Physician-Assisted Suicide: An Assessment - Essay Example

Physician Assisted Suicide: An Assessment Submitted by: Submitted Submitted] Introduction Health Care professionals are tasked to provide medical care to patients so that they may recover from their ailments and continue living without pain and discomfort. The goal is to preserve life as much as possible. However, there are instances that the patient himself requests for the doctor to terminate his life due to certain reasons one of which is to end his suffering. This state of affairs is already happening in some parts of the world and is termed as Physician-Assisted Suicide (PAS). Assisted Suicide isaperson'svoluntary suicide with help from another individual. A suicide is an intentional, self-caused death. Individuals who elect to kill themselves with the assistance of another person typically have an incurable illness or are experiencing extreme physical suffering. (Egendorf , 1998) PAS occurs when a doctor, upon the requests of the patient, provides a lethal overdose of medication for the patient to self-administer explicitly knowing that it will enable the patient to commit suicide. Euthanasia, on the other hand, is where the doctor himself administers the lethal overdose. PAS is also ethically and legally distinct in the case wherein the doctor provides medication with the goal of only relieving pain but understanding that death could occur as a secondary effect. There are currently three places in the world where PAS is legal namely the state of Oregon in the United States and the Netherlands. United Kingdom is also considering the legalization of PAS. The prescribed medication involves a lethal dose of barbiturates that is taken in liquid or in tablet form. (Emmanuel, 1998) Due to the fact that PAS involves termination of life of an institution that was tasked to save lives, the issue has been hotly debated primarily on moral and legal terms. Those on the supporting side argue that individuals should have control over the timing and manner of their own deaths. Some argue that actively bringing about one's death is no different legally than refusing life-sustaining treatment. However, opponents contend that legalizing assisted suicide will cause many problems. They fear that vulnerable individuals may be coerced into suicide as a result of financial pressure or fear of burdening their families. Religious opposition to assisted suicide is often based on the belief that God, not humans, should make the choices regarding death. With PAS, doctors are actually actively "killing" patients by making a lethal dose available whereas treatment refusal would only result to a passive involvement in the death of an individual. (Emmanuel et al, 2000) The issue is further complicated by the fact that the legal considerations has not been defined and determined once and for all. IntheUnitedStates, only one state, Oregon, has adopted a law specifically allowing physician-assisted suicide. In November 1994 voters in Oregon approved a ballot measure adopting the Death with Dignity Act, which authorized physicians to prescribe lethal doses of medication for terminally ill patients. However, opponents of assisted suicide challenged the constitutionality of the law and prevented its enforcement. In 1997, after the U.S. Supreme Court determined that the states have the authority to regulate this issue, the voters of Oregon again approved the act. However, in November 2001, the US attorney general came out with a statement that physicians involving themselves in assisted suicide would nevertheless be violating federal drug laws.() While they may not be liable to criminal prosecution, physicians would have their permission to prescribe medication revoked by the Drug Enforcement Agency. Also, the DEA would not bother examining the medical records of patients in enforcing federal drug laws and would instead get all the names of the physicians involved in PAS in a regulatory body created by the Oregon Death with Dignity Act. (Pacheco et al, 2005). The state of Oregon and its physicians promptly filed a lawsuit and has prevailed in the district court. In January of 2007, the U.S. Supreme Court ruled 6 to 3 against Attorney General John Ashcroft's interpretation that federal drug laws impliedly criminalize physicians-assisted suicide. This is not the end of the issue, however, as opponents of PAS are planning to bring the issue to the Congress and call for an Act that would effectively prohibit the availability of the prescribed drugs used for PAS. (Vicini, 2006) Definition of Problem In the absence of a definite decision regarding the legality of PAS, it becomes clear that there are great legal risks involved in instituting PAS in the health care setting. The question now is: "How will the health care management team respond to the legal challenges brought by the legal uncertainty of PAS" It is assumed here that the health care institution is already involved in PAS and that there is a firm belief that PAS should continue to be applied until all legal issues has been resolved. Our main concern is determining solutions so as to minimize the repercussions to the institution of having PAS declared as illegal. There is also a need to assess responses to court litigations that may arise from the practice of PAS. Literature Review The management of any business involves not only the evaluation of financial aspects of the trade. It also involves social and political considerations because these external factors greatly influence business standing. This information is very important in determining whether implementation of PAS will be ultimately accepted as legal. Since public policies are usually fuelled by public opinion, there is a need to assess what the public has to say regarding the implementation and acceptance of PAS. To what degree is society ready and willing to have PAS now and in the future Perhaps most pronounced in the discussion of physician-assisted suicide is the rapidity of cultural change. Cultural change is well recognized in the history of death and dying. Beginning in the 1960s, society began to acknowledge the patient's right to refuse life-prolonging treatment in the face of terminal illness, and attitudes about physician-assisted suicide began to shift. Within the last several decades, it has become socially acceptable to