The Right to Die, Physician-Assisted Suicide
” I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect” — The Hippocratic Oath
Physician-Assisted suicide is one of the most controversial issues in our society today. During the 1990’s, assisted suicide has become the subject of public debate and legislative action across the nation. Even the U.S Supreme Court has been involved in critical decisions involving the legalization of Physician-assisted suicide. These matters call into question the ethical standards and legal bases for all Doctors and Health Care Providers. The American Heritage Dictionary defines euthanasia as “the act of killing an individual for reasons considered to be merciful”. Killing in this case is a physical action where one individual actively kills another. The word “euthanasia” comes from the Greek eu, “good” and thanatos, “death” or “good death”. Doctor assisted-suicide can be considered auto-euthanasia. The Doctor provides the means for a patient to take their own life painlessly but does not actively or physically help that person die. Doctor assisted suicide is nothing new to society, dating back to the time Socrates 470-399 BC. With the interventions of Jack Kevorkian M.D., being played out in the media and in the courts, Doctor assisted suicide has become the focus of intense public and professional debate. Most of this attention is focused right here in Michigan because of Dr. Jack Kevorkian AKA, “Doctor Death”. Doctor Kevorkian has assisted in over one hundred assisted suicides.
There are many arguments for and against assisted suicide. Points for and against this practice encompass legal, ethical, religious and medical arguments. They are very complex and lengthy. Listed are just a few simplified issues from both sides of the debate.
A person should have control over one’s own body. This is a fundamental right, and individuals should have a “right to die”.
The values of individual well being and compassion for suffering mandate that we end suffering when we are able to.
The distinction between withholding or withdrawing treatment in terminal situations and directly ending a life is often not meaningful. By withholding or withdrawing treatment under these conditions is legally permissible and medically accepted by most. Proponents argue that society should also sanction assisted suicide under the same conditions.
Assisted suicide is already taking place. Allowing the practice to continue in secret leaves providers isolated, without the advice of colleagues or ethics committees. This also keeps them from public accountability for their actions. To legalize assisted suicide would help ensure it is used compassionately and appropriately.
Legalization is necessary, to ensure medical safeguards and make it equally available to all who choose it. Proponents wish to avoid “back-alley suicides” much the way “back-alley abortions” used to be performed. This also erodes the privacy of the provider/patient relationship, exposing both to criticism and attacks on personal safety similar to those involved in the acts of abortion.
Legalization begins a process that will inevitably lead to involuntary, active euthanasia of patients who may or may not be terminally ill.
Legalization will subject the elderly, disabled or others who are disenfranchised in our society to bow to social pressures to die in order to relieve social, economical, and emotional burden on others. It is even more dangerous here in the United States because of the current pressure for profit in managed care, cost containment, clinical decisions being made by non-clinicians and growing social inequities.
Many feel that legalization of assisted suicide will erode the devotion of the physician to the patients’ best interests, and that it is not a medical role to decide which life is worth living. Opponents also fear the possibility of clinicians drawn to the practice by power or ego considerations instead of compassion.
Legalization of assisted suicide diverts attention away from the need to optimize palliative care. Hospice care remains unavailable to many, because of the cost many insure will not cover the care. Most opponents feel that expert pain management, aggressive treatments and attention to the patient’s and family’s physical and emotional needs would eliminate the need for assisted suicide.
Just because the act may be morally acceptable to many does not mean that it is sound public policy. Some doubt the ability of our health care system to practice euthanasia humanely and without substantial abuse.
Euthanasia circumvents the grieving process, thereby taking away meaning from death and making the survivor’s healing more difficult.
These are just a few of the arguments for and against assisted suicide, and should give the reader a good flavor for the fierce debate going on right now in our society.
I would like to relate a personal experience to lead off with my position on assisted suicide. This tragedy involves the death of an Uncle, who I was very close too. Uncle John, was my Father’s older Brother. My Father always looked up to John and they were also very close. When I was growing up Uncle John would take me fishing and hunting, something I will always remember. Uncle John was a big, strong man and was always very active. He retired at the age of sixty and was looking forward to spending his time doing the things he loved. The first hunting season after he retired, we were at our camp in the mountains of Pennsylvania. He and I were walking through the woods talking. He told me he had not been felling to good lately and had to go see the Doctor when we returned home from our trip. I didn’t think too much of it at the time but thought he probably had some type of bug. Well as it turned out Uncle John had colon cancer. To make a long story short, He became very sick within a matter of just one-year. After a few surgeries, radiation treatments and chemotherapy, the doctors sent him home to die. Uncle John suffered greatly and was hooked-up to a morphine drip for nearly six months. There was no hope for him and everyone watched this big strong man wither and die a slow and agonizing death. The point I am trying to make here is that I agree with Doctor-assisted suicide in some cases. Even though the Doctors’ had given him all the pain medication needed to minimize his pain he still suffered by knowing that he was going to die. He was bed ridden and unable to do anything to help him-self. This put a tremendous strain on the whole family and I am sure Uncle John would have chosen euthanasia if he had been given the option.
In Pennsylvania at this time euthanasia was and still is against the law. It is also against the Doctor’s Code of Ethics to take a life. I feel that a patient should be kept informed as to the severity of their medical condition and should be given all the information about their chances for survival. The patient should also be informed of the severe pain and suffering involved, what treatments are available also how effective they are. This way the patient can, while still in a proper state of mind, make an informed decision about using Doctor assisted-suicide as an option. As with the case of Uncle John, If he had been fully informed about his condition and was given the choice, I am sure he would have chosen Doctor assisted-suicide. Personally I would make the same choice under the same circumstances. This is not to say that it should be used for just any ailment but only in the case where there is no chance for survival and the death comes slow and painfully. It should also be the choice of the individual, and be made while they are of sound mind.
There are moral and ethical issues involved when patients request assistance with dying. Because of the trust developed between the patient and Doctor, and between our society and the medical profession, it is very important to examine these issues. The principles of trust, justice, informed consent, confidentiality, and care serve as a basis for ethical caring. By applying these principles and through experience the medical profession will increase their understanding of assisted-suicide and begin to make the right choices. Today with the increasing debate about assisted suicide, the medical profession needs to re-examine how to treat terminally ill patients.
NLN Resolution #9
Press Release. April 22, 1997 – White Paper on Assisted Suicide Life-Terminating Choices: A Framework for Nursing Decision-Making.
The Social Aspects of Assisted Suicide
Health Care Ethics USA, Fall 1996, Vol. No. 4
Weir, Indiana University Press, May 1997, Medical Ethics
Annals of Internal Medicine, 15 July 1997.
Court Unanimously Rules Against Doctor-Assisted Suicides
Carelli, Detroit Free Press, June 26, 1997
Kevorkian’s Moral Lapse in Right to Die.
Sirico, The Detroit News, Editorial, Sunday December 1, 1996