Category: Assisted Suicide

Autonomy, Dignity & Assisted Suicide: Terminal Illness Case

I. Assisted suicide should be an option for terminally ill patients

The topic discussed in this paper is assisted suicide as an option for terminally ill patients. Assisted suicide for terminally ill patients consists of a terminally ill patient requesting that a physician write a prescription for a medication that intentionally results in the patient’s death. The terminally ill patient then self-administers this medication, ending his or her life. I will explore the ideas of autonomy, dignity, and the role of the physician and connect these ideas to physician-assisted suicide. My argument is: Physician-assisted suicide should be an option for terminally ill patients; physicians should be able to prescribe life-ending medication without being held civilly or criminally liable for having caused the death.

In most of the United States, physician-assisted suicide is a crime, though there are doctors willing to practice assisted suicide and patients that wish to partake in assisted suicide. Many people who die each year in the United States experience many hospitalizations over the course of an illness, especially terminal illnesses, in the last few months of their life. These individuals experience pain and suffering as well as loss of autonomy and dignity. Assisted suicide allows the patient to die when and how they would like. It utilizes autonomy and preserves dignity. It allows the doctor to fulfill his or her role of relieving suffering when treatment is not an option or treatment causes more suffering. Yet, more of the population is against physician-assisted suicide than for it; I hope to change opinions on the topic.

I would like to mention that physician-assisted suicide is different from euthanasia. Though both are medical procedures classified as physician-assisted deaths, in euthanasia, the patient does not self-administer the lethal medication. The argument I am going to present applies only to physician-assisted death by assisted suicide. Due to my having little knowledge on end of life protocol in other countries, I will limit my argument to terminally ill patients in the United States. I will assume that everyone agrees that autonomy and dignity are moral rights that should be granted to all human beings.

II. I will prove that assisted suicide should be an option for terminally ill patients in the following way:

Patient autonomy should be honored. This means that a person capable of making his or her own decisions should be able to. Respect for autonomy is an important aspect of medical practice. I will go on to explain that terminally ill patients deserve to die with dignity. Dignity is often lost in end-of-life treatment and care. Finally, I will explain that the role of doctors is to minimize suffering. Many people with terminal illnesses experience some form of suffering or will experience some form of suffering. In situations where a patient cannot be healed, the role of the doctor shifts from healing to minimizing the patients suffering. Assisted suicide allows the patient to decide when and how they wish to die, allows terminally ill patients to die with dignity, stops the patient’s suffering, and allows the doctor to carry out his or her role of minimizing suffering.

III. Not only does my argument have a sound structure, it is valid because I have used precise and consistent language in the following ways:

Patient autonomy should be honored. The definitions of the following terms are needed to understand this premise. Autonomy is the right of adults deemed capable of making decisions to make decisions. A person with autonomy, an autonomous person, is an individual capable of deliberation about personal goals and of acting under the direction of such deliberation. Terminally ill patients deserve to die with dignity. The definitions of the following terms will be useful in understanding this premise. Dignity is self-determination and respect. In medical practice, it is a highly valued principle. End-of-Life will be abbreviated EoL. EoL care is

Care is provided to patients with terminal illnesses in their final stages of life. The role of doctors is to minimize suffering. The definition of the following term will be useful in understanding this premise. Suffering is physical and or emotional pain. It can be caused by an illness and or attempted treatment for an illness.

IV. My argument is comprised of well-researched premises that effectively demonstrate why assisted suicide should be an option for terminally ill patients

Patient autonomy should be honored. Autonomy is an important aspect of medical practice. It involves the patient making a decision about their care and their doctor respecting, and helping to carry out, the patient’s wishes. “To respect autonomy is to give weight to autonomous persons’ considered opinions and choices while refraining from obstructing their actions unless they are clearly detrimental to others” (Belmont Report). The Belmont Report explains that applying autonomy involves the patient’s decisions and actions. In cases of physician-assisted suicide, the patient decides when and how they wish to die, and the ultimate act of causing death is performed by the patient, not the physician.

When it comes time for end-of-life treatment and care for an individual with a terminal illness, the individual is the only person that can and should decide if physician-assisted suicide is the procedure that should be provided. This is because the only person that can decide if a life is worth living is the person living that life. Each person is the best judge of the value that the continuation of their life would afford them. (Velleman). Someone may choose to end his life while he is capable of living and dying with dignity rather than continue to suffer from an illness that takes away their ability to choose.

In 2019, in Oregon, where physician-assisted suicide is an option, one of the most reported end-of-life concerns for individuals with terminal illnesses was “losing autonomy” (Public Health Division). These individuals were able to choose to die before their illness, resulting in a loss of dignity and loss of autonomy. This option to exercise autonomy in the final medical procedure of an individual’s life should be given to all terminally ill patients.

Terminally ill patients deserve to die with dignity.

A person’s life is comprised of physical aspects as well as intellectual, emotional, psychological, and spiritual aspects. “Life is not mere living but living in health. Health is not the absence of illness but a glowing vitality – the feeling of wholeness with a capacity for continuous intellectual and spiritual growth. Physical, social, spiritual, and psychological well-being are intrinsically interwoven into the fabric of life” (Yeo). End-of-life (EOL) care, and procedures must consider all of these aspects of the person.

Preservation of dignity at the EoL requires that self-respect be promoted and that the patient be treated with respect. Part of respecting the patient is considering all aspects of the person. Most currently used EoL interventions focus predominantly on symptom control rather than holistic care, and with that, the patient is not respected, and dignity is lost (Kennedy).

