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PHYSICIAN-ASSISTED SUICIDE.
Term Paper ID:24637
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Essay Subject:
Federal & state legal issues, suicide rates & causes, medical ethics, consent, pros & cons, role of health care professionals.... More...
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10 Pages / 2250 Words
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Paper Abstract:
Federal & state legal issues, suicide rates & causes, medical ethics, consent, pros & cons, role of health care professionals.
Paper Introduction:
PHYSICIAN-ASSISTED SUICIDE
Introduction
The issue of physician-assisted suicide is a part of the broader issue of a person’s right to die. Both the broader concept and the more narrow issue of physician-assisted suicide are highly controversial in North American society (Alpers, & Lo, 1997).
The right to die concept is complex, and often encompasses issues of suicide, assisted suicide, do-not-resuscitate (DNR) orders, livings wills involving terminal health care, and family decisions related to the cessation of terminal health care (Annas, 1994; Elpern, Yellen, & Burton, 1993; Kowalski, 1993; Lee, Swinburne, Fedullo, & Wahl, 1994; Sansone & Phillips, 1995). This current research, however, is concerned only with assisted suicide wi
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This latter contention, as an example, has servedas the basis for religiously-oriented public prosecutors in the State ofMichigan in the United States who have laid charges against Dr. Kevorkianfor the assistance he has provided to persons deciding to end their ownlives. Informed consent: From the ambivalence ofArato to the thunder of Thor. Hospital administrators and legal counsel, by contrast, out of fear ofan exposure to legal liability typically attempt to limit the rights ofpatients and their families. Thus, the implication of this argument isthat advance medical directives are indefensible at the philosophicallevel. Diseases that are at once incurable, painful, and lead to a loss ofpersonal dignity are frequently motivators for an individual to decide on acourse of suicide-assisted or unassisted. 1358). (1994 Spring-Summer). P., Swinburne, A. Reasons and persons. The law does notpermit a physician to substitute her or his own judgment for that of thepatient by any form of artifice or deception (Arabian, 1994). Assisted suicide: Where do nurses drawthe line? "The developinginterdisciplinary consensus ... Euthanasia implies that some party other than the individual who is todie makes the decision concerning how and when that individual should die.The essence of the concept of the right to die, however, is that suchdecisions are made by the individual who is to die (Kowalski, 1993). Accepting the implications of Parfit's contentions and prohibiting theuse of advance directives would assure a cruel outcome for many people inthe terminal stages of life. 265). What these ostriches cannot see from theirdisadvantaged perspectives is that in the evolving contemporary society arefusal to accommodate patient rights in itself will expose health careinstitutions and providers to legal liability. Reitman, J. B.(1994 January 19). Complicating the issue of the right of an individual to make decisionsconcerning her or his own death is the confusion introduced into the debatethrough attempts to equate an individual's right to die with euthanasia(Callahan, 1995). (1993). uniformly recognizes the patient's right ofcontrol over bodily integrity as the subsuming essential in determining therelative balance of interests" (Quoted in Arabian, 1994, p. Oneof the requirements to assure that the consent of an individual containedwithin an advance directive is informed is that the individual must be ofsound mind so that the information provided by health care providers may beunderstood. Opponents of theOregon law found a sympathetic judge on the Ninth circuit to invalidate theinitiative. In 1996, however, the full Ninth Circuit Court declared aWashington law concerning assisted suicide unconstitutional. While the nominalresponsibility for such decisions is that of physicians, other health careprofessionals and members of hospital establishments contribute to suchdecisions. Parfit, D. The implication of this position is that coherentindividuality does not exist across time. This current research, however, is concerned only withassisted suicide within the context of a person's right to die. (1995 July 15). Journal of the American Medical Association,277(21), 17 5-17 8. In this context, many elderly persons have indicated clearly thatthey no longer want to be burdens, and want to end their lives with dignityand grace while they are still aware and alert human beings (Annas, 1995).Certainly, not all people agree with this position. Both the broader concept and the more narrowissue of physician-assisted