Physician-‐Assisted Suicide 1
Physician-Assisted Suicide Bri Weed HCA 417 May 1, 2014
Physician-‐Assisted Suicide 2 ABSTRACT: Death is one certainty of life. Technological advances have given the power to sustain live and prolong death for patients who are terminally ill. Today, the United States life expectancy rate is 78.64 years, the highest it has ever been (World Bank, 2014). However, the ethical dilemma presented through extending life is, does the patient have quality of life or are they in a vegetable state with no dignity or autonomy? Quality of life can only be determined by the individual, which results in both ethical and legal implications. Some patients believe their duty on this Earth is completed and want to die or there is no reason for them to wake up in the morning and have life by machines. Rather than go through a gruesome, undignified and spontaneous act of suicide, a patient can ask a trained medical professional for their assistance. Physician-assisted suicide is suicide committed by the patient with assistance from a physician. The reasons a patient would want this type of “treatment” varies depending on their situation, however, the patient must be competent enough to make this type of decision. The idea of “right to choice” is a very debatable subject, which will be examined throughout this paper in opposing viewpoints. In order to understand what physician-assisted suicide is and the ethical implications it poses to the patient, family and physician, terminology must be distinguished. The MerriamWebster dictionary defines suicide as, “the act of killing yourself because you do not want to continue living” (Suicide, 2014). Physician-assisted suicide is where the physician provides the necessary means or information and the patient performs the act of suicide (EndLink, 2014). Physician-assisted suicide can be mixed up with euthanasia, however, these two completely different acts and have different ethical and legal consequences. Euthanasia is the act of bringing about the death of a hopelessly ill and suffering person in a relatively quickly and painless way for reasons of mercy (Back et al, 1984). Essentially, euthanasia is where the physician performs
Physician-‐Assisted Suicide 3 the act of suicide. Patients can also commit suicide through their advance directive. If a patient is enrolled in Medicare/Medicaid they can refuse life extending or life saving treatments through the Self-Determination Act passed in 1990 by United States Congress (American Cancer Society, 2013). By refusing life saving treatment, the patient could be committed suicide without directly committing the act. Physician-assisted suicide is not a new activity. It has been noted that requests to end ones life has been received since the beginning on medicine. Physician-assisted suicide allows the patient to be placed out of their misery at a time and place of their choosing. In the United States of America, on the federal level, there are no laws about physician-assisted suicide; these decisions are generally left up to the states. There are four states, which have legalized physician-assisted suicide, and 46 states, including District of Columbia, which considers physician-assisted suicide illegal (ProCon.org, 2014). Oregon is the one of the four states to legalize physician-assisted suicide. Under the Death with Dignity Act of 1997, it allows terminally-ill-adults-Oregonians to obtain and use prescriptions from their physicians for selfadministered, lethal doses of medications (Oregon.gov, 2013). With the Death with Dignity Act, Oregon Health Authorities requires physicians and patients who participate in this act to report specific information, which in turn is turned into an annual statistical report. This report can help improve the care and treatment options given to terminally ill patients either considering physician assisted suicide or nearing the end of their life. No physician wants to lose a patient; it can be hard enough to see them in a vegetative state or in excoriating pain. It can also place a physician in a legal and ethical position when asked by a patient for assistance (Andre and Velasquez, 1987). Without proper consent and examination, assisting a patient in suicide could result in the loss of their medical license and a
Physician-‐Assisted Suicide 4 murder or manslaughter conviction (Baron et al, 1996). In order for a patient to have the right to choice and physicians not have legal implications, a specific stature must established. Strict guidelines need to be established in order to determine if the patient is competent enough, mentally sound or in unbearable pain or suffering. It can also place a physician in a difficult position to determine which patient gets their assistance. Many organizations that support physician-assisted suicide state the patient criteria to be eligible for physician-assisted suicide is a six- month estimated lifespan (Baron et. al, 1996). Developing more qualifying criteria can lead to more ethical confliction, such as how much pain does a patient have to be to be classified as excoriating or unbearable or how bad one’s quality of life have to be in order qualify. The patient and physician must determine if patient qualifies for this type of “treatment”. It is very important to focus on the patient, because after all, it is his or her life and how they choose to self-govern. As a human being, there is a right to autonomy. Autonomy is the right or condition of self-government (Morrison, 2014). This includes anything regarding to ones self and can be used as the basis for determining moral responsibilities and accountability for one’s actions. As part of human rights, everyone accepts the responsibility not to infringe on the rights of others and to support those whose rights are abused or denied (Flowers, 2014). Many individual, who are not sick, have every opportunity to commit suicide, they have the right to choose whither they live or die today. However, someone with a terminal illness or a handicap may not the necessary means to go through this act in a dignified manner. Asking someone to assist them is degrading to their autonomy because they have to admit to someone else they want to die. They have to admit to their family they have no reason to wake up and go another day through their treatment. As treatments progress and the quality of life diminish, a patient has the right to allow