talk about death and dying with someone who is terminally ill, and as traditional religious and legal strictures have begun to loosen; it has become possible for a person facing death to consider what role he or she wants to play in it. (Emmanuel et al, 2000) A 2005 national poll conducted by the Pew Center for the People and the Press states that 70% of respondents believed that a patient's autonomy on death should be respected while 22% were of the opinion that patients should not be allowed to die even with insistent requests. This was supported by a nationwide 2005 Gallup Poll which found that terminally ill patients have the rights to hasten their death. Also in 2005, a Harris Poll indicated two thirds of U.S. adults think that it is only right those patients in severe distress and requesting for suicide to be given the opportunity to do so. (Yabroff et al, 2005) With the use of surveys, we now know that majority of the populace will support any person in his decision to terminate his life due to medical conditions. What is more important to know is how the public will perceive the assistance of physicians in the process. This is very important to know because the public may sympathize with the patient but may feel disgusted with the incapability of the physician to give remedies to the patient and help him change his decision. Fox News hired the services of survey specialist Opinion Dynamics and found that 48% of American respondents were in favor of PAS while 39% were not in favor. The margins are quite close but other polls had a wider margin. In a poll conducted by Wake Forest University Baptist Medical Center and published in the December 2005 issue of the Journal of Medical Ethics, patients would not lose trust on their doctors if they knew that the doctor engaged in PAS (Emmanuel, 2002). Also, the majority of every demographic group also expressed that they would continue to trust their physicians who engaged in such practice. The 2005 Gallup Poll also included a question of whether doctors should be allowed to assist in the 'suicide' of their patients and 75% of Americans from East to West Coast and from conservatives and liberals said yes. (Yabroff, 2005) Another concern that must be addressed is physicians' perception of being involved in the suicide of their patients. In business, it is not only the public/customers that must be assessed for concerns. Employees must be also evaluated for their job satisfaction. While the public may accept PAS, the physician might have values that go against assisting somebody in committing suicide. There is a need to assess the willingness of physicians. A national survey of 677 physicians by HCD Research in 2005 found that 2/3 of the respondents is willing to dispense life ending medications to patients to end their suffering. A Finkelstein Poll of physicians undertaken by the Institute for Religious and Social Studies indicate that physicians believe that it is ethical to help individual terminate their life so they would be free from unbearable suffering. It may seem that PAS is accepted by majority of the populace even by the physicians who would be involved in the process. What explains then the fact that only Oregon has legalized PAS while other states have criminalized the practice A study conducted by Wolfe et al (1999) published in the Journal of Clinical Oncology found that there is a marked instability of attitudes towards PAS. There were several important findings and they are as follow: One third of participants (public and physicians) changed their attitudes regarding PAS and euthanasia over a 6- to 12-month period. Physician opposition to PAS is on the increase. Only a minority of patients who had considered euthanasia or PAS for themselves tended to change toward further acceptance of these practices. It should be noted that even majormedicalprofessional organizations-including the American Medical Association (AMA, the American Nurses' Association, American Geriatrics Society and the Canadian Medical Association (CMA)-maintain that physician-assisted suicide is not justified by a patient's request under any circumstance. (Pacheco et al, 2005) Aside from public and physician perception, preparing for legal challenges requires that we should have knowledge of what is legal. Physicians who assist in a patient's suicide must follow strict guidelines: The patient must make a voluntary, stable request to die and have a clear understanding of his or her condition and prognosis; the physician must carefully review the patient's condition; the patient must be suffering unbearably with no hope of improvement; and a second physician must be consulted and must agree with the decision to help the patient die. Many issues arise from the requirements such as whether the patient is indeed capable of forming his decisions or he is only pressured to do so just to remove the financial burden it takes on his family. The physician might also be subject to biases in the formation of his decision. There is no clear cut definition of the degree of suffering that should serve as the basis for approval of PAS. For example, Faye Girsh, executive director of the Hemlock Society USA, a right-to-die organization, wrote in the March 29, 1999, issue of USA Today: "The law must change to permit an exemption to murder for doctors who provide a peaceful death to a suffering, irreversibly-ill adult who makes a competent, repeated request for an assisted death." The use of the term irreversible is telling. It implies terminal, but that is not what it actually means. For example, arthritis is irreversible. So are diabetes, multiple sclerosis, spinal cord injury, and some mental illnesses. (Emmanuel, 2000) While the US Supreme Court has dismissed the US Attorney General's directive that revokes licenses PAS-involved physicians, the decision was based on the autonomy of states to draft statutes without federal restrictions so long as it is constitutional. It was not a decision of whether PAS is legal or not. To date, no other state in the US has removed its criminal tag on PAS other than Oregon. In other words, there is no assurance of being free from legal prosecution when PAS is instituted. A good example of how the law can be so unpredictable is the case of Michigan pathologist Jack Kevorkian. Kevorkian began to help suffering individuals end