Physician Assisted Suicide Legalized
Should assisted suicide be legal?
Introduction and Social Problems
Physician-assisted suicide, the practice that allows physicians to prescribe medications to terminally ill people to end their lives, is illegal in forty five states and Washington, DC. Oregon in contrast, is one of the five states that have legalized this procedure. One of the most recent and publicized cases of euthanasia (as it is also known) happened there, in 2014. The patient, a former California resident had to move to Oregon so she could get a physician to prescribe the drugs for her. Her story led to a bill that legalized euthanasia in California. The bill was signed into law by the California governor on October 5, 2015. Assisted suicide is also permitted in Washington, …show more content…
Vermont and Montana.
Proponents believe assisted suicide should be legal in all of the United States and no euthanasia prohibition should exist because when it comes to individual health care choices each person should be able to decide what the best course of action is in their personal case. Otherwise, it creates social and economic problems. Some of the social problems that arise, according to them are: a) elevated and extended costs of medical care in general, not just for the patient or their families, b) unnecessary suffering and agony for the terminally ill patient and their families. Statistics show that 55% of the terminally ill people die while in pain (“19 Great”), c) loss of personal control, and d) psychological harm to the patient due to the prospect of a painful death. Advocates also emphasize that the individual’s right to freedom of choice is violated since their options become limited by making euthanasia illegal. Aid in dying, as they prefer to call it, should be legal so individuals can die with dignity.
Opponents on the other hand, think that by making it legal, the following social problems are created: a) corruption of the medical practice, b) conflict of interest for the health care providers, c) violation of religious and social morals and values, d) promotion of unethical behavior (killing is immoral). They believe compassionate, palliative care is the way to manage terminally ill patients. By legalizing euthanasia, another social problem is created: palliative care further development and practice will be eliminated and this will increase even further the number of unnecessary deaths. In the Netherlands, where Physician Assisted Suicide (PAS) is legal, palliative care has been decreasing. “In 2002, palliative care teams were consulted in 19% of euthanasia cases; by 2007 it had declined to 9% of cases” (Pereira e40). Critics also emphasize prevention as the focus of medical efforts. “It [prevention] is more important than the cure” (Alexander 44).
History and Current Policy
This issue dates back to the Fifth to First Century B.C. , even though the Hippocratic Oath was already in effect, few followed it faithfully. The Oath reads: “I will keep [the sick] from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” (Veatch 3). Greeks and Romans tended to support assisted death, such as infanticide, euthanasia and suicide in cases of agony. For many of them there was no intrinsic value of human life. In the twelfth Century, with Christianity’s view of life as a trust from God, euthanasia was definitely forbidden. By the fifteenth century, opposition was almost unanimous in the medical community. In the seventeenth century, Common Law tradition prohibited suicide and assisted suicide in the American colonies ("Historical Timeline”). Modern legislation and positions started to emerge in the 19th century and continued to the present day:
• “1828 - First US Statute Outlawing Assisted Suicide Enacted in New York.
• 1885 - American Medical Association Opposes Euthanasia.
• 1952 - Groups Petition the United Nations to Amend the Declaration of Human Rights to Include Euthanasia.
• May 5, 1980 - Pope John Paul II Issues Declaration Opposing Assisted Suicide.
• 1997 - Oregon Voters Keep Death with Dignity Act.
• Nov. 4, 2008 - Washington Death with Dignity Act Is Passed.
• Dec. 5, 2008 - State of Montana Legalizes Physician-Assisted Suicide.
• May 20, 2013 - Vermont Becomes the Fourth State to Allow Physician-Assisted Suicide. (“Historical Timeline”)
• Oct. 5, 2015 - California Becomes the Fifth State to Legalize Physician-Assisted Suicide” (“Historical Timeline”).
Currently, euthanasia is illegal in 90% of the United States. The case in Oregon in 2014 however, led to an intensification of the Death with Dignity Campaign (as supporters like to call it) to advocate for state legislation that will allow mentally competent but terminally ill people get physician assistance in dying (DeBonis). Euthanasia is not a federal offense; there are no federal laws or federal policies to follow. In 1997, it was left to each state to decide and legislate on the matter. In Washington v. Glucksberg, the US Supreme Court declared that assisted suicide has not been a right in our history or traditions, this in response to the allegations of violation of due process by the plaintiffs. As a result, each state is free to bring PAS to the consideration of their constituents and legislative process so they can determine whether it is legal or not. Traditionally, Republicans have been against it and Democrats in favor this may explain why it is permitted in California, Montana, Oregon, Vermont and Washington.
Stakeholders
Demographics and religion seem to contribute to one’s position in regards to euthanasia. Studies show that white Americans tend to be more supportive of Physician Assisted Suicide (Braun 51). African Americans and Latino Americans tend to oppose PAS (Burdette 90). Overall, “strong religious commitment and frequent religious service attendance, regardless of religion, were associated with low support of PAS” (Braun 52). Conservatives tend to oppose it while Liberals advocate for it (Burdette 90). While these studies are important, it appears that one’s identification with conservative or liberal views is what determines their position with regards to PAS.