A study done to address the human context of dying, known by the acronym SUPPORT, involved 10,000 terminally ill people, five medical centers, and five cities in the United States. The study found that approximately half of all patients spent their EoL in what the researchers called an undesirable state in which their wishes were not respected or they were in serious, insufficiently treated pain. (Dorff).

Healthcare professionals cannot ensure that someone dies with dignity, but they can contribute to death without indignity. This can be done by ensuring that they respect people’s autonomy and incorporate human reason. They can also ensure people die without indignity. This can be done by not imposing indignities such as taking choices away from people at the end of their life and by minimizing indignities such as suffering. (Allmark).

Physician-assisted suicide would allow the individual to die before parts of their person are lost. In carrying out physician-assisted suicide, the individual and their wishes are respected. Along with this, the patient’s suffering is relieved, and further suffering is not imposed.

The role of doctors is to minimize suffering.

A bioethicist, Daniel Callahan, and his colleagues conducted a five-year international study to come to an agreement on the goals of medicine. It was determined that “medicine has four primary goals: prevention of disease and injury and maintenance of health, relief of pain and suffering, care for those that cannot be cured, and pursuit of a peaceful death” (Panicola). According to the American Medical Association, “Physicians have an obligation to relieve pain and suffering and to promote the dignity and autonomy of dying patients in their care.” Yet, when it comes to current EoL treatments, physicians often fail to prevent or treat suffering adequately and sometimes, inadvertently, cause it as a result of treatment (Cassell).

Suffering is experienced by persons, not just bodies. “Suffering comes from challenges that threaten the intactness of the person as a complex social and psychological entity. Suffering can include physical pain but is not limited to it” (EJ Cassel). In the United States, conditions such as heart disease and cancer are the leading causes of death. Patients with these diseases often deteriorate slowly and painfully.

Medical interventions may prolong their suffering or keep them alive until they have lost their autonomy (Steck). These patients suffer both physically as a result of the illness, but also mentally and emotionally as they lose autonomy and dignity. Physicians should be able to carry out physician-assisted suicide and help patients who are suffering from a terminal illness exercise their autonomy and die with dignity.

One objection to my argument stated: I will object to your second premise on the grounds that a universal definition of human dignity (and, therefore, dying with dignity) cannot be codified into law or practice without contradicting someone’s religious or personal beliefs. My response is that this objection is valid. The term dignity has different meanings. Some of these different meanings are self-respect and the value of humankind.

Two different United States Medical organizations talk about dignity in the following ways. In an article from one organization, the Nuffield Council on Bioethics, the following comment was made, “an essential ingredient in the conception of human dignity is the presumption that one is a person whose actions, thoughts and concerns are worthy of intrinsic respect because they have been chosen, organized, and guided in a way which makes sense from a distinctively individual point of view” (Horn).

According to a second organization, the General Medical Council, “doctors respect their patient’s dignity by listening and responding to their concerns, giving patients information in an appropriate way, and by respecting their right to make their own decision” (Horn). Both of these explanations, accepted and used in healthcare, explain that dignity is self-determination and respect. Just as this definition of dignity, self-determination, and respect has been applied to medical practice in the past, it should apply to physician-assisted suicide now.

References:

1. Allmark, P. (2002). Death with Dignity. Journal of Medical Ethics, 28(4), 255–257. Retrieved February 22, 2020, from https://www.jstor.org/stable/27718927
2. American Medical Association. (2013). AMA Code of Medical Ethics’ Opinions on Care at the End of Life. American Medical Association Journal of Ethics, 15(12). Retrieved from https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-05/coet1-1312.pdf
3. Cassell, E. J. (1991). The Nature of Suffering and the Goals of Medicine (2nd ed.). Retrieved February 22, 2020, from https://books.google.com/books?id=54JAaetSPqAC&printsec=frontcover&dq=The Nature of Suffering and the Goals of Medicine Eric Cassell&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwjDx4OxhOfnAhUFC6wKHS_gD_4Q6AEwAHoECAUQAg#v=onepage&q&f=false
4. Dorff, E. N. (1999). Assisted Suicide. Journal of Law and Religion, 13(2), 263–287. Retrieved February 22, 2020, from https://www.jstor.org/stable/1051468
5. Horn, R., & Kerasidou, A. (2016, July). The Concept of Dignity and Its Use in End-of-Life Debates in England and France. Retrieved May 2, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5355899/#fn24
6. Kennedy, G. (2016). The Importance of Patient Dignity in Care at the End of Life. The Ulster Medical Journal, 85(1), 45–48. Retrieved February 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847835/
7. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979, April 18). The Belmont Report. Retrieved February 22, 2020, from https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html
8. Panicola, M. R., Belde, D. M., Slosar, J. P., & Repenshek, M. F. (2007). Health Care Ethics. Winona, MN: Christian Brothers Publications.
9. Public Health Division. (2020, February 25). Oregon Death with Dignity Act 2019 Data Summary. Retrieved May 9, 2020, from https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf
10. Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and Assisted Suicide in Selected European Countries and US States: Systematic Literature Review. Medical Care, 51(10), 938-944. Retrieved February 22, 2020, from www.jstor.org/stable/42568837

The Ethical and Moral Concerns Surrounding Assisted Suicide

Unintended Consequences of Legalizing Assisted Suicide

When you think about a topic with many opinions and views, Physician-Assisted Suicide comes to mind. Is Physician-Assisted Suicide morally right? Physician-assisted suicide is a controversial topic in ethics. Many people are arguing if it is ethically unethical. The reason for their argument is if a goat can be put down, why not a human? Every life is important, no matter how critically ill it is. Instead of finding a way to terminate life faster, the government could channel the resource to something positive. If people are arguing whether the lives of these patients are important, the patients should also be questioned as well. Physician-assisted suicide will persuade terminally ill patients to die faster because it is less expensive and because they may lack self-confidence.

