Assisted Suicide as the Compassionate Choice - Research Paper Example

Assisted Suicide, the Compassionate Choice Introduction Imagine for a moment lying in bed, looking up at the ceiling and wondering what life would be like if the injury or illness didn’t make you are a prisoner in your own mind. Though conscience, you may not appear to be and communicating the level of pain is impossible. You can think and feel but nothing more. Medications help but only partially and in phases that alternate between feeling moderate pain in a semi-sleep state and a more lucid condition but experiencing excruciating pain. The minutes pass like hours and you’ve been in this condition for three years. Relatives and friends occasionally come by but the visit is brief and filled with only sadness. What are you thinking as the minutes, days, months and years pass? Most, it would seem, would be praying to die wondering why anyone would be allowed to suffer physical and psychological pain endlessly. It is the worst type of torment, one without control or end. If you can speak, no health care worker will hasten death. If you cannot speak you cannot even express your wishes. If you were the family dog, society would have fully condoned that the “humane” option was taken and you were “put to sleep.” Laws that prohibit euthanasia are government mandated torture. The option of euthanasia, or doctor assisted suicide (DAS), strengthens the important doctor/patient relationship, respects an individuals dignity and right of personal autonomy in addition to reducing the suffering of patient, their families and the medical costs to both. Euthanasia is the contraction of Greek words meaning “good death” but too many people die gripped in pain, guilt and humiliation, a bad way to die. It’s shameful for a society to somehow justify the prohibition and criminalization of DAS. Statistics The General Population Those who oppose the concept of legal DAS usually do so based on religious grounds, believing that only God has the right to give and take life. Others claim that because people don’t decide how and when they are born they should not decide how and when they die. They also caution that legalizing euthanasia is a “slippery slope” and could result in an abuse of authority, that people could be euthanized when they don’t really want to die. Opponents to euthanasia are in the minority however, and support for a compassionate death is growing. In 2002, a Harris poll found that sixty-five percent supported legalization of DAS while sixty-one percent supported implementing a variation of Oregon’s Dignity Act enacted in their own state. The Act allows terminally-ill patients to die by self-administrating lethal drugs that were prescribed by a doctor for that specific reason. A series of studies involving patients with a terminal illness revealed at least two-thirds would like to have the option of a DAS. Surveys taken in California during 2005 and 2006 found seven in ten favored the idea that “incurably ill patients have the right to ask for and get life-ending medication.” (Fieser, 2011) Though it didn’t pass, a DAS bill introduced in 2005 to the California State Legislature gained passionate support. The Medical Community Support for legalized euthanasia is also found among those of strong religious faith though not to the degree as the general public and medical community. A 2005 national survey of doctors found fifty-seven percent consider DAS ethical. A Journal of the American Medical Association survey in 2001 found a clear majority support the Dignity Act. Also in 2001, the Journal of General Internal Medicine found that forty-five percent of doctors thought DAS should be lawful and just thirty-four percent opposed. Mental health professionals realize that terminally ill patients can choose to die while mentally competent. A rational person can choose death as an alternative. Many medical groups have determined to adopt a “studied neutrality” stance on the subject of DAS, realizing not all within the medical field agree. (Fieser, 2011) States and Nations Three countries and three states permit DAS, Montana, Washington, Oregon, Luxembourg, Belgium and the Netherlands. Washington and Oregon have enacted laws while Montana’s Supreme Court established that DAS is considered a medical treatment. The three countries outside the U.S. sanction both DAS and euthanasia. Although Switzerland does not allow DAS or euthanasia, DAS is not subject to punishment unless it is performed due to “selfish motives.” (Marker, Hamlon, 2010) Though only three states have decriminalized DAS this option has become increasingly accepted among a society that is living longer though not necessarily better. Possibly because proportionately, the population in the country and the world is becoming older. “It is anticipated that by the year 2020, the elderly will constitute about 25 percent of the world population.” (Fieser, 2011) Clearly, the death-with-dignity issue is becoming increasingly significant. Suffering Physical/Psychological Pain It is often thought that the main argument for legalizing DAS and certainly the most passionate is that of pain. In the opinion of many a lingering life enduring an incurable illness where pain is “managed” but not eliminated is not worth living. “Efforts to prolong life have produced instances where terminally ill patients suffer horrific deaths despite efforts to control pain.” (Larue, 1999).Patients who are terminally ill often find their quality of life severely limited