Assisted Suicide

Introduction: Physician assisted suicide by definition is "When a patient dies as a result of the voluntary ingestion of a fatal dose of medication that a physician has prescribed for that purpose." Physician assisted suicide is one of the most debated topics in the healthcare world today with over 1.58 million patients in hospice in 2012. Many of these patients must decide between medication to ease the pain or having to make the difficult decision of physician assisted suicide to relieve the pain of dying from their terminal illness.

APA: Menzel, P. T., & Steinbock, B. (2013). Advance Directives, Dementia, and Physician-Assisted Death. Journal Of Law, Medicine & Ethics, 41(2), 484-500. doi:10.1111/jlme.12057

Summary: Physician-assisted suicide in the States and the Netherlands is the topic in this article. The purpose of the article was to discuss the laws and regulations of physician assisted suicide (PAD) and the deciding factor of when PAD should be implemented when patience have dementia and are unable to make decisions on their own. In the Netherlands they have come up with a “advance euthanasia directives” (AED) in which pt's with early onset dementia could write an AED stating that if they ever progressed into severe dementia they could stop the suffering with PAD. The controversy as you could imagine comes from the difficult decision of knowing if the pt is enjoying any form of living when they cannot make decisions to let you know how they feel. This is where many people argue that PAD is not right even if the AED was signed while the pt was fully competent, stating that physicians do not have the right to determine if the pt is enjoying life or not. The other side argues that if you are allowed to refuse care in ways such as AMA (Against Medical Advice) or refusing life sustaining treatment and die a slow painful death people with dementia should be able to choose a fast painless death to relieve them from a slow painful death. The largest problem for doctors would be the legal issues resulting from family going against the pt's AED and may try to keep the physician from going through with the PAD which may lead to many Legal issues down the road even if the doctors was acting within his scope of practice.

Critique: I found the article very interesting and made me think of all the hard decisions people have to make with assisted suicide from the pt all the way through the family to the doctor. This article was very easy to read using everyday language to describe a topic dealing with medical terms for which people could easily read and identify with. I believe the hardest part of this article is to choose what side to be on, whether or not to fallow the AED or not to. Do we as people show respect for these people by fallowing out the AED or do we disregard if the pt who still has some memories of the past which brings enjoyment. This is where it gets tricky and would have to think of it as if I were the pt what would I want. In my own opinion I would want to go out with some sort of dignity and would want them to fallow through with the AED as they stated in which they do in most cases for the pt's that they fallowed. The only thing that could make this paper would be more stories with more cases of pt's but with the limited ability of PAD in the United States it is hard to study this topic with people in this situation.

APA: Hendry, M., Pasterfield, D., Lewis, R., Carter, B., Hodgson, D., & Wilkinson, C. (2013). Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying. Palliative Medicine, 27(1), 13-26. doi:10.1177/0269216312463623

Summary: This article reviews the opinions and ideas of the results from the studies conducted of the patients, carers, and the public regarding assisted suicide. The results from the 11 electronic databases was revived and the findings were revealed that "people valued autonomy in death as much as in life." These people who were involved in the study would much rather have the ability to decide on death for themselves rather than the country they derive from. The study showed that many people who were suffering from psycho-social behaviors such as loneliness also believed in assisted suicide ads much as those who were suffering from unbearable pain. This was the results from 2/3 of the people from the 16 qualitative studies and the 94 surveys which were conducted for this study. The main reason behind the disagreeing with assisted suicide was the opportunity to abuse the system. Such as a slippery slope where caregivers used assisted suicide to rid of people who were a major cost to the facility and who had a terminal illness and that their wishes may not be respected and taken advantage of by healthcare insurance's.

Critique: The article was more likely for people in the medical field to read regarding some of the language that was used to explain there findings. I surprised by the findings that more people with Psychosocial disabilities have also come through with the ability of assisted suicide if it was presented to them and legal. Many of the key decisions in the studies showed that many people stated that if they had unbearable suffering they would more then likely ask for help to die. I also agree that their would be a large abuse of the ability of assisted suicide by healthcare insurance companies and many special need facilities do to the high cost of these patients. This high cost of healthcare in the last couple months of these people life "cost medicare $50 billion dollars last year."(http://www.cbsnews.com/news/the-cost-of-dying/) I believe Medicare would take advantage of this to save money that does not effect life.

APA: Nyatanga, B. (2013). Attitudes to death: a time to pose difficult questions. British Journal Of Community Nursing, 18(10), 512.

