Physician assisted suicide refers to the act of providing information to a competent patient with a sole purpose of assisting the patient end his or her life. The physician administers equipment or prescription for medication at the request of the patient with an intention of ending the patient’s life. For the patients to qualify they must be diagnosed by two physicians as having less than six months to live (Robert 17). They must also have made two independently witnessed requests. If the request is finally granted the patients must administer the drug themselves and not the physicians. Human life is precious and it is held with a lot dignity and value. The society is normally willing to take up any cost to save life. It therefore follows that for a competent person to make a choice to end his life there must be some unbearable pressure that drives them to such decisions. Patients who are vulnerable for such cases are the terminally ill patients who suffer for long periods of time. As their conditions deteriorate they become hopeless and feel their being alive is a burden to the family members. They are sure of the limited life span and they choose to meet death earlier. The issue of PAS has been with a lot of controversies on legal and moral grounds. This is because physicians have an obligation to relieve the patients of pain and suffering and also to promote the dignity of dying patients. Physicians must also respect the decision of competent patients who want to forgo their life.
There are various reasons that lead to patients making such decisions to end their life. Most patients who request for the physician assisted suicide do so due to unrelieved or unrelievable physical and psychological pain/ suffering (Lawrence 16). It has been proved that it is very rare to find a patient with terminal illness who does not keep the thoughts of suicide into consideration. The patients could be under the pressure of physical, psychological, social and spiritual suffering. Other reasons could include fears of future suffering, loss of control, indignity and a feeling of being a burden to others (Cassell 64).Upon the request by a patient for assistance to end his life, the physicians should always perform though investigation for the reasons which could lead such a patient to make such request at the specific time. This should be done with a lot of understanding of the patients suffering and with sustained efforts to relieve the patients any depression. Requests for PAS should be able to abate upon the realization of the causes of such request.Physicians should also make commitment to the patients care and address the suffering with a lot of counseling on the alternatives to the patients request (Germino110).
The issue of physician assisted suicide became a governmental agenda in the state of Michigan following a vigorous campaign by Dr Jack Kevorkian. Jack Kevorkian was a retired pathologist (Palmer 50). He started his campaign in 1990 when he assisted Janet Adkins a patient who suffered from Alzheimer disease commit suicide. The procedure was conducted in the back of his Volkswagen van using a machine to deliver a lethal drug. The actions of Jack attracted attention of the international media. The prosecutors did not succeed in stopping him Michigan did not have any laws regarding PAS. Michigan State Legislature responded to the issue by temporarily banning assisted suicide (Palmer 70). The Michigan commission on death and dying was formed to create legislative measures on assisted suicide. In reference to political, moral and religious grounds there emerged three different definitions for PAS. Kevorkian claimed to have assisted 130 people to die. He was for convicted of a jail term of 10-25 years for his actions but he only served 8 after which he was let out to his kidney illness (Kopelman 155).
The measure to legalize assisted suicide in Michigan was brought to ballot in 1998. A group named Merians friends took the responsibility of bringing the proposal to the ballot box after they successfully secured the required 247,000 valid signatures. It adopted the name from Kevorkian friend who died in 1993 after suffering from Lou Gehrig disease (Kopelman 163). Michigan became the fourth state to put assisted suicide up for voting after Washington in 1991, California in 1992 and Oregon in 1997. The advocates of the motion were keen to the language they used to try win vote to their favor. The proposers choose to name their move, “Terminally Ill Patient Right to End Unbearable Pain or Suffering.” While the opponents just called it “Proposal B” (Zucker 40). Both sides had different titles for the ballot box. Merian friends adapted a title from their initiative where they wanted the ballot titled, “to end unbearable pain or suffering through self administration of medication to hasten death”. On the other hand the opponents wanted the ballot titled, “a legislative initiative to allow the prescription of lethal drugs to terminally ill persons for the purpose of committing suicide.” which was a more clear title. The final title was, “Initiated legislation to legalize the prescription of a lethal dose of medication to terminally ill, competent, informed adults in order to commit suicide. The first line of the prescription read that a patient with less than six months to live could obtain a lethal dose of medication to forgo his life. The initiative to legalize the physician assisted suicide was however overwhelmingly defeated with 71% against 29% (Battin 30).
