The Death With Dignity Act

This paper explored the medical ethics behind physician-assisted suicide stemming from the Death with Dignity act enacted in 1997 in Oregon. As the population gets older, the aging process lengthens and becomes more complex. Death, to some, is the merciful end of a long and tiring journey of medical problems. The right to die means that the terminally ill person has the right to refuse further treatment. Physicians and nurses working with terminally ill patients and must deal with the conflicting ideas of ethics, medicine, and their own moral views on the topic of assisted suicide. Human rights are not a matter of public opinion, and when they are they can become weakened. Does a mentally competent adult with a terminal illness have the right to choose to end their life painlessly and quickly, when no other option is available besides life-sustaining therapies? A patient should not be limited to having to live and continue treatment because a higher power is the only morally correct deciding power on when life is terminated.

Keywords: Right to Die, Suicide, Assisted Suicide, Medical Ethics, Nursing, Terminal Care

Death with Dignity

Although some arguments against physician-assisted suicide have many strong points, terminally ill patients should have the right to terminate their lives through the voluntary self-administration of lethal medication, which were prescribed for that purpose. Patients who suffer from a terminal illness that will cause their life to end in less than six months, and whose judgment is not impaired by a psychiatric or psychological disorder, should be able to end their lives at home and peacefully, rather than refusing life-sustaining treatments and suffering until the patient dies. Currently, Oregon and Washington are the only U.S. states that allow physician-assisted suicide, originally stemming from the Death With Dignity Act enacted in 1997. The act was a citizens’ initiative passed twice by Oregon voters.

In assisted suicide, someone makes the means of death available, but does not act as the direct agent of death; this is often confused with euthanasia. Euthanasia, as defined by the Council on Ethical and Judicial Affairs for the American Medical Association, is when a physician performs the immediate life-ending action, often by administering a lethal injection. During assisted suicide, a physician provides a prescription and information about the lethal dose of the prescription, all the while aware that the patient is intending to commit suicide. While a physician is obligated to respect a patient’s decision, a physician is not required to provide a treatment that is not medically sound. Assisted suicide may be deemed as medically unsound; however, certain situations can be extremely complicated and when the patient does not consider death to be an undesirable outcome it can make the decision for physician-assisted suicide medically sound.

A physician has many responsibilities during patient care and they are only obligated to offer treatment to patients. When a patient decides to withdraw or withhold from participating in life sustaining treatments such as chemotherapy, it is not considered to be physician assited suicide. The idea that physician assisted suicide may lead to a slippery slope within the nation is often a large argument. The slippery slope is an idea that physician assisted suicide will slowly and inevitably spread to the disabled or mentally ill patients who are deemed competent, but not terminally ill. Another argument against physician assited suicide is the possibility of involuntary euthanasia, in which an incompetent person’s life would be ended against their will due to someone else’s decision.

Medical professionals are faced with their own moral dilemmas and ethical beliefs with physician assisted suicide. A doctor in Oregon has a private choice to participate in prescribing a prescription to a patient in order to assist in their suicide. However, a doctor is not the only medical professional who has the knowledge that the prescription has been written and will be used in the manner of a lethal dose. While the prescribing doctor is the only individual that is directly responsible for assisting the patient to commit suicide, there are other medical professionals that may do no harm but also actively participate in the process of physician-assisted suicide. The pharmacist that fills the prescription also has to make the choice to participate in the act. Nurses are often the first to hear of patients concerns and wishes for treatment, and communicate often with the doctors. They are faced with the decision to communicate this information to the doctor or asking to be taken off of the patients care and having another nurse take over the duties. The American Nursing Association (ANA) stated that assisting an individual to die is not compatible with the nurse’s role in society (ANA, 1994). The act violates the Code for Nurses with Interpretative Statements, along with the well-entrenched nursing standard of indisputable ethics (ANA, 1994).To call all of this physician assisted suicide is to only encompass the physician and the patient, even when there are many more individuals involved.

The Death with Dignity Act states that in order to participate, a patient must be eighteen years of age or older and a resident of Oregon. The patient must be capable of making and communicating health care decisions for themselves and diagnosed with a terminal illness that will lead to death within six months. The patient’s physician is the determining factor to determine that all the criteria have been met.

While the patient must be a resident of Oregon, there is no minimum residency requirement, they must only show that they are a resident of Oregon. Patients who meet these criteria are able to request from their physician a prescription of lethal medication in order to terminate their lives. According to Oregon’s Death with Dignity Act website, the physician must be a Doctor of Medicine or Doctor of Osteopathy licensed to practice medicine by the Board of Medical Examiner for the State of Oregon.

The desire to control the circumstances of death, the wish to die at home, and loss of dignity or fear of that loss, are often some of the most important reasons for patients to request from their doctor the prescription for lethal medications. According to the New England Journal of Medicine, most of the requests from patients for physician assisted suicide are those that are currently enrolled in hospice programs. The high quality of care at the end of life provided by hospice programs may possibly explain the extremely low rate of assisted suicide among terminally ill patients in Oregon.

In order for a patient to get a prescription from a participating physician there are many levels of communication that must be done. First, the patient must make two verbal requests to his physician, spanning fifteen days apart, followed by a written request to the physician. This request must be signed and witness by two other individuals, one not being a relative of the patient. The attending physician must confirm the patient’s diagnosis and prognosis and then determine if the patient is competent and mentally capable of making the decision to request a prescription for lethal purposes, if the patient is not then he is referred for a psychological evaluation. The patient, at this time, must be informed and aware of all other options including hospice care and pain control. The physician can request that family members are informed of the decision to receive a prescription to aid in suicide. If the patient receives the prescription he will have a period of fifteen days to participate and complete the final treatment. Most often the prescription is an oral dosage of barbiturate.

Discussion

Physician assisted suicide is a moral and ethical argument with many valid points on both opposing sides. Only society has a choice to legalize and offer this method of treatment for terminally ill patients. Before making a decision, all aspects must be reviewed and moral objections evaluated. End of life care is a difficult topic to discuss, but with education concerning the methods, background, and legal options it is possible to see that changing the laws governing this sort of care is a positive choice and a basic human right of free choice and free will.

The United States is not a country that publicly declared that it is governed by Christian law; however most of the ideas that oppose Christian thinking do not make it to the point of becoming a law because of those in public office. Murder is against Christian beliefs regardless of the situation; the Death with Dignity Act is ultimately viewed as an act of murder in certain religions and cultures. Cultural and religious beliefs, practices, and values are a major opposing force to the Death with Dignity Act being fully accepted throughout the entire country. In 1957, Pope Pius XII stated “extraordinary means need not be used if they impose grave burdens or when the values of life and health conflict with superior spiritual value" (Connelly, 1998). Such a known religious leader had at this point publicly denounced ending life care. His use of “extraordinary" emphasizes the moral decisions that a patient must make rather than the medical ones. The religious view of the Death with Dignity Act is that natural law which is of a higher being is the ultimate decision on the creation and termination of life. By interfering with natural law one is interfering with morals that will affect him in the afterlife.

Death can become dehumanizing due to the amount of medications the patient is on, breathing and feeding tubes, the inability to control bowels, and the slow constant pain that lingers until a painful end of life occurs. Dignity is not only a personal matter but also one that the public is constantly commenting on. In order to allow one to end their life, when in the situation of a terminal illness, doctors and other medical professionals can restore this one aspect of life back to the patient.