Is Physician Assisted Suicide Ethical, should a patient decide
A patient is in incessant pain or has an incurable illness. The patient can only be kept alive on machines or by enduring this pain. Should a patient who is in these circumstances be allowed to choose death over this life? A patient who wishes to make a conscious decision to end their own life does not have many choices. Physician assisted suicide is illegal in most states. Should physician assisted suicide be made legal?
Identify the problem
At the time of this writing three states have made physician assisted suicide legal, California, Montana and Washington (Lachman, 2010). Should PAS be made legal in the United States? Physician assisted suicide is the practice of a physician supplying the means to end a patient’s life (Meyer, 2009). Is PAS the same as murder or is it a service to the patient? Does the patient have the right to choose death in this manner? The question will involve considering the patient’s rights. The decision to make this legal will rely on the question of autonomy for members of society (Spindelman, 2008).
Some terms that will appear in the discussion are defined here. Physician assisted suicide (PAS) it the process of a doctor giving the patient a prescription for a medication that will end his life. The patient chooses when to administer the medicine. Active euthanasia is a conscious decision to end a life and passive euthanasia if the process of removing medical machines and allowing the disease or illness to take the patient in death. Palliative care is the procedure of keeping a patient comfortable through pain medication and other medical services when facing death (Allen, 2011).
Identify Possible Solutions to the Problem
If the courts were to make PAS legal physicians could prescribe the medication necessary to end a patient’s life without worry of legal consequences. Patients who are terminally ill would have recourse to a way to end their suffering.
If the courts continue to prevent PAS through laws patients would rely on passive euthanasia to bring about their death or seek to go against the law in order to bring their death. PAS would be considered the same as murder. This would be considered the same as taking a human life in any other capacity.
Examine Assumptions and Points of View
Janine Fiesta says, “A growing number of Americans have begun to call for the legalization of euthanasia and assisted suicide" (Fiesta, 1997). Fiesta is an author, speaker and Health-Care Director. Fiesta feels that more Americans are intimidated by medical technology and being able to choose the time and place of their death gives them some have power over this technology. The natural fear of death and pain may also have a bearing on the call to make PAS legal (Fiesta, 1997).
Some people have the opinion that if PAS is made legal it may be abused. That poor or uninsured people and the elderly would be targeted along with other groups. Many people who are religious are against assisted suicide stating that God has dominion over death. A survey conducted between 1977 and 1996 showed that more people are agreeing with assisted suicide. The numbers of people who favor the right to die have grown from 36% to75% in the intervening years (Reiner, 2007).
Many physicians oppose PAS and state that medical technology has made palliative care a reasonable end-of-life is a deterrent to assisted suicide. These doctors believe that controlling the pain at the end-of-life is sufficient and believe that with excellent care people ask for assisted suicide less often (Allen, 2011).
Marc Spindelman, an attorney and teacher of law alleges that domination by the government is cited by critics to be a hold on the citizens and autonomy is neglected. By continuing this domination the government holds power over the right to die. The wish for less government control over private persons is the catalyst for changing the laws for assisted suicide (Spindelman, 2008).
The States that have made assisted suicide legal have reported that there are severe regulatory practices in place to keep this from happening and report that abuse is not a problem. The States also report that is has improved the end of life options and care. This would include palliative care and knowledge of end of life decisions for the patient (Fiesta, 1997).
The arguments to make PAS legal are that it is a mercy to the patient, the cost of keeping the patient on machines for the remainder of their life and the patient’s right to do with their life as they desire. Another consideration is that making PAS legal would allow the government to instill regulations and laws and this control would be better than the secretive assisted suicide that seems to be happening (Fiesta, 1997). An example of this scenario is Dr. Jack Kevorkian who by his own admission has help in 130 assisted suicides (Darr, 2007).
Oregon is one of the States that has made assisted suicide legal and the reports on patients who utilize the law suggest that it is not abused. Most patients were under the care of hospice, had insurance and many were dying of cancer. The reasons offered for the request from patients for assisted suicide was not for the relief of pain. “Patients’ desires for autonomy, dignity and control were much more common reasons" (Meyer, 2009).
The arguments to make PAS illegal are that patients who are depressed or living a life without full use of their bodies would choose to die, physicians are not psychologist and would not be able to determine if the decision was a result of extreme depression, that it would break our trust in doctor-patient relationships, the old and infirm would see it as their duty to choose assisted suicide and patients who could not verbalize their wishes would be put to death (Fiesta, 1997). Americans are living longer lives and when they become incurably ill or in constant pain some are seeking a way to end this life
Palliative care is an option instead of assisted suicide. Some nurses who were asked to perform assisted suicide claim that with the explanation of a type of medical care that would reduce the suffering the patient was under convinced the patients that palliative care would be the better choice and the patients changed their mind about assisted suicide (Lachman, 2010).
