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Physician Aid-in-Dying Ethical Topic in Medicine

PHYSICIAN AID-IN-DYING: ETHICAL TOPIC IN MEDICINE 13

PhysicianAid-in-Dying: Ethical Topic in Medicine

PhysicianAid-in-Dying: Ethical Topic in Medicine

Physicianaid-in-dying also commonly called PAD is the act by which a doctorwith the agreement or a request from a patient prescribes a lethaldose of medication with which the patient uses to end his or herlife. In PAD the doctor knowingly and intentionally provides thepatient with information or means on how to commit suicide. PAD canalso be said to be an end to life in which eligible individuals ofsane mind, but suffering from terminal illnesses can legally requestmedication from their doctor to end their life in an honorable,caring, and helpful manner compared to how the ailments would killthem. There is a slight difference between PAD and euthanasia giventhat in euthanasia, the doctor administers the means of death,whereas in PAD the patient usually uses of lethal drugs to terminatelife. Raging debates have been raised on the legality of PAD and ifit is morally acceptable. This essay elaborates why there areinstances where physician aid in dying is acceptable and should bepracticed.

Argumentsfor Physician Aid-in-Dying

Proponentsof PAD base their arguments on the most common medical ethics ofpatient`s autonomy. The notion is that the decisions about how andwhat time to die should be private and competent people with theterminal illness should be allowed to choose the manner and timing oftheir death (Battin, et al., 2007). The society should, therefore,recognize that patients have full rights to their bodies and can,therefore, select what may or should not be done on them. It isimportant for the society to agree that competent adults haveabsolute rights to their bodies, including the right to stoplife-sustaining treatment. In as much as it is illegal to help aperson end their life, if a patient were to ask for help, it would beinhuman to let them fend for themselves. Thus, this would bepsychologically draining to the patients as they try to weighoptions, which are mostly uncertain when they can be humanelyassisted (Cohen-Almagor, 2015). If people have the right to decidehow to live their lives and choose what to do, accordingly theyshould also be given the right to choose how and when they die.

Onceindividuals’ autonomy is respected, they are given a chance to endtheir suffering in times of need. According to Ganzini, et al.,(2014), suffering is not just a matter of pain rather it expands tophysical, psychological and social burdens, for example, loss ofself-control and independence to operate in a healthy manner, whichin turn jeopardizes someone`s dignity. Suffering does affect not onlythe patient but also his or her immediate relations. As statisticshow patients who do not request for PAD suffer more than those whorequest for it. Therefore, it is critical that in instances where thecure is impossible and there being no other available option to endthe patients suffering then the patient should be given a chance tojudge if death would be harmful or a viable option to take (Herx,2015). It is always next to impossible to relieve one of the acute orchronic suffering, leaving PAD as the only compassionate response toending it. Doctors have the responsibility of providing care andserving every the medical interest and wishes of patients. Thus, if aclient puts a request to end his or her suffering, doctors should beobligated to do so. It would be an uncompassionate thing to do ifpatients were consigned to unbearable suffering when they haveoptions to end it.

Ifjustice requires for every case to be treated alike, then competentand terminally ill patients have the legal right to say no totreatment that would only prolong their deaths. For patients with alifespan of fewer than six months and are not dependent on any lifesupporting machine, to equitably treat them, then PAD should beallowed as an option for them to hasten their deaths if need be(Sercu, et al. 2012). There is no way one can claim to be a championof justice, yet stifle patients that require justice to work in theirfavor. PAD offers a just and fair way in the management of terminalillness as compared to the long and inhuman suffering that thepatient face in cases where they are denied their right to determinehow and when to end their suffering. Evidently, there is no justicein seeing someone suffer, yet there are ways in which they can berelieved of their pain. Proponents of PAD respect social diversity,which accepts that people respond and think differently, making itdefensible as a policy in our society.