Supporting stakeholders:
The majority of supporting stakeholders are either members of the Democratic Party (liberals) or members of pro-assisted suicide groups and organizations. They identify themselves with the views and values of equality, protection of individual rights, autonomy, dignity and freedom of choice. They also argue that if a person is suffering and is terminally ill, they should be free to have some control in their final days and end their lives if they choose to. This option eliminates needless pain and suffering (DeBonis). Advocates believe that if people can refuse blood transfusions, terminally ill patients should be able to refuse to continue living too.
Compassion and choices is a nonprofit organization that assists terminally ill people in ending their lives. They claim everyone has choices at the end of life and “it is important to know our options so we can choose the best one” (Who we are). They state they work across the nation to protect and expand options at the end of life. The organization has been in operation for over thirty years. It has over 40,000 supporters and campaigns in nine states (Who we are). According to them, they are the largest organization of its kind in the United States. (Who we are). Compassion and Choices claim to be experts in what it takes to die well. Their purpose is: “a) to make aid in dying an open, legitimate option recognized throughout the medical field and permitted in more states, b) increase patient control and reduce unwanted interventions at the end of life c) push for additional laws ensuring full information and access to all end-of-life care options, d) normalize accurate, unbiased language throughout the end-of-life choice discussion (“aid in dying” instead of “assisted suicide”)” (Who we are).
In the District of Columbia, Councilmember Mary M. Cheh (D-Ward 3) an advocate of physician-assisted suicide introduced the “Death with Dignity Act of 2015.” She believes that if the bill is passed, it will offer “a peaceful exit” and that “the law should not force upon a person a punishing death.” (Szczepanowski). She is also a member of the Committee on Health and Human Services. She has pushed for legislation that promotes strong and good government involvement, equality for all and the District’s residents’ health improvement (About Mary).
Arguments
1) Advocates believe that Physician-Assisted Suicide should be legalized because it would prevent unnecessary suffering of the terminally ill. Statistics show that 55% of the terminally ill people die while in pain (“19 Great”). A study in 1997, established that 40% of terminally ill patients went through severe pain in the last three days of their life (Ho and Chantagul 254). Proponents say it is inhumane to allow someone to go through severe pain for days, and that no one should have to have an agonizing end of life experience. PAS would allow terminally ill patients to die with dignity and in this way, society would be showing mercy, compassion and that they care about members of the community.
2) Supporters also argue that health care costs for terminally ill would be significantly reduced and could be redirected to non-terminally ill patients. Back in 2005, it was estimated that of the 2.3 million deaths per year in the US, about 2.7% would choose PAS if it were available to them. This would represent savings of $804 million dollars (Bijou and Lester 359). These monetary resources could be instead invested in: research and development, better facilities, prevention and others. Even organ donation would be possible and it would save other ill people. Organ donation by one patient can help up to eight recipients and tissue donation can benefit over a hundred recipients ("Organs & Tissues for Transplant").
Opposing Stakeholders:
Opponents identify themselves with conservative views and values such as the sanctity of life, compassionate care to ease the pain of terminally ill people, non-corruption of the medical practice and honoring moral and ethical values. The Catholic Church, most Republicans and the American Medical Association, among others, reject assisted suicide and deem it as immoral, unethical and illegal. The United States Conference of Catholic Bishops has stated that physician-assisted suicide is simply, suicide and therefore it is against the Church’s teachings and God’s will. They also say that Christian as well as Jewish moral traditions have always rejected the idea of assisting in another’s death (DeBonis). In response to advocates who claim a violation of the right to freedom of choice, the Conference of Catholic Bishops says: “Having assistance to commit suicide is not a right”. They have also emphasized that the Catholic teachings view suicide as “gravely contrary to the just love of self, it breaks the ties of love and solidarity with family, nation and other human societies. It is contrary to love for the living God” ("Catechism of the Catholic Church").
American Life League, a pro-life group, has also highlighted that assisted suicide is a violation of the Hippocratic Oath that states: “I will keep [the sick] from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” (Veatch 3). The American Medical Association through their Ethics Group published their position with regards to Physician-Assisted Suicide in 1994 in their Code of Medical Ethics: “Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.” (Opinion). “It [Assisted Suicide] is fundamentally incompatible with the physician’s role as healer, it would be difficult or impossible to control and would pose serious societal risks” (Opinion), but they fail to elaborate on what those societal risks are.
Ryan T. Anderson of The Heritage Foundation in DC is a strong opponent who argues four reasons why it would be a mistake to legalize PAS: “a) the weak and vulnerable would be the most affected, b) it would corrupt the practice of medicine and the doctor–patient relationship, c) it would compromise the family and intergenerational commitments, d) it would betray human dignity and equality before the law.” (Anderson) (BioEdge).
Arguments
1) There are better ways (moral and ethical) of helping the terminally ill, besides assisted suicide.