Proposal B was meant to stop the initiatives of Dr Kevorkian since most of his victims would not have qualified. This is because some of his patients were not terminally ill as he claimed. In proposal B the patients who choose to end their lives were to be reported as having died as a result of the terminal illness which in reality was not the immediate cause of death. This therefore meant falsifying the death certificates. Proposal B required that the patients should be competent and make informed decisions. Voting for proposal B would have permitted Jack Kevorkian to perform his procedures legally (Robert 28).
Oregon was the only state that voted twice in favor of the physician assisted suicide. The first election was held in 1994 winning at 51% versus 49% while the second one was held in 1997 where the motion passed with 60% versus 40% (Mcnamara 76). Oregon enacted the death with dignity act which allows the terminally ill Oregonians who have less than six months to live to end terminate their lives through the administration of lethal drugs as prescribed by a physician. However the law does not permit euthanasia a situation where the physician administers the drug to the patient with an intention to end life. The law only permits adults who have attained the age of 18 years and above who must be residents of Oregon (Cassell 88). They must have been diagnosed with a terminal illness that would result to death within six months. They must also be able to make competent decisions for themselves. Patients must make at least two witnessed oral requests and also present to the physician a written request signed by two witnesses one who must not be related to him/ her. The attending physician and a consulting physician must confirm the patient’s diagnosis and assess whether the patient is able to make decisions for him/herself. If the physician detects that such request is based on some kind of depression then the patient is referred for psychological examination. Patients must also be well informed of other alternatives such as hospice care. They may also be required to inform the next of kin. A period of 15 days must elapse before the patient’s request is honored. Even with the enactment of the law, very few people have taken advantage of the law. The death act requires the Oregon Department of Human Services to collect data on the patients who choose the PAS way to die each year and issue an annual report (Zucker 68).
The Role of Healthcare Providers
Health care providers bear the burden of taking care of the patients regardless of the age or the nature of the diseases. They dedicate their lives to looking after people’s health, help to cure illness, maintain or improve the functioning of the body and also help to relieve pain and suffering in order to prolong life. Healthcare providers should also ensure that patients are in control and get good quality life. In the case of the terminally ill, the health care providers have the duty to prevent premature death, ensure a dignified death and support the families of the patients.
In the code of ethics for medical professionals, they have a role to ensure competent medical care with sympathy and respect for human dignity and rights. This helps the medical professionals attend to the terminally ill with a lot of care ensuring they get the best medical attention regardless of the fact that they have limited days in their lives. The last few days of life for any person are to be respected and therefore the patients should get the appropriate attention as any other patient. Health care providers are also supposed to ensure that the patients get principal responsibility while under their care. It therefore applies that the health providers take it upon themselves to ensure comfort of the terminally ill patients (Mcnamara 64). The ethics give the role of providing the patients with reasonable explanation of their situation and treatment. They therefore help the terminally ill patients understand and accept their situation through out their sickness till they meet their death by giving logical information about their condition. As the care givers advance their studies, they have duty of making use of developments in knowledge and reveal such information to the patients and other care givers. This has been seen through the provision of palliative treatment for the terminally ill where new developments in advancing care to them are advocated. The code provides that the care givers should extend their duty of care to the community and the society at large. In this case the care takers of the terminally ill will always take care of the family members of the terminally ill and also provide information about the treatment and awareness of palliative care to the society through various forums of passing knowledge to the society (Battin 55).
Health care givers undertaking care of a patient cannot neglect a patient unless such a patient is discharged and a notice to stop further medical services given to the patient. This means that despite how sick a terminally ill patient is sick, the care givers have a duty to ensure that they are not neglected. The code of ethics also provides that the caregivers should always seek for consultations when they are faced with difficult or doubtful situations. In the course of treating the terminally ill patients the care givers will always face various challenges especially in advocating the drugs which might hasten death without their intention (Battin 70). On other cases they may be encountered by difficult situations with the family members of the patients. The care givers may in this case consult for assistance or advice from other colleagues. Care givers are also supposed to act in the best interest of their patients but their actions should be law abiding. Even in country like Oregon that allows PAS the care givers are supposed to maintain support, comfort and confidentiality for the patients. If the patients opt for the PAS, it is done under strict guidelines and the care giver cannot administer the drug him/herself (Charlesworth 145). The care givers are not supposed to act with the sole aim of ending life. In this case a caregiver cannot decide to assist a patient to end his life by proving information or drugs in a country or state that forbids the patient assisted suicide. This leaves the care givers with the sole role of providing the palliative care to the patients ensuring relieve of pain without reducing their life span or postponing death.