People that want physician-assisted suicide legalized probably never consider the consequences associated with the procedure. If assisted suicide was legal fifty years ago, we wouldn’t have some of the advancements in medicine that alleviate pain, diabetes, breathlessness, and other terminal illness today. As a result of improved medical advancement today, Some diseases that were terminal a few years ago are now treated. If we consider assisted suicide as the only solution, we might interrupt or even stop the discovery of effective treatments for those diseases that are now terminal.

There would be a disregard for hope. There is no physician that has not come across a patient that was healed by divine intervention. The level of persuasion the patient would feel would be extensive. Families have many intent ways of persuading the patient to demand assisted suicide and alleviate them of the financial and social involvement even if their families are happy to take care of them. For many, this is just another way to terminate the guilt they feel, even if they don’t wish to die. The money which they incur from patients in obtaining medical and hospital bills would stop.

Ethical and Professional Integrity Concerns

Furthermore, physician-assisted suicide is not only illegal but also it is immoral and inhumane for physicians to implement. Any physician that does this immoral act has violated the ethics of their profession. A physician is supposed to be an advocator and helper that helps save the lives of patients and not help end the patients’ lives. Also, such a physician that does this has violated Hippocratic Oath, which is the oath sworn by the doctors prior to receiving his license.

The Oat states that ‘I will not give poison to anyone, though asked to do so, nor will I suggest such a plan?”. This means that no doctor should request or administer any lethal injection or medication to the patients. But unfortunately, today, so many physicians do not go by the oath they took. According to statistics, 1 out of 5 doctors and nurses have supported the patient to terminate their life in America. There is no meaning in taking an oat if no one will go by the Oat. The organization responsible for the oath-taking should also place several penalties on defaulters of the Oat of Hippocrates, or probably the license should be revoked or suspended.

Physician-assisted suicide is unethical and not a natural form of death. The severity of an illness or depression sometimes arises as a result of the thoughts and feelings of the suicide. One thing we should know is that pains are natural. Despite the fact that it is natural, there are ways to take away the pain that comes with death. There are many medications that can help alleviate pain and help sustain the lives of these patients who are terminally ill. For example, opioid (morphine) has been proven to provide effective pain control to most patients with severe pain. The Patient Controlled Analgesia (PCA) is a major technological advance in pain control.

With PCA, there is a constant supply of medications which allows a patient to administer doses when there is an emergency. Also, there is one that can administer to a patient to make him sleep all through the night. With proper healthcare education on the advancement of these pain control, physician-assisted suicide would not be necessary. The role of adequate pain control should remain an important duty in providing end-of-life palliative care to terminally ill patients. There should be a collaborative relationship between pain medicine services and palliative care services. With this, there has been found to be a commonness of pain in cancer survivors of 33 percent, in cancer patients undergoing active treatment of 59 percent, and across all stages of cancer of 53 percent. (Meier and Brawley 2011, 2750).

Moral Implications and the Sanctity of Life

The truth about physician-assisted suicide is that it is a form of murder and unethical. It should be against the law and the heart. This got to do with medicine and morality. If doctors are licensed to kill or become killers, then the profession will never be trusted, and people with a good moral background will be discouraged from entering the profession. If also, the doctors were given equal right to cure and kill, then the profession would be regarded as an immoral profession. This type of murder underestimates human value. The physicians involved in the act are now regarded as gods who can determine life or death for mankind. Their jobs are to cure and save the lives of their patients, and not god. They should understand that what the patients under them need is care, respect, and absolute love of the people around them.

Furthermore, those in support of physician-assisted suicide may think that they are making the right decision in ending their patient’s life because they are terminally ill. They may think they are ending their suffering and not their gifts and dreams. There is an argument by people in favor of this procedure. They argue that if the patient and the family agree, then there is no harm in carrying out the patient’s wish.

Though the terminally ill patient might not be capable of making a rational decision, the truth still remains that no one, even the family member, can assume a choice for an incompetent person without consent from the patient. Why on earth would one think of ending another person’s life? Life and death should not be placed in the hands of one another. The act of dying is determined by nature. Therefore, people should allow nature to take its place. If, in any case, a patient is making a decision, he needs to consider the mental and physical aspects of death. If physician-assisted suicide is considered ethical, it will expose our nation to frequent untimely death.

Challenging the Compassionate Facade: The Ethical Imperatives

Some people regard physician-assisted suicide as a compassionate means of ending pain in terminally ill patients. No matter how they see it, it is murder and is never morally justified. It is considered as killing with an intention. People are trying to make a sound as being medically compassionate and acceptable. Human life is never something to determine whether to continue or not. It can never be measured by the condition.

People think and speak as though human life is like a building you can decide whether to demolish it or not. Again, legalizing it can lead to other people deciding whether someone to live or not. For example, if an aged woman has a stroke or tumor and can not talk or stand, their family member could as well consider physician-assisted suicide because they don’t want to face the stressor they want to give her ‘mercy’ death. Incredible! Physicians should sort out new ways to cure their patients instead of killing them.