their lives with a "suicide machine" he designed. The device administered an anesthetic and then a lethal injection of potassium chloride through an intravenous line. Although prosecutors in Michigan have charged Kevorkian for various crimes, juries consistently refused to convict him for his assistance in the deaths of numerous individuals. However, in 1999 a jury found Kevorkian guilty of second-degree murder and delivery of a controlled substance. In this case Kevorkian himself administered lethal drugs to an incurably ill person who Kevorkian indicated had asked to be put to death. Kevorkian was sentenced to 10 to 25 years imprisonment and planned to appeal his conviction. (Pacheco, 2005) Problem Analysis From the foregoing discussion, it can be seen that PAS is indeed a complex issue that requires careful consideration from the part of the health care manager. There are many important points that can be gleaned from our discussion in the previous section. First to be considered is that while the public and physicians generally approve PAS in surveys, there is a tendency to easily switch opinions as the study conducted by Wolfe (1999) would show. The public may accept it now but it may disapprove it later. While many physicians turn out to be supportive, major medical organizations which many physicians are members do not approve of PAS. It would therefore be dangerous to assume that the public and the physicians are supportive of PAS. They basically approve of PAS when they are part of anonymous surveys whose decisions may change when they are identified. The threat of public reprisal or physician's loss of job satisfaction are very real which may even result to the public assaulting hospitals like what abortion clinics have been sustaining. Physician productivity may slump as they may be dismayed by the hospital's acceptance of PAS. Court litigations may arise from individuals questioning the PAS undertaken by the heath care institution on the grounds of murder such as what happened to Kevorkian. Physicians, themselves, may be subject to prosecution on the grounds that their judgment may have been flawed which ultimately results to the institution damage to reputation. The second point is that there is no definite legal basis for the implementation of PAS. It may be legal today but illegal tomorrow. In the world today of exorbitant attorney fees, it would be very costly on the part of the institution to be prosecuted. The case of Kevorkian shows the great uncertainty in delving into PAS. The absence of a clear cut definition of determining the validity of patient requests and physician's judgment also presents opportunities for anti-PAS to sue the institution. There is no answer to just how far can go without being told you have gone too far. Solutions Our concern now is to determining the possible solution in minimizing the risk of legal challenges brought by PAS to the institution. The assumption here is that PAS is already legal as in the case of Oregon. The following list provides two possible solutions to the problem: Stop the implementation of PAS in the institution. Implement PAS but make it a very private affair between patient, his relatives, physician and the health care management team. It will also be implemented while public opinion approves it and scrapped when support falls. Preferred Solution, Implementation and Justification There is a great temptation to stop altogether the implementation of PAS especially in the light of the great uncertainties involved. However, if we are to insist that PAS still be made available to patients who have valid requests, the health care manager can proceed to the second option. Making the PAS affair very private could diminish the public's concern for the practice and limit the probability of an outrage happening. Kevorkian made his PAS very scandalous when he even went as far as giving rights to CBS to air a PAS session which he eventually went to jail for second degree murder. The jury has continuously acquitted him before his publicity stunt which only goes to show that the matter must be kept private to minimize prosecution. The more the public is kept from knowing this, the more they will be less interested in such concerns. Of course, proper documentation will still be accomplished and made available to the public only if they are requested. There should be a rigid system of evaluating the validity of PAS which would involve not only two physicians but three or more. This would ensure that the decisions made were thoroughly studied so as to show the world that the institution did not neglect its duties in the care of its patients. References: Emanuel, E.G., D. L. Fairclough, and L. L. Emanuel (2000) Attitudes and Desires Related to Euthanasia and Physician-Assisted Suicide Among Terminally Ill Patients and Their Caregivers. JAMA, November15,2000; 284(19): 2460 - 2468. Emanuel, E.J. (2002) Euthanasia and Physician-Assisted Suicide: A Review of the Empirical Data From the United States. Arch Intern Med, January28,2002; 162(2): 142 - 152. Egendorf, Laura, ed. (1998). Assisted Suicide. Greenhaven, 1998. Emanuel, Linda L. (1998). Regulating How We Die: The Ethical, Medical, and Legal Issues Surrounding Physician-Assisted Suicide. Harvard University Press, 1998. Pacheco, J., P. J. Hershberger, R. J. Markert, and G. Kumar (2005) A longitudinal study of attitudes toward physician-assisted suicide and euthanasia among patients with noncurable malignancy. American Journal of Hospice and Palliative Medicine. March1,2005; 20(2): 99 - 104. Vicini, James (2006) "Court rules govt. can't stop Oregon suicide law," Reuters News Agency, Retrieved February 19,2007 from http://today.reuters.com/news/newsArticle.aspxtype=healthNews&storyID=2006-01-1 8T004126Z_01_WBT004563_RTRUKOC_0_US-COURT-SUICIDE.xml Wolfe, Joanne, Diane L. Fairclough, Brian R. Clarridge, Elisabeth R. Daniels and Ezekiel J. Emanuel (1999). Stability of Attitudes Regarding Physician-Assisted Suicide and Euthanasia Among Oncology Patients, Physicians, and the General Public Journal of Clinical Oncology, Vol 17, Issue 4 (April), 1999: 1274 Yabroff, K.R., J. S Mandelblatt, and J. Ingham (2005) The quality of medical care at the end-of- life in the USA: existing barriers and examples of process and outcome measures Palliative Medicine, April1,2005; 18(3): 202 - 216. Read More