The Medical Practitioners And Assisted Suicide Law Medical Essay

Published Date: 02 Nov 2017

Kevin Marley -0957837

Philosophy 4B03

Dr. V. Igneski

People in favour of legalized assisted suicide claim that the suffering associated with dying, is a situation that is forced upon patients by doctors and nurses. This situation comes about due to someone with a fatal non-curable sickness. Their wish is for pain relief at any cost, even death. The idea of assisted suicide is a concern for all healthcare professionals to think about. A potential problem I will examine is the notion that doctors and nurses are not ready to handle the reality of carrying out assisted suicide.

To start with I will identify some important terms that are vital to better understand the subject of assisted suicide. The first important term to be addressed is suicide which is: the taking of one’s own life. We can infer that assisted suicide is when someone helps the individual in this undertaking. Assisted suicide is also known as a type of euthanasia or "good death". To better understand this expression we need to take a look at the definition of euthanasia so we might better understand and help with a patient’s suffering, near the end of their life, by causing death. The best way to describe euthanasia is to break it into two categories, active and passive. Active euthanasia is to be understood as undertaking actions with the intention of ending a patient’s life. This is illegal in many countries with some people having little distinction between active euthanasia and murder. Passive euthanasia is the allowing of the death of a patient. There is no effort on the part of the care giver to quicken or slow the inevitable death. A legal example of this is when patients opt to withdraw treatment which is required for their life.

The health care providers must adhere to these wishes and do nothing to stave off the incoming death. Furthermore, it is in the right of the patient to reject any invasive procedures to their body. The idea is that the death is natural where as providing an injection that leads to death is unnatural as it would not have happened that way had the patient been left alone. This assistance seems to entwine the lines of active and passive euthanasia. Typically in this situation the healthcare provider only provides the means but it is the patient who goes through with the suicide. There is even more of a blur when we think of all the ways one can provide assistance. The healthcare provider might have only advised on the drugs to take. Furthermore, they could have brought the drugs to the patient. Even more, they could help with the administration of the drugs. All of these fall under the umbrella of assisted suicide.

A key aspect to better understand assisted suicide is the reason for requests of this nature. Sumner describes this as "exercising autonomy/self‐determination is a matter of managing one's own life in accordance with one's own values and priorities" (Sumner, p.33). The ANA (1994) has their own opinion on this matter. They believe that ""requests for assisted suicide can be related to numerous factors including unrelieved pain and other symptoms, depression, feelings of loss of control, fear of isolation, concern for family and a sense of hopelessness" (p. 3). Furthermore, The American Society of Clinical Oncology Task Force on Cancer Care at the End of Life states that "patients fear a lonely, painful, inhumane, technological attempt to delay or counter forces of nature that cannot be altered, and that the process of their dying will be out of their control" (Schnipper, 1998, p. 1987).

With this information it’s easy to see that when a patient puts forth a request for assisted suicide, it is not to be seen a wish for death but rather living in this condition is unacceptable. Sumner expresses that criminalizing assisted suicide is wrong by saying, "[a] wrong‐making feature is the violation of the victim's self‐determination or autonomy" (Sumner, p. 74). The laws are clear when it comes to a patient’s right to refuse treatment, which is evident in the 1993 Rodriguez case, the most famous court case regarding assisted suicide. Furthermore, hospitals are required to inform patients of this right and this right is upheld even if the treatment is needed to keep the patient alive. A common argument in favour of legalizing assisted suicide is the idea that assisted suicide is a further extrapolation of a patient’s autonomy.

These are ethical issues which bring to light the beneficence of health care providers. The current situation of modern medicine is about curing diseases. Yet, when there is no cure things become complicated. Everyone involved is affected. The healthcare providers have to suffer the discomfort of caring for patients in pain and who are destine to suffer a long agonizing death. This is due to the current treacherous legal issues surrounding this area. We must ask ourselves is this pain near the end of a patient’s life necessary. "If dying patients have no rights in relation to the timing and means for terminating their life, does this imply that they have the obligation to die slowly? To die painfully? To die devoid of dignity: To die financially impoverished?" (Alspach, 1997, p. 16).