Supporters believe true compassion is shown by caring for the terminally ill and helping them alleviate their pain through palliative care which is underutilized and it does not always go hand in hand with standard medical care. The American Board of Medical Specialties did not identify palliative care as a distinct specialty until 2006 ("Palliative Care"). Also, “advances in palliative medicine have produced effective strategies for managing and relieving pain for most terminally ill patients, including the possibility of palliative sedation” (Prokopetz and Lehman 97). A study conducted at the Massachusetts General Hospital between 2006 and 2009 demonstrated that terminally ill patients who received palliative care lived an average of 2.7 months longer. They also “reported a better quality of life and less depression than the patients who received standard care”, which did not include non-palliative care ("Palliative Care").
2) Having a terminal disease usually causes depression and these two conditions together lead to poor decision making and also precipitate suicide. Studies show that medical illness is related to suicide in 30% to 40% of the cases. These percentages increase significantly with serious/terminal diseases such as HIV/AIDS, Cancer and Multiple Sclerosis. The rate of major depression increases with the seriousness of the disease. (Kleespies, …show more content…
1166).
Analysis of Arguments and Evidence Both sides have valid arguments that are easy to understand. They also appeal to our common sense while backed with scientific evidence. The difference is that they come from very different perspectives. For opponents, one of their strongest arguments relies heavily on morality and ethics and how “we shall not kill”; instead we are called to ease pain and suffering. In contrast, advocates arguments are very practical and concrete. From their perspective, unnecessary suffering is inhumane and prolonging this type of life is also costly. However, the first part of this argument is outweighed by the opponents’ evidence on palliative care, which is not widespread and has proven effective for dealing with the issue of pain. The evidence presented by supporters with relation to reducing costs is weak since it is only an estimate of savings in contrast; opponents offer results of actual studies to support their position. They present a study from the Journal of Psychology that draws attention to the mental health of terminally ill patients and how much it can affect their decision making. It has been proven that depression is linked to suicide and even more so in assisted suicide cases. The study also points out that rigorous depression assessments are not typically incorporated in the overall treatment of terminally ill people. Advocates respond to this by referencing existing legislation that requires 2 physicians to certify the patient is mentally capable, i.e.: able to make and communicate health care decisions. In case of suspicion, they should request a psychological evaluation. Opponents insist in what studies have shown that unless a professional in mental health care is part of the process, most of the time patients are misdiagnosed when it comes to depression suffering. Advocates claim, the terminally ill have a right to die with dignity to which opponents respond: dignity is living one’s life until the very last moment God has chosen. Just as human beings do not decide when their lives start, they should not decide when to terminate them. Dying with dignity is getting to the end of one’s life surrounded by family and friends; they agree with opponents but also with the help of the medical professionals whose job is to alleviate pain and make the process easier for the sick, not by terminating the process of life. There are medical treatments to aid in pain management as well as stress management that are not being incorporated to the treatment of terminally ill people and that is another reason why patients that are in severe pain choose to end their lives. The percentage of people who die in severe pain is a good argument for proponents but it can be countered with opponents’ argument that palliative care should be rigorous and applied in every case, their figures make a better argument since as a result of legalizing euthanasia in Belgium; palliative care fell 10% in only 5 years. Overall, the arguments and evidence presented by opponents is more persuasive because depression does play an important role in one’s decision to end one’s life and if it goes untreated as it often does, the provision of the legislation in Oregon and its application, for example, has failed to produce the intended result: preventing unnecessary assisted suicides.
Values
Proponents of legalizing euthanasia value: autonomy, pro-choice, human and individual rights, mercy, compassion, empathy, equality, moral obligation to relief pain and also the right to die with dignity and therefore identify themselves with liberal views. Their arguments reflect a Utilitarian approach of the issue, where they seek the greatest benefit for the greatest number. Opponents, in contrast, are conservative and value: morality, ethics, legality, preservation of life, following tradition and rules that have been established whether by religious beliefs or moral entities. Critics also value limited government: they have no business regulating who lives and who dies. Both sides however value dignity and compassion, only they understand these concepts very differently.
Solution
I believe regulation is necessary, but not to legalize physician assisted suicide. In my solution, rigorous legislation should be directed to promote intensive prevention as well as research and development of cures of incurable diseases and to educate people on good health care habits, so we can break the circle. “Prevention is more important than the cure”, said Dr. Leo Alexander (44) in his 1949 article: “Medical Science Under Dictatorship”, almost 7 decades later, this statement is still true. To effectively address the issue of terminally ill patients, we need more dedicated palliative care centers and specialists that will manage all components: pain, distress, depression, family, etc. Particularly in states such as Alabama, Alaska, Arkansas, Mississippi, New Mexico, Oklahoma and Wyoming that have received a “D grade because only 40% or less of hospitals have palliative care” ("Press Releases"). And “only 23% of for-profit hospitals have palliative care” ("Press Releases"). Treating terminally ill patients as any other patient is the wrong approach. Instead as soon as someone is diagnosed as terminally ill, palliative care needs to be the absolute next step along with the corresponding standard medical treatment. This will take care of the pain and suffering issue along with the quality of life argument.
