Physician Assisted Suicide or Hospice - Essay Example

 Physician Assisted Suicide or Hospice Informed consent is a commonly used term within the healthcare industry. Any trip to the hospital or doctor’s office in most cases, and should by law, always include the ethical practice of informed consent, “In the modern field of health law and bioethics, the doctrine of informed consent is about as classic a doctrine as we have.”(Mehlman, 1999). In actuality, the burden of responsibility lies within the hands of physicians, to properly ‘inform’ patients of any and all of their medical options pertinent to their ailments, diagnoses and/or health maintenance. What this essentially means is that once a patient is diagnosed, and prior to any medical intervention that follows, the patient must be educated not only about the details of their diagnosis but also on the subject of their treatment option(s). Once the information detailing treatment options has been explained, it is up to the patient to either be treated as per the doctor’s prescribed treatment and care plan, or to decline the treatment options altogether. A patient’s right to decline treatment is as strongly protected as said patient’s right to receive appropriate treatment and council as per the details of that treatment. One of the biggest reasons that informed consent is so crucial is because a patient is entitled to be afforded information which may be used to make an informed decision about their health care options or lack thereof, “Informed consent is the legal embodiment of the concept that each individual has the right to make decisions affecting his or her well-being. It is generally accepted that individuals should consider -- that is, trade-off -- the risks and potential benefits flowing from their decisions”(Merz, 2008). Medical ethics dictates what the rights of patients in fact are, when being medically diagnosed, counseled or treated. This means in part, that a patient is to be treated with dignity and autonomy as well as to be informed of and involved in their own medical treatment and decision making. Furthermore, is is the right of all patients as per the Hippocratic oath, to be treated with all fairness and to hae their life protected equally as any other individual’s life would be protected. In the event that the patient is unable to speak or make sound decisions about their health care, their legal guardian or caretaker must be informed of diagnosis and treatment as per informed consent on behalf of the patient, in order to decide what treatment is acceptable to the patient for whom they represent. Usually this individual who is responsible for the heath related decisions governing the patient in the event of the patient’s incapacitation, is known as that patient’s power of attorney. The patient’s spouse automatically assumes this responsibility unless otherwise stated in the patient’s living will. A living will names an individual or a group of individuals who are granted the legal power of making decisions concerning the patient, in the event of the patient’s incapacitation or inability to make sound decision. This is appropriately applied to patients who are placed on life support indefinitely, or for patients who have sustained brain damage to the point of permanent brain death. In addition to being an ethical principle which upholds the rights of the patient, informed consent also mandates that physicians must explain the benefits and risks of any and all treatment options. This is necessary in order to be sure that the patient is aware of what they can expect from the treatment or what medical side effects the treatment carries with it. In medicine, ensuring that patients are made aware of possible side effects or resulting circumstances due to treatment, allows for them to formulate their decision to either accept or decline treatment. Information and education provided by the health care professionals treating a patient, allow that patient to make a decision with the knowledge that either a prescribed treatment not only has side effects but also carries a risk of loss or damage to the body. In addition, patients should know what type of prognosis they will have based on a decision conducive to non-treatment. Some surgeries carry the risk of amputation or debilitation, this is an example of how critical informed consent really is. As a general rule, informed consent should resemble the following steps: Diagnosis from a physician which is then explained to the patient in a manner which they can understand. At this point, the patient should be told what treatment option(s) are available to him/her. This is including but not limited to the option to decline treatment. This may be the time to refer a patient if the patient is diagnosed with something requiring a specialist of some kind. The patient should be allowed to ask questions pertaining to their diagnosis, prognosis and treatment options. In cases where individuals are diagnosed with serious or life threatening diseases, treatment may be highly risky or invasive which may lead the patient to desire a brif time frame to discuss treatment with family members or others within their support network. At this juncture, the patient should be encouraged to make a decision in their treatment which must them be communicated in some way to his/her doctor. There are two types of informed consent. Implied consent is defined as under reasonable