Analysis of an Ethical Conflict in Practice - Research Paper Example

Running head: Physician-assisted suicide Physician-assisted suicide (school) Physician assisted suicide is filled with unresolved issues. It is a practice which was proposed as a better alternative to euthanasia, wherein the patient requests for a medication to end his life and the physician prescribes such medication. These patients suffer from the debilitating effects of a terminal disease, hence the request. Supporters of assisted suicide proclaim that a person has a right to die and to die with dignity. Opponents of the practice however insist that assisted suicide must also be considered in the context of other ethical values and principles. I personally believe that based on the various ethical principles, that assisted suicide must not be legalized. Measures to resist its passage into law are being proposed in this paper, along with active measures to advocate for patient’s lives – not their death. Physician-assisted Suicide Introduction Physician-assisted suicide is one of the most controversial issues in health care today. It is an issue which straddles both the legal and ethical planes of health care practice; it is also an issue which is not likely to be fully resolved even with the application of legal provisions and accepted ethical principles. This paper shall discuss the ethical issues in assisted suicide. It shall identify its stakeholders, along with their claims and interests. This paper shall also describe this student’s final ethical position on the resolution of the conflict. A specific moral action shall also be presented in this paper in the hope of coming up with a clear and comprehensive understanding of this subject matter. Discussion Background of the study Physician-assisted suicide is defined as the “voluntary termination of one’s own life by the administration of a lethal substance with the direct or indirect assistance of a physician” (Medicine.net, 2004). It is the practice of giving a fully competent patient medication in order to end his or her life. The state of Oregon is the only state in the US which has legalized this practice. It has allowed terminally ill residents to receive and obtain prescriptions from their physicians and later to take these medications to end their lives. Assisted suicide is a practice which is differentiated from euthanasia in the sense that, in euthanasia, the physician is the one who administers the medication in order to end the patient’s life. There may or may not be knowledge or consent on the patient’s part. In assisted suicide, the will and request to commit suicide comes from the patients, and the physician’s role is to assists in the process (Medicine.net, 2004). Physician-assisted suicide is associated with the long-standing debate on a person’s right to die, especially in cases of painful terminal diseases (Pickert, 2009). The Judeo-Christian societies have emphasized the importance of the commandment – ‘thou shall not kill’ as their basis for not supporting euthanasia, and by association, physician-assisted suicide. Throughout the years, different countries have been conflicted in providing any support for this practice, with some nations legalizing it, and others, criminalizing it (Pickert, 2009). Different cases of patients committing suicide because of their unbearable symptoms have been publicized throughout the years and these cases form the basis for those who argue on one side (or the other) of the issue. In one case, a man who was terminally ill apparently committed suicide and was helped by his family to carry out the act. No charges were filed against the family (Pickert, 2009). In another case, a group of individuals in Atlanta apparently assisted a man in committing suicide and authorities later investigated the case as a homicide. Another man also committed suicide because he was informed of his terminal illness. It later turned out that he did not have a terminal illness (Pickert, 2009). The case of Dr. Kevorkian, also known as ‘Dr. Death,’ will forever be considered the landmark case for euthanasia and assisted suicide. In one of his assisted suicides, he was deemed guilty by the courts and later sent to prison. The world was also fascinated by the case of Terry Schiavo who was in a vegetative state and was the subject of contention between her parents – who wanted to keep her alive because they believed that her will to live was strong – and her husband – who claimed that his wife did not want to be kept alive anymore (Pickert, 2009). Her husband won the legal battle and her breathing and feeding tubes were later removed. Other similar cases have captured our attention throughout the years and the major argument has always revolved around a person’s right to die, a person’s right to self-determination, and a person’s right to die with dignity (Picket, 2009). So far, in the United States, these rights have not yet been firmly used to support assisted suicide and euthanasia. The primary provisions of the law and of ethical practices in the medical field still emphasize that assisted suicide is punishable by the law. From the perspective of the medical practitioners, this issue has also divided them. Some practitioners who are in close proximity to the patient’s suffering would likely agree with the practice of assisted suicide (Lau, 2004). However, these practitioners would also admit that they have encountered cases of patients recovering from their illnesses even when all medical interventions have failed (Lau, 2004). It is for these miraculous recoveries that some health professionals, including nurses and physicians are reluctant to sign off on assisting their patients in ending their lives. Ethical issues The right to act and to govern oneself is one of the main principles being used to support assisted suicide. According