Counterarguments
Advocates for PAS believe that terminally ill patients should have the right to decide when to end their lives with the assistance of a physician who would prescribe a lethal dose of drugs. What they have failed to recognize is the motivation behind it, the majority of patients who would consider euthanasia do so because of 2 main reasons: fear of suffering and they worry they would become a burden to their families. Palliative care is not a standard of care and it is still in the optional implementation stage, therefore it is due to lack of information that patients worry about agonizing and find PAS a viable solution. To counter the opponents’ argument of the role of depression on these decisions, advocates insist that existing regulation in states that allow this practice, requires 2 physicians to agree on the patient’s mental health at the time they make this decision. An important distinction that needs to be made is that a physician is not a mental health professional and unless a psychological evaluation is requires, unnecessary PAS will continue. It is our duty as a society to stop this and to prevent it. I believe in going the extra mile to care for this type of patients, and their care also includes drugs to alleviate their pain not to eradicate lives. Another argument from advocates is organ donation and how it would save the lives of others, while I agree with it, the viability of organs from the terminally ill is not higher than organs proceeding from non-terminally ill donors and once this subject is brought up to the patient it puts more pressure on them to make a decision towards PAS and faster.
a. Values
The 2 values that I hold most strongly in choosing to eliminate PAS are prevention and excellence. By heavily promoting good health care habits some types of cancer for instance, can be prevented along with sudden unnecessary deaths such as: heart attacks. There are other diseases or conditions however, that are not curable so far. We therefore need excellent palliative care centers to assist patients in these situations. We are all equal under the law so we should all have the right to live our lives until our very last minute and not to have them shortened for fear to be a burden, for fear of agony or because our organs can be put to better use. We also have a right to be informed. Terminally ill patients more than anyone should be advised that palliative care exists and what it consists of so they can get some sense of relief and put aside their fears of suffering and agony.
b. Obligations
As mentioned above, we have an obligation to our fellow human beings to do all that is humanely possible to preserve life and eliminate suffering. With the advancement of technology, we have been able to cure more and more diseases and what was deathly before, is now in the books of history. Although finding cures takes years of research and studies, a cure is eventually found, approved and available to patients. It is our responsibility as individuals and as a society to see that these cures become a reality through our legislative bodies which enact regulation that facilitates and expedites research and development. Anyone can become terminally ill at any given time, proof that we are all the same not just under the law but to mother nature.
c. Consequences The first consequences I anticipate are: rejection of the preventive measures which will include banning cigarettes, among other substances including certain types of processed foods that have been proven to adversely affect health and lead to incurable diseases.
Economic interests will inevitably play a major role but as we have seen through history, change will come even if it is at a slow pace. Another consequence is rejection to the extensive institution of palliative care centers throughout the country, once again economic interests will play a decisive role. However, once PAS has been banned and legislation that promotes prevention as well as research and development is in place, the consequences that will be seen are: more and more healthy people, a significant decrease of depression in terminally ill patients and members of their families who also suffer from depression, due to lack of tools to be able to cope. Better and significantly improved quality of life due to palliative care centers. Prevention will also reduce health care costs and other diseases that do not necessarily fall under the category of incurable or that render the individual as terminally ill, such as hypertension, obesity, heart disease, etc. This will lead to physically and mentally healthier
individuals.
Two Normative Principles
The Principle of Ends supports my solution. It forbids us from treating others as mere means to an ends but always as ends in themselves. If we were to legalize PAS, society would be getting rid of terminally ill patients as a means to reduce the cost of treating them and also as proponents suggested, as a means to get organs to patients who need them. This approach reflects regard for the terminally ill patient as an object, not as a person and complete disregard for their families in the sense that no family wants any of their members dying prematurely.
Another principle that supports my solution is the principle of Equality which states that each person is entitled to treatment as an equal, i.e., should be shown the respect and concern of which any moral being is worthy. It cannot be achieved if a poor and older terminally patient does not receive the same type of care that a younger and wealthy patient diagnosed with the same disease would. Very rarely would euthanasia be suggested to a wealthy patient and palliative care would be the first on the list to alleviate any type of discomfort until all options are explored or until the end of their lives. This approach would not be the same for the poor and elder. This difference in treatments leads to inequality and discrimination, neither one coincides with the values on which this country was formed.
Conclusion
We cannot expect this controversy to be over anytime soon due to its own nature: a conflict of values and perspectives as well as economic interests that always play a fundamental role. If this solution is approved and implemented, it would make the United States a country that prioritizes the wellbeing of their people over other interests. Opponents would see it as the government trying to control its citizens and as a violation of their rights but instead what the government would really be doing is protecting its citizens, particularly the most vulnerable, in this case: the sick. At the same time, it would be establishing the conditions for a more prosperous country. We cannot expect progress and a better, happier life if we are unhealthy and sick. Also, as individuals we need to assume responsibility for our own good health and take care of it. In the pursuit of happiness, a healthy body and mind are paramount.
