I like the idea of Ron bringing along with him in the suitcase a small medical kit with two syringe, morphine doses and potassium chloride. It shows that he is really ready to help his friend in his wish to end his suffering if everything turns well; that is if the physician assisted suicide is legally and morally accepted. This is the thought that always linger in Ron’s mind ever since Patrick said over the phone “ I can count on you, can’t I?”(Chamberlain 9). I can’t blame Patrick for making that statement which bring Ron being his close friend to a situation of not responding negatively to his request. If I am in Ron’s situation I cannot say no as I am his last hope to alleviate his suffering. I hate Patrick’s style of pushing me to the wall but I can’t blame him. Putting my foot on Patrick’s shoes, I will do the same. On that day of Ron’s arrival to help his friend, he also decided to attend a consultation meeting of sort to discuss the legalization of Physician Assisted Suicide.
This will help him decide wisely as to his next move to help his friend. This research paper aims to assist Dr. Ron Grey travel the minefield and continent of contrasting ideas, analyze the pros and cons of physician assisted suicide in the context of morality, professionalism, legality, social consideration and come up to a decision on how he can best help his friend Dr. Patrick Metcalfe. Morality and Professional Issue There is a distinction between physician- assisted suicide or ( PAS) and euthanasia. When a physician through the request of a mentally stable but terminally ill patient provide a dose of pill enough to cause death to the patient and the patient took the dose, it is PAS. If a physician with the request of the terminally ill patient inject a lethal dose of medication and cause death of the patient, it is considered euthanasia and not PAS. ( Physician Assisted Suicide, Is Physician-Assisted Suicide the Same as Euthanasia?, 1st par.)
The big question is whether it is morally acceptable or professionally ethical for a physician to assist a terminally ill patient to commit suicide and end the suffering. Morally acceptable or 2 professionally ethical in this juncture is considering the duty of the doctor to promote life and not to end it as they took and swear to the Hippocratic Oath before they can practice their medical profession. Patrick, J in the 4th paragraph of his book review of Dr. Quill’s Death and Dignity stated that: For Quill, as for the medical profession in general, the role of the physician is to be a provider: to facilitate, to heal, to enable, but never simply to stand by. If at the end of life the patient has had enough of anguish, pain, or despair, the role of the physician ought to be that of an agent who, in Quill’s terms, helps the patient “over the edge into death.” Rather than “abandoning” (a word that appears often in the book) the patient at the final stage, Quill argues, the doctor ought to facilitate as smooth an end as possible. ( Patrick, J., Book Review on Death and Dignity: Making Choices and Taking Charge by Dr. Anthony Quill).
This statement simply imply that the role of the physician aside from promoting life is to be a comfort- provider for the sick especially the terminally ill. In the medical profession, it is the responsibility of the physician to aid the patient who seek to end his life thereby also end his and his family’s suffering. Therefore, from the point of view of morality in medical profession, it is acceptable to facilitate the smooth and painless end. There are some considerations however regarding the medical morality of PAS. The physician should analyze very deeply the root cause of the request for PAS. First and foremost, the patient should be sane enough to make the decision for the request. It is an accepted fact that people who are suffering for quite a long time are depressed and commonly are not in position to analyze the repercussions of his decision.
A 2002 report by the Southern Cross Bioethics Institute of U.K. revealed that “Depression and hopelessness are the strongest predictors of a desire for hastened death among terminally ill cancer patients.34 Depression, not disease, makes people suicidal.35 And it must always be treated because free choice is meaningless when the patient is choosing “from under a cloud of depression-induced despair”.36 (Euthanasia and physician-assisted suicide, A reflection 3 on voluntary euthanasia and physician-assisted suicide, page 9).It is an accepted fact and can be deduced from experience that when one is depressed, when one feels lonesome and dejected ; that nobody seems to care, the thought of ending one’s life normally lingers in the mind. In an intensive care clinic situation, a patient who thinks that he has experienced so much intolerable may opt for PAS. In this situation, the depression should be properly alleviated first by encouraging the patient to continue fighting and all sorts of positive encouragement should be done before PAS will be considered.
Secondly, it should be the physician who will decide after careful and thorough evaluation if the patient is terminally ill or not. Thirdly, the physician should inform the patient and family that it will be the end of the road and cure from medication is hopeless. The patient and the family will be the one to decide; the physician’s role is merely an aide towards ending the pain and suffering through PAS. Legal context of PAS The implementation of PAS as a last practical alternative will result to death of the patient. Under American law PAS is illegal and therefore a crime. The first paragraph of the online article Physician- Assisted Suicide under the topic Is PAS illegal revealed that only the state of Oregon to this date has legalized PAS. This means that out of 50 states in the U.S., only Oregon recognizes the practically of PAS. Other states maintain a wait and see attitude on what will be the experiences in Oregon.
