Research — Wiseman101

Is Death also a Choice?

Physician-assisted suicide (PAS) as part of euthanasia is one of the oldest points of contention in medical ethics. The original Hippocratic Oath forbids it, and many religions and societal traditions have rejected it since antiquity. In physician-assisted suicide, a suffering or terminally ill patient is aided by a certified health practitioner to get access to a lethal dose that the patient then administers on themselves. If the patient is incapable of doing so, they can request the physician to administer the lethal substance to end the patient’s life. [Physician-assisted dying (PAS) as part of euthanasia is one of the oldest points of contention in medical ethics. The original Hippocratic Oath forbids it, and many religions and societal traditions have rejected it since antiquity. In physician-assisted dying, a suffering or terminally ill patient is aided by a certified health practitioner to get access to a lethal dose that the patient then administers on themselves. If the patient is incapable of doing so, they can request the physician to administer the lethal substance to end the patient’s life.]

It is called physician-assisted because the doctor supports in dying and hastening the death of the patient. In this case, the doctor takes the step knowingly and ready to make the patient die. There is a difference between physician-assisted suicide and the euthanasia. In euthanasia a doctor, assist the patient to die through the administration of a lethal drug while in physician-assisted dying, the doctor deals with a sound mind individual who requests voluntarily to die by requiring a dose of barbiturates that will kill him or her. The state of the art palliative care should be established to treat these people suffering and almost ending their lives. The practice of physician-assisted suicide continues to raise debate as only five American states, a handful of European Countries and Colombia permit some form of doctor-assisted suicide. Even though many governments and organizations do not formally accept physician-assisted suicide as a standard medical practice due to ethical concerns, they should adopt it because it is a show of respect to individual civil liberties as provided by the right of every individual to choose what is best for them without government or societal interference. [The practice of physician-assisted dying continues to raise debate as only five American states, a handful of European Countries and Colombia permit some form of doctor-assisted suicide. Even though many governments and organizations do not formally accept physician-assisted suicide as a standard medical practice due to ethical concerns, they should adopt it because it is a show of respect to individual civil liberties as provided by the right of every individual to choose what is best for them without government or societal interference] Nobody should control how someone should die; therefore, patients should be given a right to die anytime they will.

[The text in purple is reproduced from a Pay-for-Paper site called Course Hero where papers are purchased for college courses. https://www.coursehero.com/file/35361015/Physician-Assisted-Suicide-A-Protection-of-Individual-Civil-Libertiesdocx/ ]

Many states have illegalized physician-assisted suicide. However, there has been a recent flurry of legal implications in this case. Kopelman also claims that, the issue of whether of whether to legalize physician-assisted deaths (PAD) has been on debate for a long time now. In the United States, most of the states have prohibited PAD and terming it as unconstitutional, but it the real sense it constitutional. Individuals should be given their liberty under the constitution.  She says that there have been several attempts to change this law. One of the federal challenging the constitutionality of these prohibitions of PAD includes two Supreme Court cases, Washington vs. Glucksberg and Quill vs. Vacco. After several attempts to legalize PAD failed, then the Death with Dignity Act was passed in Oregon in 1995 and also in Washington state in 2008. These laws allow an individual who wishes to die through physician-assisted practice to do so freely.

There has been a controversy on how to recognize the right of PAD individuals. According to Kopelman, some people associate the word suicide with some mental illness and some irrational behavior. However, these people should be given a right to control their lives because there is a point a patient realizes that death is the only best option for the illness, this is a self-preservation means. That is why when the states legalized this means of dying called is physician-assisted suicide.

There are various reasons why the right to physician-assisted suicide should be recognized. The first reason is patient autonomy. A patient should be guaranteed a right to control any possible circumstances surrounding his death. Respect of the patient is one duty of a doctor. The sole responsibility is to relieve pain the patient is undergoing, physician-assisted suicide is one of the approaches used. This practice was practiced in Oregon whereby over 100 patients obtained a prescription for lethal doses under the law, which was passed in 1997. 850 patients die after taking such doses. Most of these patients had critical and acute diseases like cancer whereby death was the only remaining option. It should also be noted that physician-assisted death is a personal choice; therefore, people should be given their right to choose what suits them. Sometimes the pain in the patient can be too much to contain, therefore when the patient recognizes it is better to die, nobody is supposed to prohibit that, secondly, there is an aspect of mercy. If the pain and suffering the patient is undergoing cannot be relived through the palliative care, then the doctor has the powers to do anything possible to assist the patient to relieve the pan, even if it means hastening patient’s death. Because, honestly, sometimes pain can be unbearable.