suicide are highly controversial in NorthAmerican society (Alpers, & Lo, 1997). In the Fall of 1997, the United States Supreme Court refused to hearan appeal of the reinstatement of the Oregon law. (1995 September). References Alpers, A., & Lo, B. Advance directives for elderlypeople: Worthwhile cause or wasted effort? As of early-1999,physician-assisted suicide is legal in the State of Oregon. The absurdityof such laws lies in the inability of the state to punish the person who issuccessful in committing suicide. The prosecutors have consistently failed in their efforts to sendJack Kevorkian to prison for these acts. J., & Wahl, G. A preliminaryinvestigation of opinions and behaviors regarding advance directives formedical care. (1999 January). Sansone, P., & Phillips, M. J., & Lo. Physician-AssistedSuicide: Reflections on Oregon's First Case, Issues in Law & Medicine, 17,4-24. Western Journal of Medicine, 163(3), 226-23 . Relevance of the Issue to Health Professionals Health services delivery, as this concept applies to assisted suicide,involves the ethical value of individual autonomy in relation to healthcare. A. Derek Parfit (1984), however, disputes the sacrosanct nature ofindividual time preferences. Important moral implications derive from this concept of individualself-identity in relation to advance medical directives. Does it make clinical sense toequate terminally ill patients who require life-sustaining interventionswith those who do not? The Roman philosopher Senecawrote that: "Just as I shall select my ship when I am about to go on avoyage, or my house when I propose to take a residence, so I shall choosemy death when I am about to depart from life." Euthanasia is a deliberateaction by a second party that leads directly to death of another, whileassisted suicide is the provision to patients of the medical means tocommit suicide (Gordon & Michael, 1995). Living wills are not a newconcept. Gordon, M., & Singer, P. Withdrawing care. These issuesinclude considerations ranging from a patient's right to die to adhering tophysicians' "do not resuscitate" orders to so-called living wills (Lee,Swinburne, Fedullo, & Wahl, 1994, p. Rather, it isprecisely because people know that self-identity changes with changing lifeconditions that advance medical directives are used in the first place. Annas, G. Anglo American law starts with the premise of thorough-going selfdetermination. Mariner, W. Journal of the American Medical Association,271(3), 2 9-212. The self of the past, within thecontext of this argument, has no right to obligate the self of the futurewith respect to issues of fundamental self-identity. This contention is exemplified by Thor v.Superior Court. The health professional, with respect to assisted suicide, is beingasked by proponents of a person's right-to-die, to place patient autonomyahead of professional and personal interests. Controversy surrounds the concept of a patient's right to die and theexercise of that concept through the use of a living will. Hastings CenterReport, 25(6), S12-S14. (1996 Winter). Roman Catholic Archbishop William Levada in Portland termed theinitiative murder in the name of mercy (Mariner, 1995). Health care professionals, however, are increasingly beingasked and expected to assume such advocacy roles. Increasing the completion of the durable power ofattorney for health care. & White, M. (1994 Winter). Thisapproach to the issue is favored by Roman Catholics and FundamentalistChristians opposed to the concept of an individual's right to makedecisions concerning her or his own death. In November 1994, a similar initiative was approved by Oregonvoters. Rubin, S. A. Euthanasia is most often defined as painless putting todeath persons suffering from incurable diseases or other types of incurableand intolerable health conditions (Lee, Swinburne, Fedullo, & Wahl, 1994).Considered only in this very general context, the act of a person opting tocommit suicide in some painless way to escape an intolerable healthcondition could be viewed as a form of euthanasia (Reitman, 1995). Society is being required bysuch individuals to collectively confront the issue of whether suicide canbe a rational choice for such persons (Kowalski, 1993). The right to die concept is complex, and often encompasses issues ofsuicide, assisted suicide, do-not-resuscitate (DNR) orders, livings willsinvolving terminal health care, and family decisions related to thecessation of terminal health care (Annas, 1994; Elpern, Yellen, & Burton,1993; Kowalski, 1993; Lee, Swinburne, Fedullo, & Wahl, 1994; Sansone &Phillips, 1995). Physician-Assisted Suicide Introduction The issue of physician-assisted suicide is a part of the broader issueof a person's right to die. Lee, D. Medical ethics and thelaw require that advance medical directives be made by individuals who arefully informed of the implications of such directives (Brock, 1996). In Thor, Howard