Sandra Cerwinsky

SOC 120: Introduction of Ethics and Social Responsibility

David Strand

September 24, 2012

Ethical/Personal Issues of Physician Assisted Suicide

Physician assisted suicide is a very passionate topic for me. I totally agree that it should be legalized and used when a terminally ill patient has totally used every possible avenue of treatment and there is nothing left to do. As a Utilitarian you definitely want the right thing to be done. Then what is right is right and wrong is wrong. I am sure that in egoism there would be a problem because they would only want to be the hero so to speak and do what is correct of the family and everyone else’s needs. As we go through the issue you will see different views and feelings involving all providers involved which are doctors, nurses, patients, friends, and family members.

What is physician assisted suicide? For the lack of a better term physician assisted suicide will be addressed as “euthanasia”. Euthanasia is defined broadly as “the mercy killing of the hopelessly ill, injured or incapacitated” (Pozgar, 2010). Euthanasia is a Greek word meaning “good death” or “easy death” (Pozgar, 2010). As a healthcare worker/provider for many years I have come to have great feelings on passive euthanasia as well as many other healthcare individuals have. We must discuss the fine lines of legal issues as well as ethical issues. Is there a right or a wrong, when it comes to the end of life for an individual? Who really needs to understand anyone’s wishes and fulfill them? There are strong feelings involved in these issues by many individuals of different walks life.

Euthanasia is a dilemma worldwide with many different opinions and feelings from all walks of life. In some cases if it were used some individuals would die a dignified death. That I believe would help some family members deal with a loved one’s death a lot easier. They would know that they did not suffer the agony of a painful death. They would have the knowledge of knowing they were no longer suffering from an incurable long painful illness or suffering from unfixable injuries from an accident.

I believe this is where rule utilitarian would have a conclusion that the act of physician assisted suicide would not be the best result or the correct choice for anyone involved because of the legal issues involved. A definition of rule utilitarian to act utilitarian could be as follows for a decision of PAS. “The rule utilitarian may, in some cases, disagree, contending that one should do things that as a rule generate the greatest good for the greatest number (Mosser, 2010). This could be the final decision of not helping the dying individual end life sooner than later. Because all the friends and family didn’t have enough time with them or didn’t get the chance to make things right because they were gone before they could have their peace.

There are so many issues with physician assisted suicide “euthanasia”. Is it morally correct to assist someone in dying or should we just let nature continue its course and eventually the individual will die. A physician has taken a Hippocratic Oath when they become a physician. Just as a police officer, has to take an oath to protect the public from harm while doing his job. One part o it states “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect…In for swearing the giving of poison when asked for it, the Hippocratic physician rejects the view that the patient’s choice for death can make killing him right. So the deepest ethical principle restraining the physician’s power is not the autonomy or freedom of the patient; neither is it his own compassion or good intention. Rather it is the dignity and mysterious power of human life itself, also what the Oath calls the purity and holiness of life and art of which he has sworn devotion” (Top 10 Pros and Cons, 2010). This is a similar decision I believe a Utilitarian or even a deontologist would say it is the correct decision to make in PAS for all involved. This decision could be derived from emotivism or even the use of relativism. Because the decision of taking an individual’s life is the balance of emotions and what is right and wrong.

With these decisions being so deeply driven emotionally by all involved with the individual under palliative care there is the use of deontology as well as relativism and emotivism (Mosser, 2010). The deontologist will come to the decision of using PAS if it is the morally correct choice for the rules that apply to the use of physician assisted suicide. Along with the use of emotivism or relativism they help aide in the final decision made by the family, patient or the power of attorney that has been appointed for the individual. Which emotivism is really ethical theory that is completely emotion driven but can be morally correct for the emotions of the patient themselves or based on the moral emotional decision made by the family or the life partner significant other of the patient themselves to benefit them and not the patient at all. These choices are so hard and when some emotions are involved the decisions are not thought through and benefiting the patient who is really the individual who needs to be addressed.

There are three states in which PAS is legal and they are Oregon, Washington and Montana (Lachman, 2010). The individuals who usually get these requests are nurses and they are not allowed to participate in such acts do to the Code of Ethics for nurses and by the ANA position statements (Lachman, 2010). But yet these nurses will stay with these patients and take care of them while they have taken the lethal dose of medication provided to them by a physician because the nurses will use choices of relativism and support them emotionally and physically while they slip away from life.

I am big on making the right decision for the patient that is involved in the care and has made the decision to end their life because everything has been exhausted to the point there are no more treatments. Not even a fix to put the patient in the state that everyday activities can be carried out without any difficulties presented with this care. This is where I believe morals would definitely come into effect. Everyone prides themselves on their own morals and if they don’t they really should think about it because they have morals whether they really think they do or not. The right to die with dignity is a very strong moral of mine and I definitely want my parents and siblings to die a very dignified death if at all possible. It is definitely a very important discussion that should be spoken about and I feel frequently when your parents are at a certain point in their adulthood. Especially if anyone so close and dear to you is diagnosed with an incurable illness. These discussions should be done with the correct decisions given a rational explanation as well as using relativism making the right moral choices. Especially, given that the individual is of their complete sound mind and can make these decisions rationally.

