The Positives and the Negative Aspects of Physician Assisted Suicide - Research Paper Example

PHYSICIAN-ASSISTED SUICIDE The very public death of Terri Schiavo in the 2005 alerted Americans tothe growing medical, ethical, and social crises accompanying the status of end of life issues and decisions in the USA. Physician-Assisted Suicide (PAS) is legalized in only two USA states, yet there have been numerous requests across the country to perform the operation. As indicated in the 2012 PBS Frontline documentary; there is an underground world that has added new legal and moral complexity to one of the most divisive issues in the United States of America. The practice of Physician-assisted suicide has been legal in Washington and Oregon states since 1997-09. In Montana State, the Supreme Court ruled in 2009 that physician-assisted suicide was legal, even though the issue has been the subject of contention (Antiel and Curlin, 267). In February 2012 in the Georgia State, the Supreme Court rejected a law aimed at controlling information about PAS. There have been several unfruitful efforts to legalize PAS in States such as California, Massachusetts, Maine and Hawaii. In the international front, the Physician-assisted suicide has been legalized in few countries including the Netherlands, Belgium and Switzerland. Public opinions data from 1947 to 2011 report that Americans support greater rights for individuals facing end-of-life decisions- including euthanasia and PAS (Gill, 120). This research paper focuses on physician-assisted suicide as a medical issue and theories that attempts to explain this issue. In particular, this paper attempts to determine both the positives and the negative aspect of Physician-assisted suicide. Several questions arise in relation to physician-assisted suicide. But the most important one is whether physicians should be granted the power to intentionally end life of their patients. Well this paper will try to look at opposing and supportive arguments about physician-assisted suicide before making taking a personal position on this matter. Physician assisted suicide is the voluntary termination of one’s own life by administration of a lethal substance through the use of indirect or direct assistance of a physician. It is the practice of delivering a competent patient with a prescription for medication for the patient to utilize with the basic intention of ending his or her own life. Physician assisted suicide has both opponents and proponents (Antiel and Curlin, 156). Some people argues that physician-assisted suicide is a violation of the fundamental tenet of medical profession and believes that medical practitioners should not assist in suicides because to do so in not compatible with the doctor’s function as a healer. Suffering has always been part of human existence. Since the beginning of medicine, requests to end suffering by means of death through physician-assisted suicide. Controversy over PAS decisions has been prevalent since the beginning of the 20th century, but was particularly heated in the early 1990. In the USA, the Patient Self-Determination Act (1990) went into effect nationwide, requiring nursing homes, hospitals, and hospice facilities to provide their patients with legal documents to put across their decisions and opinions about physician-assisted suicide (Frank and Anselmi, 105). In 1991, Derek Humphry-Hemlock Society founder-published Final Exit, a book that gives incurably ill patients detailed instructions for committing suicide. In the same 1991, Jack Kevorkian’s license to practice was provoked by Michigan Board of Medicine after he apparently assisted three patients in ending their lives. While the Patient Self-Determination Act has resulted to a nationwide mandate on living wills, individual states also attempted to resolve questions concerning PAS. A numbers of studies have shown that there is a significance differences in the rate of Physician-assisted suicide among different people of the society. Quite a large number of studies argue that 57% of the current doctors have received a request for physician-assisted suicide in some form or another. For instance a study by van Bruchem-van de Scheur et al (pg 1619), revealed that physicians should take responsibility in administering the PAS and these actions should not be left to the nurses. To some extent unrelieved physician suffering may have been greater in the past. However, modern medicine now has more skills and knowledge to relieve suffering than ever before. In simply terms, specialists in palliative care believe that if all patients had access to proper assessment and optimal supportive care and symptom control, the suffering of most patients with severe illness could be reduced adequately to eradicate their desire for hastened death. Even with the persistent of the desire to relieve pain, there exists other ways and avenues other than euthanasia or physician-assisted are available to remedy suffering and avoid prolonging life against the wish of the patient. PROPONENTS Physician-assisted suicide is a divisive topic, and hence the different interpretations of its meaning, morality and practice abound. Proponents of active physician-assisted suicide and a patient’s right to die, do not recognize the difference between passive and active