Kopelman also points out that, not all medicine can relieve human suffering. The pain and suffering of a dying patient can be too much. The suffering is caused by somatic symptoms like nausea, pain, depression, anxiety and even hopelessness. For most of the patients, when they feel to have the control over their death timing, they get comfort. However, it is reasonable to ask for medicine before opting for death directly. As much as there should be a right for physician-assisted individuals, nobody wants patients to die but have freedom and a right to remain alive and in good health. However, it should be noted that PAD is controlling suffering on terminally ill patients.

There is an unexpected benefit of allowing patients to have a right to physician-assisted suicide. However, it should be noted that the laws and rights for physician-assisted right do intend to kill a patient but to assist in pain relieving. In the study by Boudreau, Donald J., and Margaret A. Somerville, “Physician-assisted Suicide Should Not Be” in this exercise, patients have the opportunity to die with dignity; they experience less trauma and pin when dying. In addition, the patient has all the time to say goodbye to the friends and family members. It should be noted that when the patient requests to die early, he saves the financial burden that the family would have used to treat a disease, which will not get ill at the end of the day. The other most crucial benefit of such a death is that some useful organs like the kidneys can be saved for that patients and be used to save the lives of other patients. In addition, one can imagine if there were not physician-assisted suicide, many people could have committed suicide in a mess and horrifying, traumatic manner.

The other most important reason for legalizing physician-assisted suicide is that it gives patients freedom of choice. The capability to control your mind and body is fundamental to any human being. Boudreau and Somerville agree that, a patient should not be allowed to continue suffering for long in this world when in the real sense there are no hopes for healing members. Death is never enjoyable to witness, but also it is more saddening to see your loved one struggle in pain which will not end any time soon members. Therefore, physician-assisted death helps the terminally ill patient to end his life without necessarily undergoing agony for a long time. Physician-assisted suicide is the best method to determine the right time and manner of a terminally ill patient. This liberty grants the patients alternatives to choose. The constitution provides this liberty and makes it clear for everyone. However, some proponents can argue that physician-assisted suicide should be illegalized since the doctors have no right to determine the right time for a patient’s death.

Although physician-assisted suicide can be regarded as a sound practice, there are valid arguments against its application. According to Margaret Sommerville in her book “Death Talk, Second Edition: The Case Against Euthanasia and Physician-Assisted Suicide,” she claims that the constitution recognizes the right to life, and when life and death are compared, life will take precedence. Allowing physician-assisted dying is a contradiction of the first liberty. [Although physician-assisted suicide can be regarded as a sound practice, there are valid arguments against its application. First, the constitution recognizes the right to life, and when life and death are compared, life will take precedence (Sommerville, 2014). Allowing physician-assisted dying is a contradiction of the first liberty.]

In a literature review by Nicole Steck and Matthias Egger “Euthanasia and assisted suicide in selected European countries and US states: systematic literature review,” they conclude that it is also possible that legislating doctor-assisted suicide will be the first step on a slippery slope that will involve threats to the vulnerable as premature death is enacted as a cheap alternative for palliative care. This is true when one considers that a dose of euthanasia costs an upward of $50 and kidney failure treatment may cost an upward of $89,000 per year in the US. Also, Sommerville points out that, unproductive and poor citizens will be targeted and this, again, goes against the right of every American to access quality healthcare. [It is also possible that legislating doctor-assisted suicide will be the first step on a slippery slope that will involve threats to the vulnerable as premature death is enacted as a cheap alternative for palliative care. This is true when one considers that a dose of euthanasia costs an upward of $50 and kidney failure treatment may cost an upward of $89,000 per year in the US (Steck, Egger, Maessen, Reisch, & Zwahlen, 2013). Unproductive and poor citizens will be targeted and this, again, goes against the right of every American to access quality healthcare.]

For some people, the contention is absolute and moral. Life is sacred and the suffering that comes with it till one dies confers its dignity and consequently, deliberately ending a human life is wrong. Finally, how long will it take before physician-assisted suicide becomes involuntary? When relatives approach a 92-year old man on life support and request them to sign the physician-assisted suicide forms, is that not indirectly violating their rights as they have no choice? [For some people, the contention is absolute and moral. Life is sacred and the suffering that comes . . . . My free preview of the Course Hero document ended here. I did not purchase the paper to continue the comparison.]