and impaired by interminable physical conditions such as paralysis, breathlessness, incontinence, difficulty in swallowing, vomiting and nausea. Opponents of DAS claim that medical science is continually advancing in its understanding of how to better treat pain therefore the pain argument for DAS is becoming increasingly invalid. Firstly, pain is a subjective phenomenon. When a person is not actually experiencing pain it’s much easier to quantify levels of discomfort. Even being in relatively small amounts of pain for any sustainable time period is torturous. Secondly and maybe counter intuitively, surveys conducted in the U.S. and the Netherlands revealed pain was not the foremost reason patients requested DAS. Less than one-third sought DAS due to pain and suffering concerns. Psychological factors also play a major role in people contemplating DAS. Terminally ill patients fear a loss of dignity and control over their lives and consider themselves a burden to family leading to bouts of deep depression. Mercy At the end-of-life people are often suffering a multitude of physical and psychological problems. It seems only humane to show mercy to those in this very frightening and vulnerable condition by relieving their suffering by DAS if this outcome is desired. This culture accepts putting our beloved pets ‘out of their misery’ is the humane course of action when they are nearing the end-of-life and are in misery. Our culture also considers pets as childlike and integrated into the family which reinforces the appropriateness of ending their life when necessary, not because the pet has become inconvenient but because people feel great affection for them therefore fight through the grief to act in a responsible, humane manner. It’s unclear why this compassionate, humane response isn’t transferred to human family members but one theory stands above others as a possible explanation. A person’s moral obligation to alleviate suffering is only one of numerous moral values that people possess. “Our moral tradition also acknowledges the duty of fortitude, that is, the ability to endure difficult situations, the duty to courageously face fear, and the duty of self-preservation; these values may be contrary to active euthanasia.” (Fieser, 2011) The moral responsibility to relieve pain and suffering should be undeniable for dying patients. Whatever the justifications to not allowing DAS is trumped by the Golden Rule which means to show someone else the compassion you would want for yourself. Golden Rule Legal euthanasia is substantiated by the Golden Rule. This is the logical progression when deciding a pet should be euthanized. A person imagines themselves in the place of the pet or loved one thinking that they would not want to live in pain or a state of incapacitation. The choice they would make for themselves is made for the sufferer. This rule is often quoted and largely understood to be the foundation for moral thinking, the gauge for how people should treat others. To demonstrate true compassion this rule must be observed. DAS is the compassionate route while opposing it is the opposite. “The Golden Rule does suggest that I must give desperate people help and show them kindness.” (Fieser, 2011). Autonomy Suicide Factor People have the choice to live or die. They can decide to commit suicide whenever they wish; approximately one million people worldwide do it every year. There are more suicides in the U.S. each year than homicides. (“Suicide,” 2012). Attempted suicide is not a criminal act and of course successful suicides are not either, there is no point to it. However, helping someone to die is a felony no matter the circumstances. If you try and fail at suicide you get treatment but if you assist a person desperate to die and begging your help you go prison for a long time. This societal reality defies logic and reason. This one aspect of the euthanasia debate alone is reason enough to reexamine the legality of DAS. Self-Determinism The government serves the populace well, generally speaking, providing schools, roads, a court system, military and fire and police services. Government officials inspect foods we eat, planes we fly, prosecutes corruption and regulates pollution among thousands of other benefits we tend to take for granted. However, the government is overreaching its authority by forcing people to remain alive. In a bedridden condition a person cannot kill themselves and the law in most states prohibits anyone from assisting. If you’re able and distraught it’s doable but not if you’re suffering and will die soon anyway. It’s a travesty of morality and justice. Being forced by a sterile institution to contradict a terminally ill patient’s requests, postponing death by all means available is contrary to rational thought. It is also heartless and inhumane. “There comes a time when continued attempts to cure are not compassionate, wise, or medically sound.” (Marker, Hamlon, 2010) Death is an intensely private concern. Providing no one else is harmed, the government should not interfere. Self-determinism embraces the concept of free will, that we determine our own destiny. It enables a person to be responsible for outcome of their own life or in the case of DAS, their preferred way to die. To disallow competent persons, especially the elderly, the freedom of choice is disrespectful and too closely associated with medical paternalism. An adult of sound mind can legally refuse life saving efforts and medial treatments but cannot choose DAS. People