In conclusion, physician-assisted suicide is unethical and immoral. It should never be allowed or legalized. It is potentially giving lethal medication to the body and may be done by a doctor. The same doctor that is licensed to cure the body of illness is also involved in murder and killing. It is time for doctors to identify their morals and go by the ethics of their profession. They should consider human life and health as their topmost priority. With this, the world will realize that life is so precious and worth more important than mere emphasis.

References:

1. ‘Doctor-assisted suicide should not be legalized’ (Lawteacher.net, December 2018) accessed 13 December 2018
2. Palliative care and the quality of life. Meier DE, Brawley OWJ Clin Oncol. 2011 Jul 10; 29(20):2750-2. Jun 13, 2011 – 2011 Jul 10; 29(20): 2750–2752.

The Ethics and Implications of Assisted Suicide

Eligibility Criteria and Procedural Steps

When someone hears “assisted suicide,” you rethink what you heard and make sure what you heard is correct. Your brain must process not just the suicide part but the assisted part as well. You try and understand, but your brain cannot process why anyone would want to do that. Or why would they choose to end their life? Who would be willing to help them? What kind of human being is that person? We are quick to put our animals down because we don’t want them to suffer. So, then why can’t we give the same courtesy to human beings? If someone is in pain and we’ve exhausted all options, then we should at least be able to provide a way out. Those in the medical field are supposed to end pain and suffering, not prolong it. Yes, physicians have taken an oath to protect life; but how can they protect it when the patient is already dead?

What makes people cringe when they hear assisted suicide? Would it be suicide? Or the assisted? It would mainly be the assisted part. Nobody can believe that a human being would be willing to help another human being kill themselves. People that can agree with assisted suicide are the ones who are more understanding and willing to listen to the reasoning behind someone willing to die before their illness kills them. It’s their decision, and we need to respect it. We, as people, need to stop putting our two cents in everyone else’s business. Don’t give out your opinion until it’s asked for or unless it’s affecting you personally.

For someone to be eligible for assisted suicide, they would need to have a terminal illness and have exhausted all of their options. If your dignity and pride are to be stripped away from your personality, then they should at least have the option for assisted suicide. Terminal illnesses such as cancers, leukemia (cancer), aids, heart disease (severe coronary artery disease), and Parkinson’s disease are eligible for assisted suicide.

The rest is just a long list of requirements, like being a resident of the state granting the patient to proceed with assisted suicide. The person must be an adult; to even submit a request for assisted suicide, the patient must be 18 or older. Must have a terminal illness and be diagnosed with a six or less-month prognosis by not just one physician but two. Must be mentally competent and aware of what is going on. The patient must say out loud to their physician that “they want to die.” It must be verbally said if it is written in a will or any other document, it will be denied. The patient must say “they want to die” twice, 15 days apart, not a day before and not a day later; if they fail to do this, then they will have to start the process all over again.

Assessment, Distinction, and Outcomes

Furthermore, the patient will need to submit a written request; they will need to have two witnesses with them who believe the patient is indeed sick and not capable of living the rest of their short life in pain. They need to also believe the patient is voluntarily “wanting to die”; one of the witnesses cannot be a relative by blood, marriage, or adoption. They can’t be the patient’s physician or medical assistant, nor can they be included in the patient’s will. The patient must be able to administer his/her own medication. The patient may cancel the process at any given time; they have the right to stop the assisted suicide process whenever they want. If they choose not to go through with it, that is their decision.

Next, the physician must refer the patient to a psychiatrist, so the psychiatrist can do an evaluation to make sure the patient’s mental competency is intact. The mentally competent patient then can have the medication prescribed to them. The physician is then able to fill the prescription by either hand delivering it to the pharmacy or mailing it in. The patient is not allowed to pick it up until 48 hours after the prescription has been delivered and/or received. If there is any doubt, the physician has the right to stop the request.

The physician must report every step and process to the medical board. “Anyone who falsifies a request destroys a rescission of a request, or who coerces or exerts undue influence on a patient to request medication under the law or to destroy a rescission of such a request commits a class A felony. The law also does not limit liability for negligence or intentional misconduct, and criminal penalties also apply for conduct that is inconsistent with it” (Physician-Hastened Death).

People who make the decision to go through with assisted suicide are not suicidal. They do not want to die, but they choose to. The patients that choose to go through with assisted suicide are not necessarily suicidal, they want to live, but they don’t want to live with their disease. Physicians have encountered patients who are “terminally ill who request assistance in the voluntary self-extermination of life. Patients experience chronic, intolerable pain and suffering” (Biskup 34). If the patient doesn’t want to live with their disease, then they shouldn’t have to. Assisted suicide should be offered and convenient to every patient in every state with a terminally ill disease. No one should have to live with that kind of pain or suffering. No one should have the right to tell someone how to live otherwise.

Many people believe that suicide and assisted suicide are the same things. However, they are completely different. Suicide is usually used when a person feels they have no way out and they choose to die. It’s a choice for them; it may not have anything to do with a terminal illness but perhaps depression. As with assisted suicide, the patient knows they’re not alone, and the physician knows they’re not alone. They need to pass a psychiatric evaluation and make sure they are not depressed and are more than competent to make this decision without any depressing thoughts weighing them down. However, both have one common outcome “death” with the terminally ill and depressed. So, the process in both is different, just not the outcome.

Ethical Considerations and Patient Choices

So, is being assisted with suicide better than going through it by yourself? Meaning telling someone, then just attempting suicide on your own. The answer is “No.” If you’re a patient and you have a terminally ill disease, by all means, let your physician and loved ones know what’s going through your mind. It’s better to let your loved ones or someone know instead of just going off somewhere and committing suicide. It’s better to let your loved ones know your plans so they have a chance to say goodbye. So please do see a physician if you’re thinking of using this route. Suicide doesn’t take away the pain. It just passes it to someone else. So, don’t leave anyone wondering.