physician-assisted. They claim that is hard to differentiate the withdrawal of life-sustaining treatment from confirmatory steps to quicken the death of a person. In both occasions, an individual intends to cause the patient’s death, acts out of a more honest and compassionate motives, and causes the same outcome. According to the proponents, giving a lethal injection to a person and turning off a life-sustaining respirator both have the same results morally. Diseases kill people in far more cruel ways than PAS which is dignified way of dying. For this reason, proponents of physician-assisted suicide admit that it is more like an action of assisting in suicide as entirely compatible with the physician’s duty to the patient. Every human being of adults years and sound mind has a right to determine what shall be done while his/her own body. Respect to the autonomous wishes of patients was established in common law in1914 when Cardozo J stated in Scloendorff v Society of New York Hospital. There is a common argument that as long as the patient has the requisite mental capacity, the patient is entitled to make life-limiting decisions concerning his/her own medical treatment (Frank and Anselmi, 45). The views of John Stuart Mill and Immanuel Kant on autonomy can be applied when talking of PAS. According to Kant, autonomy should be governed by rational choice while Mill on his part argued that people have a right to self-determination as long as their actions do not hurt others. These views of autonomy would support the PAS partnership and relationship model of decision making that integrate mutual respect and reasoned negotiation. Therefore, the physician-assisted suicide becomes one-sided with the emphasis being bestowed on patient’s desires and demands. Supporters of physician-assisted suicide appeal mostly to aspiration dignity. As a result, what principles and standards one has tried to adhere to during life, one may not be able to achieve in death if physician-assisted death is disallowed. Many proponents of PAS would consider anyone in possession of rationality, self-awareness and autonomy as being unequivocally a person thereby in the right state of mind to determine whether PAS should be performed to him or her. Opponents of physician-assisted describe life as a divine gift and creation, and invoke natural law and religious arguments to protect it before natural death. However, supporters of PAS point out that while we may be infringing God’s privilege by taking life and thus altering the divine timing of death; on a similar circumstance, we may be infringing divine sanction when intervening to save a life. Libertarians emphasize that physician-assisted suicide should be available to any competent adult who wants it (Gill, 24). Some promote a more middle ground approach, supporting the legislation of physician-assisted suicide but with stringent safe-guard. The field of medicine and especially the concept of physician-assisted suicide have been characterized by studies by various scholars. One of the scholars who have made much contribution in this field is Derek Humphry. Humphry is a former journalist who is the founder of Hemlock society in 1980. The organization continues to advocate for the right of incurably ill individual to choose voluntary physician-assisted suicide. Humphry has written several books on the subject of voluntary physician-assisted suicide. He presents physician-assisted suicide as a dignified and a merciful option for people whole illness have eroded their quality of life beyond hope. He points out that physician-assisted suicide is helpful in daily lives as doctors make decisions concerning the end of life. Others, including some medical ethicists, claim that a decision to withhold oxygen, antibiotics, or nutrition from incurably ill patient is no less active a form of physician-assisted suicide than is administering a fatal dose of morphine. According to him, Humphry see the common practice of withholding life support is more vulnerable to potential abuse than the act of physician-assisted suicide. Physician-assisted suicide is less visible and therefore easily regulated in term of decision. Proponents of physician-assisted suicide accept the real possibility of abuse of the laws related PAS. Nevertheless, the mere potential of abuse should not be a limiting factor in the quest for legalization of PAS. What is needed are strict safeguard to reduce or prevent these abuse. Doctors should be well trained to spot signs of depression which can occur in terminally ill patients. Keown argues that if physician-assisted suicide is legalized, this will inexorably lead to the acceptance of involuntary and non-voluntary euthanasia because of loss of effective regulation. Some believe that physician-assisted suicide is contrary to the professional role of the physician. Patients may trust physicians less and be fearful of hospitals if physician-assisted is legalized. PAS could be compromised because of too little trust that may exist between physicians and patients. However, studies have revealed that palliative care treatments have in fact improved where physician-assisted suicide is legalized. The availability of physician assisted may also encourage physicians to address other concerns regarding the end-of-life, such as decreasing