Andrews, a prisoner under a life sentence,became a quadriplegic from a fall. This approach to therelationship between euthanasia and an individual's right to die suffers,however, from a lack of intellectual honesty. The decisions of health care professionals to permit death areamalgams of medical, ethical, and legal judgments. Medicaleducation and socialization focus on offering and providing treatment, asopposed to the facilitation of death. (1984). Oxford, England: OxfordUniversity Press. His attending physicianinitiated proceedings, seeking an order allowing the use of agastrojejunostomy tube or percutaneous gastrostomy tube to feed andmedicate Andrews against his will. Nursing & Health Care, 14(2), 7 -76. Argument For Assisted Suicide Suicide is prohibited by law in almost all countries. International Aging and Human Development,37(4), 313-325. W. The court,however, did not rule specifically on the assisted suicide issue, nor didthe court close the door on an individual's right to die under unspecifiedconditions that may occur and may be brought before the court in the future(Hendin, Foley, & White, 1999). Under this view,the prior competent self would have no authority to speak for the newincompetent self. Milbank Quarterly,74(4), 599-618. It follows that each person is considered to be master ofher or his own body, and he or she may, if he or she be of sound mind,expressly prohibit the performance of lifesaving surgery. S. If this premise is accepted,then the concept of individual autonomy is inconsistent with the concept offuture obligations or commitments. Following thefailure of Michigan juries to convict Dr. Jack Kevorkian for such acts, thestate legislature and the governor rushed through legislation making theprovision of assistance for the purpose of committing suicide a crime inthat state. Additionally, suicide rates among the elderly maybe higher than for other age groups because of a widening social acceptanceof the concept of the rational suicide for those individuals in theadvanced stages of terminal illnesses, with serious and incurable physicalillnesses, and those experiencing debilitating pain, with no recourse forrelief which would leave then as alert and viable human beings (Kowalski,1993). Subsequently, he refused to eat orreceive necessary medication, placing him at serious risk of further injuryand death. How we lie. Bycontrast with these medical and legal criteria, Parfit (1984) contends thatchanges over time (substantial memory loss and other psychological changesas examples) may produce a new person, whose connection to the earlierperson could be less strong and could be no stronger than the relationshipbetween two separate people. The contemporary issue of the so-called "right to die" is bound inmany cases to the preparation by an individual of an advance directiveindicating that a "do not resuscitate" (DNR) should be applied when thecriteria of the advance directive are fulfilled. The debate on assisted suicide-redefining morally appropriate care for people with intractable suffering.Issues in Law & Medicine, 11(3), 299-329. Because suicide is prohibited by law,however, many states also specifically prohibit providing assistance tohelp someone commit suicide, and even in those states where specific legalprohibitions are not in place, other statutes are used by prosecutors tolay charges against persons assisting others to commit suicide (Kowalski,1993). It isbut a short step from this logic to a logic that permits physician-assistedsuicide. Of those interests guiding the doctrine of informed consent inrelation to suicide, the principle of personal autonomy must be consideredpreeminent (Arabian, 1994). Theintellectually bankrupt opponents of the right of an individual to makedecisions concerning her or his own death, however, extend their flawedargument even further by contending that, regardless of who makes thedecisions regarding an individual's death, if the individual asks andreceives assistance to commit suicide, then the assisting individual ispracticing euthanasia. Later, theruling against the Oregon law was overturned on appeal by the Ninth CircuitCourt. B., & Burton, L. At the same time, patients often worry that advanceddirectives such as living wills may foster abandonment by health careproviders. Within thecontext of this conception, identity refers to self-meanings in a role.These self-meanings, according to Parfit (1984), change over time. The relentless advanceof medical technology assures that the pressures on health care providerswill continue as the means to maintain biologic life far surpass the healthcare professional's ability to protect the quality of a patient's life. In 1997, the United States Supreme Court ruled on a Kansas casethat the constitution does not guarantee a right to die. American Journal of Critical Care, 2(2), 161-167. The nurse, with a traditional role that is