Every human being has the power to make decisions throughout the course of his or her life. People make choices every day, and it is the control that people have over their own lives that allows them to do so. This ability to have options and be able to make decisions should not cease to exist as a patient approaches the end of life. People have the right to believe strongly in personal autonomy and have the determination to control the end of their lives as wished (DeSpelder 238). Toward the end of life, people should still be given the chance to make decisions, in order to allow them some form of control in a life.
The option for Physician Assisted Suicide allows for those, who are approaching death, to end their lives without losing any dignity. Physician Assisted Suicide is when a physician intentionally assists a person in committing his or her own suicide by providing drugs for self administration at a voluntary and competent request (Oliver 2006). With Physician Assisted Suicide, the physician provides the patient with a prescription for a lethal dose of medication, and counseling on the doses and the methods the patient must follow through with to complete the act (Sanders 2007).
The physician may be present while the patient self-administers the medication, although this is not legally required. Also, the physician, or any other person, cannot assist the patient in administering the medication (Darr 2007). Physician Assisted Suicide should not be confused with Euthanasia. In the practice of Physician Assisted Suicide, it is the patient who makes the final administration of the lethal medication. As far as Euthanasia is concerned, it is a deliberate action done with the intention to hasten or cause the death of an individual (Sanders 2007).
Physician Assisted Suicide is only legal in the state of Oregon, while Euthanasia is illegal across the United States. Even though Euthanasia is illegal, it was performed casually by a physician by the name of Dr. Jack Kevorkian. Dr. Kevorkian would typically start an IV running saline, and allow the patient to then initiate the flow of barbituates and potassium chloride which would result in death (Darr 2007). After having assisted in the deaths of nearly 130 people over the course of ten years, Dr.
Kevorkian was found guilty of having given a man a lethal injection which caused the man’s death, and Dr. Kevorkian was sentenced to prison. Although some may see Dr. Kevorkian’s work as wrong and immoral, others support him and his symbol as the public debate on ethical and legal issues surrounding Physician Assisted Suicide (DeSpelder 238). There are many different types or forms of Euthanasia. These types of Euthanasia are: passive euthanasia, active euthanasia, active voluntary euthanasia, and active involuntary euthanasia.
Passive euthanasia is the occurrence of a natural death through the discontinuation of life-support equipment or the cessation of life-sustaining medical procedures. Active euthanasia is a deliberate action to end the life of an individual. Voluntary active euthanasia is the intervention of lethal injection to end the life of a mentally competent, suffering individual who has requested to have his or her life put to an end. The last form of Euthanasia is active voluntary euthanasia in which a physician has intervened in such a way to cause the patient’s death, but without the consent from the patient (Scherer 13).
One may wish to experience Euthanasia to end his or her life for many reasons. Many patients wish for control and influence over the manner and timing of his or her own death. He or she may also wish to maintain his or her dignity and wish to have relief of severe pain that may be caused by a terminal illness. Other thoughts that may affect the choice for Euthanasia involve wanting to avoid the potential for abuse from his or her doctor, family, health care insurance, and society (Scherer vii).
On the other hand, a patient may wish to pursue Physician Assisted Suicide, or a hastened death, because of an illness related experience such as agonizing symptoms, functional losses, and the effects of pain medications on his or her body. The patient may also feel that the mystery of death is a threat to his or her sense of self, and wish for some sort of control over the matter. Also, patients may fear for the future as far as the quality of life is concerned. A negative past experience with death, and the fear of becoming a burden on amily and friends, can greatly influence a person’s choice to seek Physician Assisted Suicide. As the end of life is approached, care can become much more involved, placing strain on those who are responsible for caring for the dying (Quill 93). In caring for the terminally ill and those near death, certain medications may be prescribed to reduce pain and a patient’s experience with suffering. When administering such medications in an attempt to control symptoms, a physician or nurse may inadvertently cause a person’s death. This occurrence is known as ‘double effect’ (Oliver 2006).
The doctrine of double effect states that ‘a harmful effect of treatment, even if it results in death, is permissible if the harm is not intended and occurs as a side effect of a beneficial action’ (DeSpelder 238). Because the dosage of medications may need to be adjusted to relieve pain at specific periods of end-of-life, it is likely that respiratory distress may occur soon afterward, leading to death. This has become known as ‘terminal sedation’, yet the Supreme Court has ruled that such instances do not account for Euthanasia or Physician Assisted Suicide because the main intent was to relieve pain (DeSpelder 239).
It may appear at times as though the law and medical profession hold strong views that oppose assisting death, but in many ways, they have also shown that under certain circumstances, hastening death can be justified. Hastening death through interventions which do not take place in the context of clinical complications, errors, negligence, or deliberate killing have been demonstrated by the legal and professional acceptance of particular cases.