Physician-‐Assisted Suicide 5 treatment to stop. It has always been all patients have a right to choose among appropriate medical treatments, but is killing a medical treatment? (Egnor, 2009) As the previous paragraph eluted to, is killing a medical treatment? Does a medically trained and license physician have the right to kill another contributing member of society? The main question is, is killing in their scope of practice? A medical professional duty is to first do no harm (Morrison, 2014). Another part of a medical professional duty is to do what is best for the patient and support their decisions. A physician is there to support, lay out treatment options and use their medical knowledge assist the patient in making decisions about their own medical care. Physicians are a crucial part in physician-assisted suicide. However, not all physicians or nurses are comfortable with the idea of purposely giving prescriptions to a patient to kill himself or herself. They have a duty to provide care to the patient, however, this a blurry line when it comes to the boundaries regarding their scope of practice. In most states, physician-assisted suicide can be considered legal, leaving a physician with legal consequences. Many who oppose physician-assisted suicide consider it murder (Gloth, 2014). The definition of murder is, the unlawful premeditated killing on one human being by another (Murder, 2014). Yes, physicianassisted suicide is premeditated and has an end result of one person being dead, but this “treatment” option was consented and carried out by the patient. A key figure in the ethical dilemma of physician-assisted suicide is Jack Kevorkian or Mr. Death. He first made headlines when he assisted a woman with Alzheimer’s end her life before the degenerative disease took full effect (Jack Kevorkian, 2014). The State of Michigan immediately charged Kevorkian second-degree murder for injecting a lethal dose to a patient.
Physician-‐Assisted Suicide 6 However, the family was accepting of the women’s death and supported her decision. From this moment on, he was on the crusade for assisted suicide. He lost his medical license, but still administered medication with the intent to relieve pain and suffering. He allowed the news program, 60 Minutes to air a tape of him administering lethal injection to a patient. From this public act, he was charged with second-degree murder and sentenced to twenty-five years of prison. He brought many ethically and moral issues to the public eye and shed light on alternative treatment options for the terminally ill. Children are taught in school; it is never accepted to give up and quit. When situations get tough or today is rock bottom, they are told that it gets better and find the positive. They are also taught there is always someone worse off then you and be grateful for what you do have. However, if we apply this logic to terminally ill patients, vegetable patients or lonely abandon parents, we have different advice. It is hard to imagine, a patient who is terminally ill for years and who lives in sever pain daily find the positive in life. Is this person living? Many argue, “By allowing a person to take their life when they feel hopeless, it might give off the wrong impression to the public that when life becomes hard it is acceptable to quit (Dieterle, 2007). Unfortunately, the healthcare system has become a business where profit comes before helping and treating the sick. Managed care is all about keeping the cost to a minimal while weight the cost and benefits of each treatment. This brings an ethical dilemma between doing what is best for the patient versus making a profit. It is also a possibility case managers would suggest or hint at the idea for financial reasons. A 1998 study from Georgetown University’s Center for Clinical Bioethics made a strong connection between profit-driven managed healthcare and assisted suicide. The link is between cost-cutting pressure physicians and their willingness to advise or prescribe lethal options to patients (DREDF, 2010). To avoid having
Physician-‐Assisted Suicide 7 patients being pressured to take the lethal route, the patient must bring it up on their own terms and decide what treatment option is best for their quality of life, with the guidance and support from the physician. In conclusion, physician-assisted suicide can bring many ethical, moral and legal consequences. Patients near the end of life must continue to receive emotional support, comfort care, adequate pain control and respect for patient autonomy, and good communication (AMA, 1996). Every person has the right to die with dignity, physician-assisted suicide allows for that. Most the patients who are requesting this “treatment” have been through a lot all ready and are seeking a way to leave the Living Earth with dignity and autonomy. The main goal of physicianassisted suicide is to comfort, provide compassion and care to the terminally-ill patients.