Outside of the U.S., only Netherlands effective April 1, 2002(Euthanasia and physician-assisted suicide: recent developments and ethical analysis, The Netherlands, p.6) and Belgium (p2.) last May 16, 2002 has legalized PAS. The debate on legalization of PAS is centered on two important considerations. First, on the PAS itself: due to the fact that the U.S. Supreme Court in many legal cases ruled out that aiding a terminally ill patient to death is a punishable crime. The 3rd paragraph of online article “ Physician- Assisted Suicide, Is PAS illegal “ revealed that in 1993, Dr. Timothy Quill was put under investigation but not indicted for aiding his terminally ill patient die of injecting barbiturates. The 4 incident was unknown for some years until Dr.
Quill published his account of PAS in his book “Death and Dignity: Making Choices and Taking Charge” The 3rd paragraph of the online article also reported another case which was unknown for a couple of years until the doctor aired a 60 minute tape showing himself administering a lethal injection. That was in November 1998 and the physician is Dr. Jack Kevorkian. His patient was Thomas Youk, 52 years old suffering from Amyotropic Lateral Sclerosis ( ALS disease) or Lou Gehrig’s Disease. Dr. Kevorkian was found guilty of second degree murder by Oakland County Jury, Michigan and sentenced to 10 to 25 years imprisonment (Physician-Assisted Suicide, Is PAS illegal, 3rd par.). The source added that the court ruled out saying the physician crossed over the line of PAS into euthanasia by doing the act (of injecting the patient ) and is considered a murder. In all cases recorded by the U.S. Supreme Court, the second consideration of personal autonomy is always upheld.
This means that the act of choosing PAS by sick patients, terminally ill or not is a constitutional right guaranteed under the Due Process Clause of 14th Amendment of the U.S. Constitution. The Due Process Clause extends to a guaranteed liberty of a mentally competent but terminally-ill patient to opt for PAS. In other words, if the right to live is a constitutional right, it follows that the right to die including the choice of the way to die is also constitutional. There are two conflicting contexts here which remain up to this time for resolution. While the constitutional right of the individual to choose the way one opt to live and die is upheld, the choice of dying by PAS [which appear to be more practical] of terminally ill but mentally stable patients is outlawed. A legally upheld way to end the intolerable pain and suffering is for the patient to refuse further medical treatment or refuse the taking in of artificial food or anything that will prolong life.
The article entitled “ Termination of Life Sustaining Treatment “ under heading “ Does the Patient Have to be Terminally Ill to Refuse Treatment” revealed that “Most states, including Washington State, have laws that guarantee the right to refuse treatment to terminally ill patients, usually defined as those having less 5 than 6 months to live. These laws do not forbid other patients from exercising the same right. Many court cases have affirmed the right of competent patient to refuse medical treatments “ The right to refuse treatment is guaranteed under the personal autonomy provision of the U.S. Constitution. Sociological and Religious Context of PAS Mr. Patrick, J. in the 5th paragraph of his Book review stated that “In a society that sees little earthly reason for enduring physical (or mental) suffering, and which fears of the loss of control over one’s life as a fate worse than death, Quill’s radical medicine will go down relatively easily”.
The quotation implies that if one can’t control his own destiny and cannot make the right choices under today’s American society, in effect, one has no good reason to continue living. A physician under this type of society and running out of medical technological fixes to extend comfort to his ill patient, normally will not see even a little reason to encourage a patient to live on. Actively assisting a patient to get a dignified death can be lonely and sad but a loving gift. This is blunt but we have to face it. The sense of values in American society has changed a lot under a capitalist economy. Sociology researcher Shapira, D. revealed that about 80% of dollar spent in health care goes to people who died in less than a year after being terminally ill. About two million Americans die each year and most of them are the elderly but tremendous amount of money was spent in resuscitating these elderly to no avail. The sociologist further stated that the money spent on non-survivors from illness is normally double that of survivors and only 10% of patients admitted in intensive care survive.
Due to this fact, the author continue saying that in the past 15 years, the health care cost increased from 8% to more than 13% of the gross national product or a 50% increase (Shapira 3). The American society sees this as a tremendous and costly drain from the U.S. circulating money which could have been more profitable if invested in other business apart from maintaining the dying and the terminally ill. Moreover, the psychological pain and time given for emotional healing by the members of the family greatly affect the 6 productivity .The precious time lost could have been used for a more productive endeavor. The costly spending can be effectively minimized by aggressive management of severe and terminal illness through legalization of PAS. This is how urgent the U.S.need to act to satisfy the increasing clamor of society for a legal remedy on the increasing burden of the sick and the terminally ill to society and the U.S. economy.
