Palliative Care vs Physician-Assisted Suicide - Essay Example

? Dignity in Life and in Death Palliative Care vs. Physician Assisted Suicide Issue # Dignity in Life and in Death Introduction The issue of dignity in life and death is centered on the discussion on how human beings should have the right to die. The right to die with dignity is often taken from the afflicted, a wasting away of their body taking with it the aspects of personal comfort and function that is both mentally demoralizing and a furtherance of the problems associated with catastrophic illness. While depression and mental health often create the effect of believing that death would be a better alternative, when an individual is afflicted with a terminal illness for which nothing but pain, discomfort, and indignity is left, allowing physicians to assist in the passing into death is a truly humane act. One of the alternatives that have emerged is the concept of palliative care in which the patient is sedated, often to the point of unconsciousness, so that their last days are without the pain and the knowledge of their undignified state. Palliative care is not the level of dignity that people deserve and the right to die should be given where palliative care is nothing more than a less politically charged substitute. Background One of the things that slip away very quickly when faced with illness is the right to direct one’s own life. The first thing becomes the choices about the future and the way in which one will live within that future. As doctors, family members, and eventually hospital staff begin to make the decisions about how, what and when one will do things, an individual slips into the role of ‘the patient’, no longer able to function without instructions and care. The right to choose death over a continuation of indignity, pain, and eventual harsh treatment of the body has become an issue through which many different opinions have emerged. Euthanasia is illegal in all fifty states, with the exception of Oregon and Washington where it is legal for physicians to prescribe, but not administer, drugs that will lead to death in the case of terminal situations.1 The right to choose death over pain and the indignities of a prolonged illness that is terminal is denied, leaving people to languish in their final days. Dignity in death is not a new issue. In the 1970s one of the solutions that emerged was the development of hospice care. Hospice care has an emphasis and spiritual and comfort, the individual does within that type of care not wanting aggressive medical care (McKenna & Feingold, 2010). The choice within the hospice environment is death through natural and dignified means to the extent that it is possible. Hospice care is most often done in the home, people given the opportunity to pass in their own beds or at the least in a space that is comfortable and filled with memories. The average length of care for hospice is 26 days, with the end clearly near. This unfortunate late arrival, however, fails to allow for the full use of hospice that might have prolonged the peaceful experience of passing into death.2 Hospice care, however, is not always a good option and an intermediate form of providing some dignity with death is that of palliative care. Under palliative care, the patient is given high levels of pain killers although the loss of consciousness is not the intended result. This gives the patient the opportunity to interact with their families, creating a more healing environment even when the restoration of health is unlikely. Often, though, it will lead to an unconscious state, relieving pain and keeping the sedated through the end of their time. The high level of pain reducing medications are maintained until the patient dies, giving the end of their days relief from either pain and often from the conscious knowledge of their physical state. Palliative care offers a solution to the problem of how the end of life comes to a patient in a great deal of pain and living in an undignified set of circumstances. The American Medical Association The American Medical Association (AMA) released a paper entitled “Sedation to Unconsciousness in End-of-Life Care” in which the argument for palliative care is presented. The purpose of palliative care is presented as a way to manage the end of life so that suffering is relieved and the patient is given a less unpleasant end to their life. The paper questions the idea of using palliative care to fully sedate a patient, fearing that it is another method for euthanasia in which the patient is given into death through the subterfuge of sedation. There is the concern that through the eagerness to sedate, too much medication might hasten the individual towards their death. The report intends to examine the issue of the ethics of using palliative care as it relates to the shadowed issues of euthanasia and physician assisted suicide, discussing how palliative care should be differentiated from the idea of bringing about the end of life.3 One of the issues that is raised within the report by the AMA is that between 5% to 35% still experiencing a high level of pain and intractable symptoms during their experiences in hospice care as palliative treatments are administered.4 Palliative care to unconsciousness is recommended as a last recourse solution for those within terminal illness when no other relief is available. Palliative care is recommended when the large variety of symptoms that come from illness, such as vomiting, diarrhea, shortness of breath, urinary retention that leads to blood clots, and uncontrolled bleeding all lead to an overall set of painful and undignified states of being for a terminal patient. Whether or not palliative care is appropriate for the mental suffering of patients through isolation or loneliness is controversial, the purely mental consequences of terminal illness not fully qualifying for the use of palliative care to end suffering.5 The AMA addresses the concept of palliative care while dismissing