Physician Assisted Suicide The Controversy Law Medical Essay

Published Date: 02 Nov 2017

Nicole M. Pasquale

SOC 120

Dr. Chishamiso T. Rowley

The topic I have chosen for my Final Reflective Paper is "Physician Assisted Suicide". I believe that this topic has many different ethical questions upon which need to be answered or at least thought upon. I will do my best to present the pros and cons of this ongoing debate and whether or not it should be legalized in all 50 states. But first we need to understand what this topic actually means.

What is Physician-Assisted Suicide? In any discussion of physician-assisted suicide or euthanasia, it is important that the terminology is clear. Although they may have similar goals, physician-assisted suicide and euthanasia differ in whether or not the physician participates in the action that finally ends life: In Physician-assisted suicide the physician provides the necessary means or information, the patient performs the act. In Euthanasia: The physician performs the intervention. Euthanasia is defined as "the act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy". (Lurie, 2004)

Suicide has generally been regarded in Western history as wrong and even evil. In fact, it has traditionally been regarded as a serious sin by the Roman Catholic Church and by most of the Protestant denominations that have arisen since the Reformation. Other cultures have not always branded it as evil, however. In Japan, for example, there is a long history of what is known as "honorable suicide." The view concerning honorable suicide is that in some cases it is more honorable to commit suicide than it would be to live on in shame. Even in Western culture, if we examine the beliefs of ancient Greece we will encounter the Stoic school of philosophy that expounds the view that inner tranquility is the most important thing in life. Consequently, the Stoics taught that although a wise person will aim to maintain inner peace – even in the face of external adversity – the rational thing to do, in some severe cases, is to end one’s life. The door, they believed, was always open.

We face a dilemma today that is related to the Stoics’ ideas. On the one hand, physicians and medical personnel want to maintain a patient’s health and inner tranquility. They want to relieve pain and suffering as much as possible. But with advances in medical knowledge and the ever-increasing use of times years in situations where, in the past, the patient would have died. In one sense, this is a great success story for medicine. But in another sense, one may wonder how much of a success it is. It is currently possible for patients to be kept alive on machines for longer than the time after which they would have naturally died. And during this additional time, the patient does not have a strong quality of life; on the contrary, the patient ends up deteriorating more and more, until finally medical science can do no more and the patient dies.

Many people are in denial about dying. Even physicians sometimes seem to be in denial. If a physician always counts the death of a patient as a "failure," there is denial. Physicians might feel that it is their job to "save life." But another way of looking at this situation is to say that it is the physician’s job to help us into, through and out of this world.

Patients themselves are wary of the treatments that they might receive at the end of live. There comes a point, some would say, when the imposition of medical technology, which is supposed to help promote "inner tranquility," is actually disruptive of inner tranquility. They might maintain along with the Stoics that at some point positively choosing death is the rational thing to do. And if that is indeed their choice, then they may well be in need of medical assistance in actually bringing it about.

Many people agree that there are horrifying situations at the end of life which cry out for the help of a doctor to end the suffering by providing a peaceful, wished for death. But, many others would argue that does not mean that the practice be legalized. They contend that these are the exceptional cases from which bad law can result.

I disagree. It is precisely these kinds of hard deaths that people fear and that happen to 7 to 10 percent of those who are dying that convince them to support the right to choose a hastened death with medical assistance. A poll in this country and other countries showed that 60 to 80 percent of people support the legalization of assisted suicide is that people want to know they will have a way out if their suffering becomes too great. They dread losing control not only of their bodies, but of what will happen to them in the medical system.

It is not pain that causes people to ask for a quick death but the indignities and suffering accompanying some terminal disease such as cancer, stroke and AIDS. The primary reason to choose help in dying is to avoid "senseless suffering."

We have the right to commit suicide and the right to refuse unwanted medical treatment, including food and water. But what we don’t have, unless we live in Oregon, is the right to get help from a doctor to achieve a peaceful death. As the trial judge in the Florida case Kirscher vs McIver, an AIDS patient who wanted his doctor’s help in dying, said in his decision: "Physicians are permitted to assist their terminal patients by disconnecting life support or by prescribing medication to ease their starvation. Yet medications to produce a quick death, free of pain and protracted agony, are prohibited. This is a difference without distinction."

The Oregon example has shown us that, although a rather large number of people want to know the choice is there, only a small number will actually take advantage of it. During the first eight months of the Oregon "Death with Dignity" law, only 10 people took the opportunity to obtain the medications and eight used them to end their lives.

To the credit of the right-to-die movement, end-of-life care has improved because of the push for assisted dying. In Oregon, end-of-life care is the best in the country: Oregon is Number 1 in morphine use, twice as many people there use hospice as the national average and more people die at home than in the hospital.