generally support the concept of personal autonomy, that a person is entitled to make their own choices without any outside authority interceding. The principle of autonomy is widely defended although the act of DAS enjoys somewhat less support. Gay marriage is a life choice that is opposed by those who normally champion the idea of personal autonomy. Freedom with exceptions is not freedom at all. (“Your Body,” 2007). Just the same as other life choices made by competent adults that do no harm to others, DAS should be considered by law as a right, a right of choice and personal freedom. If you are a freedom loving person, legalized DAS should not be a debate. Those opposed are not likely the ones dying and suffering or have the ability to empathise. It is not only immoral but violates the precepts of freedom to force a person to live past the time they wish. The American Civil Liberties Union in the Vacco v. Quill (1997) case stated in its brief that: “The right of a competent, terminally ill person to avoid excruciating pain and embrace a timely and dignified death bears the sanction of history and is implicit in the concept of ordered liberty. The exercise of this right is as central to personal autonomy and bodily integrity as rights safeguarded by this Court’s decisions relating to marriage, family relationships, procreation, contraception, child rearing and the refusal or termination of life-saving medical treatment.” An end-of-life decision is seldom, if ever, done alone. Self-determinant individuals usually consult with family members and doctors before making decisions this significant. Choice such as this are not lightly considered. Society consists of individuals whose personal rights should be honored. Too often society decides to limit freedoms based on a person’s perception of how society should operate rather than what is in the best interest of the individual. Opposing DAS based on religious beliefs, for example. Those opposed to legalizing DAS do so because they think it wrong but attempt to have their own morals legislated expecting all others to abide by their point of view. Proponents of DAS consider an act immoral if it does harm to others and do not insist everyone else’s personal freedom of choice be constricted to only include one viewpoint. (“Your Body,” 2007). Cost Human Beyond the compassion and personal freedom aspect of DAS is the needless financial burden involved in end-of-life care. In addition, there is a cost of human life, one not in a terminal condition and waiting for an organ transplant or simply waiting in another room for a nurse to care for them. Patients close to death require continuous medical care. The health care industry is usually experiencing a shortage of employees. The “Baby Boom” generation is becoming older which will be further stretch health care resources. Caring for terminally ill patients is more time consuming than for most other types of care. Some of the time allocated to dying patients should be used for patients who are expected to live. By not permitting DAS society is forfeiting the health of otherwise healthy individuals for unfortunate persons who will not live and are suffering as they linger. Monetary Healthcare costs are a significant burden for both individuals and the nation’s economic health. These costs would be lessened if resources were apportioned more efficiently, a portion of health care workers and equipment reassigned from those who are dying to patients who have manly years to live. Recently the news reported that hospitals all over the country are experiencing drug shortages. Patients are unable to obtain crucial medicines. However, these shortages are not occurring in one area of medicine, hospice, or end-of-life care. Drug manufactures are inclined to produce more of what is most profitable which includes medications for terminal patients. “Literally dozens of extraordinarily expensive cancer drugs and medical devices are now entering the market, all of them are “effective” - they prolong life but the added time is often measurable in weeks and months, not years, which yields very high cost-effectiveness ratios, literally hundreds of thousands of dollars per quality-adjusted life year.” (“Should,” 2012). Patient’s Loved Ones According to the British Medical Journal family and friends of cancer patients who die naturally suffer from symptoms of post-traumatic stress at a much greater rate and level of intensity than do loved ones of cancer patients who choose DAS. It not only the compassionate alternative for the person dying but also for those who live on and grieve the departed. A study of euthanasia’s impact on family members in the Netherlands discovered similar results. Surveys were conducted from more than 300 family members of patients who died naturally from cancer and nearly 200 relatives whose dying loved one choose DAS over a seven year period. “The family and friends of cancer patients who died by euthanasia had less traumatic grief symptoms, less current feeling of grief, and less post-traumatic stress reactions than the family and friends of cancer patients who died of natural causes.” (“Effects,” 2003) The loved ones of people who have chosen DAS suffer fewer symptoms of grief because they were better psychologically prepared by knowing the date and method of death, had the chance to say goodbye and were able to speak more frankly of the impending death prior to the event. Doctor-Patient Relationship The doctor-patient relationship is important for