Medicine and Euthanasia
Medical advances over the past hundred years have extend the life expectancy astronomically. Medicine provides hope that in the event of an “accident” we can be sure everything will be done to preserve our life, and that the healthcare community will exhaust all possibilities and resources in trying to accomplish this goal. Healthcare also give the reassurance of palliative care to ensure the remaining time on Earth is a painless as possible. However, there are those moments when medicine cannot achieve the goals it sets out to. There are times when the pain is still too much handle. It is during these times in which an individual should be able to decide if they wish to continue on. Physician assisted suicide, while ensuring all safeguards and last resort options such as palliative care are met, gives patients an important additional option to their end of life care.
Background / Presentation of Ethical Theory: Webster’s defines euthanasia as, “the act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy.” According to the principalism theory, principalism uses key ethical principles of beneficence (do good), nonmaleficence (do no harm), autonomy (respect for the person’s ability to act in his or her own best interests), and justice in the resolution of ethical conflicts or dilemmas. Fidelity (faithfulness) and veracity (truth telling) are also important ethical principles that may be at work in managing ethical dilemmas. (Chitty & Black, 2011) This theory can be applied when discussing euthanasia. The first part of this theory is to do “good”. When a patient is experiencing unrelenting pain associated with a debilitating disease a physician can practice beneficence by eliminating their pain through euthanasia at the patients wish. It is important to note at the same time the physician must “do good” by ensuring euthanasia is the patient’s decision and the patient’s decision alone.
Another aspect of this theory that can be applied to euthanasia is the respect for the person’s ability to act in his or her own best interests. It seems a lot like murder when you think of administering a lethal drug; however, the patient has a right to make decisions about their health and how their end of life is carried out. Patients put their trust and faith in medicine and the health care providers that prace medicine. They trust that the physicians have their best interest in mind and have the knowledge to treat them. These aspects also play another role in the principalism theory—in that physicians have the ethical responsibility to be faithful and truthful to their patients at all time. Physicians should have the opportunity to explain to their patients that there is an option to end their pain and suffering should they wish. While the medical field provides hope to cure diseases and preserve the quality of life when neither of these two can be accomplished the medical filed should also offer the patient an end to anguish. Applying theory, Pros/ Cons: The decision to legalize euthanasia comes with a lot of grey area and is often referred to as a slippery slope.
There are many positives to legalizing euthanasia such as a patients right to die. “ The right of a competent, terminally ill person to avoid excruciating pain and embrace a timely and dignified death bears the sanction of history and is implicit in the concept of ordered liberty.” (Euthanasia. ProCon.Org, 2013) Through the eyes of the court a mentally competent person has the right to legally make decisions regarding marriage, contraception, the right to refuse medical treatment, as well as the right to an abortion. This concept applies to the principalism theory in which there is respect for the patient’s ability to act in his or her own interests. Another affirmative side to euthanasia is the ability to end patient suffering at end of life. “It should be considered as much of a crime to make someone live who with justification does not wish to continue as it is to take life without consent.” (Euthanasia. ProCon.Org, 2013) The principalism theory also suggests the ethical responsibility to “do good” – in “doing good” means to carry out a patient’s wishes related to their medical treatment.
Commonly used today are living wills in which individuals depict their end of life wishes. “Living wills can be used to refuse extraordinary, life prolonging care and are effective in providing clear and convincing evidence that may be necessary under state statutes to refuse care after one becomes terminally ill. A living will provides clear and convincing evidence of one’s wishes regarding end-of-life care” (Euthanasia. ProCon.Org, 2013) It is in the living will that patients can depict how and if they choose euthanasia and under what circumstances. The patient could then expect the physicians to be faithful in carrying out their wishes. While there are many positive sides to euthanasia there can also be some not so clear areas. Such as euthanasia being viewed as legalized murder. Dr. Edmund D. Pelligrino states, “If terminating life is a benefit, the reasoning goes, why should euthanasia be limited only to those who can give consent? Why need we ask for consent?” (Euthanasia. ProCon.Org, 2013)
There is the thought that incompetent patients or the elderly could fall victim to assisted suicide through an advanced directive – in which they are unable to make these decisions with sound mind. End-of-life care can be very expensive whether it be hospice or after a debilitating accident in which the patient remains in the hospital for quite some time. Most of the elderly patients will be on Medicare therefore costing the government large sums of money. There is the argument that assisted suicide drugs cost about $35-45 dollar making them far less expensive than providing medical care. Many worry that cost implications will lead to unjustified euthanasia. Lastly, there is concern of certain social groups that could be at risk for abuse. New York State Task Force state, “It must be recognized that assisted suicide and euthanasia will be practiced through the prism of social inequality and prejudice that characterizes the delivery of services in all segments of society, including health care.” (Euthanasia. ProCon.Org, 2013) They continue to say that physicians are just as susceptible prejudiced and influenced by race and class as the rest of society.
As much as we would like to think that racism and prejudice doesn’t exist in our society it still does. There is great concern that certain social groups could fall subjective to unjustified euthanasia. Conclusion: In the debate of euthanasia commonly referred to as physician assisted suicide there are many valid arguments to both sides—the patients right to die, end patient suffering, and following a patients living will. While these arguments are valid there are other that speak to the contrary such as euthanasia being referred to as legalized murder, physician assisted suicide because of cost implications, and social groups being at a greater risk. There are many areas in legalizing euthanasia that will need to be further though out; however, a patient has the right to decide their medical treatment and, with an evaluation from a psychiatrist, should be allowed to choose euthanasia if they wish. Often times physician assisted suicide is looked upon with a bad connotation.
A study conducted in Oregan on the families members views of physician suicide described their family members as, “individuals for whom being independent and in control is important, who anticipate the negative aspects of dying, and who believe that the impeding loss of self, abilities, and quality of life will be intolerable.” (Linda Ganzini, MD, MPH, Elizabeth R. Goy, PhD & Steven K. Dobscha, MD, 2008) For these patients euthanasia was a way to provide them with control—control of the last remaining aspect of their life, to die with dignity.