Religious and secular traditions promote the belief on the sanctity of life. The article of Washington School of Medicine on Physician-Assisted Suicide under the “ Arguments against PAS” stated that “ This argument [ sanctity of life] points out strong religious and secular traditions against taking human life. It is argued that assisted suicide is morally wrong because it contradicts these beliefs”. This only prove that PAS is morally unethical in the context of religion. Anti- PAS Issues In any society be it democratic or Marxist, actions and activities of citizens are governed by laws. In the U.S., it is now an accepted fact that PAS is considered a crime as evidenced by cases resolved in the Supreme Court. According to Ethics in Medicine by Washington School of Medicine, The following are the issues preventing its legalization and the ways to resolve the issue. 1. Religious belief that life is sacred Morality in society is slowly changing this belief as a result of modernity. Society now looks on the economic side of managing the terminally ill patients.
The expenditure in useless prolonging the agony of the dying now amounts to 13% of the U.S. gross national product ( Shapira 3) not to mention the decline in productivity of families of terminally ill patients due to depression and moral obligation to assist the dying. 2. PAS is equated to active killing The society at present is confused between passive killing and active killing. Withdrawal of 7 treatment and refusal to do the treatment by physician is passive killing and is more preferred by society over active killing or PAS. Active and passive killing are both unethical according to Hippocratic Oath. There is a gradual shift observed in favor of PAS as the economics of letting death complete its course naturally over PAS is realized. 3. PAS legalization may lead to abuses as to its applicability Documented cases of abuses related to PAS had been known from Oregon state and from The Netherlands.
The Euthanasia and Physician –Assisted Suicide pdf article revealed that in Oregon, PAS is legally applied to terminally ill patients with less than 6 months to live as determined by at least 2 competent physicians, the request is made by mentally stable patient and the patient himself will be the one to administer the dose. It was documented that the less than 6 months lapse is ignored and PAS is being administered to people with lapses of up to 466 days from date of request ( p.6 ). In the Netherlands, a doctor was convicted but not jailed when he assisted a man end his life for the mere reason that the man is tired of his life. This shows that stricter policies are needed to prevent these abuses which will definitely be considered in the legalization of PAS. 4. Professional Integrity The practice of medicine is guided by Hippocratic Oath; that is it’s, the duty of the doctor to promote life and not to end it.
Today’s interpretation of promoting life includes promoting comfort for the ill like introduction of pain killers& anti-depressant drug. Promoting comfort ethically includes assisting the terminally ill-patients cross life’s edge to death ( Patrick, J. Death and Dignity: Making Choices and Taking Charge.). 5. Mistakes in diagnosis Physicians are only humans and being so are open to mistakes. Alleviating depression and 8 treatment of pain should be properly implemented first before considering the request for PAS. This is for the reason that the terminally ill patients normally request for PAS out of depression and great pain being experienced. Summary and Conclusion The continent and minefields of conflicting arguments about PAS was completely traversed by Dr. Ron Grey in search for valuable insights to aid him in his decision about the request for PAS by his close Friend, Dr. Patrick Metcalfe. All possible angles of PAS were deeply analyzed.
This include the moral and medical ethics side which says that the role of the physician as provided in the Hippocratic Oath is to promote life and provide comfort for the sick and terminally-ill. Providing comfort means aiding the terminally-ill from life’s edge to tranquility. Social and religious considerations all pointed to the direction of PAS approval considering the economics of care for the sick and terminally-ill. The only minefield that’s left to be diffused is the legality of PAS. The five important anti-PAS sentiments namely religious consideration, PAS definition ( active killing issue), possible abuses, professional integrity and misdiagnosis were all given due considerations and corrective measures were proposed to ensure its legalization approval.
In the meantime that PAS legalization is pending, the legal option of a written will from the terminally ill patient declaring that he or she is refusing further treatment and taking in of artificial food is the most appropriate decision to make. This is guaranteed under personal autonomy provision of the U.S. constitution.
9 Works Cited
Chamberlain, P. Final Wishes: A Cautionary Tale of Death, Dignity and Physician-Assisted Suicide. Varsity Press, Illinois. 2000. 215pp. “Euthanasia and physician-assisted suicide: recent developments and ethical analysis”. 2002 April. 6 November 2007 < www.spuc.org.uk/documents/papers/Euthanasia-assistedsuicide.pdf > Patrick, J. “Book Review on Death and Dignity: Making Choices and Taking Charge”. 16 July 1993. 6 November 2007 <http://www.thefreelibrary.com/Death+and+Dignity%3a+Making+Choices+and+Taking+Charge. a014059960> “Physician-Assisted Suicide”. 2001 October. Ethics in Medicine, University of Washington School of Medicine. 6 November 2007 < http://depts.washington.edu/bioethx/topics/pas.html > Shapira, D. “The Right to Die: Perspective of the Patient, the Family, and the Health Care Provider”. To Die or Not to Die? Cross- Disciplinary, Cultural and Legal Perspectives on the Right to Choose Death. 1990. 7 November 2007 < http://www.questia.com/PM.qst?a=o&d=15083248