PAS: A Complex Ethical Dilemma
PAS: A Complex Ethical Dilemma

PAS: A Complex Ethical Dilemma

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  • Pages: 11 (2982 words)
  • Published: May 5, 2017
  • Type: Case Study
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Physician-assisted suicide: The voluntary termination of one's own life by administration of a lethal substance with the direct or indirect assistance of a physician. It is the practice of giving a fit patient a prescription for toxic medication upon the patient’s request to use with the intention to end his or her life. Define the Problem: PAS is only permitted in Oregon and Washington States in the United States.

The Oregon Death with Dignity Act of 1996 of allows terminally sick person to be given prescription for lethal medications by their physicians to administer by themselves if they are to die within 6 months. PAS has its supporters and opponents. Some of the opponents are the physicians that believe that it against the fundamental principle of medicine and the duty of physicians which is to take care of

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ill patients; physicians are supposed to be healer.

Some opponents think that some of the patients were forced to assisted suicide to make the financial burden easy and simple for the family member taking care of them. They also worry that assisted suicide could lessen pressure to provide better palliative care and find new cures and therapies. Those with religious faith said that God should determine the time for death and not humans. PAS supporters think that terminally ill patients should be able to determine and decide when they should go if the pain is too much to be handled, autonomy.

Some argue that if a terminally sick person have the legal right to refuse treatment that will make a live long such as respirators or dialysis, so do physician assisted too because without the respirator or dialysis, death i

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fast approaching for the patient. Some said that assisted death have always been around but because it is considered illegal in all states but Oregon and Washington, does not allow the physicians to relates it as an option to terminally sick patients that are going through severe pain. Legalization of PAS would help open discussions between physicians and patients.

It may also promote better end-of-life care as patients and physicians could more directly address concerns and options. Should physicians be allowed by law to assist terminally sick patient to commit suicide upon the request of the patient? Good question Literature Review: There have been several high-profile cases related to specific incidents of physician-assisted suicide. The first was Dr. Timothy Quill, Varco v. Quill, who was investigated for giving one of his leukemia patient sleeping tablets but not indicted for participating in the suicide of the patient. The second was Dr.

Jack Kevorkian who claimed to have assisted over 100 patients in death. He was tried and found not guilty in the court for his actions in the death of 3 patients. In October 1989, he announced a new developed device that can put an end to people’s life quicker, painlessly, and humanely. In November 1998, Dr. Kevorkian and his 52 years old patient, Thomas Youk, who suffered from Amyotrophic Lateral Sclerosis, appeared on the TV show 60 Minutes where Dr. Kevorkian administered a lethal injection. Dr. Kevorkian was tried for first degree murder in Oakland County, Michigan as the result of the TV show.

Prosecutors argued that, in administering a lethal injection to Youk, his actions constituted euthanasia rather than PAS. Kevorkian was convicted of second degree murder

in 1998, sentenced to a 15-25 year term of which he served 8 years, and was released in 2007 . In Florida, the court ruled that an AID dying man do have the right to inject himself with the lethal dose of medication prescribed to him by his physician. The court said that a dying person’s right to physician-assisted suicide is under the privacy issues of the constitution.

The Death with Dignity Act of Oregon, Washington, and Montana has harsh patient eligibility criteria that limit access to competent, legal residents of over age 18, with terminal illness that were given an estimated life expectancy of 6 months or less which is to be confirmed by two independent physicians. There is also a requirement for two oral requests with a 15-day waiting period in between, as well as a written request that must be witnessed. The prescriptions may be written by the physician not less than 48 hours after the receipt of the written request.

Patients must be mentally and physically be able to take the medications on their own. Through 2008, 292 cancer patients died with the assistant of the physician. A majority of Americans in a poll supported the physician-assisted suicide. About half of the people that responded to the May 10-13, 2007 survey were asked this question, when a person has a disease that cannot be cured and living in severe pain, do you think doctors should or should not be allowed by the law to assist the patient to commit suicide if the patient requests it?

The results showed that 56% of Americans support and 38% do not. Democrats including independents that lean toward the

Democratic Party voted yes, 62% and 32% no while 49% Republican voted yes and 45% no. It seems that Americans are now getting what physician-assisted suicide really means according to surveys that have been taken. The surveys indicated that about two thirds of the American public is now in support of physician-assisted suicide and more than half of the doctors in the United States even with the influences of the physicians that were against.

The court and the American people need to know that number one important ethical principle in medicine is the respect for each patient’s autonomy, respect for person. Autonomy is the right for a patient to make his or her own decisions about treatments, which includes informed consent and telling the truth from the physician. Autonomy can only be used when the patients have been fully informed about their options of treatments. The informed consent includes information, comprehension, and voluntariness.