the validity of euthanasia or physician assisted suicide as unethical in relationship to the physician’s role as a healer. What is considered ethical is the withdrawal of medications or life-sustaining methods in order to allow death to come naturally. The use of palliative care is not considered to be a form of physician assisted suicide as there is no indication or research that shows that palliative care shortens the life of a terminally ill patient. In addition, although it does sometimes lead to death, the administration of the drugs is intended to relieve suffering in the form of pain, not because the individual is living. The AMA considers the intentions of the physician as relevant to the overall consideration of whether or not palliative care is used towards finding death for the patient.6 The morality argument is based on the idea of intention. The physician that intends to relieve suffering of pain due to illness is legitimate, even if the sedation does lead to death. The justification occurs when the level of medications can be put into context with the level of pain relief that is needed. Once again, it is the intention and the proof of the intention that is valid when considering the accident of death that might occur because of the use of palliative care. In order to create a sufficient differentiation, the basis for the care must meet a standard that is recognized. It is also important to consider how the decision to use palliative care is reached. A decision maker might need to step in when a patient has reached a point where they can no longer make decisions for themselves. This begins the discussion on how a person structures their end-of-life preparations. In regard to how the decision is made the principle of beneficence must be taken into consideration so that the decision maker can make the appropriate choice based upon the concept of relief from pain. The decision maker must be able to evaluate, with physician assistance, when it is appropriate for palliative care to begin. Palliative care requires appropriateness, monitoring, and the appropriate amount of intention. The AMA is clear that palliative sedation must never be used for the intention of ending life.7 Margaret P. Battin Margaret P. Battin discusses the idea that palliative care is a compromise in the political debate about physician assisted suicide, that for all the concepts of ‘intention’, the end result is that it creates an induced unconsciousness that will likely never be ended until death comes. Battin writes that “The principle of autonomy holds that people are entitled to be the architects, as much as possible, of how they die”.8 Between the principle of beneficence and that of the principle autonomy is the physician assisted suicide, but now what has been put in place between those ends operating in concert is that of palliative care. Battin shows that the two objections that are most often heard about physician assisted suicide are that of the sanctity of life as it is defined on religious terms and the second is that it might lead to an abuse of a system of physician assisted suicide. The concern with abuse is that physicians might make decisions towards death that is unwanted by the patient. Battin refers to the joint claim that physicians should not kill, but if they are allowed to kill they will begin to do so with too much zeal. The concept is that it is against the principles of a healer to take life, but that given the opportunity they will do so liberally. The conflict of this philosophy is discussed by Battin with the intention of showing the hypocrisy with which palliative care has become a compromise. Philosophical Argument There is definitely a need for palliative care. There are many circumstances where palliative care can lead to a natural end to life, but providing with freedom from the pain that will accompany that end. Palliative care for a few days while nature takes its course would seem to be a natural course of events in which medicine and nature are hand in hand towards a dignified end. Palliative care that lasts for long periods of time, weeks even, would seem cruel and without mercy. Battin speaks about mercy as the sedation of patients provides them with a release from the indignity and suffering that accompanies pain, but also she discusses that a patient must be in pain in order for the course of treatment that is palliative to begin. 9Therefore, a patient has descended into pain and had to suffer before relief can be found. This does not suggest a sense of mercy, but can reveal a sense of earned sedation in which it is balanced against what the patient must endure to earn that final rest in life, before rest in death. This does not suggest mercy. Another lack of mercy that is associated with palliative care is through the form of death that is most typical for those who undergo the sedation. Palliative care often results in physician induced dehydration which can and often does lead towards death. An argument made by Battin that has a great degree of validity is that death that is hastened through natural processes that are developed through unnatural means does not fit into the principles of physicians in relationship to preserving life.10 Therefore, the philosophy of palliative care is a shroud through which the result is physician assisted suicide with enough proof to the contrary to placate the medical and political communities. In terms of abuse, the abuse of sedation seems far more critical than the abuse of physician assisted suicide. Distress that is caused by the pain and suffering of a patient is easily set aside when they are sedated into unconsciousness. Medical staff and family would find great distress by a patient who is suffering; therefore, the sedation would not only relieve the patient but the staff. The suffering of a patient who is raving due to mental capacity issues could also find themselves in sedation, unconscious even though their suffering might not warrant being unconscious. This does not mean