Physician assisted Suicide

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PHYSICIAN ASSISTED SUICIDE

Introduction Physician-assisted suicide is a type of suicide performed with the assistance of a competent individual. The patient however, is the one that administers the means by which he shall die, which in most cases is a lethal drug. According to the Constitution of the United States of America, a citizen of the state cannot lose his life, property or liberty without first being heard. The Supreme Court of the land stated that this protection extended to cover the issue of liberty. It echoed this fact in the case of Cruzan V. Director, Missouri Department of Health, by stating that a patient has the right to refuse medical treatment even if this refusal may ultimately lead to his death (Koenig 171). There is no provision in the constitution that grants the right to physician assisted suicide. Five states in the USA have legalised the issue, namely, Oregon, Vermont, California, Montana and Washington. The judicial system protects the issue through either legislation or court rulings in states where there is no legislation provided to protect it. For the five states, a clear distinction is made between the act of suicide and medical aid given to induce death. Legislation for instance, expressly provides that all actions performed in accordance to the law on physician-assisted suicide should not include or constitute homicide, suicide, assisted suicide or mercy killing. Assisted suicide is illegal because it involves aiding an individual to end his life by providing the necessary means in which he executes his wishes, such as the provision of poisons, weapons

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or dangerous tools. The legal definition of physician-assisted suicide precludes mercy killing from the actions that constitute it, therefore it cannot be synonymous to euthanasia. Physician-assisted suicide should not be legalized at a national level. This paper looks into this sensitive issue, giving arguments for and against it, with sufficient reason as to why it should not be legalized.

The argument against Physician-assisted suicide Private choice and mental incapacitation Lay men and pundits have argued that the decision to commit suicide is a private choice thus free from society‟s intervention. The assumption with regard to this position is that the decision to end one‟s life is as autonomous as it is rational, made by a competent individual who in the exercise of his free will has no intention to harm society. This assumption is wrong, according to researchers who have done intensive study into suicide. A good example would be a 1974 study conducted by British researchers into the state of mind of subjects who had committed suicide. The study revealed that 93% of those who committed suicide were suffering from a mental illness or disorder at the time this decision was made until its execution. Psychological evidence deduced from a study conducted in St. Louis revealed that 94% individuals who attempt suicide are predominantly suffering from a mental disorder and that they do so for reasons other than the desire to die (Quill, Timothy, Christine & Diane 170). The cases revealed that the victims had arrived at their tragic decision as a result of subconsciously crying out for help for far too long without being heard. Based on these statistics, one can infer that majority of physician-assisted suicide cases are devoid of carefully calculated judgment with regard to the issue of death. Suicidal individuals should thus be helped to deal with their problems instead of ending their lives, legalizing physicianassisted suicide at a national level would be catastrophic.

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Extending Physician-assisted suicide to incapacitated patients Physician-assisted suicide, if legalized at a national level by the courts, will create a conducive environment where the judicial system will extend it to incapacitate patients. Framing it as a basic personal right equivalent to the right to refuse medical treatment means that the medical field would shift gradually from assisted suicide to voluntary euthanasia with regard to incapacitated patients. These type of individuals lack the capacity to act on their own in instances where they had expressed a desire to engage in the act prior to their physical and mental incapacitation. Such scenarios will require that a competent medical doctor act on their own and execute the request of the incapacitated patient. The courts, in dealing with this issue will have to rely on precedent whose effect will be to extend this form of suicide to incapacitated patients. What is overlooked as a result, is the fact that the patient does not have the ability to change the decision he made prior to his incapacitation because of his current state. The courts thus could, through this extension, be legalizing manslaughter. Another issue with regard to cases of incapacitated patients is the fact that some individuals express no clear choices made prior to the incapacitation. This means that the medial doctor must rely on his own judgment to decide whether to perform it on his patient. These cases are extremely sensitive and call upon the doctor to have an esoteric degree of reasonability, competence and rationality. Violation of a doctor’s Hippocratic Oath Doctors take oath to deliver the best services to their patients, respect their privacy and treat them to the best of their ability. This oath is violated in states where Physicianassisted suicide is legalized. The independent right of choice is only enforceable if the individual is competent enough to assert it according to the courts in Quinlan. Where the patient is precluded as a result of mental incapacitation, the courts allow a competent third party to exercise this right on their behalf and must be in the best interest of the patient. The