Introduction and Social Problems
Physician-assisted suicide, the practice that allows physicians to prescribe medications to terminally ill people to end their lives, is illegal in forty five states and Washington, DC. Oregon in contrast, is one of the five states that have legalized this procedure. One of the most recent and publicized cases of euthanasia (as it is also known) happened there, in 2014. The patient, a former California resident had to move to Oregon so she could get a physician to prescribe the drugs for her. Her story led to a bill that legalized euthanasia in California. The bill was signed into law by the California governor on October 5, 2015. Assisted suicide is also permitted in Washington, …show more content…
Vermont and Montana.
Proponents believe assisted suicide should be legal in all of the United States and no euthanasia prohibition should exist because when it comes to individual health care choices each person should be able to decide what the best course of action is in their personal case. Otherwise, it creates social and economic problems. Some of the social problems that arise, according to them are: a) elevated and extended costs of medical care in general, not just for the patient or their families, b) unnecessary suffering and agony for the terminally ill patient and their families. Statistics show that 55% of the terminally ill people die while in pain (“19 Great”), c) loss of personal control, and d) psychological harm to the patient due to the prospect of a painful death. Advocates also emphasize that the individual’s right to freedom of choice is violated since their options become limited by making euthanasia illegal. Aid in dying, as they prefer to call it, should be legal so individuals can die with dignity.
Opponents on the other hand, think that by making it legal, the following social problems are created: a) corruption of the medical practice, b) conflict of interest for the health care providers, c) violation of religious and social morals and values, d) promotion of unethical behavior (killing is immoral). They believe compassionate, palliative care is the way to manage terminally ill patients. By legalizing euthanasia, another social problem is created: palliative care further development and practice will be eliminated and this will increase even further the number of unnecessary deaths. In the Netherlands, where Physician Assisted Suicide (PAS) is legal, palliative care has been decreasing. “In 2002, palliative care teams were consulted in 19% of euthanasia cases; by 2007 it had declined to 9% of cases” (Pereira e40). Critics also emphasize prevention as the focus of medical efforts. “It [prevention] is more important than the cure” (Alexander 44).
History and Current Policy
This issue dates back to the Fifth to First Century B.C. , even though the Hippocratic Oath was already in effect, few followed it faithfully. The Oath reads: “I will keep [the sick] from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” (Veatch 3). Greeks and Romans tended to support assisted death, such as infanticide, euthanasia and suicide in cases of agony. For many of them there was no intrinsic value of human life. In the twelfth Century, with Christianity’s view of life as a trust from God, euthanasia was definitely forbidden. By the fifteenth century, opposition was almost unanimous in the medical community. In the seventeenth century, Common Law tradition prohibited suicide and assisted suicide in the American colonies ("Historical Timeline”). Modern legislation and positions started to emerge in the 19th century and continued to the present day:
• “1828 - First US Statute Outlawing Assisted Suicide Enacted in New York.
• 1885 - American Medical Association Opposes Euthanasia.
• 1952 - Groups Petition the United Nations to Amend the Declaration of Human Rights to Include Euthanasia.
• May 5, 1980 - Pope John Paul II Issues Declaration Opposing Assisted Suicide.
• 1997 - Oregon Voters Keep Death with Dignity Act.
• Nov. 4, 2008 - Washington Death with Dignity Act Is Passed.
• Dec. 5, 2008 - State of Montana Legalizes Physician-Assisted Suicide.
• May 20, 2013 - Vermont Becomes the Fourth State to Allow Physician-Assisted Suicide. (“Historical Timeline”)
• Oct. 5, 2015 - California Becomes the Fifth State to Legalize Physician-Assisted Suicide” (“Historical Timeline”).
Currently, euthanasia is illegal in 90% of the United States. The case in Oregon in 2014 however, led to an intensification of the Death with Dignity Campaign (as supporters like to call it) to advocate for state legislation that will allow mentally competent but terminally ill people get physician assistance in dying (DeBonis). Euthanasia is not a federal offense; there are no federal laws or federal policies to follow. In 1997, it was left to each state to decide and legislate on the matter. In Washington v. Glucksberg, the US Supreme Court declared that assisted suicide has not been a right in our history or traditions, this in response to the allegations of violation of due process by the plaintiffs. As a result, each state is free to bring PAS to the consideration of their constituents and legislative process so they can determine whether it is legal or not. Traditionally, Republicans have been against it and Democrats in favor this may explain why it is permitted in California, Montana, Oregon, Vermont and Washington.
Stakeholders
Demographics and religion seem to contribute to one’s position in regards to euthanasia. Studies show that white Americans tend to be more supportive of Physician Assisted Suicide (Braun 51). African Americans and Latino Americans tend to oppose PAS (Burdette 90). Overall, “strong religious commitment and frequent religious service attendance, regardless of religion, were associated with low support of PAS” (Braun 52). Conservatives tend to oppose it while Liberals advocate for it (Burdette 90). While these studies are important, it appears that one’s identification with conservative or liberal views is what determines their position with regards to PAS.