that this type of suffering is not legitimate, but it would be an abuse to do so when the patient might not have wanted to sleep until the end of their days had they the capacity to make the decision. It is likely they would have, but at that point proof is not available. Abuse can be found in all professions and in all levels of humanity, thus the argument that physician assisted suicide would encourage abuse is not valid as a reason to support palliative care which is also subject to the same abuses and the same result of death. Battin discusses that there are many reasons that there are worries about the abuses that might emerge from the medical profession. She states that “physicians are overworked, anxious to cover their mistakes, unwilling to work with patients they dislike, biased against patients of certain class or racial backgrounds, beholden to cost pressures from their HMOs, and so on”.11 What this says is that physicians are human and in need of human consideration where this type of decision making process is involved. Making the decision through community is the best possible outcome when a patient has no ability to competently agree to whatever course of action is necessary. Life is about choice, where all other avenues become based upon oppression. If choice is not involved, either the situation or the community is oppressing the needs of someone who is in need in relationship to their end-of-life plan. The concept of having control of the end-of-life is the basis upon which the argument for the rights to autonomous decision where death and treatment are concerned. Control over how one dies only extend to the point of that option being dictated by having a terminal illness from which survival is not an option. For this discussion, the right to die is based upon the right to choose death earlier than the course of an illness where the inevitability of death was certain. There are a great number of legitimate concerns that should allow an individual the choice to end their life before the consequences of the disease progress to a certain point. One example of this is Alzheimer’s in which the mind and memories are slowly stripped away. Choosing to die before that process is complete would be a valid choice where the fear of what might occur when one was mentally vacant and could no longer make those choices. Through the ethical construct of utilitarianism, which defines ethical consideration by the overall end of happiness, would suggest that allowing an individual to choose to die with a still somewhat sound mind would allow them to be happier, to be remembered through happier events, and to have dignity at the end of their life. Alzheimer’s does the same to the body that it does to the mind and is a terminal disease as well as a mentally damaging illness. The issue can also be determined on the basis of virtue ethics in which the context of the action is judged upon its parameters of overall having a well lived life. A well lived life is judged by the individual, some of whom would want more time with their family through therapies and drug treatments, while others would want a quality to the time they have left before their essence was subjected to the severe changes that pain and need can place upon an individual. A well-lived life is subjective, but society has placed an absolute on it in reference to its end. Having a well-lived life that ends with dignity and through choices made about what the ending of life means provides freedom and autonomy without harming society. That suicide is illegal is dependent upon the belief that ending life is society’s choice not the individual’s choice. In the United States suicide and murder are both illegal, but execution is legal in many states. This means that the state has the power to both prevent citizens from ending life, but use death as a weapon against crime. Logically, the argument that it is wrong to end life cannot exist concurrently with the ability to put someone to death because of the degree to which their crime offends society. Absolutes are just not possible within society, thus it is important that context be applied. When someone has been determined medically terminal there is always the chance that the medical community is wrong. However, it is more likely that the diagnosis is valid and that ending life before the worst consequences of a disease takes the autonomy from an individual is a valid argument. Merely placing them in a sedated state until death comes is hypocrisy in that it is taking them out of life and placing them in a stasis that works as a political placebo. Conclusion The AMA argues that individuals do not have the right to choose death and that physicians are morally obligated to not assist death because they are termed as healers and death is not a part of healing. The overall argument on physician assisted suicide can be that death is a healing that ends suffering and finalizes the course of the disease. Palliative sedation is used as a compromise between death and the end of suffering. Suffering does end, but the patient lingers until some consequence takes their life. There is no doubt that it is used as a vehicle by some physicians to promote the end of life where the law does not allow them direct means. Margaret Battin discusses the hypocrisy of allowing palliative care where the direct solution of suicide would solve the suffering and the problem of autonomy as she believes that this methodology violates a number of different human rights issues. The AMA writes in a way in which it skirts the issue and tries to justify their position on physician assisted suicide. The answer lies in Battin’s direction, creating a thorn in the justice system where the right to live or die is concerned. Palliative care is used in place of dignified death, offering no mercy as it does not occur until the end of life. References McKenna, G., & Feingold, S. (2010). Taking sides: Clashing views on political issues. Boston, MA: McGraw-Hill Higher Education. Read More