Today,assisted death is already taking place, though it is mostly done insecret. The illegality of PAD makes it tough for the patient and thedoctor to have an open discussion about it, fearing public and legalrebukes. By legalizing PAD, it makes it easier for the doctors andpatients to talk about it openly, in an honest and transparent manner(Emanuel, et al. 2016). This would promote a better end to life giventhat the patient and the doctor would conclusively address theirconcerns and available options. Open, honest, and transparentdiscussion on PAD will provide information to the public, which theywould otherwise not know. Hence, this opens an avenue for moreinvolvement in the matter and making it a safe practice in themanagement of one`s health (Emanuel, et al. 2016). These kinds ofdiscussions will help people move past the issue of whether PAD issuicide and concentrate on intentions and the range of options androles terminal patients have to play in determining their death. As aresult, PAD should be talked about more openly, especially with therise in incurable illness in the society. Legalizing it will enablePAD to be part of a direly needed solution in the medical field.

Thereis no doubt of the societal interest in preserving life. However,this desire reduces when a person`s terminal illness causes a lot ofsuffering leaving him or her with a strong desire to die. In such acase an individual`s liberty should be considered more than thestate`s interest and thereby allow PAD. Nicole, et al. (2013), arguesthat a complete prohibition of PAD substantially infringes onsomeone’s personal interest and needs challenging the freedom andrights of the person in the process. In states where PAD has beenlegalized statistics show that only sixty percent of individuals whoseek it go ahead with it. This goes to demonstrate that knowledge onPAD availability helps aid the well-being of patients because itreassures them that they have the option to choose in case they havehad enough of their suffering (Maessen, et al. 2014). By legalizingPAD, the state will show their human face by not forcing patients tosuffer yet they are willing to die to relieve themselves of thesuffering.

Legalizationof PAD would also help protect against physician paternalism andreduce waste of resources and time in trying to treat a patient.Today patient autonomy has shifted the medical practice from theapproach of “doctors know best.” Doctors today are mandated toprovide patients will all the information regarding their illness, toallow the clients to decide on their health and make informed choices(Sercu et al. 2012). Therefore, physicians should be able to advisetheir patients accordingly, and where need be, they should be able tosuggest PAD as a way to help the patient handle his or her illness.Legalizing PAD would instantly put it as an available option for thepatients who would therein proceed in making the decision if theywould want to continue with it (Maessen, et al. 2014). Statisticsshow that most patients would go for PAD to save the valuableresources being wasted on them trying to keep them alive and alsospare their direct relations the anguish of having to watch themsuffer in the final days of their lives.

CounterArguments for Aid-in-Dying

Inas much as many will agree that it is morally right to administer PADthere are those who greatly oppose it. Their principal argument lieson the wrongness to kill, and that suicide is wrong even for the ill.To them, sanctioning PAD is giving doctors the license to kill. Thisis a ridiculous and inflammatory assertion. They have failed to basetheir arguments on any fact and always contradict themselves. Forexample, how is it that the same people who oppose PAD would be okaywith the withdrawal of life-supporting machines without the patient`sconsent yet they graciously oppose the use of lethal drugs requestedby a patient to help the patient deal with his or her illness?Cohen-Almagor (2015), challenges that this idea of how is it thatthey perceive the latter as murder and the former as not. Instead ofreferring to PAD as murder, everyone should look at it as a manner ofoffering a merciful end of the dying process. Doctors who go aheadand administer PAD to patients who are facing their deaths underunbearable conditions should not be seen as murderers rather theyshould be seen as people who are doing good to release a patient fromtheir suffering.

Opponentsof PAD also argue that if legalized people will take advantage of it.They claim that poor individuals who lack quality access to healthcare and support will be pushed into the use of PAD as a costmanagement strategy (Gamondi et al. 2014). They further claim thatfamily members and doctors may encourage patients to consider PAD andthat there may never be legislation that can address all instances ofsuch exploitation. In as much as they might have valid points inthis, they fail to address the real harm of not responding to thereal people who have genuinely requested for PAD because they cannothandle their suffering anymore. Like any other legislation enacted,people will always look to find ways of taking advantage of it, butit would be wrong if these legislations are thrown out entirely forfear of being misused (Gamondi et al. 2014). To handle theirconcerns, there should be continuous checks and balances to thelegislation. By establishing appropriate criteria that must be metbefore administering PAD, it would be difficult for individuals whodesire to take advantage of it to succeed. It is important to notethat these criteria are no guarantee that people will still not abusethe legislation. Therefore, everyone must recognize that violationshappen partly because of our tolerance.

