The Decision to Prolong or End Life - Coursework Example

Running head: THE DECISION TO PROLONG OR END LIFE. The Decision to Prolong or End Life. Name: Institution: Abstract. The individuals’ right to decide to prolong or end life is a very provocative issue which has not yet been conclusively resolved. The arguments for and against euthanasia are many and have their respective merits. The patients’ right to decide to end his life in cases of the terminally ill, suffering from chronic, unbearable pain is accepted. In such cases, it is the attendant physician who is best qualified to assist the patient to terminate life or decide to prolong it. The psychosocial factors which come into play in terminally ill patients, also make a case for a psychologist to be included in the decision making process in physician assisted suicide. Developmental issues are involved in the case of individuals with physical disabilities and mental illnesses. Physician assisted suicide is legal in the Netherlands, Belgium and in Oregon in the U.S.A. Clear-cut legislation on the issue is needed. The Decision to Prolong or End Life. The decision to prolong or end life is an issue which arouses passions on several fronts: scientific, ethical, religious, political and economic. The debate is an ongoing one, with no definite resolution in sight. Both proponents and opponents have marshaled convincing arguments to support their respective stands. Once we accept that the decision to end life is justified at least in exceptional cases in which the individuals’ quality of life is irretrievably deteriorating, we progress logically towards the view that the person best qualified to make that decision is the person who is best informed about the patients’ medical condition: the attendant physician. When we analyze that condition in depth, the role of emotional and psychosocial factors emerges, making a strong case for the inclusion of a psychologist in the decision making process. The right to end life is defined by the term euthanasia, derived from the Greek ‘eu,’ or well and ‘thanatos,’ or death, and connotes a ‘good death.’ It is the intentional killing by act or omission of a dependant human being for his or her alleged benefit. Euthanasia can be voluntary (when the person requests it), non-voluntary (when the person is unable to give consent: as when in a coma) and involuntary (when the person expressly forbids it). In assisted suicide, the individual is given help by another person. When the other person involved is a doctor, it is termed physician assisted suicide. This can be executed by acts of commission, such as a lethal injection, or omission, such as withholding food and water (Euthanasia, n.d.). The arguments advanced by the proponents of euthanasia centre around the concept of dying with dignity, relief from unbearable pain and the individuals’ right to choose to die. They contend that when suicide is not illegal and an individual has the common law right to refuse medical treatment, it follows that an individual, whose physical condition does not permit him to commit suicide or refuse treatment, should be allowed assistance to end life. The opponents of the right to end life range from religious believers, who consider life as Gods’ to give or take away, to more logical dissenters who are concerned with the abuse of euthanasia if it should be legalized. The definition of the ‘terminally ill’ is ambiguous and open to misinterpretation. Human life is devalued when it is debated in terms of health care costs. The tremendous advances in medicine have facilitated the management of unbearable pain. The potential for abuse increases in the case of the elderly and those with mental or physical disabilities and in cases of unscrupulous family members in a hurry to come into their inheritance. The patient may be motivated to end his life not by subjective views of personal well-being, but by guilt at being a financial burden to the family or by clinical depression. C. Everett Coop warns that “if we ever decide that a poor quality of life justifies ending that life, we have taken a step down the slippery slope that places us all in danger” (cited in Euthanasia, n.d.). The acceptance of voluntary euthanasia, in which the patient has a ‘living will,’ or has given ‘do not resuscitate’ orders, is fairly straightforward, as is the rejection of involuntary euthanasia. It is non-voluntary euthanasia and assisted suicide, which are now the subjects of controversy. Recognition of the right to terminate life in cases of the terminally ill, suffering from unbearable, chronic pain and expressing a desire to end their lives, is gaining acceptance. In these cases, it is obviously the attendant physician who is the best person to assist the patient in his attempt to end his life. It is the doctor who is qualified to provide end-of-life treatment, who can legally prescribe the necessary medication and make a balanced, medically sound judgment on the actual health condition of the patient. It is reasonable to expect that the doctor, steeped in the tradition of healing, has an inherent inclination to preserve life in all but the most irredeemable of cases. The doctors’ claim to be the deciding authority is further buttressed by the argument that physicians are already subject to an existing mechanism of checks and balances, such as legal regulations for the medical profession, professional ethics and a fairly searching system of peer review. It is the physician who can decide whether the symptoms can be treated, estimate, at least approximately, the lifespan remaining to the patient, weigh the