According to Bradley Denton and his partner Dr. William Bradley in their “Australian Nursing and Midwifery” journal , the views that physician-assisted dying is immoral and strips human dignity deserves some seriousness but, is not autonomy and liberty critical sources of human dignity as well? The right to choose certainly adds value to human life and people should not take a myopic view of ethics without analyzing the laws that make these ethics possible. In the society we live in where the state and religion are separated, it is queer to support the sanctity of life abstractly by exposing particular individuals to unbearable pain, suffering and indignity that comes from some terminal conditions .Furthermore, evidence from countries and states where physician-assisted suicide has been enacted shows that the slippery slope contention with regard to widespread physician-assisted suicide is a myth. In the Netherlands for example, Gopal in his “Journal of the American Academy of Psychiatry and the Law,” says that the process of doctor-assisted dying is bureaucratic and highly complex meaning that most applicants are rejected until it is established beyond reasonable doubt that the request is voluntary and will do more good than good. The Netherlands treats physician-assisted suicide as a criminal act if not carried out in the presence of an ethics expert, a legal expert, and the doctor. This implies that strict controls are needed, not blatant rejection, to ensure that this right is protected and not abused.

In the article” Academic Journal of Interdisciplinary Studies” by MSC. Suela Hoxhaj, the argument that life should take precedence over death does not hold water when analyzed from an individual’s rights perspective. Just as people have the right to live with dignity, they also have a right to die with dignity. Medical practice is supposed to alleviate pain and unnecessary suffering in patients. Take the example of a single mother of teenage children having stage four cancer. Undergoing chemotherapy means that her hair falls off even as she consistently vomits while enduring the extreme pain that her children are supposed to watch as they take care of her. Presently, the medical technology we have cannot do any better than chemotherapy and radiotherapy to treat cancer (which generally cannot restore health in stage four cancer) and in the case of this mother, the continuing suffering only robs her of her dignity and those of her children. With physician-assisted suicide, such patients and their families get a right to a dignified end.

According to Sommerville, anti-physician assisted suicide proponents argue that death is a natural process that should not be interfered with. However, doctors have and continue to implicitly exercise the right of dying on the patient’ behalf. Physician-assisted suicide fixes this by recognizing the individual civil liberty of the patient to choose and administer PAS. Doctors normally exercise this right by giving pain-relief in lethal doses or withdrawing treatment. As Steck, Egger, Maessen, Reisch, & Zwahlen notes, this is usually after talking to relatives, and even though doctors are normally investigated for overstepping this mark, they are rarely charged. [Usually this is by withdrawing treatment or administering pain-relief in lethal doses. Often doctors act after talking to patients and their relatives. Occasionally, when doctors overstep the mark, they are investigated, though rarely charged.] Numerous people welcome this fudge given that it lays limits to PAS albeit with no need to articulate the contentious moral choices involved. [Some people welcome this fudge because it establishes limits to doctor-assisted dying without the need to articulate the difficult moral choices this involves.] This is unethical and unworkable given that the explicit choice to die that should be in the hands of a patient is left in the doctor’s hands. It is hypocritical and goes against the individual civil liberties as society pretends to shun PAS while tacitly and subtly allowing it without safeguards. [But this approach is unethical and unworkable. It is unethical because an explicit choice that should lie with the patient is wholly in the hands of a doctor. It is hypocritical because society is pretending to shun doctor-assisted dying while tacitly condoning it without safeguards.] Physician-assisted dying in its openness will fix this practice of deaths through nods and winks that contravenes individual rights. [Most deaths now take place in hospital, under teams of doctors who are working with closer legal and professional oversight. Death by nods and winks is no good.]

Gopal also suggests that, the fear that physician-assisted suicide will be foisted on vulnerable individuals, bullied by rogue doctors, cash-strapped states, panicking relatives, and parsimonious insurers is unfounded. [One fear is that assisted dying will be foisted on vulnerable patients, bullied by rogue doctors, grasping relatives, miserly insurers or a cash-strapped state.] The Oregon experience, where a law allowing PAS has existed since 1997, points to the enhanced recognition of civil liberties. Individuals who choose doctor-assisted dying are in fact insured, well-educated and getting the best palliative care. [Experience in Oregon, which has had a law since 1997, suggests otherwise. Those who choose assisted suicide are in fact well-educated, insured and receiving palliative care.] These individuals are motivated by the desire to maintain their own dignity, pleasure in life, autonomy, and the pain that comes with some conditions. [They are motivated by pain, as well as the desire to preserve their own dignity, autonomy and pleasure in life.]

