The Unethical Practice that Allows Doctors to Kill
Euthanasia and physician-assisted suicide is a topic that constantly sparks ethical debate. Euthanasia has become a topic of growing interest, especially in the industrialized countries of the world because of the high standards for medical care and the idea that physician-assisted suicide can improve end-of-life care as it can take away suffering and stop patients from trying to take their own lives in more painful ways. For some, the "right-to-die" movement is compassionate as it can liberate one from the pain and suffering associated with terminal illnesses; oftentimes these patients are anxiously awaiting death so that they may be released from the torture of life. In the article, "Physician-assisted suicide: compassionate liberation or murder," Lachman (2010, 121) states that in Ancient Rome, voluntary suicide was sanctioned and it continued to be sanctioned throughout the Middle Ages. It was the influence of the Christian church, it is suggested, that "ascribed a sinful nature to suicide, which kept it from being explicitly accepted" (2010). There are a number of factors that seem to inspire varied responses to the idea that, to quote Francis Bacon, "the dying may pass more easily and quietly out of life" (Bimbacher & Dahl 2008, v). Some of the reasons are religious -- as noted above, others reasons may have to do with the historical experience of the abuse of euthanasia in the hands of reckless physicians (2008, v), and still other reasons may support the Hippocratic tradition of forbidding any physician to use the means of medicine to actively bring about the death of a patient (2008, v). Whether one says "physician-assisted suicide," "euthanasia," "right-to-die," "death with dignity," "good death" "rational suicide," "aid in dying," or "merciful release," they are all euphemisms for the possibility of killing someone or helping individuals to kill themselves (2010, 121). PAS gives a human being who is imperfect and thus able to make mistakes, the role of God, and with this role will inevitably come varying opinions on what constitutes a good reason for being given the right to die. This paper will illustrate the major problems with PAS with a specific focus on the State of Oregon's unethical Death with Dignity Act, which gives physicians the power to say who gets to die and who doesn't.
Lachlan (2010, 121) asserts that physician-assisted suicide or euthanasia, in general, is an issue that lies in a person's moral conscience as well as any legal or ethical issues that surround the patient. Literature and legislation on euthanasia (specifically in the United States, Australia, Japan, Canada and New Zealand) concerns nurses as well as doctors (Quaghebeur, Dierckx de Casterle & Gastmans 2009, 466) because of each of their specific roles in the care of patients who are dying. Nurses, as well as doctors, are quite intimately involved in the whole process of patient care and are often asked by patients to help assist them in dying. Quaghebeur et al. notes that there are a lot of feelings that go along with this topic for nurses and doctors -- feelings of personal conflict, moral uncertainty, fear, guilt, secrecy, and frustration (2009, 467). There is not any way that these feelings could not go along with the notion of assisted suicide as it is taking an active part in another person's death. It is giving one's self the authority to make the decision that no human should be allowed to make for another human. While a dying patient will have his or her own reasons for wanting to die, as well as their own beliefs about the ethical or religious challenges that go along with it, it is one thing for a person to kill one's self, but it is entirely another issue for a person to help kill another. There is simply no good or ethical way that physician-assisted suicide can be rationalized in ethical or moral terms.
In October of 1997, five months after the U.S. Supreme Court ruled that there was no right to assisted suicide in the Constitution but implied that states have the right to decide for themselves concerning whether or not to prohibit PAS (Hendin & Foley 2008, 1613) the Oregon Death with Dignity Act was enacted (even after facing its own set of legal challenges), allowing the primary care physician managing the patient's terminal illness, to prescribe a lethal medication, which the patient then self-administers (Carlson, Simopolous, Goy, Jackson & Ganzini 2005, 1160). It was believed that the Oregon Death with Dignity Act (ODDA) would act as a sort of laboratory for the rest of the United States, showing how PAS would work (Hendin & Foley 2008, 1614). However, this has not occurred because of the Oregon Health Division, which is charged with monitoring the law, has interpreted its mandate in an extremely restrictive manner (OPHD) (2008, 1614). OPHD limits its annual reports to general "epidemiological data" (2008, 1614) and collects limited information from doctors who have prescribed lethal medication. Doctors who refused to prescribe the lethal medication as well as nurses and social workers that cared for the patients, pharmacists who fill the prescriptions, and family members, are not interviewed, according to Hendin and Foley. Also, all the information collected is not made public and after one year all information collected is destroyed.
Since the passing of the ODDA, however, several different sources -- patients, families, healthcare workers, doctors, nurses, social workers, chaplains, and the advocacy groups -- have given more specific information that suggests that the implementation of the ODDA has had "unintended, harmful consequences for patients" (Hendin & Foley 2008, 1614).
The law puts in place what seem like logical safeguards when it comes to the care of end-of-life patients, for example: options for palliative care; ensuring that patients are in a state of mind that allows them to make this decision for themselves; limiting the procedure to patients who are terminally ill; ensuring the voluntariness of the request for PAS; obtaining a second physician opinion on the case; requiring the request for PAS to be persistent; encouraging the involvement of family members; and requiring doctors to inform OPHD of all cases in which doctors have written a prescription for PAS (Hendin & Foley 2008, 1614). However, Hendin and Foley note that evidence strongly suggests that these safeguards are "circumvented in ways that are harmful to patients" (2008, 1614).
In one case mentioned in Hendin and Foley's article, an Oregon woman named Helen was denied PAS by her long-time physician for reasons that were not specified, but then a second physician also refused her plea for PAS on the grounds that Helen was depressed. Helen's husband called an organization called Compassion for Dying and was referred to a physician who would help her.
The medical director of Compassion for Dying spoke to Helen and her son and daughter on the phone and described Helen as "rational, determined and steadfast" and questioned the opinion of the physician (with whom the medical director also spoke to by phone) who described her as having a depression that was affecting her wish for PAS (Hendin & Foley 2008, 1616). The medical director said that she was frustrated because she felt powerless. She was no longer able to exercise or garden, her favorite activities, and even though she was not bedridden or in much pain, the "quality of her life was just disappearing" and he believed that it was best to act quickly before Helen could no longer make decisions for herself (2008, 1617). He said she was "going downhill rapidly… She could have had a stroke tomorrow and lost her opportunity to die in the way that she wanted" (2008, 1617).
The physician who agreed to prescribe the medication for Helen's PAS met her two and a half weeks before her death and said she had more physical pain than Compassion for Dying had indicated. After twenty years, the cancer she had spread to her lungs, causing pain and shortness of breath. He followed a protocol, giving her an anti-nausea medication that Helen had taken before he arrived to be with her family when she died. She then took a mixture of barbiturates (nine grams) and syrup followed by a glass of brandy. She died within thirty minutes (Hendin & Foley 2008, 1617).
The problems with this case are that Helen was given two contradictory sets of opinions about the appropriateness of her decision. As the decision-making process progresses, nobody was questioning the fact that two other doctors had denied Helen the right to PAS. One simply refused and the other said no because he believed her decision to be coming from her depression and not a coherent state of mind.
What becomes clear in reading the case is that the doctor who eventually was responsible for Helen's death was quite impressed by Helen's determination to die (Hendin & Foley 2008, 1618). The doctor notes that he was disturbed by her haste, he could not resist. Hendin and…