Physician assisted suicide or euthanasia is definitely something that is not new to mankind but is really brought forth in many debates or discussions when talking of palliative care. This is definitely a grey area but yet a reality to everyone. The discussion has come up many times with my parents and me. They have made the decision to have me make their medical decisions in the event they cannot make them for themselves. So, I don’t want any unanswered questions to come my way that I cannot provide an answer for the way my parents want their end of life decisions to be and fulfilled. This is why a living will should really be spelled out word for word and discussed thoroughly. I have a brother and sister whom I believe would fight me on decisions because they are both of the ethical egoism. I really hate to say that about my siblings but they really are all about what is best for them their whole decision making in life has always been for the benefit of them and never about anyone who is involved. I feel these major decisions need to be discussed and should be discussed in great lengths between everyone. With the two siblings I have it is impossible they have voiced no matter what all will be done to save Mom and Dad because they can’t bare the thought of them dying. Well everyone is going to die sooner or later and this selfish act is totally unfair. I believe this is why it must be spelled out and someone possibly a lawyer so it is not a family member should be given the right to fulfill the wishes of these individuals and that way there will not be any finger pointing or any blame or even guilt put onto anyone. That is why I fully believe in PAS and carry on wishes using relativism which is doing what is right for the individuals not for me. I t will be very difficult when this time comes but I will be comfortable knowing we have discussed all of this in great lengths and have all the details written out.

I did few interviews and used a variety of people some deal with palliative care first hand and others do not they are just in the situation because they are care givers, physicians, preachers, teachers or the neighbor. The first person I interviewed was a hospitalist at the facility that I work at. He is a younger physician and is very stern with his decisions. I asked if a terminally ill patient came into the hospital because of failing care at home to take care of the pain and suffering what actions would be taken. Dr. Fulmer, states “he would have to be familiar with the patients history and then see what is happening with the patient by performing tests such as lab work, x-rays, urinalysis just to name a few. If any of these things are treatable he would address them. He would also make sure that the patient was comfortable. He would ask everyone present what was being done to control this at the other facility the patient has come to the hospital from. Are you against what Dr. Kevorkian has done in the past and has gone to prison for. In his moral judgment of what events have occurred under this doctor’s care he stated it is not wrong but as a physician and in the state of Ohio it is illegal to administer any lethal drug to a human to end life. But he would not hesitate to stop all care and give the patient there full wishes of being comfortable through to the end. He would not let them struggle and be miserable and he would sit and discuss any issues that came up with all the nurses and family that are involved with the patient. So through this interview I came to the conclusion that Dr. Fulmer was using a deontologist ethical theory because he is doing what is moral and legal correct to his line of work. He did also mention the Hippocratic Oath that a physician takes once they become a physician.

In my research I came across an article written by David C. Stolinsky, M.D. He speaks about a few articles written in the New England Journal of Medicine. He makes some very valid comments on the Hippocratic Oath and the articles in the New England Journal of Medicine. He stated the articles go away from the ethical issues of terminally ill patients and assisted suicide. They say it just needs to be done without any questions asked. “In two articles, the New England Journal found no space to mention the Hippocratic Oath or any other source of ethical values. Meanwhile, Lancet describes as “peaceful” the slow death by dehydration and starvation of a minimally conscious patient. But Lancet also describes as “barbaric” the execution of convicted murders in the same way we put beloved dogs or cats to sleep. On the contrary, someone who starved and dehydrated an animal to death would be jailed so who really is barbaric (Stolinsky, 2006)?

That brings up a very strong feeling in me. The morally right thing to do maybe it would be emotionally driven decision but I also believe it is the only right thing to do which would be PAS. It is okay to instantly put an animal out of its painful misery but we have to let a human who is terminal have a long drawn out death when we could end it immediately and painless. If everything has been done why is this thoughtless, thankless act a crime and you can be placed in prison for murder because of it?

The next individual that I interviewed was a pastor of a local church that is part of the hospice care group in my county. He firmly believes god will take all mercy on everyone involved and would want there to be no pain and horrible suffering to be given to the ill individual. But yet he does not feel it is correct to be giving medications in lethal doses to end life before God is ready to take this individual to the other side to be with him. I believe this is the matter of discussing the ethical theory or Utilitarianism so what is right it right and what is wrong is wrong. So the way of dehydration and starvation is permitted and acceptable in the pastor’s eyes with his beliefs.

Physician Assisted Suicide is a strong ethical issue with emotions involved as well as legal issues. Whether we choose to use relativism or emotivism there are morals that must be addressed and emotional and physical needs as well. So really is PAS for the family or the patient involved? My answer to that is everyone needs and deserves to die with dignity when able the pain and suffering is really overrated and we endure a lot of suffering in normal everyday life so why should it continue at the end of life. Even if several individuals and law officers feel that physician assisted suicide is murder then they should really look at it from an individual who is suffering beyond suffering and no more can be done for them. If everything has been done that can be done and there is no way that this person is going to recover from the illness or injuries from a tragic accident and the only thing that is keeping them alive is who really knows what then allow the individual to die with dignity. If that means allowing them to take a lethal dose of a medication given to them by a physician for an assisted suicide then allow it to happen with no questions ask. Palliative care is very important to family and the individual with the sickness and it is so very nice to have it all spelled out for the care takers when at all possible while the individual is still able to make all decisions about their care.

Reference

Lachman, V. (2010). Physician-assisted suicide: Compassionate liberation or murder?

Medsurg Nursing, 19(2), 121-5. Retrieved from http://search.proquest.com

Mosser, K. (2010). Ethics & Social Responsibility San Diego, CA: Bridgepoint Education

Inc. Retrieved from http:// www.ashford.edu

Muller-busch, H.C., Oduncu, F.S., Woskanjan, S., & Klaschik, E. (2004). Attitudes on

Euthanasia, physician assisted suicide and terminal sedation—A survey of the

Members of the German association for palliative medicine. Medicine, Health

Care and Philosophy. Retrieved from http://search.proquest.com

Prozgar, G. (2010). Legal and Ethical Issues for Health Professionals Sadbury: Jones

& Bartlett Publishers, LLC

Stolinsky, D. (2006, March 20). Assisted Suicide of the Medical Professions Retrieved from

http://www.stolinsky.com/news

The Top 10 Pros and Cons of euthanasia retrieved from http://www.euthansia.procon.org