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courts apply the standard of “best interest” in authorizing the conduct of an individual acting on behalf of another. In Re Conroy, for instance, the court permitted a relative to authorize the removal, from a mentally disabled woman suffering from dementia, a feeding tube, as this was in the patient‟s best interest. This standard has been counterproductive rather than helpful. It has led to the discontinuation of medical interventions by doctors in cases where the patient offers very little or no evidence of the desire to discontinue his treatment, thereby inevitably breaching the doctor‟s Hippocratic Oath. The issue of uncontrollable pain The argument in support of Physician-assisted suicide is that it is done in order to annihilate the uncontrollable pain being suffered by the victim. As a matter of opinion. This argument is rather weak. This is because the patients need not be given a chance to end their lives but rather be subjected to advanced levels of treatment and care that will obliterate the pain they are going through (Foley 289). The government must show a commitment towards the provision of efficient and effective medical services. Provision of subsidized medicines is not enough to cure the problem. The psychological state of an individual laboring under suicidal thought must be catered to as well. This can be done by setting up enough support groups, rehabilitation centers and admitting competent individuals to the medical fraternity. The goal is provide high quality psychological treatment for patients in order to reduce the number of consumers looking for physician-assisted suicide services. Pain is more psychological than it is physical. Victims of it can assert that it is more devastating to deal with psychological pain as a result of issues such as neglect, ostracization and discrimination rather than the physical abuse associated with it. The issue of terminally ill patients The most lethal assumption made with regard to terminally ill patients is that all of them express a wish to die in a bid to end their suffering. Psychotherapeutic treatment must

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be effective enough to cater to the psychological needs of a terminally ill patient in order to reduce irrational thought. A scientific study was conducted by the American Journal of Psychiatry into the state of mind of the terminally ill. The study revealed that four out of ten patients expressed a wish to end their lives. These patients were subjected to compassionate counseling supplemented with the right medication and their irrational wishes disappeared as a result. Instead of focusing on legalizing physician assisted suicide at the national level, the government should instead focus on investing in the provision of compassionate counseling that will supplement both psychological and physiological care for the patients. This is a positive approach towards catering to the needs of these individuals. Undue pressure from insurance agencies Insurance agencies may place undue pressure on a family member who has the competency to permit Physician-assisted suicide. Pressure can be catastrophic, especially in instances where it clouds one‟s judgment and prevents them from making rational decisions. Courts, even in applying the „best interest‟ standard, may fail to detect the issue of undue pressure especially in cases where there is a semblance of normalcy amongst the family members and the best interest standard has been proved. By legalizing it, the government could be paving way for the commission of murder under the guise of psychological treatment. The argument for Physician-assisted suicide Private choice and the rights conferred upon citizens by the federal constitution Lay men and pundits have argued that the decision to commit suicide is a private choice thus free from society‟s intervention. The assumption with regard to this position is that the decision to end one‟s life is as autonomous as it is rational, made by a competent individual who in the exercise of his free will has no intention to harm society. There is not constitution right granted upon individuals to engage in Physician-assisted suicide, however,

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the right to liberty, granted to all citizens of the United States of America, is protected by the Supreme Court. The Court established, in Cruzan V. Director, Missouri Department of Health, that a patient has the right to refuse medical treatment even if this refusal may ultimately lead to his death. The issue of private choice is protected by the court through procedure such as the best interest standard, which allows the court to determine if the decision to end a patient‟s life was exercised having the best interest of the individual expressing said need at heart. Refusing to legalize this process would mean that the state would deny the requests of patients who have decided to end their life by refusing to accept any further medical treatment (Diekstra 145). Such a denial would be in gross violation of the provisions of the federal constitution with regard to liberty, as well as the protection provided for by the Supreme Court with regard to the issue of medical treatment. The right to liberty must therefore, be respected. The commission of suicide in horrific or traumatic ways Physician-assisted suicide should be legalized on a national level because it will prevent the commission of suicide in traumatic and horrific ways. Furthermore, the patient undergoing the procedure has access to psychological care that will held him appreciate all the risks involved with making the decision, preventing the occurrence of death fuelled by impulse. The family of the patient is always considered with regard to physician-assisted suicide, since they are consulted in instances where an incapacitated individual had expressed the need to end his life prior to the incapacitation. An individual with suicidal thoughts may be saved from ending his life as a result of getting psychological care from a competent medical doctor or psychologist as a result of requesting for physician-assisted suicide. Saving vital organs This form of suicide is important in ensuring that vital organs such as the brain, heart and kidneys are saved from potential harm. A patient without access to physician-assisted