Someof those who argue against PAD insist that patients do not need to behelped to quicken their deaths and that they can manage to do sothemselves. If this argument is put into perspective, it does nottake one long before they realize how unrealistic this is. How wouldthis happen, do they expect a patient to jump off a building, shootthemselves or hang themselves (Maessen, et al. 2014). Desperatepatients might have used these methods, but the effects that comealong with such actions involve a hideous experience not only to thepatients but also their immediate relations. Some patients may be tooweak to finish the process and failure may have dire consequencesthat add misery to their suffering. To avoid such inhumane ways ofsuicide, assisted death by use of lethal medication becomes the onlyviable option as it ensures a dignified passing, sparing thepatient’s relation the unprecedented scenes of a bloody death.

Anotherargument against the use of PAD claims that by legalizing PAD apatient is likely to lose trust in their doctors. The fact is nopatient is lying in their hospital bed wondering if the doctor wantsto kill them rather they lie there hoping to get medical help fromthe doctors (Herx, 2015). These fears should not even arise becausethe act of administering PAD solely lies within the control of thepatient. It is the patient who decides if they want PAD delivered tothem or not, therefore, legalizing PAD would only lead to the growthof the patients` trust to the doctor. Many terminally ill peoplewould want to believe that when the time comes, their doctors willadminister PAD to them to relieve them of suffering (Herx, 2015).Furthermore, trust issues have led to many patients preferring totake their lives at early stages of diagnosis with life-threateningailment because of the fear of having that right being taken awayfrom them in later stages when they would be profoundly disabled withno one to assist them. Patients that would consider taking theirlives wouldn`t do so if they knew they had the backing of theirdoctor to administer PAD in the future.

Somedoctors have argued that patients who mostly request PAD are thosewho do not receive the needed pain control or those who have not beendiagnosed or treated properly. It is without question that propermanagement of such scenarios would significantly reduce the number ofPAD requests. This makes it important that any administration of PADshould only come after the appropriate management of the pain anddepression (Nicole, et al. 2013). However, it is also important tonote that treatable pain is not the only reason why patients requestfor PAD. Some patients request for PAD because of the changes theirbody goes through because of the illness. Accordingly, to savethemselves from embarrassment and to lose their dignity and thosethings we associate with being human they would rather go for PAD.Pain is just but a factor for one to request for PAD and it cannot beused to legalize PAD without considering the other factors.

Thereis also great concern that doctors may make a mistake and misdiagnosea patient. In such cases, the state is obliged to protect lives fromthe mistakes and improve on the control of pain at the end-of-life.This concern may be genuine, but still cannot be used to deny peopletheir rights to a dignified death when they truly need it (Herx,2015). Mistakes are standard practice in every profession and doctorshave not been left out. Legalizing PAD will not open the doors fordoctors to make more mistakes rather with the help of legislationsthey would be more in-depth with their analysis when handling aterminally ill patient. Administration of PAD would assist thedoctors to seek second opinions from colleagues who might help comeup with solutions better than administering PAD (Battin, et al.,2007). Legalizing PAD would also help doctors who are not comfortablewith it to refuse to apply it to their patients and recommend anotherdoctor. This would assist in the better diagnosis of the patientgiven that the new doctor would be required to carry out his own.

Opponentshave also argued that a society that does not assure all its citizensof their rights to basic health care has no business in consideringPAD. This argument is appalling, for it points that every patient whois seeking PAD to relieve themselves of suffering should not beconsidered because of the failures of their society. A decent societywill ensure that their citizens can access affordable health, butthis should not be a reason to illegalize PAD as there is no perfectsociety. Perfection is a process that takes time and in this caselegalizing PAD forms part and parcel of a perfect society. Moreover,the PAD would ensure that we have a community that cares for eachother and are there for each other, in particular among theterminally ill that cannot fend for themselves (Nicole, et al.,2013). Those who are seeking help should not be held hostage becauseof their failed society or because of hope for the future.

