The Problem of Physician-Assisted Suicide - Case Study Example

Is physician assisted suicide ethical for terminally ill patients? Introduction In the medical world where there are so many incredible cures and miraculous recoveries there has been to an extent a long list of deaths that may or may not have been suicidal deaths by patients who have been terminally ill. In such cases what are the reasons and why patients wish to end their life has been a question which has many speculations. Physicians have been, on occasions, held responsible for leading a patient towards death but is that justifiable? Articles can be found on the ethical responsibilities of doctors towards their patients and reasons why they should be careful in noting the symptoms where they should understand that their patients are suffering from depression and that may lead them to go for a suicide attempt. Ethical laws and other considerations There are ethical laws that nowadays deal with such kind of deaths and obviously the physicians and doctors who are made to be responsible present their case as well. But considering the fact that illnesses which are not at all curable or take very long for a patient to recover from may in any case lead a patient towards an attempt suicide. Consider such basic illnesses like “HIV/AIDS, cancers of the brain and nervous system, and multiple sclerosis” lead to the suicide death rate increasing throughout. According to Kleespies, Hughes & Gallacher (2000), the rates of “major depression rise with increasing rates of serious medical illness; however, depression and associated suicidal ideation tend to be undertreated in the medically ill.” It is the time when such illnesses become life-threatening that the patients of the clinician are faced with very tough decisions of ending their life or not. In the United States there is a huge panic about the problem of physician-assisted suicide and ethics of end-of-life decision making. Among the medically ill the data on the occurrence of suicides are inadequate. (Hughes & Kleespies, 1998). However information shows that the popularity of medical illness amongst suicides varies from 30 to 40% (Mackenzie & Popkin, 1990; Whitlock, 1986). “Across 15 studies, Whitlock (1986) reported that an average of 34% of the suicides had a medical illness at the time of self-inflicted death, while Mackenzie and Popkin (1990) reported a mean of 43% across 11 studies”. Analysis of the studies showed that they used the psychological-autopsy method, and the amount of suicides in the greater part of them was greater than 100 (e.g., 170 completed suicides in the study by Jacobsen & Jacobsen, 1972). As discovered in the articles “Estimates of the prevalence of medical illness in these samples varied greatly from eighteen percent (Edwards & Whitlock, 1968a; 1968b) to seventy percent (Dorpat & Ripley, 1960; Stewart, 1960).” One thing for sure was that the major part of these surveys did not find a match or comparison amongst the group; however, the other studies found results that were quite simila. Thus, “Chynoweth, Tonge, and Armstrong (1980), in Australia, and Whitlock (1986), in England and Wales”, made a comparison of the specific rates of disorders among suicidal cases with those of the disorders found in the common group, which has been recorded in the “Morbidity Statistics from General Practice (1979).” In a case “The traditional account of ethics and law at the end of life and its discontent”, the author talks about a doctor in Melbourne who quietly or not so quietly assists the terminally ill patients in dying. He was also known as one of the best activists for the right to assistance-in-dying. Another case tells a story about a 45 year-old man who was denoted for evaluation of depression by his primary-care physician. He said that in an attempt to kill himself he took two extra tablets of antidepressants and this state of his was because he had multiple sclerosis which was informed to him some months ago by his neurologist. The report will further discuss all such areas and then present a conclusion on the topic selected. Beginning the discussion and analysis of the said topic the first point that needs serious consideration is to see what may be the factors that play a role in making a patient attempt suicide. As discussed in an article there are several illnesses that may lead patients to fall into severe depression. Patients suffering from aids, cancer, amputation, brain and nerve disorders or illnesses are some of the examples where they try to attempt suicide. As discussed in the introduction the 45 year old patient attempting suicide case can be further understood by reviewing what a neurologists suggests with reference to the case. According to the view given by a team of researchers “Patients such as this one retell the clinician who works in a behavioral-medicine or consultation–liaison service that it is vital to know what relationship there may be between medical illness and suicide.” Subsequently “suicide” is regarded as a “multidetermined event” (Maris, Berman, Maltsberger, & Yufit, 1992), there is a very unlikely chance of having a basic “one-to-one relationship”. To an extent there is not sufficient work available in the research area that would help in identifying or accusing a person’s “medical illness as the only determining factor of suicide (Hughes & Kleespies, 1998)”. As suggested by Harris & Barraclough, 1994, “There are, however, certain medical illnesses with suicide rates that beat the general population rate”, and in words of Stenager & Stenager, 1992, “these medical illnesses can be prominent elements in suicide.” To further strengthen this point, one must consider the fact that as soon as an illness is prolonged or takes a terminal turn any medicine related to behavior given by the physician or clinician may result in finding his, her patient being forced in making tough decisions about ending their lives, even considering suicide. Investigators consider the risk of suicide for patients having HIV/AIDS to be relative amongst the patients some 30 percent or so cases have been identified. However, the number has substantially decreased when the cure and treatment of HIV/AIDS at an early stage was announced. It may have had some psychological relief to the people who may have been threatened by this disease. Another significant area is that of Brain and nervous system cancers. It also indicates a relativeness of patients towards attempts for suicide. Researchers found that “the rates of death by suicide were 9 times higher in persons with malignant neoplasms of the head and neck than in the general population, and about 4 times higher than in persons with other cancers. Other studies have found persons with cranial tumors at increased risk of suicide relative to the general population (Stenager & Stenager, 1992).” The article suggests how the role of psychiatrist is essential even while the treatment is under process. The idea of helping “patients and their families” to understand and come to terms with the condition of the patients may lessen the prospect that they will try to attempt suicide. Under the facts that are provided in another article it is not difficult to formulate an opinion that