Physician-‐Assisted Suicide 8 References AMA:American Medical Association. (n.d.). Opinion 2.211 - Physician-Assisted Suicide. Retrieved April 30, 2014, from http://www.ama-assn.org//ama/pub/physicianresources/medical-ethics/code-medical-ethics/opinion2211.page American Cancer Society. (2013, May 31). The Patient Self-Determination Act (PSDA). Retrieved April 30, 2014, from http://www.cancer.org/treatment/findingandpayingfortreatment/understandingfinanciala ndlegalmatters/advancedirectives/advance-directives-patient-self-determination-act Andre, C., & Velasquez, M. (1987). Assisted Suicide: A Right or a Wrong?. Issues in Ethics, 1(1). Retrieved May 1, 2014, from http://www.scu.edu/ethics/publications/iie/v1n1/suicide.html Back, B., Betts, R., Cassidy, K., Glagola, B., Gindler, J., Glendenin, L., et al. (1984). Back et al. Respond. Physical Review Letters, 52(5), 397-398. Baron, C. H., Bergstresser, C., Brock, D. W., Cole, G. F., & Dorfman, N. S. (1996, December 1). Boston College Law School. A Model State Act to Authorize and Regulate PhysicianAssisted Suicide . Retrieved May 1, 2014, from http://lawdigitalcommons.bc.edu/cgi/viewcontent.cgi?article=1013&context=lsfp&seiredir=1&referer=http%3A%2F%2Fscholar.google.com%2Fscholar_url%3Fhl%3Den%2 6q%3Dhttp%3A%2F%2Flawdigitalcommons.bc.edu%2Fcgi%2Fviewcontent.cgi%253F article%253D1013%2526context% DREDF. (n.d.). Why Assisted Suicide Must Not Be Legalized. Retrieved May 1, 2014, from http://dredf.org/assisted_suicide/statement.html Dieterle, J. (2007). Physician Assisted Suicide: A New Look At The Arguments. Bioethics, 21(3), 127-139.
Physician-‐Assisted Suicide 9
Egnor, M. (2009, June 20). Physician-Assisted Suicide and Autonomy. Evolution News & Views. Retrieved May 1, 2014, from http://www.evolutionnews.org/2009/07/physicianassisted_suicide_and023121.html EndLink. (n.d.). Introduction to Physician-Assisted Suicide. Retrieved May 1, 2014, from http://endlink.lurie.northwestern.edu/physician_assisted_suicide_debate/what.cfm#What is Physician-Assisted Suicide? Flowers, N. (n.d.). Human Rights Here and Now. What are Human Rights?. Retrieved May 1, 2014, from http://www1.umn.edu/humanrts/edumat/hreduseries/hereandnow/Part1/whatare.htm Gloth, M. (n.d.). United States Conference of Catholic Bishops. Physician-Assisted Suicide: The Wrong Approach to End of Life Care. Retrieved April 29, 2014, from http://www.usccb.org/issues-and-action/human-life-and-dignity/assisted-suicide/to-liveeach-day/physician-assisted-sucide-wrong-approach.cfm Jack Kevorkian. (n.d.). Bio.com. Retrieved April 30, 2014, from http://www.biography.com/people/jack-kevorkian-9364141#earlycareer&awesm=~oCYLOPfTFT147P Morrison, E. E. (2014). Health care ethics: critical issues for the 21st century (3rd ed.). Burlington, MA: Jones & Bartlett Learning. Murder. (n.d.). Merriam-Webster. Retrieved April 29, 2014, from http://www.merriamwebster.com/dictionary/murder Oregon.Gov. (n.d.). Death with Dignity Act. Retrieved April 30, 2014, from http://public.health.oregon.gov/ProviderPartnerResources/Evaluationresearch/deathwith dignityact/Pages/index.aspx
Physician-‐Assisted Suicide 10
ProCon.org. (2014, April 17). State-by-State Guide to Physician-Assisted Suicide. Retrieved from http://euthanasia.procon.org/view.resource.php?resourceID=000132 Suicide. (n.d.). Merriam-Webster. Retrieved May 1, 2014, from http://www.merriamwebster.com/dictionary/suicide?show=0&t=1398663849 World Bank. (2014, April 18). LIfe Expectancy. Retrieved May 1, 2014, from https://www.google.com/publicdata/explore?ds=d5bncppjof8f9_&met_y=sp_dyn_le00_i n&hl=en&dl=en&idim=country:USA:RUS:CHN