Supporting stakeholders:
The majority of supporting stakeholders are either members of the Democratic Party (liberals) or members of pro-assisted suicide groups and organizations. They identify themselves with the views and values of equality, protection of individual rights, autonomy, dignity and freedom of choice. They also argue that if a person is suffering and is terminally ill, they should be free to have some control in their final days and end their lives if they choose to. This option eliminates needless pain and suffering (DeBonis). Advocates believe that if people can refuse blood transfusions, terminally ill patients should be able to refuse to continue living too.
Compassion and choices is a nonprofit organization that assists terminally ill people in ending their lives. They claim everyone has choices at the end of life and “it is important to know our options so we can choose the best one” (Who we are). They state they work across the nation to protect and expand options at the end of life. The organization has been in operation for over thirty years. It has over 40,000 supporters and campaigns in nine states (Who we are). According to them, they are the largest organization of its kind in the United States. (Who we are). Compassion and Choices claim to be experts in what it takes to die well. Their purpose is: “a) to make aid in dying an open, legitimate option recognized throughout the medical field and permitted in more states, b) increase patient control and reduce unwanted interventions at the end of life c) push for additional laws ensuring full information and access to all end-of-life care options, d) normalize accurate, unbiased language throughout the end-of-life choice discussion (“aid in dying” instead of “assisted suicide”)” (Who we are).
In the District of Columbia, Councilmember Mary M. Cheh (D-Ward 3) an advocate of physician-assisted suicide introduced the “Death with Dignity Act of 2015.” She believes that if the bill is passed, it will offer “a peaceful exit” and that “the law should not force upon a person a punishing death.” (Szczepanowski). She is also a member of the Committee on Health and Human Services. She has pushed for legislation that promotes strong and good government involvement, equality for all and the District’s residents’ health improvement (About Mary).
Arguments
1) Advocates believe that Physician-Assisted Suicide should be legalized because it would prevent unnecessary suffering of the terminally ill. Statistics show that 55% of the terminally ill people die while in pain (“19 Great”). A study in 1997, established that 40% of terminally ill patients went through severe pain in the last three days of their life (Ho and Chantagul 254). Proponents say it is inhumane to allow someone to go through severe pain for days, and that no one should have to have an agonizing end of life experience. PAS would allow terminally ill patients to die with dignity and in this way, society would be showing mercy, compassion and that they care about members of the community.
2) Supporters also argue that health care costs for terminally ill would be significantly reduced and could be redirected to non-terminally ill patients. Back in 2005, it was estimated that of the 2.3 million deaths per year in the US, about 2.7% would choose PAS if it were available to them. This would represent savings of $804 million dollars (Bijou and Lester 359). These monetary resources could be instead invested in: research and development, better facilities, prevention and others. Even organ donation would be possible and it would save other ill people. Organ donation by one patient can help up to eight recipients and tissue donation can benefit over a hundred recipients ("Organs & Tissues for Transplant").
Opposing Stakeholders:
Opponents identify themselves with conservative views and values such as the sanctity of life, compassionate care to ease the pain of terminally ill people, non-corruption of the medical practice and honoring moral and ethical values. The Catholic Church, most Republicans and the American Medical Association, among others, reject assisted suicide and deem it as immoral, unethical and illegal. The United States Conference of Catholic Bishops has stated that physician-assisted suicide is simply, suicide and therefore it is against the Church’s teachings and God’s will. They also say that Christian as well as Jewish moral traditions have always rejected the idea of assisting in another’s death (DeBonis). In response to advocates who claim a violation of the right to freedom of choice, the Conference of Catholic Bishops says: “Having assistance to commit suicide is not a right”. They have also emphasized that the Catholic teachings view suicide as “gravely contrary to the just love of self, it breaks the ties of love and solidarity with family, nation and other human societies. It is contrary to love for the living God” ("Catechism of the Catholic Church").
American Life League, a pro-life group, has also highlighted that assisted suicide is a violation of the Hippocratic Oath that states: “I will keep [the sick] from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” (Veatch 3). The American Medical Association through their Ethics Group published their position with regards to Physician-Assisted Suicide in 1994 in their Code of Medical Ethics: “Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.” (Opinion). “It [Assisted Suicide] is fundamentally incompatible with the physician’s role as healer, it would be difficult or impossible to control and would pose serious societal risks” (Opinion), but they fail to elaborate on what those societal risks are.
Ryan T. Anderson of The Heritage Foundation in DC is a strong opponent who argues four reasons why it would be a mistake to legalize PAS: “a) the weak and vulnerable would be the most affected, b) it would corrupt the practice of medicine and the doctor–patient relationship, c) it would compromise the family and intergenerational commitments, d) it would betray human dignity and equality before the law.” (Anderson) (BioEdge).
Arguments
1) There are better ways (moral and ethical) of helping the terminally ill, besides assisted suicide.