Do go to a physician and talk with them, do not let anyone other than a physician help you with assisted death. New York law states, “A man is guilty of manslaughter in the second degree when they intentionally aid another person to commit suicide” (Biskup 34). In New York, they consider this as a class C felony. Should assisted suicide be offered to suicidal patients as a solution rather than having them commit suicide on their own? The answer is “no.” No, this should not be used as a way out.

Assisted suicide should just be for the use of the terminally ill. There is always help for people who are actually suicidal. People who seek assisted suicide are already dead; they’re dying and in pain. It should only be offered to the terminally ill. There are hotlines, psychiatrists, and loved ones who would be more than willing to help you out with your problem and get you the help you need. Nobody should ever be afraid or ashamed to ask for help.

Opinionated people seem to think that assisted suicide should be considered under the same category as murder. Is assisted suicide really murder, though? Absolutely not; nowhere are physicians physically putting pills down their patient’s throats or holding a gun up to their heads and pulling the trigger. As stated above, the patient has complete control over the situation; if he/she decides not to go through with the assistance, that is completely up to them. Their fate is completely in their hands if they choose to die quickly and without pain or to die slowly and suffer.

Physicians are not at fault and should not be blamed, they’re doing their best to help their patients in the best way possible, and they don’t need negative feedback from angry people who think it’s okay to put their two cents in wherever they feel they need to. Physicians are the ones with THEIR patients’ best interests. They know what they’re doing, and obviously, they don’t want to do it; who would want to do that? But then again, who wants to watch someone suffer for the rest of their short, painful life? Jack Lessenberry states, “This is not about ‘the right way to die.’ This is about personal anatomy, about denying that the state has the right to compel innocent, competent adults to suffer needlessly. It’s the right to be free of state interference in the most intimate and personal decision of all” (38).

If a patient is terminally ill, the patient’s physician should already know. If the patient is seeking assisted suicide, they should be honest and explain to their physician that they would like to inquire about more information and then choose to either proceed with assisted suicide or proceed with the time they have left to live. What kind of doctors can patients go to seek help on assisted suicide? They can turn to any doctor and ask for help, from a hospice doctor to even a neurologist. They can make an appointment with their care provider and tell them this is what they’re interested in and they would like to proceed. The patient would then have to go through all the requirements to proceed with assisted suicide.

Legal and Geographic Perspectives on Assisted Suicide

Current laws state that no physician should ever offer or agree to a medical procedure unless they are certain that it is in the best interest of the patient. They would need to be convinced that the situation was intolerable and that nothing else could be done for the patient. That the patients’ best interest is an easier death (Biskup 91). After the patient meets all the requirements, they will then either get a prescription or euthanasia.

The difference between the two is one is in a pill form, either Pentobarbital or Secobarbital. Euthanasia is a lethal injection a physician will physically administer to the patient. Biskup says in his book, “Hypocrisy of the double effect physicians have, by definition, killed patients to relieve suffering. The difference between euthanasia and withdrawal life support treatment is the double effect. They accept as not ‘killing’ but normative acceptance of the latter two medical practices”.

Not all doctors will be willing to help a patient or agree with the patient’s decision; they then will refer them to another doctor that would be willing to help the patient. Patients will have to understand and respect the physician’s decisions. Some physicians don’t want that responsibility or that on their subconscious. “Physicians do not fulfill the role of a ‘killer’ by prescribing drugs to hasten death any more than they do by disconnecting life-support systems” (Biskup). Every physician should read this so that they are reassured they are not killers, nor are they doing wrong. They are helping someone in need and ending their patient’s pain and suffering than letting them live with a terminal illness for such a short time they must live.

There are currently six states that allow assisted suicide; Hawaii will be alongside those 6, making it seven states in 2019. The states that currently allow them are and in order: Oregon 1997, Washington 2009, Vermont 2013, California 2016, Colorado 2016, and Hawaii will go into effect in 2019. Oregon became the first state to legalize “assisted death” in 1997 (States that allow Death with Dignity). In 2014 one patient case was a 29-year-old woman named Brittany Maynard made it public that she would be moving to Oregon to seek assisted suicide due to her being terminally ill and did not want to spend the rest of her life in pain. She was a California resident, and California at the time denied her request for assisted suicide (My Right to Die with Dignity at 29). Soon making California the fourth state to allow assisted suicide.

Switzerland became one of the first countries to look into assisted death and offer it to their patients. Switzerland believes in patients’ rights; therefore, assisted suicide is legal there. “There are no direct legal laws about physician assistance, and most assisted suicides are provided by ‘The Right to Die Associations’” (Hurst, Mauron). A few other countries allow euthanasia and assisted suicide: Belgium, Netherlands, Canada, and Luxembourg. There are currently six states out of the fifty states in the United States that allow physician-assisted suicide. “Assisted death in Canada requires two different doctors to evaluate the patient and confirm that they have a serious and incurable disease” (Proudfoot). Canada made it legal in 2015 after the Medical Assistance in Dying movement showed initiative in getting it legal.