Itis also argued that the number of requests put forward for PAD is notenough to warrant changing the law. Many doctors claim they havenever been asked by a patient to administer PAD (Sercu et al. 2012).The question, therefore, should not be why there is a small number ofpeople who are asking for PAD rather why people are not asking forit. This can be explained because not all patients will directly asktheir doctors for PAD some would rather test to see if theirphysicians are receptive to the idea or not. In most cases, asstatistics show many doctors are not receptive to the idea and theywould rather treat their patients to their death. Patients are mostlikely to ask doctors who are receptive to the notion of PAD comparedto those who are not.

Rebuttalof Counter Arguments

Manypeople will agree that PAD should be legalized and legislations tocontrol it should be there. PAD should be a personal and privatedecision to those patients who are suffering from terminal illnessbut are still of sane mind. As for morality, the only person itaffects is the person making the decision, in this case, the patient,relieving him or herself from unprecedented suffering (Ganzini, etal. 2014). If they feel it is morally right for them to receive PAD,then there should not be obstacles denying them of this right. Ifthey do not feel it is morally right for them, then they should alsobe at liberty to seek advice from another doctor who can fulfilltheir wishes. Some states have already legalized PAD which marks asatisfactory progress towards the global realization of it. PADallows patients to have a sense of normalcy and dignity they sorightly want, while on the other hand, it assures the doctors and themedical team that they were able to provide their patients with thecomfort they crave for until the very end.

Legally,it should be made impossible for those who are not in a painful andagonizing position to access PAD but the law should allow those whogenuinely pain and suffering to access PAD and make the decisionaccording to their self-belief. It can be argued that continuoussedation can be used as an alternative to PAD problem with this isthat most of the time the patient is still conscious and depending onthe type of sedation used at the end of it all the patient is stilldestined to die (Battin, et al., 2007). Sedation only keeps thepatient alive for others by prolonging the inevitable. When all issaid and done, the question boils down to if it is morally andethically right to administer PAD. The answer here is it is notethically or morally right to take away the rights of a person who isin dire need of a service. It is only the patient who knows theextent of his/her suffering. Therefore, it should be their decisionwhen it comes to PAD.

Conclusion

LegalizingPAD is likely to reduce the pressures involved with suicide. Patientswould no longer have to fear the suffering that comes with the finalstages of their terminal illness because they will be assured of themuch-needed help they require. With their concerns dealt with, thesepatients can easily concentrate on their abilities to withstand whatlies ahead of them. Life without a doubt is the most precious giftgiven to all humankind, but there comes a time that it loses itsvalue. A sane terminally ill person who has carefully weighed theoptions between the suffering that lies ahead and death should nothave to find drastic solutions when more humane means exist.

References

Battin,M. et al., (2007). &quotLegal physician-assisted dying in Oregon andthe Netherlands: evidence concerning the impact on patients in&quotvulnerable&quot groups&quot. Journalof Medical Ethics(10) 591-7.

Cohen-Almagor,R. (2015). An argument for physician-assisted suicide and againsteuthanasia. Ethics,Medicine and Public Health,1, pp 431-441.

Emanuel,E. et al. (2016). Attitudes and Practices of Euthanasia andPhysician-Assisted Suicide in the United States, Canada, and Europe.JAMA.316(1):79-90. doi:10.1001/jama.2016.8499.

GamondiC, et al. (2014). Legalization of assisted suicide: a safeguard toeuthanasia? Lancet,384(9938):127.

Ganzini,L., Harvath, T.A. &amp Jackson, A. (2014). &quotExperiences ofOregon nurses and social workers with hospice patients who requestedassistance with suicide&quot. TheNew England Journal of Medicine.347 (8): 585.

Herx,L. (2015). Physician-assisted death is not palliative care.CurrOncol.22(2): 82–83.

Maessen,M. et al., (2014). Euthanasia and physician-assisted suicide inamyotrophic lateral sclerosis: a prospective study. Journalof Neurology,261(10), 1894-1901.

Nicole,S. et al. (2013). Euthanasia and Assisted Suicide in SelectedEuropean Countries and US States: Systematic Literature Review.MedicalCare,51(10), pp 938-944.

SercuM. et al. (2012). Are general practitioners prepared to end life onrequest in a country where euthanasia is legalized? JMed Ethics,38:277.

Wang,S. et al (2015). Geographic Variation of Hospice Use Patterns at theEnd of Life. JPalliat Med.18(9):771-80. doi: 10.1089/jpm.2014.0425.