to this principle, a person has the “right to act and govern oneself in accordance with one’s own private beliefs, values, and choices without interference as long as one’s behavior does not harm others” (Salem, 1999). According to supporters of euthanasia, the right to act should also include a person’s right to control the circumstances of his death – even if such choice or right would include suicide. These supporters further emphasize that one’s right to die is a personal choice and the right to assist someone in dying comes under the purview of self-determination which should be free from interference from the state, from doctors, family members, and religious groups (Salem, 2009). Physician-assisted suicide, in other words, is said to be a natural offshoot of the legally protected right to privacy and the moral right to self-determination (Salem, 2009). Those who disagree with the above concepts set forth by the proponents of assisted suicide oppose the supremacy accorded to patient autonomy in the light of social values and interests. They point out values like sanctity of life, protection from abuse, ethical integrity of the health profession are values which bear a second look in settling the crucial issue of assisted suicide (Salem, 2009). Even as individuals indeed have the right to self-determination, opponents of assisted suicide point out that it is a right which does not exist in a vacuum. It is a right which has to be considered and delivered in a wider societal context. These opponents further argue that indeed, physician-assisted suicide, serves autonomy, however, in order to protect other goods, there are limits to this right (Salem, 2009). A crucial argument of these opponents to assisted suicide revolves around the fact that euthanasia and assisted suicide would, in effect, allow the concept of autonomy to put at risk the common good, in the name of private views on life (Salem, 2009). Assisted suicide is considered to be a major issue in the current medical context because various medical advancements have equipped us with more tools in order to save and sustain lives (Andre & Velasquez, 1987). These technologies have indeed managed to sustain the lives of different people, especially those who would not have the same chance 10 or 20 or even five years ago. But now these technologies are widely available. Even more technologies which can prolong and sustain life would surely be invented in years to come. And these technologies assist medical professionals in carrying out their tasks of treating patients. Unfortunately, even the most advanced technologies cannot treat all medical ailments. During these times, the crucial question of using technological advancements to further prolong human life has become even more controversial. As was previously mentioned, the argument of those who support assisted suicide is largely founded on the moral right to choose freely. They believe they are not doing any harm to anyone else but themselves; therefore, their right to die should not be interfered with. Instead, it should be supported by medical professionals (Andre & Velasquez, 1987). It is their right, after all, to die with dignity because the debilitating effects of the disease are already causing more suffering than they can bear. When these people request for their lives to be ended, proponents of assisted suicide claim that it would be considered inhuman and cruel to let them suffer further pain and indignities (Andre & Velasquez, 1987). On the other side of the coin, society also argues that it has a moral responsibility to preserve life – and when they would allow and assist people to end or destroy their lives, they are also violating their primary duty to human life (Andre & Velasquez, 1987). They further argue that laws which pose threats to human lives, especially the lives of innocent people, should not be passed. Laws which support assisted suicide and euthanasia present a threat to innocent lives because if the act of assisting a terminally ill patient is based on compassion and the desire to end human suffering, then, “what will keep us from assisting in and perhaps actively urging, the death of anyone whose life we deem worthless or undesirable? What will keep the inconvenienced relative of a patient from persuading him or her to voluntarily ask for death? What will become of people who, once having signed a request to die, later changes their minds because of their condition, are unable to make their wishes known?” (Andre & Velasquez, 1987). These opponents further point out that when people accept that only life which is of a certain quality is worth continuing, then such determination may not stop them from holding judgment over other lives which may not even suffer from the same terminal condition. Furthermore, when one life is decreased in value, then all other lives are diminished in value as well (Andre & Velasquez, 1987). In the end, those who live vulnerable and chronically handicapped lives are in danger of being encouraged and considered for assisted suicide or even euthanasia. The principles surrounding this issue remain to be unsettled arguments between the proponents and opponents to assisted suicide. Ethical considerations can both be justified under compassion, but the application of compassion stems from an opposing context. Stakeholders There are various stakeholders to the issue of assisted suicide. These stakeholders include: the patients, physicians and other health care givers, patient’s family, and the taxpayers. Patients are the major stakeholder in this debate. These patients are terminally ill or have a condition which is incurable or untreatable and for which reason may or may not want to cut their life short. They often suffer from severe pain which is unrelieved by analgesics and they also suffer through