Impact of Pas on Patient Trust
There is no empirical evidence to show clearly the impact of PAS on the trust that is between patients and the physicians (Zucker 50). Some studies have indicated that legalizing PAS would only result in reducing the trust between the patients and the physicians. It would make it very difficult for the patients to believe that the physicians are acting to the best of their interests. A small percentage of patients would consequently change their physicians on learning that they ever participated in assisting some body to die. Survey carried in the US indicates that there is little impact on patients trust as a result of legalizing PAS (Battin 39).
The moral debate surrounding the Physician assisted suicide is whether it is right to take away life intentionally and whether it is right for the medical professionals to assist the patients who want to take away their lives regardless of the pain and suffering they may be going through. Customary it is held that everyone has the duty to preserve life. The issue of one having to make a choice about terminating his life has always raised grounds for debate (Zucker 59). The society holds the medical professionals with the responsibility of taking care of the sick. For the terminal illness cases, it has been debated that there are hospice homes to care for them and therefore most people cannot conform to the issue of PAS. Religious beliefs such as the Christian faith and practices hold high dignity for human life. The administration of palliative treatment is deemed to be morally accepted for terminally ill patients as opposed to physician assisted suicide (Kopelman 170).
Palliative care is upheld since it advocates for treating the sick with compassion which respects the dignity of life. The health providers have the obligation to encourage patients. Physician assisted suicide denies the patients the opportunity to exercise their power to achieve their goals values and objectives before they finally die. Suffering a chronic disease does not give the right to die but gives a chance for the care givers to encourage the patients to fight to the bitter end. Care givers in the moral sense should be a source of strength to survive but not an aid to end life. They are professionally obligated to promote health to prolong life of the patients.It is also morally challenging for the care givers to remain honest for such patients since it might result to complete hopelessness for the patient (Mcnamara 73).
Pain is physical / external signal of discomfort in our bodies. It is acts as a warning that something is not functioning well in the body. It is as a result of occurrence of things we do not control or things that we do not intend to happen. For example one will feel pain as a result of a fracture that may occur as result of an accident or even when we are cut by something or sickness that gives sharp signals of impairment. It is temporally since it quickly goes away as soon as one gets medical attention (Cassell 68).
Suffering on the other hand is what we have to bear with as consequence of certain thing occurring. Suffering goes a long away in one’s life as we choose to live with it. For example if one lost a leg as a result of an accident, he or she will have to suffer operating with one leg for the rest of his life. It is what follows after experiencing pain in our bodies.
Terminally ill patients continue to face pain and suffering and their bodies become fragile over time. They are in constant drug administration in order to relieve pain. Their bodies and minds are less active and they suffer physically, psychologically, spiritually and emotionally. With time they become used to their situation and start accepting the reality of death (Mcnamara 94).
Having known the risk of death for such patients, it raises the need for good medical care for them before they eventually meet their death. Palliative care is the term used to refer to the special care administered to the terminally ill patients and their families. It concentrates with the treatment of the symptoms other than the disease. It addresses the physical, psychological, social and spiritual needs of the terminally ill patients and their families. Its intention is to prevent and reduce pain and suffering to improve their quality of life. Through relief of pain and suffering, palliative care gives the patients hope for living and presents death as a normal life procedure. It addresses the needs of the patients and their families by helping them cope with the illness and live a good quality life till death (Cassell. 103).
It provides counseling for grief and sorrow giving a positive approach towards the illness. It also supports the patients to aggressively live normally without quickening or posting death. In this way palliative care helps to avoid the thought of ending one’s own life especially for the terminally ill patients who are due to suffer for long periods of time.
The demand for palliative care calls for adequate promotion and educative programmes in order to increase awareness to the patients, their families and also the general public (Kopelman 205). This role basically lies with the medical professionals since they are the ones who hold the primary duty of providing such services. The educative programmes are generally referred to as, “Health Promoting Palliative Care” (Cassell 108) which is mainly concerned with health education, death education and also social support. The community at large needs to have information on this type of care through vigorous campaigns by active public health professional groups. The main intention for such campaigns is to empower the patients, health professionals and the public in order to enhance knowledge, value and practice of palliative care. Knowledge for palliative care ranges from the simple awareness of its availability to its administration and provision to the patients. In the 1990’s there were political and economic reforms in Europe that advocated for palliative treatment for the terminally ill (Battin 76). Currently there is enhanced training of palliative care where it has been added in the undergraduate and post graduate curricula besides various healthcare studies. There is also enhanced training of the public health professionals on the basic skills of palliative care.