circumstances, if a patient alludes non verbally to give consent to his/her attending physician, then the act of informed consent has been completed.. An example of this is acting in a way that indicates that consent is being given such as providing an arm for blood panels to be drawn or other physical gestures indicative of consent. Implied consent is a relatively big issue in the arena of medicine and the law as well. In the event that one has been pulled over by an officer of the law, the simple act of driving a car automatically grants law enforcement officers the right to ascertain blood alcohol levels. Expressed consent is a more proactive means of obtaining a patient’s consent., as it is done in a written or verbal fashion. Informed consent is however, is not to be the responsibility of any health care individuals but the attending physician only. The attending physician is usually the head of a medical team mad is most qualified to relay to the patient, benefits and risks of treatment which are appropriate to diagnosis. If the attending physician has a medical student shadowing him/her, implied consent is still the sole responsibility of the attending physician. Medical students and other hospital personnel are not always granted the ability to act in place of a licensed physician, in attaining consent. In fact, if someone other than the doctor is explaining and obtaining consent, a medical mal practice law suit can result, particularly if the health care individual does not adequately explain possible risks due to lack of experience or high level medical training.. This is also the case for physicians who may forget to provide a patient with the treatment options prescribed, or who simply neglect to do so at all. Medicine is often a trade off. What this means is that in some instances, life saving or sustaining medications or procedures may be necessary but also carry a promise of adverse or even dangerous side effects. The question which physicians must ask themselves prior to prescribing treatment, is whether the benefits of a certain treatment outweighs the risks it carries. In some cases, it is better to accept the side affects of treatment as the diagnosis, if left untreated, will surely present a larger problem or risk to the patient than the somewhat adverse treatment plan would do. An example of this is chemo therapy. Chemo therapy is just as it sounds, chemicals which are used in a therapeutic capacity. The function of chemo therapy is to destroy cells within the body. This is because cancer cells are really body cells which have lost their cell cycle check point and hence, continue to undergo mitosis (cell division) unstoppably. Since chemo therapy actively destroys cells, it also destroys cancer cells. Certainly, this is a life extending or life saving treatment in many cases but it is also effective at causing patients to become quite ill. This is a severe case of adverse effects but serves to illustrate why physicians are held responsible for keeping patients informed including explanation of pros and cons of treatments. Consent can also present as what is know as ‘simple consent’. Simple consent is usually pertinent to treatments which are very minor in relatively healthy patients. Each time a trip to the pharmacy is made in order to fill prescriptions, that patient is actively providing simple consent to their attending doctor. The process of providing consent after the steps of informed consent have been completed, is not only in place for patient protection and autonomy but also, it provides the physician with a legal go ahead to peruse your treatment as per your approval. In cases of negligent malpractice, physicians have omitted expressing to patients, the drastic consequences or possible consequences of treatment. These types of instances have erupted into very large mal practice suits and in some cases, physicians have lost their medical liscence due to such things. In almost every doctor’s office today, patients will be asked to sign a form known as an implied consent form. This is a legal document meant to protect the physician from a lawsuit stemming from mal practice. It should be noted that implied consent is not simply an ideological and ethical value which is just commonly excepted, it is actually something in which laws have been made. Informed consent laws state that informed consent is a type of disclosure which make the patient aware of the element of probability or chance pertaining to their treatment options and diagnosis. Even if the chances of a specific risk is very minimal, it is the physician’s responsibility to disclose that information to the patient prior to administering said treatment. These laws apply to the need to disclose information about any sort of possible loss or injury which the patient is at risk of incurring, regardless of how small the risk may be. The topic of euthanasia has been widely controversial since the public trial of Dr. Jack Kevorkian. Kevorkian is known as the doctor who assisted his terminally ill patients in committing suicide in order to end their suffering. As a result, he lost his medical license and served time in prison for homicide. When discussing euthanasia, one can discuss the moral and medical differences between active and passive euthanasia. First of all, passive euthanasia is simply discontinuing or withholding medical treatment thus allowing the dependant, terminally ill