Physicians have duties to create the conditions necessary for autonomous choice in their patients. Respect for autonomy for a physician is respecting the person’s right to self-determination and creating the conditions. People go to physicians for help and guidance in making decisions because they do not have any knowledge or enough experience for making the right decisions. One of the duties of the physicians to their patients is to educate them so that they understand the situation or problems clearly. Physicians address fear and calm emotions that affect the patient’s ability to make decisions.

They counsel patients when they cannot make decisions about their health and well-being. Respect for autonomy includes confidentiality, seeking consent for medical treatment and procedures, disclosing information about their medical condition

to patients, and maintaining privacy. Examples of promoting autonomous behavior is presenting all options of treatments by explaining the risks in the language that the patient understands, making sure that a patient understands the risks and agrees to all procedures before doing any treatments.

In healthcare, patient can use their self-determination by asking that all life-support treatments be stopped and if they do, the physicians are in no position to turned them down but accept the patient’s wishes if they are mentally competent. The other thing that the public need to know is that death is not fair and is often painful. Some people die quickly, and others die slowly but peacefully. Patients with AIDS, cancer, progressive neurologic disorders die in severe pain regardless of all the morphine or pain killer and the effort of the physicians and nurses, just like the case of Mr.

Smith mentioned above. Patients who ask for some kind of treatment to be alive such as assisted ventilation or dialysis, can slow down death by been on life support, but for those that doesn’t want to be on any life-sustaining treatment may badly need help that is not available to them now because of the opponents of physician-assisted suicide. The Ninth Circuit Court compared abortion to physician-assisted suicide, saying that they are both protected personal choices by the Constitution and if physician assisted suicide is made illegal, it will abolish the rights.

If the states can regulate abortion, why can’t they regulate physician-assisted suicide too? During the Quill versus Vacco’s case, the Second Circuit Court said that the state doesn’t have interest in prolonging lives of patients that are in severe pain that

their families are praying for death to take them away from their miseries. If the state doesn’t have time for such lives, why do so many people oppose legalizing physician-assisted suicide.  Problem Analysis: There are number of arguments against physician-assisted suicide, some that makes sense than the other.

Some of the arguments are that few will be helped but many will be harmed; easy way out for the less financially fortunate patients; fear, bias, and prejudice against disability; undiagnosed depression underlies request for assisted suicide; supposed safeguards are illusory; expanding narrow proposals; and claims of free choice are illusory A very few helped - a great many harmed The reason for wanting to legalize assisted suicide is to help people that have suffered greatly in pain before dying.

There exist legal alternatives now that can help some of the people that have died with the help of the physician-assisted suicide. It is legal in all the states for a person to create an advance directive which enables the patient to stop any unwanted treatment under any conditions if the person wishes. Patient also has the right to refuse any treatment or stop any treatment not wanted. It is legal to receive as many painkillers as the patient want to be comfortable, even if they want to die before is time for them to die.

It is legal for imminently dying patient to be sedated to the point that they are comfortable. But, if a patient is not terminally ill or got depressed due to the illness and their judgment is affected, he or she is not eligible for assisted suicide. Consequently, the number of people whose situations would

actually be eligible for assisted suicide is extremely low. The rich and people with good health insurance are the people that will benefit from legalizing assisted suicide.

At the same time, large numbers of people, particularly among those less privileged in society, would be at significant risk of harm. Easy way out for the less financially fortunate patients When are you dead? When your brain dies? When your heart stops beating? When you stop breathing? When you are in an irreversible coma? No one really has come up with a working definition of death, so the concept gets abused, especially since death involves money. The longer sick people are kept alive; they cost the family or insurance more money.

Last illnesses cost more than any other medical category. About one-third of Medicare’s budget goes for costs incurred in the last one year of life, and 40% of that goes for expenses in the last one month of life. We save more money if we can persuade patients that they do not have hope for the future and if we can convince them to die early, we inherit their money more quickly. The government saves on Social Security and Medicare and the company they work for saves pension mon. This is the Martin Sheen argument against assisted suicide.

He believes that assisted suicide laws will put poor people and those without health insurance at an extreme disadvantage within the medical system. Think of the money we’d save on CAT scans, x-rays, medicine, nursing care, rehabilitation, disability payments, etc. if we had this cheap assisted suicide. Fear, bias, and prejudice against disability If the assisted suicide is legalized even with

the most limited forms of suicide, the opponents argued that the handicapped, poor, the elderly, abnormal babies, and anyone who becomes inconvenient might eventually be killed too.