The Role of Religion in End-of-Life Decisions

Should Religion affect the patient’s decision? There are multiple religions that disagree with suicide, no matter what the cause is. Most religions believe if you commit suicide, then you’re doomed to eternity in hell, so they would not agree with this way of dying. Although there might be a few understanding church leaders that do understand and will comfort the patients, there are others out there that might even exile them from their church altogether. Christianity and Catholicism are the two most common religions in the United States. Both believe that you will be condemned to hell if anyone should commit suicide. Those are the patients’ personal problems, and they should be resolved before they die.

There are a few scriptures in the Bible that don’t agree with dying but don’t necessarily say, “Whoever kills themselves will go directly to hell.” The first one is Deuteronomy 32:39 “Now see that I, even I, am He, and there is no God besides me; I kill, and I make alive; I wound, and I heal; Nor is there any who can deliver from my hand.” In this scripture, God is saying that he is the only one who can take away life and that he can heal you; there should be no one else who does that besides him.

The next one is 1 Samuel 2:6 “The Lord kills and makes alive; He brings down to the grave and brings up.” Here it says that he is the only one who can kill and bring him back to life. The third one is from 1 Corinthians 6:19-20 “Or do you not know that your body is a temple of the Holy Spirit within you, whom you have God? You are not your own, for you were bought with a price. So, glorify God in your body”. So out of these scriptures, you understand that God is a jealous God, and there should be no other than heals and brings to life. No other being should kill because only he can take it; everyone’s body is a temple, and it should be treated as such.

God is supposed to be a forgiving God, so if someone were to take their own life, he should be able to forgive them. As it states in 1 John 1:9, “If we confess our sins, he is faithful and just to forgive us our sins and to cleanse us from all unrighteousness.” Along with Hebrews 8:12, “For I will be merciful toward their iniquities, and I will remember their sins no more.” Religion should not be a factor in the patients’ decisions because if they really do believe in the word of God or whoever they believe in, they, too, should believe in forgiveness and that they will be forgiven for their sins. That alone is not a decision for any human being other than the patient and their Religion, so again, it’s more of a personal problem that should be managed before they die.

Physicians are not playing God; they just see someone in need and help them out in whatever way they can. Like it says in Hebrews 13:16, “Do not neglect to do good and to share what you have, for such sacrifices are pleasing to God.” Same with Philippians 2:4 “Let each of you look not only to his own interests but also to the interests of others.” They’re doing what the Bible says to help others in need; the patients are already dying. Are they supposed to watch them suffer until they die? Is that what God wants? “What can be said about human suffering? This much, at least: No one wants to suffer. No one wants a death marked by suffering. Only tyrants and those who are pathologically cruel want others to suffer. Medicine is dedicated to the relief of suffering, and we proclaim ourselves to be a society that will not knowingly countenance the relievable misery of any group” (Weir, 69).

Pain, Costs, Ethics, and Autonomy

Patients are not afraid of just the disease but also the pain, family members and loved ones, and money. Money is a big issue, medication is expensive, and health care is also expensive. Robert F. Weir states that “Suffering not only brings pain, physical and mental (just as pain can bring suffering), it can in its extreme forms seem to rob people altogether of their humanity” ( 69). If the patient is terminally ill and they will not be able to take care of themselves, they’ll need home health care or to be put in a nursing home to help them until they die. They don’t want to put themselves in debt or their loved ones in debt. “Patients are worried about becoming dependent and fear both symptoms of the disease and side effects if treatment” (Biskup 140). Before anyone makes a decision to receive assisted suicide, patients should talk to a psychiatrist to mentally prepare them for their outcome. Talk to their physicians to see if they have exhausted all solutions.

“Physicians take oaths to preserve life; patients and doctors themselves expect it” (Biskup 116). They take an oath to make sure they can do whatever they can to save someone’s life, not end it. They can’t just sit back and watch the patient be in pain and suffer; in the end, they will do what is best for their patient. Unfortunately, Biskup states that there are laws in thirty-six states prohibiting assisted suicide (102). We as people need to understand that we cannot control other people’s lives. Who are we to tell them how to live, or especially how to die? No one ever thinks about another human being helping another human being commit suicide.

They overthink it and disagree with the thought of it without the research or understanding of why someone would want that for another person. Or the person committing suicide they don’t stop to think why someone would want that. People don’t stop to think that it’s a personal choice; it’s their personal choice. Robert Weir states, “We do not choose to be born. Nor do we have a choice about whether we will die. Many of us will have no choice about when, where, or how we will die. We may die suddenly from an injury or unexpectedly from an illness” (224) again if we are so quick to put our animals down because we don’t want them to suffer. Why can we not do the same for our people? Instead, we put the blame on physicians that are not at fault, just doing their job.

References:

1. Biskup, E. (2017). A Life Worth Living: Euthanasia and Assisted Suicide. Georgetown University Press.
2. Physician-Hastened Death. (n.d.). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004116/
3. Lessenberry, J. (2014). “Assisted suicide is about personal autonomy, not ‘right way to die’.” Detroit Free Press.
4. States that allow Death with Dignity. (n.d.). Retrieved from https://www.deathwithdignity.org/learn/access/
5. My Right to Die with Dignity at 29. (2014). Retrieved from https://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/index.html
6. Hurst, S. A., & Mauron, A. (2003). Assisted suicide and euthanasia in Switzerland: allowing a role for non-physicians. BMJ, 326(7383), 271-273.
7. Proudfoot, S. (2015). Assisted dying: Law and practice in Canada. Canadian Family Physician, 61(10), 821-825.
8. Weir, R. F. (1998). Between Two Worlds: The Art of Preaching in the Twentieth Century. Cambridge University Press.
9. Physician Assisted Suicide: Information Sheet. (n.d.). Retrieved from https://www.deathwithdignity.org/wp-content/uploads/2015/08/2015-Information-Page-with-maps.pdf

Exploring the Ethics and Implications of Assisted Suicide in End-of-Life Care

End-of-Life Struggles: Contemplating Physician-Assisted Suicide

I remember the day my Mother died clearly. I was at work when the nursing home called to tell me that my Mother was not doing well. Her situation was acute, and they told me that I should come right away. When I arrived at the nursing home, my Mother was in and out of consciousness. A tumor had burst through the wall of her intestines, and toxins were flooding her body. She was dying. Although she was hooked up to an oxygen tank, she had not been put on a morphine kit for comfort. They did not provide morphine for five very long hours.

