Euthanasia in the United States - Coursework Example

Euthanasia in the United s Euthanasia, also known as mercy killing, has come to the forefront of attention as the public, health care workers, and the medical profession wrestles with new attitudes and ideas about the ethics and legality of the centuries old practice. The intentional taking of the life of a patient runs counter to the role of the physician as healer and had always been deemed officially unacceptable, while ethical considerations for euthanasia have sometimes been accommodated in the name of relieving suffering. The issue has become ever more important as the Supreme Court has opened the door to greater experimentation by the states in this area. Health care organizations and health care workers are faced with changing state laws that may be at odds with their personal and professional ethics. It is vital that the health professionals understand the cultural, legal, and ethical climate that may allow, forbid, or dictate the use of what is commonly called euthanasia. For the purposes of this discussion, euthanasia is in context with patients that are terminally ill, have a poor prognosis, a very limited life span, in palliative care, and are suffering due to a low quality of life or intense pain. While euthanasia is a generic term often used by the public, it requires further definition. Voluntary euthanasia is done at the patient's request, while non-voluntary is committed when the patient may be incompetent to make the decision or in a comatose state and the decision is made by a surrogate (Cohen et al. 1099). Withholding treatment that could sustain life is a form of euthanasia, and may come at the request of a patient, a surrogate, a physician, or a medical review board (Cohen et al 1099). Terminal sedation is, "the practice of sedating a terminally ill competent patient to the point of unconsciousness, then allowing the patient to die of her disease, starvation, or dehydration" (Braddock and Tonelli). Physician assisted suicide (PSA) is the prescribing of a lethal dose of drugs with the knowledge that the patient intends to commit suicide (Cohen et al. 1099). Each form of euthanasia carries its own legal ramifications and is governed by its own set of ethical considerations. While Belgium and the Netherlands in the European Union have enacted laws that permit euthanasia in a well-regulated setting, in the United States it is generally forbidden. From a legal standpoint, voluntary euthanasia (suicide) is allowed in only four states due to "neither statutory nor common law prohibitions against suicide" (Darr Part II 33-34). Non-voluntary euthanasia is outlawed in all fifty states and would fall under the statutes that prohibit murder (Cohen et al. 1099). While these forms of euthanasia are against the law in most US jurisdictions, other forms may be permitted in special situations. Physician assisted suicide (PAS) is a topic that has gained wider discussion in recent years as medical treatments may prolong a person's life, but are unable to add to the quality of life. PAS came to the public's attention when Dr. Kervorkian admitted to assisting suicide in as many as 130 separate cases (Darr Part II 32). According to Darr Part II, "All his assisted suicides occurred in Michigan, which initially had no law banning it" (31). Michigan subsequently passed a law, but Dr Kervorkian continued the practice. He was eventually sentenced for murder and after exhausting his appeals the US Supreme Court denied his writ for certiorari in 2002 (Darr Part II 32). However, these actions opened the door for states to create legislation that would permit PAS. Currently only Oregon has a law that permits PAS. In Texas, PAS is governed under section 22.08 of the state penal code that states if, "the actor's conduct causes suicide or attempted suicide that results in serious bodily injury" it is considered a jail felony (Chapter 22). The argument over PAS has been, and continues to be, controversial. Kervorkian's argument was predicated upon Roe v. Wade on the basis of individual autonomy and the right to privacy of the patient (Darr Part II 32). "Some Oregon physicians remain adamantly opposed to the law, maintaining that a patient's wish to hasten death may reflect unrecognized treatable depression or a lack of support for other options" (Okie 1629). The professional associations of the AMA and the AGS codes of ethics prohibits PAS and "the Hippocratic oath states, "I will not administer poison to anyone where asked," and "Be of benefit, or at least do no harm" (Braddock and Tonelli). However, nearly two decades ago, the US Supreme Court stated, "Americans are engaged in an earnest and profound debate about the morality, legality, and practicality of physician-assisted suicide" (qtd. in Gostin 1941). The Oregon PAS law has been challenged, without success, in the US Courts. In 2001, Attorney General John Ashcroft issued a rule that declared that Oregon's law was in violation of the federal Controlled Substance Act of 1971 (Darr Part II 34). The Supreme Court reached a decision in 2006 in the case of Gonzalez, Attorney General et al. v. Oregon et al. and the majority opinion stated that, "the CSA does not allow the attorney general to prohibit doctors from prescribing regulated drugs for use in physician-assisted suicide under state law permitting the procedure" (Darr Part II 34). As of this date, the states of California, Washington, and Maine have unsuccessfully attempted to pass legislation similar to Oregon's. Far more common than euthanasia or PAS, and more complex, is the withholding of treatment or the