patient to die. This method of euthanasia is in some cases, expectable if for example, a spouse allows for life support to be discontinued on a neurologically dead patient, as per the patient’s last will and testament. Active euthanasia is on the other hand illegal and classified as homicide if performed on one individual by another. In the case of Dr. Kevorkian, the use of a lethal injection was utilized to assist in the deaths of his terminal and suffering patients. The concept of assisted suicide is certainly similar in action to any other form of homicide but with an entirely different and surprisingly humane motive. From the standpoint of those who have deceased due to assisted suicide, the right to extinguish their own life due to suffering seems rather fundamental and humane. The Hippocratic oath taken by physicians however, clearly mandates that a physician’s capacity is to preserve and improve quality of life but in no way does it provide for the assistance in ending a terminally ill patient’s life prematurely regardless of the views or wishes of the patient. The following exert reflects the ethical standard established by the American Medical Association: The intentional termination of the life of one human being by another -mercy killing - is contrary to that for which the medical profession stands and is contrary to the policy of the American Medical Association. The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family. The advice and judgment of the physician should be freely available to the patient and/or his im­mediate family. The question of whether killing a person in an active manner is worse than allowing them to die, is a large part of the euthanasia argument. It is truly a matter of proactive versus non intervention, but both are intended acts of kindness. In some instances, one may be able to adequately justify active euthanasia by explaining that taking a passive approach would merely cause the patient more suffering. For example, let us assume that a patient is in the final stages of a life threatening illness, and will most assuredly die within days. By discontinuing the medical treatment sustaining the patient‘s life, the patient will also die just as if everything possible were continued on his/her behalf, “The traditional distinction between active and passive euthanasia requires critical analysis. The conventional doctrine is that there is such an important moral difference between the two that, although the lat­ter is sometimes permissible, the former is always forbidden”(Rachels, 2002). Having discontinued the treatment however, the patient experiences a much higher level of pain and consciousness in addition to an even longer duration of life (by hours or days). This form of passive euthanasia has then only served to prolong the patient’s suffering and has defeated its own purpose. Having taken an active approach to euthanasia, the physician could have arguably ended the patient’s suffering and discomfort in a rather quick and painless way, through the act of prescribing an injection of a lethal dose of opiate analgesic or potassium chloride (or various other medications or chemicals which in a proper dose, are immediately and painlessly lethal). At this point, it is necessary to make a distinction between physician assisted suicide and euthanasia. In the event of physician assisted suicide, the physician will knowingly provide the patient with the means to end their own life. An example of this is for the physician to prescribe a lethal dose of opiate pain medicine or potassium chloride (as mentioned previously) in order for the patient to self administer the prescribed agent with the intentions of ending their own life. Euthanasia however, is an event consisting of active participation on the part of the physician, such as in the case of the infamous Dr. Jack Kevorkian. Kevorkian actively administered lethal injections to his terminally ill patients, which resulted in their immediate and pain free death. In some cases, Kevorkian’s patients were physically incapacitated by their illness making it impossible for them to take part in their own suicide. Physician assisted suicide will be further discussed at a later portion of this paper, as the present topic is specifically euthanasia in both active and passive form. To clarify a clear understanding of euthanasia and the moral platform of the issue, it is necessary to first refer to the basis for proper medical ethics as well as the laws governing such ethics. As is the case with most laws which govern human rights and actions, the act of murder is not meant to be subjective or negotiable. Prior to even the consideration of the creed of conduct that governs the ethical practice of physicians, the very basic of laws set in stone for most parts of the world, dictate that knowingly participating in the death of another individual or unknowingly participating in the death of another individual but acting in negligence resulting in the death of another individual, is illegal and punishable by law. The laws established by the United Nations even dictate that a very basic human right, is the right to protection from homicide. Given these laws as a fundamental measure of human rights and conduct, it is essentially wrong for a human being to actively take part in the death of another human being. Additionally, it is wrong for a human being to be party to information about or to facilitate