It is gratifying that the specter of assisted dying has spurred such concern for care at the end of life. Clearly, if we take the pressure off, the issue will disappear back into the closet. No matter how good the care gets, there still will be a need to have an assisted death as one choice. The better the care gets, the less that need will exist.

Making physician assisted suicide lean as a matter of public policy will accomplish several objectives. Right now we have a model of prohibition. There is an underground cadre of doctors, of whom Kevorkian was the tip of the iceberg, who are helping people die. The number varies, according to surveys from 6 to 16 percent to 20 to 53 percent. There is some information that the majority of these deaths were done by lethal injection. If this practice is regulated, there will be more uniformity, doctors will be able to and will have to obtain a second opinion and will have the option of having a mental-health professional consult on the case. More importantly for patients, they will be able to talk about all their options openly with their health-care providers and their loved ones. The biggest consideration is that terminally ill patients won’t have to die the way someone else want them to die, rather they would get to die the way they choose.

An important argument against legalizing physician assisted suicide is that many physicians themselves do not support the practice. Despite the efforts of a few physicians in legal actions and renegade actions of Jack Kevorkian, the majority of physicians, as well as the organizations that license and represent the interest of physicians, continue to oppose legalization.

Many physicians and others, are concerned that assisted suicide has never been a part of medical practice, and they would not like to see it made a part of practice. Legalization also poses the threat that suicide will become seen as an acceptable substitute for treatment, which could reduce public support for medical research into cures for serious illnesses. If suicide were to become more acceptable, many worry that minorities, the elderly and other groups who receive substandard care will be more often pressured into suicide.

Many physicians are concerned that if more members of their profession begin to participate in suicides, and the practice is legitimized, then integrity of the medical profession will be compromised and people will lose their faith in doctors. Laws in each state regulate the practice of medicine. Additionally, the medical profession, through the American Medical Association and the state medical boards, has established a code of conduct that regulates what a doctor can and cannot do, often placing more restrictions on doctors than the laws on the books do.

The first code of conduct for the medical profession was the Hippocratic Oath. Hippocrates was a physician in ancient Greece who is considered by many to be the "father of medicine," even though medical practice at that time was vastly different from today’s practice. One thing that has not change is Hippocrates oath against physician-assisted suicide:

I will follow that system of regimen which, according to my ability and judgment, I consider for the benefits of my patients, and abstain from whatever is deleterious and

mischievous. I will give no deadly medicine to any one if asked, nor suggested any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.

Although for legal and societal reasons, United States physicians are no longer barred

from performing abortions, the American Medical Association continues to maintain steadfast opposition to physician-assisted suicide in its code of ethics, calling the practice "fundamentally incompatible with the physician’s role as healer." In explaining that regardless of the origins of the Hippocratic Oath it is still important for physicians to abstain from assisting in suicide. Philosophy professor Bernard Bauman wrote:

"It is not merely qua physician that one most not deliberately endanger others under the guise of doing medicine, but that a physician is to always be a champion of life and health . . . Public perception binds the practitioner as tightly as an oath."

In other words, physician-assisted suicide threatens both the moral integrity and the

reputation of the medical profession, which is important in maintaining public trust. The medical profession certainly does not want to see a proliferation of "suicide specialists" like Jack Kevorkian. The American Medical Association and state medical boards constantly police physicians, trying to prevent practices that twist the traditional doctor-patient relationship. For example, state medical boards have taken action against physicians who have written excessive numbers of prescriptions for painkillers.

It is suggested that only a small percentage of people have terminal illness that really are incurable. However, this claim asks the question of what could be done to make the percentage of people with incurable illnesses even smaller.

Many people, whose illnesses might have been considered incurable a century ago, or even 20 years ago, now have hope for recovery thanks to advances in the medical field.

Opponents of physician-assisted suicide question whether these advances have been made if the approach of the medical community had been to ensure a quick and painless death rather than to do whatever was possible to save the patient’s life.

In medical research the United States is considered the leader. Through private donations and federal research funding, physicians and researchers have aggressively pursued research for treatments that will prolong and improve the quality of the lives of people suffering from diseases such as various forms of cancer, liver failure, heart disease, respiratory ailments and many other illnesses. Much of the advancement is the result of dedicated advocacy by individuals suffering from illnesses, as well as groups such as the American Heart Association, American Liver Foundation, and the National Associate of People with AIDS.

Although medical research continues onward, many people will continue to die from serious diseases, but not all of these people are willing to consider suicide as an option, even if a cure is impossible. These people want and deserve access to the most advanced palliative care and hospice care that attends to the physical, psychological and spiritual needs specific to the end of human life. Great advances have been made in pain relief and hospice care has been developed in response to the public’s concern about the lack of emotional support and comfort in a patient’s final days. Opponents of physician-assisted suicide worry that if the public begins to accept suicide as an acceptable option, than improvements in palliative and hospice care will no longer be seen as a priority.