patient-centered,must counsel the patient and the patient's family, and where requiredbecome an advocate for the patient. F., Weiss, S. Arabian, A. An initiative legalizing assisted suicide was defeated narrowly in theState of Washington in 1991. Parfit's (1984) concept of individual identity, however,implies that these medical and legal criteria miss the point entirely. M., Strull, W. J., Fedullo, A. Accepting Parfit's logic would force suchindividuals to endure the pain and loss of dignity that they wish to avoidon the basis of making an abstract distinction of the concept of selfidentity an iron-clad law. Kowalski, S. M., Fialkow, M. J. Drawing from California case law and a wide panoply of state and federaldecisions, the court concluded that a competent adult has the right todecline medical treatment after proper disclosure of the relevantinformation, even when death will inevitably result (Arabian, 1994). In refusing the order, the California Supreme Court emphasized theimportance of personal autonomy (Arabian, 1994). A similar initiative was defeated, alsonarrowly, in California in 1992. Callahan, D. Thus, the very idea of a right todie or the right to refuse care is difficult for many health care providersto accept, much less become an advocate for a patient in suchcircumstances. There are many people,organizations, and religious groups in this country who strive to preventsuicide by the elderly, regardless of the circumstances involved. Decisions and care at theend of life. Staff psychiatrists found him depressed but mentally competentto understand and appreciate his circumstances. S. (1995 Winter). The health care professional, therefore, is in a situationwherein he or she must be prepared to advocate patient autonomy, whilesimultaneously providing assurance to the patient that any care desired bythe patient will continue to be provided. Argument Against Assisted Suicide Among the many reasons why the suicide rate is so high for the elderlysegment of the population is the isolation and loneliness that leads todespair, also boredom, depression, uselessness, loss of loved ones,economic hardships, general feeling of unhappiness with life, and personswho suffer from a psychological affliction, from loss of purpose and asense of meaningfulness after retirement and separation from family andfriends (Stevens, 1993). What is the moral authority of familymembers to act as surrogates of incompetent patients? H., Yellen, S. The Legal Status of the Issue Michigan was one of the states without a specific law coveringproviding assistance to a person in committing suicide. (1997 4 June). Effectuating the patient's freedom of choice remains the primary goal. Journal of the American Medical Association,271(17), 1358-1361. Stevens, E. Lancet, 346(8968), 163-166. Nevertheless, health care providers, physicians and hospitalsspecifically, more often than not have thwarted patient wishes on thepretexts that living wills fail to provide clear and convincing evidence ofa patient's desires (Rubin, Strull, Fialkow, Weiss, & Lo, 1994). (1995 November-December). The acknowledgment of this contention lead tothe view that individuals change over time, and as individuals change overtime, they should be considered new "selves" or persons. (1993 February). Outcomes assessment in healthcare reform: Promise and limitations. (1993). Social Work, 4 (3), 397-4 1. Health care professionals in the contemporary period are confrontedwith an array of issues that contain moral dimensions. Elpern, E. Issues in Law & Medicine, 1 (3), 261-298.(25) Brock, D. Frustrated mastery: The culturalcontext of death in America. Hendin, H., Foley, K. Socialinteractionists contend that individuals develop both their own self-concept and individual identity through social interactions. W. American Journal of Law & Medicine,2 (1-2), 37-57. K. Making sense of usefulness: An avenue towardsatisfaction in later life. Opponents of assisted suicide appealed to the United States SupremeCourt. K. (1995 May). In the initiative campaign in Washington,Roman Catholics and Fundamentalist Christians acted without scruples in thepurposeful misinterpretation of the specifics and intent of the initiativewording. (1994May 4). The major issues remain to be settled in theremaining 49 states, and even in Oregon they are attempting to work out theprocedures for the actual implementation of the law (Hendin, Foley, &White, 1999). The action bythe United States Supreme Court in the Oregon case, however, was not aruling on the merits of the case, and, thus, does not establish legalprecedent for other states. Parfit's reasoning that individual identitychanges over time is not being challenged by this argument. Juries in Michigan, however, continue to acquit Dr. Kevorkianfor such acts (Annas, 1995). Patients seek autonomy and self-determination through the use ofliving wills.
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