The Ethical Dilemma of Physician Assisted Death
THE ETHICAL DILEMMA OF PHYSICIAN ASSISTED DEATH
Euthanasia and more specifically physician assisted suicide is an ethical dilemma facing our society today as more and more of our citizens live longer. I will explain the ethical dilemma for physicians in the process of physician assisted suicide and why some physicians have chosen to ignore ethics and proceed with their heart and mind to assist patients based on the needs of the patient.
Should we allow trained professionals to assist those in the latter stages of illness to die with dignity or do we force them and their families to further suffer in life? That is the ethical dilemma.
The ethical dilemma for physicians begins with the Hippocratic Oath they take. The classical version of the Hippocratic Oath in medicine has various requirements for physicians. Among those, the physician is required to state that: “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to that effect,” (Hosseini, 2012).
“Physician assisted death is not new. Ancient civilizations upheld the right of citizens to kill themselves. For example, many Greeks believed voluntary death was preferable to endless suffering. In fact, physicians upon request, often gave their patients poison,” (Friend, 2011).
Within the 50 states, only Oregon, Washington, Montana and Vermont have laws permitting physician assisted suicide or death.
“Almost all jurisdictions where physician-assisted death is legal require that the requesting individual be competent to make medical decisions at time of assistance,” (Menzel and Steinbock, 2013).
This is an important safeguard in the process of physician assisted death, to ensure the decision is made with a clear mind and competent mind.
“Although the patient must be able to take the medication independently by his or her own hand, the prescribing physician is morally and legally responsible as an accomplice,” (Quill, 2012).
“The requirement of contemporary competence is intended to ensure that physician-assisted death is limited to people who really want to die and have the cognitive ability to make a final choice of such enormous import,” (Menzel and Steinbock, 2013).
Limiting the physician assisted death to those with terminal illness further justifies the process of physician assisted death to limit it to those in need and excluding those who just want it.
“Along with terminal illness, defined as prognosis of death within six months, contemporary competence is regarded as an important safeguard against mistake and abuse, arguably the strongest objections to legalizing physician-assisted death,” (Menzel and Steinbock, 2013).
Of course, when you build in specific safeguards to a program such as physician assisted death, you run the risk of excluding some people who may want and need a physician assisted death, but, lack the ability to inform others of their wishes within the construct of state laws.
“The insistence on contemporary competence is problematic. It means that someone who has dementia is ruled out as a candidate for physician-assisted death, even if she is terminally ill and suffering terrible and un-relievable pain. It also rules out individuals with strong and unwavering desires not to end their life in dementia,” (Menzel and Steinbock, 2013).
The ethical issue becomes more pressing as we as a society continue to age and live longer. Should we allow trained professionals to assist those in the later stages of illness to die with dignity or do we force them and their families to needlessly suffer in continued life. “This issue will become particularly pressing as the world’s population ages. By 2040, the number of people over the age of 85 will nearly quadruple from what it was in 2000,” (Menzel and Steinbock, 2013). Physician assisted death can best be argued from a virtue ethics point of view. The physician, by helping the patient to die, might be doing so in a charitable fashion or for a benevolent reason.
Relativism brings the morality of physician assisted death to question. I do not feel this is a moral issue, but, a personal issue to be discussed, planned and organized by the terminally ill patient with their families and their doctor. By allowing others to decide when and how a terminally ill person lives or dies encroaches upon our rights to decide what is the best course of treatment for the terminally ill. I am a supporter of physician assisted death as long as all protocols are followed and all the concerned parties are in agreement. Physician assisted death should not be confused with suicide. Physician assisted death is a treatment option available only to those who are terminally ill, of sound mind and have the support of their families. Though only few states have laws for legal physician assisted death, the option is available in other countries as well such as Belgium and the Netherlands for those who are well enough to travel and have the funds to get there.
“During the last few decades, physicians, lawyers, philosophers, and judges have discussed questions regarding withholding medical treatment in certain situations. As Carol Levine argued in 1997, their deliberations have resulted in a broad consensus that competent adults have the right to make decisions about their medical care, even if those decisions result in death. These discussions have also given rise to debates about euthanasia and physician-assisted suicide, both of which take place for various reasons and can be considered merciful,” (Hosseini, 2012).
“It can be argued that although physician-assisted suicide is opposed by the American Medical Association (AMA), it still remains a moral/ethical dilemma. Physician–assisted suicide may be defended on the basis of certain ethical principles, despite of the fact that it is only legal in a few states, (Hosseini, 2012).
The most famous or notorious depending on who is doing the talking, “Dr. Jack Kevorkian of Pontiac, Michigan, began his physician-assisted suicide-related activities in the 1980s, when he built a machine that could administer a narcotic followed by a lethal dose of potassium chloride to patients, ensuring a swift death. Dr. Kevorkian believed that people have a right to avoid a lingering, miserable death by ending their lives with help from a physician who can ensure that they die peacefully and with dignity, (Hosseini, 2012)
Physician assisted suicide is often spoken in legal terms, but, for most physicians, it still remains an ethical dilemma. “Legality aside, all professions should be guided by ethical behavior. In ethical terms, to be professional is to be dedicated to a distinct set of ideas and standards of conduct. It is to lead to a certain kind of life defined by special virtues and norms of character. This is particularly true of the medical profession, since physicians deal with human
life. Ethical behavior of physicians especially matters in situations where they have to decide whether or not they should assist patients to commit suicide in very painful situation,” (Hosseini, 2012). Physician assisted death does have ethical issues, but, it may be the best and last treatment option for those who are terminally ill. Some people have deemed ethical dilemma of physician assisted suicide to be similar to abortion. The argument is that both are the killing of a human life. Advocates of physician assisted suicide state that legalizing it will prevent it from further developing in the alley ways and basements. Another player in the process of physician assisted suicide is the pharmacist. “So far in the ongoing ethical controversy over physician-assisted suicide, the major focus has been physicians and patients. However, in most cases a pharmacist plays a large role in physician-assisted suicide—not only as a member of the interdisciplinary patient care team but also as the dispenser of lethal doses of medication,” (Fass & Fass, 2011).