the physicians or clinicians are to an extent responsible for the deaths of their patients. In a case already mentioned in the beginning of this report where it was found out how a doctor had been involved in the deaths, it becomes clear that the doctors feel that the death of such a patient who is to die eventually is not criminal or unethical. Although the law in no way allows such a death. If this death has taken place with the consent or suggestion of a patient’s own physician than one feels an injustice on the doctors part. Consider the following “Physicians draw conclusions on a body of specialized, technical (clinical) knowledge from which society is largely omitted. How can law help to preserve trust in the medical profession when it cannot second-guess doctors’ technical expertise, and where the things that doctors do in end-of-life care are essentially ambiguous, and hidden from the gaze of the community? Large doses of analgesics and sedatives are managed, life-support is withdrawn, and patients do die! The answer is that law imposes a kind of virtue ethic on the profession: doctors must practice their craft with pure intentions! (Beauchamp and Childress 1994, 62–4). Physicians are exposed to the risk of criminal liability in circumstances where their intent was to hasten death, as distinct from relieving distressing symptoms.” For and Against Interesting views are found on the website of a Medical School in Washington. (See the link below for details). The University of Washington School of Medicine website provides arguments in favor and against the topic under discussion here. Viewing both the arguments one may be left on their own belief in the ethics to justify the act of a physician or to blame them completely. The argument in favor discusses briefly 5 points that are as follows: 1. Respect for autonomy 2. Justice 3. Compassion 4. Individual liberty versus state interest 5. Openness of discussion The strongest point of this argument is “Justice”. It suggests that "treat like cases alike." This falls in the category of “Principlism”; a term that is commonly used when referencing to the Bioethical context of these cases. “Competent, terminally ill patients are allowed to hasten death by treatment refusal. For some patients, treatment refusal will not suffice to hasten death; only option is suicide. Justice requires that we should allow assisted death for these patients.” The points that represent the unfavorable argument are as follows: 1. Sanctity of life 2. Passive vs. Active distinction 3. Potential for abuse 4. Professional integrity 5. Fallibility of the Profession From amongst these points the strongest one that would also base towards the conclusion is the fourth one. Here comes the choice that the person who becomes a doctor has taken and that too willfully. The argument suggests that it is totally hypocrite on behalf of the doctor who at one stage has taken an oath "I will not administer poison to anyone where asked," and "Be of benefit, or at least do no harm." Amongst several cases that have been studied one shows how a doctor feels confused within the social, ethical and professional responsibilities while giving a drug to his patient. Although his main concern here is that his patient could at least fully live what may be left of her life. Another argues that it is better to let the person make the best of the time that is left instead of being under the toxic effects of the medication. This enables the person to enjoy and in some cases extends the time that they have (Syme and Quill; Bioethical Inquiry 2009). Where the blame lies? An example that can be viewed at the University of Washington School of Medicine website tells about the physician who assisted a lady in her willing suicide. It is contradictory to the above taken oath in the medical profession. The story says that the retired doctor was found to be guilty of this obstinate murder in the year 2000. The doctor himself confessed of having given “an overdose of morphine to a woman chronically ill after 20 years with MS who begged for his help.” The result of this help was the cancellation of his license to practice nonetheless he did not go to jail. Although he had repeatedly appealed his case even straight up to the “Supreme Court” he lost every time. “Dr. Sandsdalen died at 82 and his funeral was packed with Norway’s dignitaries, which is consistent with the support always given by intellectuals to euthanasia.” Thus doctors are said to be using medical overdose and putting their patients into deep sleep or unconsciousness which leads to their deprivation of food and finally to death. In many cases however the patients who suffer from such terminal diseases like Aids or cancer have been known to live longer than initially suggested by their doctors. This as many would say is the will to live; however many of the patients refuse to exert their will as they are shunned by the society and they wish to end their life as they cannot face the daily humiliation and disregard from even their close ones. Conclusion Doctors have to be more person than just mechanics of body. In truth the code of ethics or the social responsibility that they have agreed to withhold is too great to let go because someone pleas for death. The major need that has been identified in the discussion is for the physician/clinician is “Treat the person not the disease.” They have to make the person suffering from an incurable disease to learn to love life and what may be left of it. Referring them to psychiatrists at the right time can be helpful and may save lives of people suffering from depression. Administering the dosage of these patients, so that it does not push them towards willful suicide. These doctors have their social responsibilities and to recognize them is as much important. However, they can’t be blamed as some can do only what they are limited to do. They act in a manner which seems cold to any normal person but that is due to the fact that they face these issues on daily basis and their mind have become used to it unlike us. This report has on a major scale considered the acts of physician in both aspects of being ethical or unethical and the debate still continues. It actually is up to the person assessing the scenario and what beliefs do he/she upholds in this respect. Doctors are humans too and at times they may succumb to the pleas and the begging of their patients to end their misery. They may give in to the compassion even knowing it is against their professional integrity. References Kleespies, P.M., Hughes, D.H., & Gallacher, F.P. (2000). Suicide in the medically and terminally Ill: Psychological and ethical considerations. Journal of Clinical Psychology, 56(9): 1153–1171. Humphry, D. (2005). Tread Carefully When You Help to Die. [Online] Available at: http://www.assistedsuicide.org/suicide_laws.html [Accessed 23 February 2010]. Magnusson, R.S. (2009). The traditional account of ethics and law at the end of life – and its discontents. Journal of Bioethical Inquiry (2009) 6(3): 307-324. University of Washington School of Medicine. (n.d.). Physician-Assisted Suicide. [Online] Available at: http://depts.washington.edu/bioethx/topics/pas.html [Accessed 23 February 2010]. Read More