PHYSICIAN-ASSISTED SUICIDE.   Term Paper ID:24350 Click to get this paper

Essay Subject: Legal, medical, ethical issues, pros & cons, types of death, patient autonomy, pain management, informed choice, social impact.... More...

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Paper Abstract: Legal, medical, ethical issues, pros & cons, types of death, patient autonomy, pain management, informed choice, social impact. Paper Introduction: The purpose of this research is to examine issues surfacing around the arguments for and against physician-assisted suicide (PAS). The plan of the research will be to set forth the major arguments on both sides of the debate and then to discuss the distinctions between allowing a patient to die and aiming at death vis-а-vis the limits of autonomy, with a view toward identifying the strongest pro and con arguments in the controversy. In 1991, the Patients' Self-Determination Act (PSDA) required federally funded hospitals to tell patients at the time of admission about their rights to accept or refuse medical treatment and to create advance treatment directives, which can take various legal forms, about their preferences for their own care should they lack the capacity to make such directives for thems Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. The purpose of this research is to examine issues surfacing around thearguments for and against physician-assisted suicide (PAS). Along the same lines, Kubler-Ross says, assisted suicidebreaks a "universal law" and masquerades as mercy (58); in her view, thosewho cooperate in a patient's suicide are not helping the patient escapemisery but instead putting themselves out of their own misery (Humphry andWickett 296). 24 -2.Quill, Timothy E. That desire includes the wish to be informed of all treatmentoptions and the discretion to give or withhold consent on one or more suchoptions. . In Dyck's view, the situation is either that people have an inherentright to die, by which is meant that the individual has a claim on part orall of the community to facilitate that right, or that the community has amoral claim on the individual to advocate life as a first principal, aspart of the individual's obligation to participate in the "moralrequisites" of a community of which the individual is a member. "Seduced by Death: Doctors, Patients, and the Dutch Cure." Issues in Law & Medicine 1 (1994): 123-68.Humphry, Derek, and Anne Wickett. People might notsee lack of reason in a suggestion that the beauty of being human as muchas transcendence entails the joy of life and that such joy could well beobliterated by a tyranny of social, bureaucratic, and communitarianallegiance structures that trample opportunity either to repose in itsmemory or to relieve loved ones of the need to witness its unrecoverableabsence in one's final days. Such directives were controversial amongphysicians when the PSDA was being debated. Thus, the best end-of-life advocacy may be thatwhich does not dispose of but rather fosters and encourages the troublingtensions of debate. Hammes. "Special Report: Sources of Concern About the Patient Self-Determination Act." New England Journal of Medicine 325 (5 December 1991): 1666-71. Dyck and Hendin cite disquieting figures from the Netherlandswhich indicate that the independent exercise of professional judgment onthe part of some physicians has entailed discretionary euthanasia as wellas assisted suicide (Hendin 153-; Dyck 294-5). Fins, Bruce Jennings, James Lindemann Nelson, Jeremiah A. They do not equate actions aimed at comfort, evenwhen such actions have the effect of ending life, with actions aimed atending life" (Dyck 287). Further to this point, Dyck considers that Quill gave up too quicklyon Diane and progressively fell into a pattern that made it "difficult, ifnot impossible, for Diane and the family to take up a sustained advocacyfor Diane's therapy and . Whitehead (26) warns of the perils of winningdecisively the debate over a fractious social issue: "It may be better thatthe heavens should fall, but it is folly to ignore the fact that they willfall." Works CitedBattin, Margaret P. Belmont, CA: Wadsworth, 1982. Cambridge: Harvard UP, 1923.Katz, Jay. Ed. Advocates of PAS emphasize the wish of patients not to be deprived ofthe opportunity to die with dignity as they see it instead of according tosocially approved structures of medical care. Cain and Hammes take theposition that medical intent is the basis for the distinction, drawing aline between treatment as PAS and treatment "when death is a secondaryaccepted risk" (161). Curiously, an exceptionally strong argumentin favor of PAS can be inferred