Despite this sentiment The ANA (1994) recognizes the issue yet maintains that the providers of health care are not comfortable with administering assisted suicide. This statement is debateable. Some would argue that the medical profession is in favour of assisted suicide. However, not enough data has been collected on the subject. The Royal Society of Canada states:

Recent data on the attitudes of Canadian health care professionals toward euthanasia and assisted suicide are lacking, but opinion surveys published in the 1990s, of which there were only a few, are nonetheless informative. In a 1996 survey of more than 1700 physicians from across Canada, roughly a quarter of respondents indicated their willingness to practise voluntary euthanasia (24%) or assisted suicide (23%) if it were legal to do so, while the majority (55%) said they would not practise either.80 Overall, these physicians were more willing to refer patients to a colleague for voluntary euthanasia (44%) and assisted suicide (41%) than to carry out such acts personally. (RSC, p.18)

The health care providers are in contact with the patients directly and see every day the pain and suffering that can occur at this stage of a person’s life. This is why a balance must be found when dealing with a patient’s life and reliving their pain. I believe the health care profession needs to re-examine their ideas on this subject and understand what is expected of them. They need to ask themselves if they are up to the challenge of the added burden assisted suicide will put on them. The environment the health professional works in will bring about stress that my compromise the integrity of their decision making. This may cause a nurse to speed up the process because they do not want to deal with the horror of the patient’s pain. Those in favour of assisted suicide say that it is doing them harm to keep them alive as they are in a great deal of pain. (Kaveny, 1997).

The main argument against legalizing assisted suicide comes in the form of the requirements of health care professionals and their potential to abuse them. This is what is known as the slippery slope. In this scenario assisted suicide becomes too easy to obtain through. The slippery slope is allowed to happen because of the legalization of assisted suicide. This worry of increased assisted suicide requests might have a solution. Perhaps our efforts in making palliative care healthier would diminish the amount of requests for assisted suicide. (Wlody,1997).

In the British Medical Journal Churchill and King (1997) outline the slippery slope, "The most widely feared abuse associated with the legalization of physician assistance in death is the gradual extension of such practices to include those not terminally ill, and the expansion of physician activity beyond assisted suicide to active euthanasia". (p. 138) Currently, the push for legalization centers around the terminally ill. The worry is that without the law to stop assisted suicide, there is no way to stop anyone from receiving this option of treatment. One might wonder why the liberty of assisted suicide will be granted only to the terminally ill. When we consider incapacitating lingering diseases we might rationalize their right to assisted suicide since they will be in pain for a greater amount of time. (Kavney, 1997)

The mindset of the health care provider is of the utmost importance when coming to a decision regarding the treatment for a patient in these dire situations. One can see that a health care professional could make declarations that their patient would like assisted suicide. Furthermore, "Studies have shown that most health-care costs can be traced to expenses incurred in the last months of life. Employers and insurance companies could achieve great financial savings by encouraging patients to choose assisted suicide at the ‘appropriate’ time" (Kavney, 1997), p. 130). Not only would financially interested people have motive but the patients themselves will be thinking of their family and the potential cost associated with simply straying alive. Sumner in a public lecture says "It’s not the killing the costs a lot of money its all the stuff keeping them alive".

Due to the focus on curing illness, there is a lot more that can be done when it comes to the caring side of the health professional. If there is no chance of a cure the focus needs to shift from finding a cure to providing care. Yet even if death becomes an acceptable medical option however, it does not mean it is an acceptable nursing option. So we must ask ourselves if it is possible for nurses to add this new medical procedure into their moral grounds. Fundamentally we must ask if assisted suicide can be considered carrying for the patient.

In 1980, the American Nurses Association (ANA) defined nursing as "the diagnosis and treatment of human responses to actual or potential health problems" (Potter & Perry, 1997, p. 216.)

The ANA Code for nurses outlines the decision of nurses as being grounded in objective ethical codes "The most fundamental of these principles is respect for persons" (ANA, 1985, p.1). These codes are based upon the autonomy of the patient as well as the good will of the nurse who will not bring harm to the patient The ethical problem nurses face is fundamentally a conflict in the ideas of autonomy of the patient and the duty to not bring harm to the patient.

Even if a law does pave the way to allow for assisted suicide, that law will not force health care providers to provide any treatment they do not feel comfortable with. The autonomy of the patient does not extend and encompass that of their doctor or nurse. Let me make it clear once again, the patients do not seek death. However, the other option is so unappealing that death is a much preferred situation. Furthermore it is the duty of health care professionals to provide care at the end of life.