Both the law and medical profession allow for the right of a competent adult to refuse any type of treatment, including one which may save his or her life. Doctors are given the right to withdraw or withhold any treatments that he or she sees as futile or not in the patient’s best interest; this includes life saving and life prolonging treatments. As mentioned previously, Doctors are legally also given the right to use their discretion in administering high-dose opiates in the context of palliative care (Sanders 2007).
In looking at such scenarios, it is difficult to understand why Physician Assisted Suicide is illegal in all states aside from Oregon, yet similar procedures and actions, that end in the same outcome, are legal in all states. The only state in which Physician Assisted Suicide is legal is the state of Oregon. Oregon passed the Death with Dignity Act in 1997 which allowed the terminally ill to end their lives voluntarily through the self administration of lethal medications, prescribed by a physician, for this exact purpose (Death).
Any physicians, who are against aiding someone in ending his or her life, may refuse to prescribe the lethal medications, but each is given the ability and choice to participate (DeSpelder 237). Although Oregon is the only state in which Physician Assisted Suicide is legal, California, Vermont and Washington all hope to follow in Oregon’s footsteps in legalizing this practice (Ball 2006). Since Physician Assisted Suicide is legal in the state of Oregon, it may be feared that too many people will take advantage of such a utility and that it has potential for abuse (Quill 6).
This is not necessarily true. In Oregon, an average of 50 people take full advantage of Physician Assisted Suicide each year; yet many more than this actually receive the lethal medications and choose not to use them (Oliver 2006). Perhaps it is the feeling of having these medications to fall back on that gives people comfort. People who receive a prescription from their physicians for these lethal medications know that if they ever get to the point where they feel as if they cannot live any longer, they do not have to.
Some other facts about patients who choose to follow through with Physician Assisted Suicide are that the majority of those who took the lethal medications were more likely to be divorced or never married rather than married or widowed, had levels of education higher than general education, and had either HIV and AIDS or malignant neoplasms (Darr 2007). Although Physician Assisted Suicide was made legal in Oregon, there have been many instances where the United States Supreme Court has attempted to give Physician Assisted Suicide a bad image.
In 1997, the Supreme Court compared two cases related to Physician Assisted Suicide. The cases were Washington vs. Glucksberg, and Vacco vs. Quill. In the comparison of these two cases, the Supreme Court looked at withholding and withdrawing treatments against Physician Assisted Suicide. The Court concluded that ‘the right to refuse treatment was based on the right to maintain one’s bodily integrity, not on a right to hasten death’ but when treatments are withdrawn or withheld, ‘the intent is to honor the patient’s wishes, not cause death, unlike PAS where the patient is “killed” by the lethal medication’ (DeSpelder 237).
After examination of such cases, the Supreme Court confirmed that states had the right to prohibit Physician Assisted Suicide, or allow it under some regulatory system. In order to be eligible for Physician Assisted Suicide, there are certain criteria that need to be met. First, the patient must be at least eighteen years old and a legal resident in the state of Oregon. The patient must be diagnosed with a terminal illness which is determined to provide the patient with less than six months to live.
This terminal diagnosis must be confirmed again by a consulting physician. The patient must also be able to communicate his or her health care decisions. A patient is determined to be mentally incompetent in making such decisions, as stated by the Mental Capacity Act of 2005, if he or she is unable to understand information that is relevant to the situation or decision, is unable to retain this information being provided, cannot use or weigh information as part of the natural decision making process, and cannot communicate his or her decision in any manner (Dimond 2006).
The request for Physician Assisted Suicide must be a voluntary request, with at least one written request, signed in the presence of at least two witnesses, and two verbal request, both of which must be at least fifteen days apart. If either the attending or consulting physician feels as though the patient may be depressed, a complete psychiatric examination is done. In addition to these criteria, the physician must also provide information to the patient about hospice care and other comfort measures that may serve as alternatives to Physician Assisted Suicide (Ball 2006).
It is important to explore all possibilities for pain management and palliative care to the fullest extent in order to set aside Physician Assisted Suicide as the final resort to ending pain and suffering (Scherer 118). The request for Physician Assisted Suicide is also a prime opportunity for health care providers to examine, explore and address a patient’s fears for the end-of-life (Darr 2007). It is important to hear the request and the feelings behind it, because this could also be a patient’s means for expressing a fear of being kept alive by technological treatments, or even a way of expressing depression.
A patient may feel as though it would be easier to put an end to his or her life rather than to deteriorate (Oliver 2006). Because these possibilities may be so, it is important to analyze a patient’s behavior and requests for death carefully. These requests may not be a true wish to die, but rather what is thought to be an easy way out, or a deep lying psychological issue. It is also recommended that the physician and patient have formed a previous relationship so that there is a clear understanding of the patient’s history and future medical treatment wishes.
There must be a discussion between the physician and patient. This discussion facilitates the physician’s understanding of the meaning of the request which will then allow him or her to respond to the patient’s request with both concern and compassion. If both concern and compassion can be developed within the physician-patient relationship, then it is more likely that the physician can accept the patient’s request without encouraging the patient’s decision to pursue Physician Assisted Suicide (Scherer 118). There are many arguments both for and against the use of Physician Assisted Suicide.