Supporters believe true compassion is shown by caring for the terminally ill and helping them alleviate their pain through palliative care which is underutilized and it does not always go hand in hand with standard medical care. The American Board of Medical Specialties did not identify palliative care as a distinct specialty until 2006 ("Palliative Care"). Also, “advances in palliative medicine have produced effective strategies for managing and relieving pain for most terminally ill patients, including the possibility of palliative sedation” (Prokopetz and Lehman 97). A study conducted at the Massachusetts General Hospital between 2006 and 2009 demonstrated that terminally ill patients who received palliative care lived an average of 2.7 months longer. They also “reported a better quality of life and less depression than the patients who received standard care”, which did not include non-palliative care ("Palliative Care").
2) Having a terminal disease usually causes depression and these two conditions together lead to poor decision making and also precipitate suicide. Studies show that medical illness is related to suicide in 30% to 40% of the cases. These percentages increase significantly with serious/terminal diseases such as HIV/AIDS, Cancer and Multiple Sclerosis. The rate of major depression increases with the seriousness of the disease. (Kleespies, …show more content…
1166).
Analysis of Arguments and Evidence Both sides have valid arguments that are easy to understand. They also appeal to our common sense while backed with scientific evidence. The difference is that they come from very different perspectives. For opponents, one of their strongest arguments relies heavily on morality and ethics and how “we shall not kill”; instead we are called to ease pain and suffering. In contrast, advocates arguments are very practical and concrete. From their perspective, unnecessary suffering is inhumane and prolonging this type of life is also costly. However, the first part of this argument is outweighed by the opponents’ evidence on palliative care, which is not widespread and has proven effective for dealing with the issue of pain. The evidence presented by supporters with relation to reducing costs is weak since it is only an estimate of savings in contrast; opponents offer results of actual studies to support their position. They present a study from the Journal of Psychology that draws attention to the mental health of terminally ill patients and how much it can affect their decision making. It has been proven that depression is linked to suicide and even more so in assisted suicide cases. The study also points out that rigorous depression assessments are not typically incorporated in the overall treatment of terminally ill people. Advocates respond to this by referencing existing legislation that requires 2 physicians to certify the patient is mentally capable, i.e.: able to make and communicate health care decisions. In case of suspicion, they should request a psychological evaluation. Opponents insist in what studies have shown that unless a professional in mental health care is part of the process, most of the time patients are misdiagnosed when it comes to depression suffering. Advocates claim, the terminally ill have a right to die with dignity to which opponents respond: dignity is living one’s life until the very last moment God has chosen. Just as human beings do not decide when their lives start, they should not decide when to terminate them. Dying with dignity is getting to the end of one’s life surrounded by family and friends; they agree with opponents but also with the help of the medical professionals whose job is to alleviate pain and make the process easier for the sick, not by terminating the process of life. There are medical treatments to aid in pain management as well as stress management that are not being incorporated to the treatment of terminally ill people and that is another reason why patients that are in severe pain choose to end their lives. The percentage of people who die in severe pain is a good argument for proponents but it can be countered with opponents’ argument that palliative care should be rigorous and applied in every case, their figures make a better argument since as a result of legalizing euthanasia in Belgium; palliative care fell 10% in only 5 years. Overall, the arguments and evidence presented by opponents is more persuasive because depression does play an important role in one’s decision to end one’s life and if it goes untreated as it often does, the provision of the legislation in Oregon and its application, for example, has failed to produce the intended result: preventing unnecessary assisted suicides.
Values
Proponents of legalizing euthanasia value: autonomy, pro-choice, human and individual rights, mercy, compassion, empathy, equality, moral obligation to relief pain and also the right to die with dignity and therefore identify themselves with liberal views. Their arguments reflect a Utilitarian approach of the issue, where they seek the greatest benefit for the greatest number. Opponents, in contrast, are conservative and value: morality, ethics, legality, preservation of life, following tradition and rules that have been established whether by religious beliefs or moral entities. Critics also value limited government: they have no business regulating who lives and who dies. Both sides however value dignity and compassion, only they understand these concepts very differently.
Solution
I believe regulation is necessary, but not to legalize physician assisted suicide. In my solution, rigorous legislation should be directed to promote intensive prevention as well as research and development of cures of incurable diseases and to educate people on good health care habits, so we can break the circle. “Prevention is more important than the cure”, said Dr. Leo Alexander (44) in his 1949 article: “Medical Science Under Dictatorship”, almost 7 decades later, this statement is still true. To effectively address the issue of terminally ill patients, we need more dedicated palliative care centers and specialists that will manage all components: pain, distress, depression, family, etc. Particularly in states such as Alabama, Alaska, Arkansas, Mississippi, New Mexico, Oklahoma and Wyoming that have received a “D grade because only 40% or less of hospitals have palliative care” ("Press Releases"). And “only 23% of for-profit hospitals have palliative care” ("Press Releases"). Treating terminally ill patients as any other patient is the wrong approach. Instead as soon as someone is diagnosed as terminally ill, palliative care needs to be the absolute next step along with the corresponding standard medical treatment. This will take care of the pain and suffering issue along with the quality of life argument.