the death of another human being. Certainly, if there were allowances for degrees of freedom within these laws, aiding the terminally ill in a permanent end to suffering would be justifiably the chief exception to the law. There is however, no exception to this law on a basic human rights level nor on a legal level. This is largely pronounced in the case of physicians who are entrusted with the care of the lives of human beings. Granting exceptions in the case of murder is an extremely slippery slope. If it became legal or justifiable for physicians to actively induce the premature death of the terminally ill, other exceptions would begin to surface broadening the allowances for the act of murder or aiding and abetting in the event of murder. An example of this could be for law enforcement officers to begin actively making decisions followed by actions resulting in the death of individuals who are dubbed as menaces to society or ‘bad people’. Another example is that an increase in the occurrence of elderly extermination may increase drastically due to such allowances. Ultimately, the rules would change and suddenly, the very basic human right to life would become complexly compromised and redefined. This is not to say that individuals should not be able to make an educated decision in the continuation of medical care in certain and bleak medical prognosis. In conclusion regarding active and passive euthenasia, a patient’s personal and educated decision to discontinue their treatment is fundamentally their choice and no one else’s. If this remains the case, then the rights of the patient including but not limited to the patient’s autonomy and dignity, will be preserved and maintained. This is saying that passive euthanasia is an acceptable limit to the process of ending one’s own life for medical purposes. Beyond this, there are foreseeably, too many unacceptable risks and dangerous grey areas. This maintains that a physician’s active participation in a patient’s death, beyond the discontinuation of medical treatment, should be maintained as per the Hippocratic oath and the law of the land. Humanity and kindness are certainly a large part of holding the authority and position of a physician, but ‘playing god’ is not. Physicians, like everyone else, are human and are not always able to control or harness the decay of an already unfortunate situation. This includes the controlling or manipulating of the early demise of a patient, regardless of the patient’s wishes or unfortunate circumstances. It is now relevant to discuss physician assisted suicide. In contrast to active euthanasia, physician assisted suicide is precisely described as the physician treating the terminal patient, obtaining or prescribing a lethal dose of medication for said patient with full knowledge of the patient’s intentions to commit suicide. Unlike active euthanasia, the physician does not administer the medication and is typically not present when the medication is administered but the physician facilitates the patient with the effective and certain means to commit suicide. This is considered to be medically unethical and illegal. Even though the physician is not physically administering the injection and is not present at time of death, the physician may still be held accountable for the death of the patient. In the case of famed Dr. Kevorkian, both active euthanasia and physician assisted suicide took place. Kevorkian was charged with homicide when he aired a video displaying he and a patient prior to, during and after the patient’s lethal injection which Kevorkian actively administered. Despite the fact that the patient appeared to be fully aware of what was taking place, and was in full agreement with the events that followed, Kevorkian was still charged with criminal charges followed by an 8 year prison term. The argument made by Kevorkian and others in favor of either physician assisted suicide or active euthanasia, is that it is the right of the patient to request an end to their suffering. Certainly, this seems humane and justifiable to a point. But just as is the argument previously made in favor of protecting humanitarian laws which allocate all human beings the right to be protected from suicide, this too is a law which deserves upholding in the spirit of maintaining murder in any form as an extreme injustice with certain consequences. In so many legal arenas, allowances for exceptions are made with the intention of permitting extenuating circumstances to be justly dealt with. The act of murder however, is not such a case and in very few situations is it justifiable. This is not to say that those suffering from excruciatingly painful and drawn out illnesses should not have a right to seek an end to suffering, but it is saying that justifiable action on a physician’s part should not include anything which intentionally ends the life of the patient. The distinct difference between physician assisted suicide and active euthanasia is quite important if for no other reason than to better comprehend legal jargon and due process associated with the act. In 1997, a ruling associated with physician assisted suicide declared that it was unconstitutional and unlawful for a physician to provide patients with a means to prematurely end their life, “.It has always been a crime to assist a suicide in the State of Washington. The State's present law makes ‘[promoting a suicide attempt’ a felony, and provides: "A person is guilty of [that crime] when he knowingly causes or aids another person to attempt suicide”(The Supreme Court. 