the terminally ill patient. A trusting bond forms when delicate matters are able to be discussed openly, a circumstance which gives great comfort to the dying patient. A doctor that has the option of assisting with the death has more of a personal stake in the patient and develops an emotional connection therefore is as much of a friend as they are physician. Due to Oregon’s Death with Dignity Act enacted in 1997, “a much larger proportion of physicians discussed assisted suicide or the Death with Dignity Act with patients. Physicians perceived that more patients found these conversations helpful than upsetting.” (Spigel, 2003). Generally speaking, doctors believe that this closer connection helped them to help the patient. Doctors found they “made efforts to improve their ability to care for these patients” (Spigel, 2003). Just being able to discuss DAS and other end-of-life options with their doctor, whether or not is performed or was even legal in that state, makes the patients more at ease with the process of dying. Once patients discovered they are able to discuss DAS with their doctor, the significance of openness in patient/doctor relationship evolved to the point where the patient felt comfortable asking about other concerns such as worries, vulnerabilities and fears regarding the illness and impending death. The comfort level between doctor and patient is often more helpful to the overall well-being of the terminally ill than getting a prescription. When discussing death and dying, patients would rather speak to the doctor than anyone else as long as the relationship is friendly. By providing private and non-restrained communication the doctor instills trust in the patient who becomes more disposed to talking about all options including the physical process of dying. Without this trust the subject would not be as approachable. When emotional, physical and psychological pain is effectively treated, “both depression and suicidal ideation diminish, as well as interest in a hastened death” (Spigel, 2003). The ability to openly discuss DAS has an appreciably positive effect on the doctor/patient relationship. With trust, the doctor is has a better ability to serve the needs for both the patient and loved ones. “By making the discussion a comfortable topic, the doctor will then be able to understand the roots of the patient’s concerns” (Spigel, 2003). As expected, the doctor/patient relationship is undermined when the doctor will not, for whatever reason, discuss the subject of DAS at all. Assisted suicide is growing in popularity though slowly. People seem to understand the concept of personal freedom as it applies to DAS but may not be for legalization of the practice. People certainly sympathize with the physical and emotional pain suffered in an end-of-life circumstance and most all agree that putting down a beloved pet is the “humane” option yet may not be comfortable with the idea of euthanizing humans. It’s a pragmatic versus emotion debate. Reason and practicality will likely win out eventually on a national basis but not in the foreseeable future. Of course the same was said about gay marriage and pot legalization years ago and now some impetus is behind those movements. Possibly the generation that brought great cultural changes in the 1960’s will make changes in the way we deal with end-of-life issues as they come to the end of their lives. Works Cited Dennis C. Vacco, Attorney General of New York, Et Al., Petitioners V. Timothy E. Quill Et Al. Supreme Court of the United States Legal Information Institute Cornell University School of Law June 26, 1997. Web. December 17, 2012 http://www.law.cornell.edu/supct/html/95-1858.ZO.html Effects of euthanasia on the bereaved family and friends: a cross sectional study BMJ Volume 327, pp 189-92 July 2003. British Medical Journal. July 2003. Web. December 17, 2012 http://scienceblog.com/community/older/2003/D/20031310.html Euthanasia: Your Body, Your Death, Your Choice? The Irish Council for Bioethics. September 17, 2007. Web. December 17, 2012 http://www.rte.ie/science/euthanasia_leaflet.pdf Fieser, James. Euthanasia: From Moral Issues that Divide Us. The University of Tennessee at Martin January 15, 2011. Web. December 17, 2012. http://www.utm.edu/staff/jfieser/class/160/6-euthanasia.htm Larue, Gerald A. Euthanasia: A Global Issue. Humanism Today. 1999. Web. December 17, 2012 http://www.humanismtoday.org/vol13/larue.html Marker Rita L. and Hamlon, Kathi. Euthanasia and Assisted Suicide: Frequently Asked Questions. Patients Rights Council. January, 2010. Web. December 17, 2012 http://www.patientsrightscouncil.org/site/frequently-asked-questions/ “Should euthanasia or physician-assisted suicide be legal?” ProCon.org. November 16, 2012. Web. December 7, 2012. http://euthanasia.procon.org/ Spigel, Nadine. Euthanasia and Physician Assisted Suicide: Effect on the Doctor-Patient Relationship University of Pennsylvania. Bioethics Journal Spring, 2005. Web. December 17, 2012 http://www.bioethicsjournal.com/past/pbj1.1_spigel.pdf Suicide Prevention. World Health Organization. 2012 Web. December 17, 2012 http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ Contents: I. Introduction II. Statistics A. The General Population B. The Medical Community C. States and Nations III. Suffering A. Physical/Psychological Pain B. Mercy C. Golden Rule IV. Autonomy A. Suicide Factor B. Self-determinism V. Cost A. Human B. Monetary VI. Patient’s Loved Ones VII. Doctor-Patient Relationship VIII. Conclusion Read More