degree of pain being experienced by the sufferer and often has a long relationship with the individual. The argument that Physician assisted suicide detracts from the integrity of the physician does not hold water. Judge Roger J. Mines said in 1996, “Physicians do not perform the role of ‘killer’ by prescribing drugs to hasten death any more than they do by disconnecting life support systems” (cited in Neils, n.d.). Likewise, citing the Hippocratic oaths’ tenets as an argument against physician assisted suicide in the twenty-first century is antiquated, to say the least. The physician automatically, and rightly, consults the family members in the decision making process, but one significant aspect of the debate is largely ignored: the symptoms of psychopathology which are commonly prevalent in most terminally ill patients. Depression of varying severity and hopelessness are often present, but undiagnosed and inadequately treated, in many cases of terminal illness. Competent treatment of depression has been shown to do away with the desire to commit suicide in a large number of cases. Coupled with the wide gamut of negative emotions that a terminally ill individual generally experiences, such as fear of death, grief, fear of pain, insecurity following the loss of independence and regret at the shrinking of interpersonal relationships, this is a clear-cut call for the inclusion of a psychologist in the decision making process. The symptoms of mental illness occurring in cases of the terminally ill, are often difficult to distinguish from the physiological basis and from medication induced depression. The psychologist is best qualified to make “the correct assessment of the patients’ mental capacity, social support system and degree of self-determination” (Farberman, cited in Galbraith and Dobson, 2000). The developmental issues in the decision to prolong or end life centre mainly around those cases in which the individual is suffering from physical disabilities and from degenerative, progressive illnesses like Amyotrophic Lateral Sclerosis, Huntington’s disease, multiple sclerosis, AIDS, Alzheimer’s disease, etc. Here, there is a continuous, irrevocable deterioration in the quality of life and it is often these individuals who require assistance in their desire to terminate their lives. The desire to end life may be due to psychosocial causes rather than physical. For example, an AIDS victim may be motivated to die more because he cannot cope with the social stigma associated with his condition than because he is in pain. This again supports the argument for a holistic physician/psychologist centered approach in the decision making process to prolong or end life. The legal stance on the right of an individual to decide to prolong or end life and that of the physician to provide assistance when asked to, is very much an ongoing process of legislation and debate, both in the media and among the general public. As of today, it is only in the Netherlands that euthanasia or assisted suicide is a legal form of medical treatment by a physician who has met the requirements of ‘due care.’ Belgium legalized euthanasia in 2002, but children are excluded from the ambit of the legislation. In Switzerland, euthanasia is generally accepted, but ‘selfish motives’ must be eliminated. In the U.S.A., only Oregon has legalized assisted suicide since 1998. The Supreme Court has refused to legalize assisted suicide but encourages the States to debate the issue and take their own stands (Euthanasia.com. 2006). Physician assisted suicide is justified only in exceptional cases in which the patient is in an advanced stage of terminal illness, in chronic, unbearable pain and makes a mentally competent, well-informed request – free from any taint of coercion, for assistance to end his life. Depression and other psychosocial symptoms must be categorically eliminated. The attendant physician must give the individual or his family a realistic report on the medical condition of the patient, without a predisposing bias for or against the decision to end or prolong life. The decision to end life must be taken only after exhausting all other options such as effective treatment of pain and psychological counseling. The doctor must be subject to safeguards and his decision validated by another physician. When we accept that “regardless of illness or disability status, choosing to live or die is a personal psychosocial decision” (Sobsey,1994), the inclusion of a psychologist in the decision making process makes itself mandatory. Clear cut legislation, which eliminates all ambiguity and any potential for abuse, is the need of the hour. References. Euthanasia.com. 2006. Information for Research on Euthanasia, Physician Assisted Suicide, Living Wills, Mercy Killing. Retrieved on November 28, 2006 from http://www.euthanasia.com Euthanasia (n.d.) National Right to Life. Retrieved on November 27, 2006 from http://www.nrlc.org/euthanasia/index.html Galbraith, K.M., Dobson, K.S. 2000. The role of the psychologist in determining competence for assisted suicide/euthanasia in the terminally ill. Canadian Psychology. Retrieved on November 27, 2006 from http://www.findarticles.com/p/articles/mi_qa3711/is_200008 Neils, R. (n.d.) Death With Dignity FAQs. Retrieved on November 28, 2006 from http://www.togopeacefully.com Sobsey, D. 1994. An Illusion of Autonomy: Questioning Physician-Assisted Suicide and Euthanasia. Brief Submitted to the Special Senate Committee on Euthanasia and Assisted Suicide. Retrieved on November 27, 2006 from http://www.ualberta.ca/~jpdasddc/abuse/senate/senate.htm#tofc Read More