The American College of Physicians does not support assisted suicide, their claim is that it is unethical and is afraid that it will destabilize other EOL care (Meyer, 2009). The U.S. Attorney John Ashcroft declares that giving a patient the medication to end their life is not a legitimate medical practice in 2001 (Darr, 2007). With the information available it appears that the answer to the question of PAS will be a long debate. Each of these concerns is valid and deserves to be examined.
There are good reasons to examine physician assisted suicide. As Americans we have had many freedoms, this is another freedom that the people are seeking from the government. There are several nurses and doctor organizations that believe that palliative care is enough and assisted suicide is unnecessary. That comfort and pain control should be enough. Religious organizations are divided on the choice of assisted suicide.
Physician assisted suicide is judged as a misuse of medical technology by some, by others a mercy for the terminally ill patient. Physician assisted suicide is not fully understood by the general public. Before examining this topic more closely and during research I came in contact with many who did not understand that physician assisted suicide was available to only terminally ill patients. The explanation that physician assisted suicide is not a way out of a life that has become different due to age allowed people in the conversation to think differently.
The concern that assisted suicide would be abused if made legal is a coin with two sides. If it is not made legal the practice will continue in secrecy. Having laws that regulate PSA would be better than secrecy. If it is made legal the laws will keep abuse from happening. The government does not have the right to take away the self-rule of our lives and death. If made legal the government would be the overseer. Death would not be sought for psychiatric patients or the old and infirm.
Investigating physician assisted suicide I would use the teleological theory which is using the consequences of an action to decide whether it is right or wrong (Waller, (2008). The consequences of the action of physician assisted suicide for terminally ill patients are that the inevitability of death would be hastened.
This would allow the patient to choose to die with their dignity still intact. It would prevent the patient from suffering through constant pain. The cost of maintaining medical treatment would also be a factor. This would also have an impact on the patient’s family; the trauma associated with a long illness for the family would be eliminated.
A concern that physician assisted suicide would spill over the mentally incompetent is expressed by Janine Fiesta a nurse and author of several books on the subject of dying and death. She stresses that the words competent and terminally ill could be construed to mean different things by different individuals. Safe guards against the mentally incompetent would have to be seriously discussed to ensure the safety of these people (Fiesta, 1997).
Conclusion and Consequences
The consequences of physician assisted suicide have different meaning for different people. Some see this as a crime and others as a mercy. Those who have reasons to believe that physician assisted suicide should never be legal have sought out the ways that it could be abused or misleading. Some believe that is a pronouncement only God should make. There are ways that physician assisted suicide could be used to benefit people as well as ways that it can be abused.
In thinking about both sides to this question I can see on one hand a terminally ill patient with no hope of survival suffering in pain with no recourse but to continue with only comfort care. Being kept comfortable until the disease overtakes the patient and death is the result. Medical bills would continue to increase and the survivors being traumatized by a slow death.
On the other hand I see a patient who is terminally ill, in constant pain being offered the choice of physician assisted suicide. The choice that would eliminate the expensive treatment that would keep him alive attached to machines. Eliminate the suffering of not only the patient but the suffering of the family that is involved. The choice would discontinue the life of the patient in a way that would not involve the agony of waiting for the disease to take the patient’s life.
If physician assisted suicide were made legal in all of the United States it would alleviate the pain and suffering of the terminally ill. A mercy that would allow a medical procedure that would legally end their life. There would be no criminal proceedings for physicians that chose to help these patients. People who are terminally ill would not have to ask in secret for a medication that would end their life. People would not have to move to one of the three states where physician assisted suicide is legal to be able to use this method of death.
Hospitals and doctors would have to come to terms with this law and would have to deal with the new ethical dilemmas this would bring to their hospitals and offices. A decision on who would be allowed to give this treatment and what requirements would be for patients who make this decision.
In my decision that physician assisted suicide should be made legal I used the concepts of critical thinking to absorb the facts and analyze the thoughts of experts in this field. When I first began this research I would have said that physician assisted suicide was morally unethical. After examining the opinions and facts I have changed my mind. With laws and regulations put in place to control the terms and conditions of physician assisted suicide I think that it is a moral solution for terminally ill patients.
If the laws for the United States are changed to make physician assisted suicide legal it should be considered ethical for those who choose to take their life in this way. For those who do not feel that this is an ethical choice for them there should not be any persuasion to change their minds. I feel that this is a right of choice not a mandatory right.