physical difficulties in conducting their daily activities (Kopelman & DeVille, 2001). They consider these difficulties as indignities – indignities which they feel they should not be made to suffer (Kopelman & DeVille, 2001). Other patients may also feel that they deserve to be given as much opportunity to live and that cost should not be made an issue in their access to medical care. Physicians and other healthcare givers are also major stakeholders in this issue because they are supposed to assist the patients in committing suicide. Physicians and other medical professionals are also divided on this issue. Those who oppose assisted suicide point out that legalizing this practice is dangerous because it would open the doors to abuse (Fidelman, 2010). They emphasize that patients who are in distress would likely express the desire to have their lives ended; but after such distress, they may later change their minds. These doctors emphasize that they rarely, if at all actually have any requests from patients asking for assistance in committing suicide (Fidelman, 2010). These doctors also object to assisted suicide because they believe that this practice endangers the lives of those who cannot give their consent. They also fear that when this practice is legalized, it may become the norm in medical practice (Fidelman, 2010). More importantly, doctors and other health professionals have taken an oath of “doing no harm” to their patients. Assisted suicide is definitely an act of inflicting harm on patients (Clinton & Hart, 2005). The Hippocratic Oath does not distinguish and indicate an exception to this rule; hence, most medical practitioners adhere to these provisions in order to object to assisted suicide. The patient’s family members are also stakeholders in assisted suicide because they are often exposed on a daily basis to the pain and suffering of their loved one (Gorsuch, 2006). In some ways, they would feel that they want to be with their family member for as long as possible – to let the doctors and health care givers try and do everything they can in order to sustain the life of the patient. However, admittedly, these family members may also harbor a desire to end the patient’s pain and suffering (Gorsuch, 2006). They may feel that prolonging the patient’s life is a fruitless exercise which is not doing their patient any good. For which reason, they may feel that assisting in their death is a better option for their loved one. Taxpayers are also stakeholders in assisted euthanasia, especially in cases when public health funds are used to sustain the life of terminally ill patients. Medical cost in the US is covered by both the government and private insurers. These costs also cover the upkeep of terminally ill patients; and potentially, if assisted suicide would be legalized, would also cover the cost of assisted suicide (Worldnet Daily, 2008). Some taxpayers are quick to point out that assisted suicide would ease the burden of supporting terminally ill patients; other taxpayers however point out that assisted suicide in itself is still a costly option. They do not understand and they do not support the idea of legislators and health authorities in allocating funds for assisted suicide when they can instead allocate these funds for the support of life and for the treatment of diseases (Worldnet Daily, 2008). Ethical position I am not in favor of physician-assisted suicide. After reviewing the position of both the proponents and the opponents of physician-assisted suicide, I am inclined to agree with those who oppose it. For one, proponents of assisted suicide who couch their support for the act under the right to self-determination and the right to die are conveniently ignoring the other ethical principles – that of non-maleficence, beneficence, and justice. These are also ethical principles which can be used to oppose the claims of the assisted suicide supporters. First and foremost, the principle of non-maleficence is based on the concept of “doing no harm” to the patient (Britt, et.al., 2007). By assisting the patient in committing suicide, harm is caused or brought upon the patient and is clearly in violation of the ethical principle of non-maleficence. In considering the principle of beneficence, assisted suicide may seem to be in accordance with its requirements. Beneficence, after all, is about doing things and carrying out actions which ultimately benefit the patient (Battin, et.al., 1998). However, when assisted suicide is considered as an option for patients, it also blocks out other choices of treatment which can benefit the patient (Battin, et.al., 1998). In instances when patients cannot avail of adequate health services, they are forced into a position of having no other option except assisted suicide. This is an unfortunate consequence of assisted suicide and is certainly not in line with the principle of beneficence. The principle of justice also helps support my position on this ethical issue. Justice is basically about giving a person his due (Hoskins, 2005). In this case, all patients, regardless of their terminal or non-terminal condition deserve to be given every opportunity to live. For as long as the technology and the medical means in sustaining life are available, then such means should be used in order to support life (Hoskins, 2005). It is patently unjustified to dangle assisted suicide as an option for a person who is suffering a terminal illness when there are still other options which can extend his life for weeks, months, or even just days. Assisted suicide does not give a person his due; instead, it makes the lives of terminally ill persons seem useless and inconsequential – no longer worth supporting. Although, proponents of assisted suicide indicate that the act would not lead to any abuse, they cannot ensure the eventuality of human life