bioethx/topics/pas.html.

Burt, R. (2002). Death is that man taking names: Intersections of American medicine, law, and culture. Berkeley, CA: University of California Press.

Douglas, D., et al. (1999). Primary care physician attitudes and values toward end-of-life care and physician-assisted death. Ethics & Behavior (9)3, p. 219.

Emmanuel, E. (1997).  Whose right to die? America should think again before pressing ahead with the legalization of physician-assisted suicide and voluntary euthanasia. The Atlantic Monthly (279)3, pp. 73-79.

Gunderson, M. & Mayo, D. (2000). Restricting physician-assisted death to the terminally ill. The Hastings Center Report (30)6, p. 17.

Manning, M. (1998). Euthanasia and physician-assisted suicide: Killing or caring? New Jersey: Paulist Press.

Miller, F. & Brod, H. (1995). Professional integrity and physician-assisted death. The Hastings Center Report (25)3, p. 8+.

Oregon.gov (2008, March). Summary of Oregon’s Death with Dignity Act – 2007. Retrieved on April 26, 2008, from http://www.oregon.gov/DHS/ph/pas/ar-index.shtml.

Oregon.gov (2006, March). Death with Dignity Act History. Retrieved on April 26, 2008, from http://www.oregon.gov/DHS/ph/pas/ar-index.shtml

Oregon.gov (2006, March). Death with Dignity Act Requirement. Retrieved on April 26, 2008, from http://www.oregon.gov/DHS/ph/pas/ar-index.shtml.

Palmer, L. (2000). Endings and beginnings: Law, medicine, and society in assisted life and death. Westport, CT: Praeger Publishers.