Most cases of depression among terminally ill people can be successfully treated but because most primary care physicians are not experts in diagnosing depression, depressed patients are not treated. If the assisted suicide is legalized, the depression will remain undiagnosed and administering lethal medication will be the only treatment. Supposed safeguards are illusory The argument is that assisted suicide proposals and Oregon's law are based on the faulty assumption that it is possible to make a clear distinction between those who are terminally ill with six months to live, and everyone else.

Everyone else is supposedly protected and not eligible for assisted suicide. But it is extremely common for medical prognoses of a short life expectancy to be wrong. Studies show that only cancer patients show a predictable decline, and even then, it's only in the last few weeks of life. With every disease other than cancer, there is no predictability at all. Prognoses are based on statistical averages, which are nearly useless in predicting what will happen to an individual patient.

The affected group could include many people who may be mistakenly diagnosed as terminal but who have many meaningful years of life ahead of them. Research overwhelmingly shows that people with new disabilities and new diagnoses of terminal illness frequently go through initial despondency and suicidal feelings, but later adapt well and find great satisfaction in their lives. However, the adaptation usually takes considerably longer than the mere two week waiting period required by assisted suicide proposals and Oregon's

law.

If assisted suicide is legal, it would be too easy to go for the assisted suicide in the early period before one learns the truth about how good one's quality of life can be. Claims of free choice are illusory Assisted suicide is supposed to be about free choice and self-determination, but there is an important danger that many people would want take this "escape" due to external pressure. For example, elderly people who doesn’t want to be financial or caretaking burden on their families might choose assisted death.

In Oregon's third year Report, "a startling 63% of cited fear of being a ‘burden on family, friends or caregivers' as a reason for their suicide". Since elder abuse is so rampart in this country and the perpetrators are often family members, the abuse could easily lead to pressures on the elders to choose assisted suicide. In addition, leaders and researchers in the African-American and Latino communities have expressed their fears that pressures to choose death would be applied disproportionately to their communities.

The elderly might also undergo assisted suicide because the lack good health care, or in-home support, and are terrified about going to a nursing home, they might demand assisted suicide. As Diane Coleman noted regarding Oregon's law, "Nor is there any requirement that sufficient home and community-based long-term care services be provided to relieve the demands on family members and ease the individual's feelings of being a ‘burden'. Legalizing assisted suicide would not guarantee choice; it would actually result in deaths due to a lack of choice.

Real choice would require adequate home and community-based long-term care; universal health insurance; housing that is available, accessible, and

affordable; and other social supports. They also argue that if assisted suicide is legalized, it might reduce the pressure on society to provide all the various kinds of support services, therefore reducing genuine options even further. As Paul Longmore has stated, "Given the absence of any real choice, death by assisted suicide becomes not an act of personal autonomy, but an act of desperation.

It is fictional freedom; it is phony autonomy". Possible Solutions For assisted suicide to be legalize, we need to be sure to go against all the opponents reasons for not wanting it to be legal such as making sure that those that need to be helped are helped and none will be harmed; is not an easy way out for the less financially fortunate patients; not discriminating against disability; not because the patients are depressed; making sure that the predicted dates are right; and making sure that the claims are free of choice as proposed.

The pros and cons of each possible solution was needed Solution and its implementation When a patient requests assisted suicide the physician must determine that the patient is in pain from a disease that the physician knows will kill the patient within six months; that the choice to die is voluntarily; that the patient is competent enough to make decision; that the patient is making decision after being diagnosed; and that the decision is been constant for fifteen day.

Another physician must confirm the primary physician’s opinion. If either of the physicians believes that the patient is suffering from a mental disorder or a depression that is not making her make a good judgment, the patient should be referred

to a licensed psychiatrist or psychologist. Physician would also be sure that all treatment options are exhausted, the best of hospice and palliative care has failed to relieve unbearable suffering, and if a mentally competent patient continues to request it.

Then, with the opinion of an outside physician that everything has been done, the physician would be permitted to prescribe medication that the competent patient can administer themselves to hasten death at a time of the patient's choice. It is the physician choice to be with the patient at the time of administering the lethal medication. Another option will be to find out that patient is not requesting assisted suicide because of any financial obstacles such as insurance or because of elderly abuse by the family.

The other option would be to find out that the patient is not asking for assisted suicide because they are disable and doesn’t want to depend on people feeling that they liability. Justification If all the law’s provisions and acts are followed by the physician, the physician is protected from criminal or civil liability or professional disciplinary action. The states that have physician-assisted suicide legalized in the United States are Oregon; Washington; and Montana.

 

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