ability to participate in activities that makes life enjoyable, loss of dignity and loss autonomy more effectively. The basic claim behind arguments for physician-assisted suicide is that many people who prefer it are experiencing excruciating physical pain. This conventional wisdom is summarized by the 1996 decision of the USA court of appeal for the 9th circuit supporting a constitutional wisdom. This is line with this famous quote: “Americans are living longer, and when they finally succumb to illness, lingering longer, either in great pain or in astuporous, semi-comatose condition that results from the infusion of vast amounts of painkilling medications”( Frank and Anselmi, 24) However, this argument is false at least according to some studies. Several studies carried based on interviews of patients with AIDS, cancer and other chronically disease have indicated that patients who opt to physician-assisted suicide or euthanasia tend not to be motivated by pain. According to these studies, only 22%of the patients who died between 2009 and 2009 by physician assisted suicide in 3 US states of Washington, Oregon and Montana, where the practice is legalized, were in great pain or were in afraid of pain, according to the physicians who conducted the operations (Hosseini, 206). In the late 90s, when physician-assisted suicide was briefly legalized in Australia, among the seven patients who received physician-assisted suicide, three reported no pain, and the pain of the remaining four patients was adequately controlled by medication. Opponents The ongoing debate about the legalization of active steps to end life intentionally end life as a means to terminate suffering remains contentious. According to the modern history, this topic comes up for intense attention sporadically. While people cite diverse reasons for opting to end their lives, Those suffering from a terminal diseases characteristically state that a serious disease or disorder has adversely affected their quality of live to the extent that they do not enjoy living any longer. The additional risk of misunderstanding that overrides the patient’s wishes ensures that there is currently more support for physician-assisted suicide as opposed to other life ending means such as euthanasia. As opposed to the Physician-assisted suicide debate, the right to analgesic care is uniformly recognized. In the United States of America, the Supreme Court justice concurring opinions supported the right of every American citizens to receive quality analgesic care (Frank and Anselmi, 88). Opponents of physician-assisted on their part claim that it undermines the value of, and respect for, all human life; erodes trust in physicians; desensitizes society to killing and thereby acts a contradiction to various people’s religious beliefs. In addition, they argue that the nature and intentions of active and passive physician-assisted suicide are basically the same. With the active physician-assisted suicide, an individual directly intends to cause death and utilizes available means to achieve this end. In passive physician-assisted suicide, an individual decides against using a particular kind of treatment and directs that such treatment be withdrawn or withheld, accepting but not proposed the patient’s death, which is as a result of underlying illness. Differences between individual’s moral and religious perspectives have resulted to a heated debate over the merit of physician-assisted suicide. Those who consider themselves religious are less likely to support physician-assisted suicide or to consider it for themselves. Conservative protestants and Catholic considered active euthanasia as more acceptable as compared to suicide and favored the physician, rather than the family member or patient, to facilitate the dying process. This interesting finding is consistent with the results of a research study carried out in Ohio. The study entailed that individual’s expressed support for PAS when physician were actively involved and exerted authoritative control over voluntary procedure. This can explain why the public opinion was highly polarized regarding the famous end-of-life involving Terri Schiavo (Curlin et al. 76). The topic of physician-assisted suicide in many countries has been influenced by several medical practices in other countries. For instance the legalization of both euthanasia and physician-assisted suicide in the Netherland has been of great influence some developed and developing countries. In the Netherland, the physician assisted suicide is conducted within strict guidelines that incorporate the following requirements: the patient must be experiencing intolerable pain and suffering, there should be voluntary request from the patient before the suicide is undertaken, each and every available and viable options to treatment must be explored before exploring the suicide option, and finally the physician must consult with another independent physician before proceeding with the suicide mission. A study in the Netherland indicated that 300 deaths (about 0.2%) were as a result of physician-assisted suicide (van Bruchem-van de Scheur et.al, 620). Critics of physician-assisted suicide argue through the use of familiar slippery slope, proposing that once the legalization of the physician-assisted suicide, other