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suicide may resort to harmful ways of ending his life. These may destroy organs which could have been harvested to help others in need. For instance, one may take poison, which may destroy the liver and kidneys. Competent medical doctors subject their patients to the safest means of ending their lives, ensuring that they do not go through unnecessary and unbearable pain during the process (Diekstra 148). Their goal is to make the decisions of their patients bearable, and this is done by committing to the Hippocratic Oath of the provision of services to the best of their ability. With more organs readily available at hospitals, the need to engage in black market organ trade is reduced and the government can root out the problem. Reduction of the cost of medical care The drugs administered to aid in the commission of suicide are cheaper than the cost of continued medical attention without hope of recovery. The family and the government is able to save costs incurred in the provision of efficient and effective medical services. This ultimately reduces the financial strain on the parties involved while reassuring them that all will be well (Uhlmann 111). The decision to terminate the life of the patient is thus financially prudent and the family is able to decide on whether vital organs should be donated to assist those with medical conditions that require immediate attention. The annihilation of pain and suffering Patients who have gone through immense suffering as a result of an illness such as a terminal one, are given the chance to put an end to it. The mere fact that the decision is made by the patient or a representative from the family paying attention to the victim‟s best interest destroys any guilt involved in executing the wishes of the patient. The parties to the decision and execution of it rest assured that what has been done was legal. Grief becomes easier to handle When family members are cognizant of the fact that a loved-one has decided to exercise his liberty and engage in physician-assisted suicide, they are more accepting of the

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fate to come than waking up to the devastating news of his or her death. They are able to spend more of their limited time in the company of the patient, begin planning for the funeral as time approaches and give the individual a decent burial. The retention of dignity Physician-assisted suicide enables the patent to choose the most favourable way of ending their life; have family and friends available at any time before the death occurs. In addition to this, the family is able to prepare for the final days on earth for the victim, so that they cater to his or her needs effectively. Conclusion The government of the United States of America expressed, through the Supreme Court cases of Vacco V. Quill and Washington V. Glucksberg, its desire to preserve life and protect it from intentional killing by stating that this desire outweighed a patient‟s liberty in choosing to die. The interest will be destroyed once the government legalizes physicianassisted suicide on a national level. With regard to private choice and mental incapacitation, majority of physician-assisted suicide cases are devoid of carefully calculated judgment with regard to the issue of death. Suicidal individuals should thus be helped to deal with their problems instead of ending their lives, legalizing physician-assisted suicide at a national level would be catastrophic. Instead of focusing on legalizing physician assisted suicide at the national level, the government should instead focus on investing in the provision of compassionate counseling that will supplement both psychological and physiological care for the patients. This is a positive approach towards catering to the needs of these individuals. The argument in support of Physician-assisted suicide is that it is done in order to annihilate the uncontrollable pain being suffered by the victim. As a matter of opinion, this argument is rather weak. This is because the patients need not be given a chance to end their lives but rather be subjected to advanced levels of treatment and care that will obliterate the pain they

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are going through. The government must show a commitment towards the provision of efficient and effective medical services. Physician-assisted suicide, if legalized at a national level by the courts, will create a conducive environment where the judicial system will extend it to incapacitate patients. Framing assisted suicide as a basic personal right equivalent to the right to refuse medical treatment means that the medical field will shift gradually from assisted suicide to voluntary euthanasia with regard to incapacitated patient. Doctors take oath to deliver the best services to their patients, respect their privacy and treat them to the best of their ability. This oath is violated in states where Physician-assisted suicide is legalized. Even with the introduction of a “best interest standard”, this has been counterproductive rather than helpful. It has led to the discontinuation of medical interventions by doctors in cases where the patient offers very little or no evidence of the desire to discontinue his treatment, thereby inevitably breaching the doctor‟s Hippocratic Oath.

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Works cited

Diekstra, René FW. "Dying in dignity: The pros and cons of assisted suicide." Psychiatry and clinical neurosciences 49.S1 (1995): S139-S148. Foley, Kathleen M. "The relationship of pain and symptom management to patient requests for physician-assisted suicide." Journal of pain and symptom management 6.5 (1991): 289-297. Koenig, Harold G. "Legalizing physician-assisted suicide: Some thoughts and concerns." Journal of family practice 37.2 (1993): 171-180. Quill, Timothy E., Christine K. Cassel, and Diane E. Meier. "Care of the hopelessly ill: proposed clinical criteria for physician-assisted suicide." (1992). Uhlmann, Michael M. "Last Rights? Assisted Suicide and Euthanasia Debated." (1997).