being given less value in the face of higher health costs and prioritization issues. I oppose assisted suicide because it presents a danger to the most vulnerable members of society – those who cannot afford health care, the elderly, and the socially disadvantaged (Bilirakis, 1998). In instances when they are suffering from some terminal illness, and cannot afford healthcare, legalizing assisted suicide would likely place them in the greatest danger of being prompted to commit suicide. Although they would not be forced to commit suicide, the simple act of offering the option of suicide places a pressure on them to consider suicide as a means of ending their suffering (Bilirakis, 1998). For those who indeed want to end their lives through suicide, this is a welcome respite from their pain and suffering. However, for those who do not want to end their lives, this is a Sword of Damocles hanging over their head – as good as being told that they are a burden to their loved ones and to society in general. Assisted suicide is a dangerous option to take because it carries so many implications and consequences which our current society is not ready and equipped to face. We do not have the safety precautions in place in order to ensure that its practice would not be abused. Although it may be considered an option under palliative care, it is a terminal option as well. It places so little value on life and on the human spirit – elements which are largely unpredictable. Medical practitioners can attest to the fact that even as they believe patients to be near the end of their life, they cannot still pinpoint for sure when that end will come. For some patients, it may be as short as a few minutes, and for others, it may be as long as a week or a month. In the meantime, family members can spend time with their loved one and allow for precious moments of communion. Specific moral action plan A specific moral action plan which can be taken in order to prevent the legalization of assisted suicide is to gather testimonies from different terminally ill patients who live in Oregon (where assisted suicide is legal) and another state where assisted suicide is not legal. In gathering their testimonies, their mental, physical, and emotional state shall be assessed and evaluated. Such evaluation will hopefully yield a true sentiment from patients on assisted suicide. This will help determine, once and for all how patients feel about their lives and about their health options when they know that they can opt for assisted suicide to end their suffering and when they know that it is not an option in their state. There is a reason why assisted suicide is not widely supported in the US and in other countries. The majority opinion is still on placing the utmost value on human life. In order to prevent moves to legalize it, I would send letters to legislators detailing the risks and dangers that they are inviting by considering the legalization of assisted suicide. I would become an active lobbyist for patient’s rights – for them to receive the best palliative care possible. This lobbying would also involve a call for an increase of funding in research which would help address the symptoms of terminal illness, like pain. These symptoms cause patients much anxiety, prompting them to express the desire to die and to end their suffering. When more options to relieve their symptoms can be offered to patients, then more dignity in their life can also be ensured. With these possible options for patients, expressing a desire to die would likely be reduced. I would become a patient’s advocate because I firmly agree with Frankl’s statement (as cited by Lent, 2010): “every life, in every situation and to the last breath, has a meaning, retains a meaning. This is equally true of the life of a sick person, even the mentally sick. The so-called life not worth living does not exist”. Conclusion Assisted suicide is one of health care’s most controversial issues. It has been proposed as an option for patients who are suffering from a terminal disease. Based on the arguments presented above, those who support it claim that it is patient’s right to die and to determine his own future. He should therefore be supported in this venture. This is firmly opposed by other people because they believe that there are other considerations in assisted suicide which are over and above a patient’s personal right to die. Based on the above discussion, I firmly oppose assisted suicide because it devalues life; it is against the ethical principles of beneficence, nonmaleficence, and justice; and it opens the doors to potential abuses against those who live vulnerable lives. I believe that there are better options to take – options which favor life, not death. 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(2010) Doctors, nurses tell Quebec euthanasia hearings to reject assisted suicide. Montreal Gazette. Retrieved 02 December 2010 from http://www.montrealgazette.com/news/Doctors+nurses+tell+Quebec+euthanasia+hearings+reject+assisted+suicide/3497374/story.html Gorsuch, N. (2006) The future of assisted suicide and euthanasia. New Jersey: Princeton University Press Hoskins, W., Perez, C., Young, R. (2005) Principles and practice of gynecologic oncology. Philadelphia: Lippincott Williams & Wilkins Kopelman, L. & DeVille, K. (2001) Physician - Assisted Suicide. New York: Springer Publications Lau, M. (2004) Assisted suicide: what is your role? NurseWeek. Retrieved 02 December 2010 from http://www.nurseweek.com/features/98-6/dead.html Lent, T. (2010) Viktor Frankls View of Physician-Assisted Suicide. Suite 101. Retrieved 02 December 2010 from http://www.suite101.com/content/viktor-frankls-view-of-physician-assisted-suicide-a301331 Pickert, K. (2009) A brief history of assisted suicide. 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