forms of euthanasia will more likely be practiced as well. They picture the idea of physician-assisted suicide as potentially leading to scenarios whereby chronically ill, elderly and handicapped people, along side others, are killed through non-voluntary, active euthanasia. This argument is related to the opinion that widespread practice of physician-assisted suicide might result to the death of those individuals whose intolerable suffering is caused by treatable depression. Basically, according to the critics, terminally ill people often suffer from depression, and that in spite of their illness, the feeling of hopelessness can sometimes be addressed through some application of counseling and antidepressant medication means of treatment (Gill, 15). MYTHS SURROUNDING PHYSICIAN-ASSISTED SUICIDE The primary motive of patients who prefers physician- assisted suicide is not to escape physical pain but psychological distress. Psychological distresses are the drivers are hopelessness, depression and fear of loss of autonomy and control. In a report published in 2005, Dutch researchers followed 138 incurably ill cancer patients and found that depressed patients were 4 times more likely to request physician-assisted suicide. Nearly half of those appealed to physician-requested suicide were depressed. Typically, the response to suicidal feelings linked to hopelessness and depression is not to give people the means to end their precious lives but offer them care and proper counseling. There are several myths that have been linked to the concept of physician-assisted suicide. These myths include: Advanced technology The myth surrounding physician-assisted suicide in relation to technology is that the important result of a high-technology medical culture that can sustain life even after people have become incontinent, debilitated, bound and incoherent to a machine. It is the unavoidable consequence of changes in the causes of death, development of new technologies and advancements in medical science. If history can be linked to the interest physician-assisted suicide, then it is the rise of individualistic strains of thought that overrides the personal interest, but not the development of high-technology in the medical field. Mass appeal This second myth states that physician-assisted suicide will improve the end of life for everyone. After all, everyone is vulnerable to death, and legalized assisted suicide would give way for any person to avoid an agonizingly painful death. However, the fact is very few people take advantage of physician assisted suicide even in areas where the practice in legalized. For instance, in the Netherland where physician-assisted suicide has been legalized for last two decades, less than 3% of patients die by this means (Hicks, 39). For most patients, it will have no impact on improving the ends of their lives. Legalize physician-assisted suicide benefits the well-educated, well off, typically suffering from cancer, which are used to basically controlling everything in their lives. On the other hand, the poor, less educated and dying patients who are seen as a burden to their societies, are most likely to be abused if physician-assisted is legalized (van Bruchem-van de Scheur et.al, 56). A good death Many proponents of physician-assisted suicide claim that it is a quick, painless and guaranteed type of death. However, there is no medical prove attached to this claim. It turns out that complications may arise during the process of assisted suicide. For instance, among 15% cases in the Netherland study, 7% of the cases vomited up their medications. Patients did not die and eventually died after a very long time after the doctors interventions (van Bruchem-van de Scheur et al., 66). Conclusion Since 1947, American support of PAS has steadily risen. This rise in trend suggests that American is increasingly sensitive to the plight of incurably ill patients and are more ready to support PAS under certain circumstances. Cases such as Terri Schiavo, Nancy Cruzan and Karen Ann Quinlan made national news and thereby raised critical questions concerning quality of life for patients in a persistent vegetative state (Antiel and Curlin, 34). This has, without doubt, played a significant role in changing public sentiment concerning PAS and euthanasia. It is with hope that this paper has provided some essential imminent into the arguments for and against physician-assisted suicide. Death is the unavoidable fate of every human being. When faced with death, the question that may linger in your mind is whether or not a third party should be allowed to intentionally terminate life of a patient or help that patient to commit suicide. Researches continue to influence and inform individual’s thinking on future legislation but they also demonstrate that the present case for change is overwhelming. Many have argued for or against the concept physician-assisted suicide. It is essential that society embarks on a full and informed debate on this interesting issue as it is likely to get more relevant with patients continues to travel to places where PAS is legalized to seek PAS.` Work cited Antiel, Ryan M; Curlin, Farr A. Dignity in End-of-Life Care: Results of a National Survey of U.S. Physicians. 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