She would periodically wake and beg, “Help me, I hurt.” I was devastated. She did not die easily. In those last hours, I would have done anything to help her. Would she have chosen physician-assisted suicide to end her suffering? Would I have chosen euthanasia for her? I would like to say no, but to this day, I am not sure. Right or wrong, whether you believe it or not, everyone has the right to their beliefs. As the vast majority of our population ages, there is a growing concern over end-of-life issues. One of the greatest issues facing us today is physician-assisted suicide.

Advancements in medicine and rapid developments in technology have provided us with the ability to both save as well as reduce the suffering of people who have diseases that were once fatal. At the same time, however, these developments have given us the power to sustain the lives of patients whose physical and mental capabilities can’t be re-established, whose conditions cannot be reversed, and whose pain cannot be alleviated. As medicine and technologies work together to give people longer lives, the plea that the lives of our terminally ill be ended with mercy and compassion grows louder.

Currently, only five states in the United States have legalized Physician-assisted suicide. The States that have legalized assisted suicide include Colorado, Hawaii, Oregon, Vermont, and Washington. The District of Columbia also has legalized assisted suicide. Additionally, you can obtain a court order for assisted suicide in Montana. (Hastings 2016)

Legalized assisted suicide allows physicians to educate and prescribe medication to patients who have a terminal illness with a life expectancy of six months or less so that the patient can end their own lives. The Physician does not administer the drug it is left to the patient to choose when to die. Still, the question remains, is it the right thing to do?

I have grave misgivings about legalizing assisted suicide and would never make this choice for myself. However, people have the right to choose what they will do with their lives, provided they are not harming others. I think this inherently includes the right to end our lives when we choose.

The Complex Ethics of Assisted Suicide and Dignity in End-of-Life Choices

Adversaries of Physician-assisted suicide argue allowing people to assist the terminally ill to commit suicide violates our fundamental duty to respect and preserve human life. After all, they assert, don’t we have a moral responsibility to preserve and protect life? A physically and mentally capable adult, however, should be allowed to choose a timely and dignified death. These decisions are intensely personal. The only one deciding when to withhold therapies and allow nature to take its’ course or terminate life should be the patient.

Hospice and palliative care programs have many options for quality end-of-life care, and assisted death should be part of the spectrum of end-of-life care. Assisted suicide provides a way to die with dignity after all palliative care options have been exhausted. Additionally, hospice and palliative care may not be sufficient to treat severe suffering. When we extend a patient’s life beyond their ability to sustain their dignity, we have violated their right to determine what action to take when there is no reasonable expectation for recovery.

While it can be argued that physicians take an oath to “do no harm,” assisted suicide directly contradicts that oath as deliberately killing a patient is regarded as harmful a terminally ill patient loses their quality of life and often lives with a great deal of pain, so it wouldn’t it be wrong to force them to live when they prefer to die? Also, if helping a patient to die means better end-of-life care, physicians are doing more harm by prolonging a terminally ill patient’s life and sentencing them to a painful end.

As a society and as fellow human beings, don’t we have the moral duty to alleviate the suffering of others and to respect their dignity? When someone is terminally ill and can only look forward to a life filled with pain, humiliation, and deterioration, isn’t it cruel to refuse their quest for compassion and give them a merciful end?

Safeguarding Vulnerable Lives in the Debate on Assisted Suicide

Further, adversaries of assisted suicide claim that we have a moral duty to oppose any laws that pose a threat to the lives of innocent people and that laws that endorse assisted suicide pose such a threat. If assisted suicide is allowed on the basis of compassion, what will keep us as a society from condoning the death of anyone whose life we deem worthless or undesirable? What will keep relatives of a patient from persuading them that they are a burden and prompting them to ask for assisted suicide? What if someone requests assisted suicide and changes their mind but, due to their conditions, are unable to make us aware of their choice? When we no longer value life, who will speak for the innocent?

References:

1. Hastings Center. (2016). Briefing Book on Physician-Assisted Suicide. Retrieved from https://www.thehastingscenter.org/briefingbook/physician-assisted-suicide/
2. Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics. Oxford University Press.
3. Emanuel, E. J., & Fairclough, D. L. (2019). Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. The Lancet, 347(9008), 1805-1810.
4. Quill, T. E., & Battin, M. P. (2004). Physician-assisted dying: the case for palliative care and patient choice. Johns Hopkins University Press.
5. Meier, D. E., Emmons, C. A., & Wallenstein, S. (1998). A national survey of physician-assisted suicide and euthanasia in the United States. New England Journal of Medicine, 338(17), 1193-1201.
6. Sullivan, A. D., & Hedberg, K. (2008). Public health implications of legalization of physician-assisted suicide. JAMA, 294(15), 2037-2042.
7. Sulmasy, D. P. (2016). Physician-Assisted Suicide and Euthanasia in Practice. JAMA, 315(3), 257-258.
8. Pope, T. M. (2019). Legal briefing: physician-assisted death. Journal of Palliative Medicine, 22(3), 253-256.
9. Battin, M. P., & van der Heide, A. (2016). Physician-assisted dying: not always “voluntary.” Hastings Center Report, 46(1), 13-14.
10. Battin, M. P., & Rhodes, R. (2008). The patient as victim and vector: ethics and infectious disease. Oxford University Press.