1997). This supreme court ruling based on the decision on the fourteenth amendment of the U.S. constitution. The fourteenth amendment allows for what is known as due process provided by the ‘due process clause‘. It was decided that since physician assisted suicide is not really the same as an individual who is sick and then commits suicide without the prior knowledge of said suicide on the part of the attending physician. The laws dictate that knowing before hand about a future suicide or attempt at one by a patient, puts the physician in a position of ethical and legal violation. The plaintiff in the case (Washington) also pointed out that patients who decidedly take their own life, can do so without the help of a physician. To properly argue that physician assisted suicide is unacceptable, is a difficult and unique subject. It is agreeably an act of kindness in motive but it still violates a very fundamental human right. Because of this, it simply can’t be reasonably condones. Beyond this, its approval and installation as protocol in terminal situations, would lead to an entirely new way of looking at the constitution. The acceptance of this event alone could spiral into other instances where murder or facilitation to murder might be acceptable. To briefly present a counter discussion on the topic, euthanasia is certainly a drastic step but is the only option in terminally ill patients who are no longer responding to any type of pain management or comfort measures. If one were to pull up court documents in cases where doctors have faced severe punishment for their participation in patients’ suicides, one would see justification upon the physician’s given reasons for having provided lethal doses of medication to terminal patients. Human suffering is certainly an acceptable reason for one to take one’s own life, and certainly a physician providing assistance in patient suicide is undoubtedly a humanitarian effort, but assisting in an individual’s death is simply not the job or task of the physician. In fact, the oaths taken by physicians make it abundantly clear that physicians are expected to support and extend life. There is no allowance within that oath for helping a patient die through active euthanasia, passive euthanasia or physician assisted suicide. Making ‘mercy killings’ legal is rewriting the law and the fourteenth amendment, which is not the place of either physicians or of the supreme court. Ultimately, choosing an end to one’s pain is certainly up to that person. The experience of suffering encountered by the terminally ill is indescribable to most of us as well as incomprehensible. Individuals who are unfamiliar of what it is like to be ill and dying, are hard pressed to make an ideal and empathetic decision as to the extent, if any, that physicians could theoretical go to act humanely and with kindness to an extremely ill patient. With that, it is for no one to decide or aid in the decided death of a terminal individual, except for that individual and perhaps their family members. Removing the legality and ethical ramifications of the subject momentarily, and only seeking the moral judgment call, it is inherently wrong to kill. Though laws around the globe vary, virtually every government in the world has recognized murder as a crime punishable by the law of the land. Arguably, this is a set moral which ‘good’ people adopt but there is exceptions to every rule. The subject of murder as a moral and mortal crime with gray areas is simply going too far. The act of murder is permanent unlike so many other crimes dealing with other people’s belongings, money and behavioral laws. Most of these things can be committed, with the remainder of a victim who eventually recovers. Murder is entered into by at least 2 people but upon completion, yields less people than its original actors. Works Cited: The American Cancer Society, (2008), “Informed consent”, retrieved from website at: http://www.cancer.org/docroot/ETO/content/ETO_1_2X_Informed_Consent.a sp Fink, M.D,. George H.(2001) “Last Acts: Jack Kevorkian, Physician Assisted Suicide or hospice”, retrieved from website at: http://www.dcmsonline.org/jax- medicine/2001journals/May2001/lastacts.htm Mehlman, Maxwell,. (1999) “Informed consent”, retrieved from website at: http://www.thedoctorwillseeyounow.com/articles/bioethics/consent_3/ Merz, John F. (2008) “An Empirical Analysis of the Medical Informed Consent Doctrine: Search for a "Standard" of Disclosure”, retrieved from website at: http://www.fplc.edu/risk/vol2/winter/merz.htm Rachels, James (2002) “Active and passive euthanasia”, retrieved from website at: http://www2.sunysuffolk.edu/pecorip/scccweb/etexts/deathanddying_text/Rach els_Active_Passive.htm ------, (2001) “Elements of medical conformed consent”, University of Virginia, retrieved from website at: http://www.med- ed.virginia.edu/courses/rad/consent/ The United States Supreme Court, (1997) “Washington vs. Glucksberg”, num 96- 110, retrieved from website at:http://www.med- ed.virginia.edu/courses/rad/consent/ Weingart Law firm, (2008) “Implied consent”, retrieved from website at: http://www.arizonaduilaw.com/PracticeAreas/Implied-Consent.asp -------------, (2008), “The Kevorkian interviews”, PBS online, http://www.pbs.org/wgbh/pages/frontline/kevorkian/ Read More