administering of palliative care that leads to death. A patient's request to remove vital life support equipment and treatment is universally honored in all fifty states (Cohen et al. 1099). In addition, a physician or a hospital review board may request the removal of life support systems. End-of-life treatment may include the administering of large doses of drugs to ease pain and suffering that ultimately lead to a patient's death. While these areas are generally legal, they can be a complex mix of conflicts between the medical staff and the patient's family or surrogates over the adequacy of the treatment. There are also complicated issues of medical ethics that must be considered. Generally, the legality of the decision to remove treatment or prescribe coma-inducing drugs is made under the ethical Rule of Double Effect (RDE). This is an 800-year-old concept that allows a negative outcome (such as death) to occur if the intention was moral (such as reduced pain). The act must meet the four conditions of being good or neutral, that it permits evil but does not intend it, that it does not use evil means for a good outcome, and the good proportionally outweighs the bad (Cohen et al. 1099). The decision to remove treatment or administer palliative care must be an ethical decision that carefully weighs the needs and desires of the patient against the principles of the RDE . Texas has a law that mandates the removal of treatment in futile situations. A patient who is determined to be a futile case by an ethics review board can order that treatment be removed. The surrogate then has a limited time to find another facility and stand the expense of the transfer. "If the transfer does not occur at the end of 10 days, the hospital has no obligation to continue treatment" (Pfeifer 26). This law has led to some controversial cases recently. The controversy arises when practical considerations are placed before ethical concerns. In the Texas case of Tirhas Habtegiris, the 26-year-old patient had metastatic angiosarcoma and was unresponsive. She was being kept alive by a ventilator that doctors recommended removing, "but family members would not consent to withdrawal of ventilator support" (Pfeifer 25). No other facility would accept her as a patient and she died 15 days later. This case indicates, "that the hospital initiated the process to avoid incurring treatment costs" (Pfeifer 25). In this case the financial considerations would be unethical, though the law would not hold the facility liable since they followed the law. In fact, "economic oneness between the physician and the organization raises significant ethical issues, such as the risk that the patient interests will be less prominent" and an early death may be a cost reduction alternative (Darr Part III 37). These conflicts of interest will eventually diminish the trust that is an integral part of the physician-patient relationship (Darr Part III 37). Most of the Western world's medical law and ethics are derived from the dominant religion. In the United States, the attitudes towards euthanasia and PAS are based upon the beliefs of the Christian religions. The dominant Christian religions believe that "God holds exclusive authority over the transition from life to death" (Burdette, Hill, and Moultin 80). Burdette, Hill, and Moultin further report that more conservative attitudes toward PAS and palliative care are strengthened by church attendance and depth of devotion to their religion (80, 83). There are also cultural concerns in the way that death is viewed such as African-Americans who are "less accepting of physician-assisted suicide than whites (Burdette, Hill, and Moultin 90). Because ethical beliefs are so deeply ingrained in religion, they will be slow to change and slow to evolve. In conclusion, euthanasia is commonly used as an umbrella term that covers several types of patient care in an end-of-life situation. Mercy killing is prohibited in all 50 states and is considered to be murder in all jurisdictions. Physician assisted suicide is allowed only in Oregon, but the US Supreme court has allowed the states to make their own laws concerning it. The more common types of end-of-life treatment, such as withholding care or palliative treatment, are the most difficult for the health care system to confront. There are complex legal and ethical issues as well as an emotionally charged situation of physicians, families, patients, and surrogates who may all disagree. In Texas, the medical ethics review board has the ultimate authority to withhold treatment in futile cases, even against the family's will. This has invited some criticism of a conflict of interest between economics and the well-being of the patient. As Americans change their attitudes, change may be slow due to the intensity of the religious belief in the sanctity of life. This area of healthcare is a complex mix of legal, ethical, moral, and religious implications. Works Cited Braddock, Clarence H., and Mark R. Tonelli. "Physician-Assisted Suicide." Ethics in Medicine. 11 Apr. 2008. University of Washington School of Medicine. 5 June 2008 . Burdette, Amy M., Terrence D. Hill, and Benjamin E. Moultin. "Religion and Attitudes Toward Physician-Assisted Suicide and Terminal Palliative Care." Journal for the Scientific Study of Religion 44.1 (2005): 79-93. Blackwell Publishing. 5 June 2008. "Chapter 22. Assaultive Offenses." Penal Code. 1994. State of Texas. 5 June 2008 . Cohen, Lewis et al. "Accusations of Murder and Euthanasia in End-of-Life Care." Journal of Palliative Medicine 8.6 (2005): 1096-104. 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