Since physician assisted suicide remains a very controversial topic throughout the country. “Terminally ill patients, physicians, and pharmacists often have different beliefs about the practice. The Code of Ethics for Pharmacists, developed by the American Pharmacists Association (APhA) in 1994 and endorsed by ASHP, does not discuss physician-assisted suicide. The code describes the roles and responsibilities of the pharmacist with statements such as, “A pharmacist is dedicated to protecting the dignity of the patient,” and “A pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust,” (Fass & Fass, 2011).
“In the context of physician-assisted suicide, the code may be interpreted differently, depending on the individual pharmacist’s perspective. APhA does not endorse a specific moral position on the issue of physician-assisted suicide, according to APhA-adopted policies, but supports the use of pharmacists’ professional judgment under such circumstances,” (Fass & Fass, 2011). Pharmacy owners also have a hand in the physician assisted suicide two-step. “Pharmacy owners in states with statutes determine whether their establishment will participate in physician-assisted suicide. They inform their employees and create written policies and procedures so that the staff is equipped to respond to physician requests,” (Fass & Fass, 2011). This involvement by the owners, depending on their personal beliefs may throw a moral dilemma onto the plate as well. Some owners may have a religious view that would otherwise prevent them from supporting physician assisted suicide support from their pharmacies and pharmacy staff. And though an owner can prohibit a pharmacist from dispensing the required drugs, by law the pharmacist cannot be prevented from providing counsel upon request. (Fass & Fass, 2011).
“Studies examining pharmacists’ attitudes toward physician-assisted suicide demonstrate that a large number find it acceptable under certain conditions. However, only about one third would be willing to personally dispense lethal medication doses. The studies also indicated that younger pharmacists and those who describe themselves as more religious are more likely to oppose physician assisted suicide,” (Fass & Fass, 2011).
“Some say right to die, good death, rational suicide, aid in dying, and merciful release are all euphemisms for the possibility of killing or assisting individuals to kill themselves,” (Lachman, 2010).
Also involved in the ethical issue of physician assisted suicide are the nurses. “A few studies have documented nurses’ willingness to engage in assisted suicide or active euthanasia. One study found 85% of 218 Australian nurses carried out the requests of physicians for active euthanasia,” (Lachman, 2010).
How wide-spread are the requests for assisted suicide? “Approximately 1 of 1,000 dying Oregonians obtain and use a lethal dose of medication; 17% personally considered it as an option. Almost two-thirds of surveyed hospice nurses and social workers in Oregon reported having at least one patient ask them about the option during the previous year,” (Lachman, 2010). How far a nurse can go assisting is specific in “The American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements (2001) identified the expectation that nurses provide interventions to relieve pain and suffering of the dying patient, even if they may hasten death. However, the same passage states, “…nurses may not act with the sole intent of ending a patient’s life even though such action may be motivated by compassion, respect for patient autonomy and quality of life considerations,” (Lachman, 2010).
“The ANA (1994) indicated a belief that nurses should not participate in assisted suicide or active euthanasia because such an act is in direct violation of the Code of Ethics for Nurses, the ethical traditions and goals of the profession, and its covenant with society,” (Lachman, 2010).
“When requests are made, nurses should respond by first examining their own values about assisted dying, listening to the patient’s concerns, addressing unmet needs with palliative care options by aggressively managing symptoms and maintaining a nonjudgmental attitude,” (Lachman, 2010).
For clarification, the United States stands apart from other countries were assisted suicide is legal. “None of the U.S. laws authorize mercy killing, lethal injection, or active euthanasia. Unlike laws in several European countries, the line in the United States is drawn at allowing physician-assisted suicide,” (Lachman, 2010). The ethical dilemma for physicians ends with the Hippocratic Oath they take. “The physician is required to state that: “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to that effect,” (Hosseini, 2012).
Menzel, Paul and Steinbock, Bonnie. (2013). Advance Directives, Dementia, and
Physician-Assisted Death. Journal of Law, Medicine & Ethics.
Quill, Timothy. (2012). Physicians Should Assist in Suicide When It Is Appropriate. Journal of Law, Medicine & Ethics. Friend, Mary Louanne. (2011). Physician Assisted Suicide: Death with Dignity? Journal of Nursing Law. Hosseini, Hengameh. (2012). Ethics, the Illegality of Physician Assisted Suicide in the United States, and the Role and Ordeal of Dr. Jack Kevorkian before His Death. Review of European Studies. Fass, Jennifer and Fass, Andrea. (2011). Physician-assisted suicide: Ongoing challenges for pharmacists. American Journal of Health-Systems Pharmacy. Lachman, Vicki. (2010). Physician-assisted suicide: compassionate liberation or murder? MEDSURG Nursing.
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The Ethical Dilemma of Physician Assisted Death. (2016, May 22). Retrieved from https://graduateway.com/the-ethical-dilemma-of-physician-assisted-death/