If we focus effort on creating better end of life care we will have fewer requests for assisted suicide. However, "Nurses may provide interventions to relieve symptoms in the dying client even when the interventions entail substantial risks of hastening death" (ANA, 1985, p. 4). There are similar treatments currently accepted which nurses are required to perform. Despite the similar outcomes some maintain there is a strict difference. It is through the doctrine of double effect that shows unwanted effects do not out way the intended good effects even if the unwanted effect is death. Therefore health care professionals are able to seek comfort in their intensions of ending pain and improving quality of life. Intent is the important factor. Many health care providers believe this is where the line is to be drawn. If the action was intended to help then it will be allowed. Yet, if the same action is undertaken with the intension to end life then that action is unacceptable.

This discomfort with being a part of assisted suicide is tied closely to what the practice of health care professional stands for. Dedication to bringing about good health is the mind set of these providers, ending a patient’s life does not seem to fit that description. However, helping a patient with assisted suicide does not have to be required of health care providers. We might wonder if legalizing assisted suicide will give "an excuse" to health care professionals to not better the current end of life treatment. (Kaveny 1997 p.131) However, Sumner has stated in a guest lecture that the legalization of assisted suicide does the exact opposite. He has found that "you do not want to be that society that has people choosing death over trying to get better, so I have found that places where they have legalized assisted suicide they actually work harder on bettering their end of life policies".

The legal status is starting to change allowing nurses to engage in assisted suicide. This will put even more pressure on the ethical questions surrounding assisted suicide. Although the Rodriguez ruling did not find a right to assisted suicide, there is pressure on the law makers to put forth a law that allows for some instances of assisted suicide such as Oregon’s Death with Dignity Act. Recently we have a ruling that is pushing for limited legalization of assisted suicide in Carter v. Canada. However, it appears most nurses do not agree with assisted suicide. Wlody (1997) has looked at a few studies and found "common threads include the compassion nurses feel for patients’ suffering and the finding that most nurses state that they do not and would not participate in assisted suicide (or euthanasia)" (p. 75). A response to this objection would be, if it becomes legal it does not have to require any health care giver to provide the treatment.

The issue of assisted suicide is a problem that needs to be addressed, but not just by doctors. Patients and nurses need to be on the same page when it comes to this topic. When it comes down to it, assisted suicide is fundamentally a conflict between a care giver’s non-maleficence and the patient’s autonomy. Assisted suicide should not be our only focus as an option for terminal illness. We must also pursue palliative care that allow and end of life option where patients feel they still have dignity. If we want to bring down assisted suicide requests, we should look to the causes of these requests and try to make it easier for patients in that situation. It is the unchecked pain and losses of motor control that are the main reasons for assisted suicide request. If we can provide help with these issues in mind we can infer we will have fewer requests for assisted suicide. Despite the fear of a slippery slope the laws are beginning to change. Yet still healthcare providers, especially nurses, do not want assisted suicide to be a part of their job requirements. The ANA (1994) holds that "nurses are obliged to provide relief of suffering, comfort and, when possible, a death that is congruent with the values and desires of the dying person. Yet, nurses must uphold the ethical mandates of the profession and not participate in assisted suicide" (p. 5). Furthermore, The American Association of Critical-Care Nurses’ point of view is more unambiguous. Their position is that nurses should not participate in acts of assisted suicide and active euthanasia. Such acts are inconsistent with the ethical norms of the profession and undermine the integrity of individual practitioners and the care they render. (Asch)

In order to bring about a shift that allows for assisted suicide there needs to be more than simply a change in the laws. Clearly everyone involved needs to be on the same page when it comes to assisted suicide. I further support the idea for expansion in the field of palliative care to give patients a wide range of options. However, I must insist that despite the hesitation from the medical professional community and the worry that a slippery slope will lead to further assisted suicide eligibility. We cannot deny the people, who have only pain to look forward to, the right to die free from that pain. When there is no chance of getting better, death must be seen as the only way to relieve the pain and allow the patient to have autonomy right up until their death. Clearly a massive change in the mindset of health care practitioners will also need to change with the laws if we want to be able to practise safe assisted suicide. I conclude the same sentiments as the Royal Society of Canada and that is, "We need to plan for end of life personally and as a society". (RSC main message)

Work Cited

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