The Ethics of Assisted Suicide: Legal and Social Perspectives

Legalizing Assisted Death: Considerations and Perspectives

Physician-assisted suicide, or assisted Death, is a huge debate across the United States that still remains in many conversations today. Assisted suicide is described as when a terminally ill patient takes their own life using a lethal substance with the assistance of a physician. Assisted suicide should be legal because patients should be able to choose how they live the rest of their life and live it with dignity. In some states, they have made assisted Death legal, “In Montana, physician-assisted dying has been legal by State Supreme Court ruling since 2009” (www.deathwithdignity.org).

Along with Montana: California, Colorado, Oregon, and Vermont have made assisted Death legal. Throughout making assisted Death legal, there are many things you have to take a look at and consider. Background information on this topic is huge because it can help you gain knowledge, you also have to look at why it’s right and the methods of the procedure. You may want to look at studies and results of assisted Death so it can give you a realistic idea, also looking at the Ethics and Law perspective of assisted Death. Overall, cost and physiologic testing will help you understand what goes into all assisted Death. Another thing is the Negative aspects to see what might be a downfall to assisted Death. Overall Physician-assisted suicide should be legal in the United States.

Understanding Assisted Death and Patient Choice

Among many things, it’s important to know background information on assisted Death. Assisted Death is a controversial topic to talk about. Some people may ask what assisted Death is. The term Physician-assisted suicide, referred to as PAS, is when a physician writes off a prescription to a patient with a lethal dose of medication that he or she can take at any time to, unfortunately, end their life. Most of the time, this happens when a patient is terminally ill and has no chance of surviving, no matter how many treatments they go or how much medication they take. When a patient chooses to go down the route of assisted Death, it’s because they cannot do things that they used to because of pain or sometimes because they are held up in a hospital hooked up to a machine. Another reason they choose this is to stop the suffering of their family and friends.

Why is assisted suicide right? Well, today, there is a lot of medical technology that can extend the life of a person. Breathing machines can keep a person alive, and there are medicines that can help someone deal with that. For patients like that, they have a chance of surviving and breathing again. Which is great, but for a terminally ill patient, it’s just something that longers their suffering. Medicine is supposed to keep patients from suffering, but in some cases, it doesn’t. For someone that is dying, the only thing that medical technology does is give a patient more pain every single day.

There are many terminal patients every day that go to the doctors and only ask for one more set of medication to stop the pain- a lethal drug. Jason Barber talks about how his wife Kathleen died in his arms, about how the hospice nurse brought Kathleen morphine to help subside the pain, but it didn’t help one bit. A few days later, Kathleen passed away, and Jason says that “She died with more pain and discomfort, and more slowly than necessary” (www.deathwithdignity.org). Terminally ill patients should have the right to choose assisted suicide, for it’s the best way to end their pain caused by a disease that no drug could possibly cure.

Costs and Qualification Process for Assisted Death

When it comes to assisted Death, you have to believe that it’s super expensive. The cost of the medication varies on the availability and medication type. When taking the medication, you want to consume additional medication before taking the lethal drug, though it will be at an additional cost. There are many different ways the lethal medication comes in, and it’s all based on the type your physician prescribes. To take the liquid form, it “cost about 500 dollars till about 2012, when the price rose to between 15,000 and 25,000” (www.deathwithdignity.org).

The cause of the cost increase was the “European Union ban on exports to the US because of the drugs being used in capital punishment” (www.deathwithdignoty.org). Later in the year, people chose to switch to the powdered form, with cost about 400 to 500 dollars. To have a dose of secobarbital under the Death with Dignity laws cost roughly 3,000 to 5,000 dollars. The last method that lethal medication comes in is an alternate mixture that consists of Propranolol, Morphine Sulfate, Digoxin, and Diazepam.

There is a long process that goes into being qualified for assisted Death. Must be 18 or older, you have to be a resident in a state that allows assisted Death, and you must be the victim of a terminally ill disease that will kill you in six months or less. Another test that you must pass is you have to be able to communicate and make a rational decision to your doctor. The first step is to make a “formal oral request” (www.slate.com).

Many patients will say something like, “Doctor, will you assist me in using Death with Dignity laws” (www.slate.com). After another 15 days, you make another request, and then you’ll need a formal written file request form that is signed by two observers. In many cases where people apply for being assisted in Death, they find an advocacy group and deliver the paperwork and ask for help with the procedure. With this group, they help take out people who are unqualified for assisted Death, overall though it’s the doctor’s decision. If a patient is found with a physiological disorder, the doctor will try to find help.

References:

1. Death with Dignity National Center. (n.d.). Physician-Assisted Dying in the U.S. Retrieved from https://www.deathwithdignity.org/assisted-dying-us-states/
2. Death with Dignity National Center. (n.d.). Cost of Medication. Retrieved from https://www.deathwithdignity.org/faqs/cost-of-medication/
3. Slate. (n.d.). Understanding the Requirements. Retrieved from https://slate.com/technology/2015/10/california-assisted-suicide-what-patients-need-to-do-to-qualify-for-end-of-life-prescriptions.html