There are bodies formed by the medical fraternity with the sole purpose of promoting the palliative care. Such bodies include Canadian Hospice Palliative Association (CHPCA), Alliance of State Pain Initiatives (ASPI), American Academy of Hospice and Palliative Medicine (AAHPM), Association for Palliative Medicine (UK), (APM) among others (Kopelman 220).
Such groups have continually campaigned in providing resources for patients and training for the attending public health care professionals. They encourage the transmission of information from the medical field to the people who suffer the chronic diseases and encourage them to seek the services. Other initiatives that have been undertaken to pass information include holding of education clinics in form of public forums by the public health professionals. Public health professionals have also come up with research firms which are aimed at finding new approaches to the pain research, getting data on the awareness of the services, advancement of the education, treatment, and practice of palliative care (Zucker 84).
The issue of the physician assisted suicide has been faced with political influences where some political activists have been campaigning for the legalization of the law of the right to die. Most governments however do not support the physician assisted suicide but instead advocate for the palliative treatment and care for patients (Zucker 87). A recent comment by the presidential candidate Barrack Obama stated that it would be mindful of the state not to slide away from palliative medicine into PAS. Most states have stood firm against the physician assisted suicide citing it as a wrong move to use the health professional assistance to end life. The 1997 debate in the supreme courts of the US failed to recognize constitutional rights to physician assisted suicide (Battin 76).The law was later passed in Oregon in 1998 after the residents voted in favor of the proposal. The Oregon state has been faced with a lot of criticism on its decision regarding the controversial issue. In particular, Oregon law faced an attack from the Bush administration which did not succeed since Oregon had a right to its laws. It has however been proven that the law does not incite the terminally ill patients from other states to move to Oregon to commit suicide. A large percentage of the Oregon residents do not take advantage of the law to commit suicide (Kopelman 223). The law has however served to improve life for the terminally ill in many other states by improving ways to care for them as an alternative measure to PAS. The issue of assisted death has been reduced to seeking services for palliative care. Though these services have been improved over the years, a small percentage of patients will not feel full satisfaction and would still go for the assistance to end their lives (Germino 107).
In conclusion physician assisted suicide has received a lot of negative impact from the society. It has been rejected by many states that choose to go for the palliative treatment as an alternative for physician assisted suicide. It is morally right for a physician to administer drugs for treatment to improve life but not to end or hasten the occurrence of death. It has there been recommended that campaigns on palliative treatment should be intensified in order to educate the society on its availability as an alternative to ending their own lives. Intensive training on palliative treatment also helps the public health providers pursue their duty of care for the terminally ill with more knowledge and skills in handling their pain and suffering.
Though the modern methods of handling the terminally ill are more improved there are still few situations where patients request for PAS. It is there fore important that the public health providers among other practioneers keep furthering their studies in order to be able to respond to the patients needs and meet their expectations. Intensified training will also enable them to offer the best care both legally and ethically. Health care providers will also be in a position to survey, understand and address the suffering of the terminally ill making them aware of the range of alternatives available for their distress.
Barbara B. Germino et al. Dying, Death, and Bereavement: A Challenge for Living. New York. Springer, 2003, 105-256.
Beverley Mcnamara. Fragile Lives: Dying and Care. Death, Crows Nest, N.S.W. Allen & Unwin.2001, 56-97.
Eric J. Cassell. The Nature of Suffering and the Goals of Medicine. New York, Oxford University Press, 2004. 64-105.
Larry I. Palmer.Endings and Beginnings: Law, Medicine, and Society in Assisted Life And Death. Westport, CT, Praeger, 48-94.
Loretta M. Kopelman, Kenneth Allen De Ville. Physician-assisted Suicide: what are the issues? Germany, Springer, 2001, 140-224.
Margaret Pabst Battin. Ending Life: Ethics and the Way We Die. New York, Oxford University Press, 2005, 24-78.
Marjorie B. Zucker. The Right to Die Debate: A Documentary History. Westport, Greenwood Press, 1999, 35-88.
Max Charlesworth.Bioethics in a Liberal Society. England, Cambridge University Press, 1993, 130-178.
Schneiderman, Lawrence J., and Nancy S. Jecker. Wrong Medicine: Doctors, Patients, and Futile Treatment. Baltimore, Johns Hopkins University Press, 1995, 8-58.
Weir, Robert F. Abating Treatment with Critically Ill Patients: Ethical and Legal Limits to the Medical Prolongation of Life. New York, Oxford UP, 1989, 17-95.