Should Doctors Help Patients Die?
Physician assisted death has always been a controversial issue in the United States that some view as a moral, ethical, religious, and legal issue. In any discussion about physician assisted suicide it is important that the terminology is clear. Physician assisted death is the procedure that a patient dies as a result of the voluntary ingestion of a fatal dose of medication that a physician has prescribed for that purpose.
Assisted death is distinguished from euthanasia in that it necessarily involved an individual who is capable physically of taking his or her life and does so with means provided by another person.
Physician assisted death was legalized through Oregon’s death with Dignity Act in 1994 and enacted in 1997. This act allows terminally ill patients to obtain and use prescriptions to self-administer lethal doses of medications. Although it is still rare in the state, between fourteen and forty-six people die each year by physician assisted death (PAD). Oregon’s Death with Dignity Act allows us to evaluate the law assessing the arguments towards whether or not physician assisted death should be legalized.
Most of Oregon’s health’s professionals may agree with the patient’s request but they lack intimate knowledge on their values and reasoning for their choices. The organization, Compassion and Choices of Oregon, is dedicated to expanding the choices at the end of life, and offers guidance and support to those who qualify for physician assisted death. Compassions and Choices of Oregon, evaluates feedback from family members to obtain information on why they felt their family members decided to fulfill their PAD request.
According to families results, with the top median score, the most important reasons patients pursued PAD request, patients wanted to control the circumstance of death and die at home, they worried about loss of dignity, future loss of independence, quality of life, and self-care ability. Ganzini, Goy, & Dobscha propose if there is better end of life care in homes helping patients maintain control, independence, and self-care in a home environment this may be en effective means of addressing some serious request for physician assisted deaths.
Interventions can help patients determine if they can deal with symptoms and make them feel more comfortable helping them to make their decision. Some argue that patients are depressed; lack social support, and vulnerable groups turn to PAD as their only last option. Although the Death with Dignity Act empowers individuals to control the timing of their death, physician assisted death still remains a controversial topic in today’s society that raises many ethical questions. Choosing their circumstances of death.
The Oregon act went through many obstacles when implementing the law to make safeguards to ensure that the law provides requirements so that it will not be abused. A major concern is about laws allowing physician assisted death is that they would open floodgates of people requesting such assistance, therefore causing a “slippery slop effect”. “The Health Division Report indicated that in 1998,23 people received such prescriptions, 15 of whom used them in hastening death during a person in which approximately 28,900 people died in Oregon. These numbers suggest that only an extremely small percentage of people (. 5% or 5 people in 100,000) who dies in Oregon received assistance under the act. “ (Batavia, 2000). Patients who are applying for the use of physician-assisted death will have to follow strict regulations and have physicians, therapist, and family members consent to the choice of the patient. All patients and health care professionals have to commit that they will be in full compliance with the law and follow the procedures. Debates over the PAD also often warn of a “slippery slope” predicting abuse of vulnerable groups such as poor people, minorities, depression, women, and uninsured individuals.
Depression can often develop among terminally ill patients when they start to loss their ability to care for themselves. According to Gazini, Goy, & Dobscha (2007) study on family members show no indication that the desire for hastened death has no association with depression or depression disorder. Oregon’s law requires that the patients must have a mental health evaluation to make certain that they are not suffering from any mental illnesses. Battin, et at, (2007) research the different vulnerable groups showing that there is no heightened risk among uninsured people, women, elderly, poor, and low educational status. Terminally ill college graduates in Oregon were 7. 6 times more likely to die with physician assistance than those without a high school diploma. ” The research is completed among people living in the Netherlands and Oregon where physician assisted death is legal and practiced. From data of patients over the years they show no increase among requests among vulnerable groups. One of the most obvious arguments is that health care providers are supposed to save lives—not take them. (de Vocht & Nyatanga, 2007). The Hippocratic oath is one of the oldest documents that are still sacred by physicians.
It was created to ensure that health care professionals would treat the ill to the best of their abilities, protect the privacy of their patients, and teach the secrets of medicine to future generations. “I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them. ” The Hippocratic oath is a doctors contract, in other words this statement can be interpreted as “do not harm. ” Helping a patient take their life is a contradicting question if physicians are violating the Oath.
Is a doctor assisting harm on a patient if they choose physician assisted death? Or is it causing harm to a patient to keep them alive suffering if they wish different? “Nurses witness firsthand the devastating effects of debilitation and life-threatening disease that are often confronted with the despair and exhaustion of patients and families” and “at times, it may be difficult to find s balance between the preservation of life and the facilitation of a dignified death” (ANA, 1994) Terminally ill patients are given medication to treat and relieve them from the pain of the illness.
Patients go through the stages of disease that health care professionals do not have medications that will relieve them of all their symptoms, pain, and harm, but they do have medications they will allow patients to end the harm and choose their death. Physicians have the right to administer medications to allow patients chose their death. Increased doses of controlled substances allows the patients to die at peace and the way they choose instead of suffering in the last phases of life. The Hippocratic oath also allows health professionals to use their judgment when treating patients.
Under the Oregon Death with Dignity Act physicians have to sign off that the patient is suffering and terminally ill, if a doctor feels that they can preserve the life of the patient they have the right to use their judgment to refuse to participate in the PAD. This is their moral right to decide if they are willing to prescribe medications to a request PAD patient if it is legal in the state. This is a time where physicians need to know how to “switch their focus from quantity, to quality of life”(LaDuke, 2006).
Health care professionals should not feel quality for completing the desires of patients and doing their job. Ganzini, Goy, & Dobscha, (2007) purpose that if clinicians should focus on improving end of life care addressing worries and apprehension about the future with the goal of reducing anxiety about the dying process. Addressing patients concerns we can create interventions to help along the process. In contrast, patients who request Death with Dignity are already in high-quality palliative care. We assume they hospice programs have little to do with the patients assisted death choice.