Summary: This article talks about the fact that people of all ages need to talk more openly about death and dying and to be comfortable with the fact that all people will die at some age. If we all become more comfortable with death it will make it easier to except it when the time comes for each and every one of us to speak out about their deepest wishes regarding death. The best way to begin opening up patience at their age and the stage that are in their life is to begin with nurses talking about death and try to make them except their fate in a way that makes it easier to deal with when the time comes. The hardest part with the nurses is that many nurses themselves do not like to talk about death which would be hard for the patients to understand and listen to them. This would just be like an obese patient telling another patient that he should lose weight while the obese gentleman continues to eat, it would be hypocritical and would not likely get the point across. One of the many other ways to help our society except death is to be more open about death to children while growing up and talking to children at the right time just like parents do with sex and underage drinking. Instead of parents excluding children from visiting family members who are on their death bed and children should also be aloud to visit funerals and in the end this should help us all except death when our time has come. If society in a whole became more open with death it would make it much more as an entity and many people would like to have a pleasant death just as they had a pleasant life, this pleasant death would come from the legalization of assisted suicide.

Critique: I would have to say that this article was by far the easiest article to read and the one in which made more sense that I could agree with most specially in the career field in which I am pursuing. I believe that many more people should be comfortable with death and dying and be able to talk about their options and not be afraid to do so. believe in the healthcare world we to have to be comfortable with talking to patients about death and options for afterlife. If we do not have the courage to talk to people who are dying about death then why should those patients want to be able to talk to us about it. I believe that if we except death we can make it easier to pass laws regarding assisted suicide and being able to make death a much better and easier way for those who are terminally ill or are suffering to end their life in an honorable way.

APA: Quill, T. E. (2012). Physicians Should 'Assist in Suicide' When It Is Appropriate. Journal Of Law, Medicine & Ethics,40(1), 57-65. doi:10.1111/j.1748-720X.2012.00646.x

Summary: Physician assisted suicide is the most humane way for this who are terminally ill and have suicide on their mind rather then the inhumane way that many people who are suffering choose to die such as refusing care and those who choose to stop eating and drinking to cause a slow and painful death. Physicians must also not go through with physician assisted suicide for all patients who request it and must evaluate if they are in their right state of mind. Many patients who choose Physician assisted suicide do not consider themselves as suicidal but more as one who would like dignity in their death and not someone who takes the easy way out. If physician assisted suicide was legal many people would not have to suffer in their last days of their lives. Physicians must evaluate all their patients before fallowing through with their wishes before assisted suicide to determine their state of mind. It is highly recommended for the patient, family, and their caregivers to research all the different ways to end their life honorable. Many terminally ill patients are put in to hospice and the physician should take this into account to see if the living conditions are tolerable and not wanting the patient to commit physician assisted suicide.

Critique: I believe that starving myself to death or having a prolonged death due to not being able to end my life in the way that I would want to as in a honorable death. I would not wish this upon anyone else to have to go through this who is suffering. I agree that some of these hospice places do not care about some of their patients and understand how many would rather die then live under those conditions. I think many physicians will know whether or not patients are trying to commit suicide by doctor or physician assisted suicide and will not abuse the system and kill people who have no reason besides the fact that they are not in their right state of mind. I do believe that some doctors would abuse it and charge a large fee for this service and not care about the patients just to make a large amount of money.

APA: Mariner, W. K. (1997). Physician Assisted Suicide and the Supreme Court: Putting the Constitutional Claim to Rest.American Journal Of Public Health, 87(12), 2058-2062.

Summary: This paper discusses the courts decision in 1997 by the supreme court that denies physician assisted suicide in the United States and the pros and cons of making it legal. More than 30,000 people commit suicide each year in American and non of which are considered illegal to do so by the state laws in which govern the people. Many of these deaths are not considered act of celebrating individual freedom nor is it an act of celebrated expression; in fact many of the suicides could be avoided. On the other many people are stating that there are too few suicides with terminally ill patients who are forced to live when they would rather not suffer. These views come from the side in which they believe that assisted suicide should be legal to prevent these issues of suffering in their final days alive. Many people on the other side state that their should be many other options people could and should resort to prevent this pain and suffering through these stages of people life. Stating that many doctors should be able to uses the drugs that are capable of sung by any means to prevent pain for these patients to ease them into death and to not let this be a stressful time in their life. "Americans deserve the right to good healthcare, and not just at the end of life.

Critique: I believe this article move in a different direction then the other articles I have listed earlier in this bibliography. This article has put a very different perspective in my head on the different decisions we could and should be able to make on our death bed. This how now showed me a new perspective of pain and terminal diseases in which is the option between assisted suicide and complete elimination of pain by heavy dosed drugs. I would lean toward the drugs if I knew i would not be suffering to spend as much time with my family as possible. On the other hand I believe that assisted suicide should still be legal and an open option for patients, or those who may not have family to end their life with and would just like to go peacefully in their sleep. In the end I do agree with the conclusion of this article and would say I am happy to have chosen the older article from 1997.

Overall Conclusion: All of these articles bring up many rest topics on physician assisted suicide from if it should be legal or not to people abusing the system and to people who believe it should not be an option. I believe these are all great points that should be taken accounted for such as the 50 million dollars it cost medicare to keep people alive at the very last stages of their life. I believe we should do something about this to save money for what is needed more. I believe this debate will go on for many more years to come with it always coming back to the abuse of the system.