Counterarguments
Advocates for PAS believe that terminally ill patients should have the right to decide when to end their lives with the assistance of a physician who would prescribe a lethal dose of drugs. What they have failed to recognize is the motivation behind it, the majority of patients who would consider euthanasia do so because of 2 main reasons: fear of suffering and they worry they would become a burden to their families. Palliative care is not a standard of care and it is still in the optional implementation stage, therefore it is due to lack of information that patients worry about agonizing and find PAS a viable solution. To counter the opponents’ argument of the role of depression on these decisions, advocates insist that existing regulation in states that allow this practice, requires 2 physicians to agree on the patient’s mental health at the time they make this decision. An important distinction that needs to be made is that a physician is not a mental health professional and unless a psychological evaluation is requires, unnecessary PAS will continue. It is our duty as a society to stop this and to prevent it. I believe in going the extra mile to care for this type of patients, and their care also includes drugs to alleviate their pain not to eradicate lives. Another argument from advocates is organ donation and how it would save the lives of others, while I agree with it, the viability of organs from the terminally ill is not higher than organs proceeding from non-terminally ill donors and once this subject is brought up to the patient it puts more pressure on them to make a decision towards PAS and faster.
a. Values
The 2 values that I hold most strongly in choosing to eliminate PAS are prevention and excellence. By heavily promoting good health care habits some types of cancer for instance, can be prevented along with sudden unnecessary deaths such as: heart attacks. There are other diseases or conditions however, that are not curable so far. We therefore need excellent palliative care centers to assist patients in these situations. We are all equal under the law so we should all have the right to live our lives until our very last minute and not to have them shortened for fear to be a burden, for fear of agony or because our organs can be put to better use. We also have a right to be informed. Terminally ill patients more than anyone should be advised that palliative care exists and what it consists of so they can get some sense of relief and put aside their fears of suffering and agony.
b. Obligations
As mentioned above, we have an obligation to our fellow human beings to do all that is humanely possible to preserve life and eliminate suffering. With the advancement of technology, we have been able to cure more and more diseases and what was deathly before, is now in the books of history. Although finding cures takes years of research and studies, a cure is eventually found, approved and available to patients. It is our responsibility as individuals and as a society to see that these cures become a reality through our legislative bodies which enact regulation that facilitates and expedites research and development. Anyone can become terminally ill at any given time, proof that we are all the same not just under the law but to mother nature.
c. Consequences The first consequences I anticipate are: rejection of the preventive measures which will include banning cigarettes, among other substances including certain types of processed foods that have been proven to adversely affect health and lead to incurable diseases.
Economic interests will inevitably play a major role but as we have seen through history, change will come even if it is at a slow pace. Another consequence is rejection to the extensive institution of palliative care centers throughout the country, once again economic interests will play a decisive role. However, once PAS has been banned and legislation that promotes prevention as well as research and development is in place, the consequences that will be seen are: more and more healthy people, a significant decrease of depression in terminally ill patients and members of their families who also suffer from depression, due to lack of tools to be able to cope. Better and significantly improved quality of life due to palliative care centers. Prevention will also reduce health care costs and other diseases that do not necessarily fall under the category of incurable or that render the individual as terminally ill, such as hypertension, obesity, heart disease, etc. This will lead to physically and mentally healthier
individuals.
Two Normative Principles
The Principle of Ends supports my solution. It forbids us from treating others as mere means to an ends but always as ends in themselves. If we were to legalize PAS, society would be getting rid of terminally ill patients as a means to reduce the cost of treating them and also as proponents suggested, as a means to get organs to patients who need them. This approach reflects regard for the terminally ill patient as an object, not as a person and complete disregard for their families in the sense that no family wants any of their members dying prematurely.
Another principle that supports my solution is the principle of Equality which states that each person is entitled to treatment as an equal, i.e., should be shown the respect and concern of which any moral being is worthy. It cannot be achieved if a poor and older terminally patient does not receive the same type of care that a younger and wealthy patient diagnosed with the same disease would. Very rarely would euthanasia be suggested to a wealthy patient and palliative care would be the first on the list to alleviate any type of discomfort until all options are explored or until the end of their lives. This approach would not be the same for the poor and elder. This difference in treatments leads to inequality and discrimination, neither one coincides with the values on which this country was formed.
Conclusion
We cannot expect this controversy to be over anytime soon due to its own nature: a conflict of values and perspectives as well as economic interests that always play a fundamental role. If this solution is approved and implemented, it would make the United States a country that prioritizes the wellbeing of their people over other interests. Opponents would see it as the government trying to control its citizens and as a violation of their rights but instead what the government would really be doing is protecting its citizens, particularly the most vulnerable, in this case: the sick. At the same time, it would be establishing the conditions for a more prosperous country. We cannot expect progress and a better, happier life if we are unhealthy and sick. Also, as individuals we need to assume responsibility for our own good health and take care of it. In the pursuit of happiness, a healthy body and mind are paramount.