The argument for Physician Assisted Suicide is focused primarily on the support of a person’s autonomous decision to end his or her life. It is believed that any person who at the end of his or her life is experiencing unbearable symptoms or distress and feels as though he or she has a poor quality of life, should be able to request assistance in ending his of her life (Oliver 2006). If we are to respect a patient’s wishes, then it is thought that we too should respect a patient’s choice of when and how to die.
If a patient has the right to make informed decisions about medical treatment, then this right should naturally extend into his or her informed choice to choose a medically assisted death (Sanders 2007). Those who are against Physician Assisted Suicide believe that a patient’s autonomy should be limited when its exercise has a negative effect on others, and that it undermines a patient’s ability to trust a doctor as a healer (Sanders 2007). Many people also believe that ‘life is a gift from God and no human being has the right to take that gift away’ (Heintz 2007).
Fears or worries may arise with the legalization of Physician Assisted Suicide. As health care workers and providers, the job at hand is viewed as maintaining life and improving a patient’s physical condition while performing Physician Assisted Suicide may remove this image. If legalized, the public may find it fearsome that the health care system has become somewhat inconsistent. This is demonstrated when a patient is asked to trust a health care provider in maintaining or improving his or her health while that same provider may be assisting other patients in committing their own suicides (Darr 2007).
I chose the topic of Physician Assisted Suicide and Euthanasia because it is something that I find interesting. There is a constant struggle going on as to whether or not these procedures and actions are ethical, and I thought that it would be interesting to learn more about the topics in order to better develop my own view on the matter. Through my research, my opinion of Physician Assisted Suicide did not change. I had originally viewed Physician Assisted Suicide as a person’s choice and right.
Now, I still have the same input on the topic, but I feel as though I could better argue my decision of being for Physician Assisted Suicide rather than against it. I have learned a lot about Physician Assisted Suicide. I find it most important that my sources of information were from both sides of the discussion. This made it helpful for me to understand both views on Physician Assisted Suicide and Euthanasia. Upon completing my research, I developed stronger feelings for the case of Physician Assisted Suicide as being a patient’s choice.
This is an individual’s choice, and for anyone to vote against such a procedure does not seem OK. Nobody has a say in what goes on in another person’s life. If this really is the case, then why should anyone be able to say that people who are suffering and nearing death cannot take a lethal dose of medication to kill themselves. It all comes down to Physician Assisted Suicide being a patient’s choice and right to have the opportunity in front of him or her if he or she deems it necessary. In conclusion, the ending of one’s life should be left in the hands of that one individual and nobody else.
It will always be said to people that “it is your life, do with it as you will”, but why should this phrase change when it is applied to someone’s death? People should be free to determine their own fates by their own autonomous choices, especially when it comes to private matters such as health (Quill 39). No one person’s life should be at the mercy of what other people believe would be best. Life or death and the way they will be carried out or ended, should be nobodies choice but the individual. Resources Ball, S. (2006).
Nurse-patient advocacy and the right to die. Journal of Psychosocial Nursing, 44, 36-42. Retrieved February 28, 2008, from the MEDLINE (through EBSCOhost) database. Darr, K. (2007). Assistance in dying: part II. Assisted suicide in the united states. Nexus. Ethics, Law, and Management, 85, 31-36. Retrieved February 28, 2008, from the MEDLINE (through EBSCOhost) database. Death with dignity act. OREGON. gov. Retrieved February 15, 2008 from http://oregon. gov/DHS/ph/pas . DeSpelder, L. , Strickland, A. (2005). The last dance: Encountering death and dying.
New York: McGraw-Hill. Dimond, B. (2006). Mental capacity requirements and a patient’s right to die. British Journal of Nursing, 15, 1130-1131. Retrieved February 28, 2008, from the MEDLINE (through EBSCOhost) database. Heintz, A. (2007). Quality of dying. Journal of Psychosomatic Obstetrics and Gynecology, 28, 1-2. Retrieved February 28, 2008, from the MEDLINE (through EBSCOhost) database. Oliver, D. (2006). A perspective on euthanasia. British Journal of Cancer, 95, 953-954. Retrieved February 28, 2008, from the MEDLINE (through EBSCOhost) database.
Quill, T. , Battin, M. (2004). Physician assisted dying: The case for palliative care and patient choice. Baltimore: The John Hopkins University Press. Sanders, K. , Chaloner, C. (2007). Voluntary euthanasia: Ethical concepts and definitions. Art and Science Ethical Decision-Making, 21, 41-44. Retrieved February 28, 2008, from the MEDLINE (through EBSCOhost) database. Scherer, J. , Simon, R. (1999). Euthanasia and the right to die: A comparative view. United States of America: Rowman and Littlefield Publishers, Inc.