Most patients have already made up there minds whether they have been in hospice care or not. Although hospice care can improve ones quality of life, it still does not change the patients choosing their circumstances of death. By any standard the first year of the Oregon Death and Dignity Act would be considered a success. This success has made other states look into legalizing physician-assisted death. In 1997, the court case Washington v. Glucksberg decided that Oregon’s Death with Dignity Act would go into effect. Eleven years later others states followed the suit, through different approaches. In 2008, Washington voters adopted a right to die initiative and a Montana judge ruled that individuals had the right to hasten their death under the states constitution. ” (Kirtley, 20011). Supporters of the Washington Death with Dignity Act organized a committee of supporters. This committee felt their chances of success were good because of similar demographics in Oregon and Washington. The eleven years between the passings of Oregon’s Act allowed people of Washington consider the facts and make their own approach to the purposing of the Act.
Novembers 2008 Washington voters approved the Death with Dignity Act, and people claimed “other states would fall like dominoes”. Following in Washington’s footsteps, a month later Montana legalized hastened death. The Montana Supreme court ruled on December 31, 2009 that nothing in the state constitution prevented patients from hastening their deaths and gave doctors the right to prescribe lethal medications. Americans now have more options for dying than they did in 1997. We know have Hospice, Palliative care, hysicians can legally pursue aggressive pain management, and states can now pass aid in dying laws. Patients may discontinue life-sustaining therapies, or voluntarily stop eating and drinking as a natural part of the dying process, and lethal prescriptions. Most important we are allowing patients to have choices to allow them to deal with their end of life care and how they wish to die. In the book Narrative Matters there is a story about a young doctor Alok Khorana who is coming to the end of his shift after working long hours to save up time for her wedding the next day.
Alok is faced with a tough situation when Mr. Kohl comes in one of his patients and has to consider end-of-life decisions. Mr. Kohl her patient is a 53 year old white male, Vietnam veteran, steel plant worker, smoker, lung cancer, that has failed two different chemotherapy regiments and his last few scans have shown and impressive disease progression. Mr. Kohl had attended a doctor’s appointment and the doctor noted shortness of breath and the need of urgent hospital care. In medical terms this means it is basically better of that he would die in the hospital and should have been on hospice care.
Alok is trying to talk the man into considering a DNR and let him know that this he might not make it much longer than a day or two. Mr. Kohl does not have any children and just has a wife named Ann. As much as Alok tries to convince Mr. Kohl to consider DNR he will not even consider it because he promised Ann he would not go without seeing her. They monitor him for a few hours trying to keep him as pain free as he can. The nurses and staff let the man know that there will not be a lot they can do for him with all of his health conditions and him suffering from pneumonia.
They provide him with information about DNR and how they think it will be his best choice. He will not give in and says he is not giving up he told him wife he will do everything he can. After some time Mr. Kohl’s lungs begin to collapse and he is hooked up to a ventilation machine to help his lungs work correctly. As his wife Ann is on her way he than is given the option to be administered enough oxygen to keep him a live without a machine for a little longer. Mr. Kohl knows what is about to happen to him, and how his medical condition cannot be reversed.
He decides to hang on and do what ever he can for the love of his wife. He promised her he would be able to see her before he goes, and than he will be ready to die. Although Mr. Kohl did not receive a physician assisted death procedure, he shares a lot of the same concerns that was researched for why patients decide when they are ready to die. Mrs. Kohl finally shows up to the hospital clasps his hands tightly, the heart monitor machines are shut off, and the morphine is administered for comfort. Mr. Kohl’s breathes start to slow down and he drifts into sleep.
Alok the doctor on duty witnessed a powerful life story that night on her shift. On his way home the day before her marriage she looks over Mr. Kohl’s struggle to hang on for life. Although he was aware of his conditions and that he will not make it much longer he wanted the comfort of his wife. Alok realizes that after years of struggles with his soon to be wife one day when he is dying, she will come in and tell him its OK to die. He will listen, and it will be okay. For many patients who consider physician-assisted death there main reasons are to control there situation of death.
Mr. Kohl was so persistant on not choosing DNR because he just wanted to control his situation and wanted his wife to be on his side. Once she was there he made his decision and he than was ready to go. Physician assisted death will always be a contradicted topic when discussing the tampering of a human life, but it is present that this Act has had no present negative effects. When laws are set up to assist patients desires to choose the end of life care, physicians should feel they are following patients request and their job, they have the right to help patients choose their death.
Legalization has to protect both of the rights of terminally ill patients who wish to die, and patients who do not. This will always be a sensitive that will differ with each state exploring the aspects of moral, ethical, and legal concerns. Work Cited Ganzini, L. , Goy, E. , & Dobscha, S. (2008). Why Oregon patients request assisted death: family members’ views. Journal Of General Internal Medicine, 23(2), 154-157. Battin, P. M. , Heide. A. , Ganzini, L. , Wal, G. , ; Onwuteaka-Philipsen, B. P. (2007) Legal physician-assisted dying in Oregon and the Netherlands:
Evidence concerning the Impact on Patients in “Vulnerable” Groups. Journal of Medical Ethics,33(10), 591-597. Batavia, A. I. (2000). So far so good: Observations on the first year of Oregon’s Death with Dignity Act. Psychology, Public Policy, And Law, 6(2), 291-304. Mathes, M. (2004). Ethics, law, and policy. Assisted suicide and nursing ethics. MEDSURG Nursing, 13(4), 261-264. Howard, R. J. (2006). We Have an Obligation to Provide Organs for Transplantation After We Die. American Journal Of Transplantation, 6(8), 1786-1789.