[The text in blue comes not from Steck, Egger, Maessen, Reisch, & Zwahlen, nor from Gopal, but from the same Economist article not named in the References. ]

Physician-assisted suicide (PAS) can be caused by the fact that there is no available care for the victim patient. According to Ardelt Monika in the handbook of death and dying 1 “Physician-assisted death,”  palliative care strategies can be effectively utilized to ensure that lives of patients are prolonged rather than shortened. It is not something that can be advocated to have the patients’ lives shortened and yet there are care services that can be incorporated to assist patients to recover from acute suffering. There are quality end-of-life programs available through many hospitals. The focus should not be whether to legalize and give patients a right to decide for their lives, but it should be aiming to provide services that guarantee life for patients. The emphasis should be trying to improve hospital care. Ardelt also claims that, there are more than 4000 hospital agencies in the United States, but due to regulations and strict laws and the rigidity nature of the Medicare hospital cover requirements patients to possess a life expectancy of six months or less, many people in the USA fail to access these services. If the trend continues, then definitely there will be more PAS scenarios and people will be committed to fighting for their rights to die through physician-assisted method. In the US, there is excellent terminal care, which is readily available in many hospitals. Every individual in all states has access to hospital care when they require it. This is made available for people of all ages, either the elderly, children, rich, poor and even the mortal people. A significant number of individuals who die in the US die under the care and the umbrella of hospital premises. The fact is not because there is no sufficient care in the US hospitals; it is not because, in America, terminally ill patients are beyond control, no, this is simply because PAS has been legalized by many states. Making the doctors lazy in the administration of required care, hence assisting patients to die early.

It is evident that at some point, PAS can be recommended for the patient who is terminally ill and experiencing acute pain, but still, we need to look at it adverse effect in the healthcare industry. There is a possibility that advocating for PAS will make many physicians to cause more harm than good. According to Margaret Somerville and Dr. Boudreau, Donald, first, physician-assisted suicide is not the core aim of a doctor, professionally. The sole role of a physician is to support the good health of a patient and assist the patient as much as possible to ensure prolonged healthy life. Permitting PAS publicly will make the doctors lazy in the provision of quality palliative care services, which are aimed to support quality life. The involvement of physicians in PAS raises the question of ethical medical practice. The physician should not assume that facilitating the death of a patient is a unique role, it is not something to recommend but to avoid at all cost.

In conclusion, physician-assisted dying is the ultimate protection of individual civil liberties in the ongoing euthanasia debate. Just as people have the right to life, they have a right to autonomy, happiness, and pleasure in life; elements that are guaranteed through the right to choose a dignified death that alleviates unnecessary suffering. Anti-PAS proponents suggest that it will open the doors to a slippery slope of forced death on vulnerable patients, but evidence from Netherlands and Oregon show that this is a myth if strict controls are in place. After all, the right to die for patients has for long been practiced by physicians and relatives on behalf of patients through the withdrawal of medication or prescription of pain medication. Physician-assisted suicide is fixing this subtle illegal practice by placing the right to die in the patient’s hands hence protecting civil liberties.

References

Denton, A., Levett, C., Bradley, S., & Thoma, L. (2016). Death and dignity: Why voluntary euthanasia is a question of choice. Australian Nursing and Midwifery Journal24(6), 18-23.

Gopal, A. A. (2015). Physician-Assisted Suicide: Considering the Evidence, Existential Distress, and an Emerging Role for Psychiatry. Journal of the American Academy of Psychiatry and the Law43(2), 183-190. Retrieved from http://jaapl.org/content/43/2/183

Hoxhaj, O. (2014). Euthanasia – The Choice between the Right to Life and Human Dignity. Academic Journal of Interdisciplinary Studies3(6), 279-284. doi:10.5901/ajis.2014.v3n6p279

Sommerville, M. A. (2014). Death talk: The case against euthanasia and physician-assisted Suicide (2nd Ed.). Sydney, Australia: McGill-Queen’s Press-MQUP.

Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and Assisted Suicide in Selected European Countries and US States. Medical Care51(10), 938-944. doi:10.1097/mlr.0b013e3182a0f427

Boudreau, Donald J., and Margaret A. Somerville. “Physician-assisted Suicide Should Not Be Permitted: option 1.” The New England Journal of Medicine 368.15 (2013): 114-145. https://www.researchgate.net/publication/305322708_Euthanasia_and_assisted_suicide_a_physician’s_and_ethicist’s_perspectives

Kopelman, Loretta M. “Does physician-assisted suicide promote liberty and compassion?.” https://link.springer.com/chapter/10.1007/978-94-010-9631-7_6

Physician-Assisted Suicide: What are the Issues?. Springer, Dordrecht, 2001. 87-102. https://www.springer.com/us/book/9781402003653

Ardelt, Monika. “Physician-assisted death.” Handbook of death and dying 1 (2003): 424-434. https://med.virginia.edu/wisdom/publications/ardelt/

Boudreau, Donald J., and Margaret A. Somerville. “Physician-assisted Suicide Should Not Be Permitted: option 1.” The New England Journal of Medicine 368.15 (2013): 114-145.

Kopelman, Loretta M. “Does physician-assisted suicide promote liberty and compassion?.”

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