from a conceptualization, after Dyck, of anindividual's obligation to support and nurture oneself toward lifesustenance in service of the larger project of nurturing the community.While any (faut de mieux) otherwise rational patient clearly could beexpected and perhaps as a member of the community should be obliged toengage in any end-of-life discourse thoughtfully and honestly, people mightnot see why an individual incurs a special communitarian social obligationas a consequence of experience in extremis and why a desire to escape sadand squalid suffering of itself lacks moral standing or violates communityexpectations when, absent terminal expectations, most members of acommunity would doubtless choose not to incur either pain or itsanticipation. . The special obligation of the terminal-careprovider is to diagnose physical or psychological suffering and "treat thewhole patient," and to exercise special care not to be manipulated intoaccepting patient depression as a condition that cannot be relieved (Miller13 -1). Cleveland, OH: Pilgrim, 1994.Glasson, J. As a practical matter, patients do not have absolute autonomy intheir course of treatment, not only because PAS implies the need forassistance but also because they lack medical expertise. Tom L. Kubler-Ross adds that, with proper counseling, dying fromterminal illness need not be a nightmare. Such a distinction affects the PAS debate in thatit appears to blur the line between active participation and implementationand acquiescing in the natural processes of death. and that in order to accomplish that objective they were obligated to attend to their patients' physical and emotional needs and to do so on their own authority, without consulting with their patients about the decisions that needed to be made. "The Hippocratic Oath." Hippocrates. People might not agree with Miller's characterization as "matureunderstanding of life and death" of Brescia's declaration that the beautyof being human entails "our intense ability to find meaning and wholenessin the face of adversity and to transcend" (Miller 132). 1668-7 ). The act, which went into effect in December 1991, specificallyguarantees patients the right to refuse medical treatment and requireshospitals receiving federal Medicare and Medicaid funding to informpatients of their right to refuse medical treatment. Battin suggests thatphysicians, mental-health counselors, and significant others can eitherreinforce or disrupt the rational construct of the PAS decision, at everylevel of choice. Some could argue, as Dyck does, that a choice to limit choice is notrational but irrational, that people "who profess a desire to commitsuicide are not functioning rationally" (293). Dyck raises two core questions about the limitations of personalautonomy. Along the same lines, Pellegrino insists that "toforesee an event is not the same as intending to cause that event" (242). . New York: Macmillan, 1969.Miller, Robert J. That idea is articulated bythe physician Timothy Quill, "a longtime advocate of active, informedpatient choice of treatment or nontreatment, and of a patient's right todie with as much control and dignity as possible" (692), although, in hisfamous discussion of the case of Diane, Quill expresses misgiving aboutDiane's single-minded choice of "almost certain death" instead of a 25percent chance of long-term survival for the disease that took her life.More generally, some believe that the terminally ill, weakened as they maybe by disease or pain, require assistance--and indeed expert medicalassistance--if they are to end their suffering efficiently and with dignity(Quill 693-4). 386-9.Kubler-Ross, Elisabeth. Dyck raises severalprincipal objections and a variety of arguments supporting thoseobjections: the physician's advocacy for life and advocacy for pain reliefare compromised (29 -1); the principle of suicide prevention iscompromised, not only within the medical community but as an aspect of the"total communal effort" at sustaining itself (291-3); the idea of "informedchoice does not serve as a limiting condition" for PAS (by which is meantthe physician withdraws medical expertise and nurturant obligation from theend-of-life discourse, this failing to honor "the patient's right to betreated as a moral equal, which includes the right of refusal or consent towhatever the physician advocates" (294-7); and medical professionalism isundermined by a doctor's withdrawal of medical expertise from theobligation to advocate for life on one hand and to fulfill the obligationto maintain the bureaucratic framework of social organization (i.e.,community) vis-а-vis the value of human life on the other (3 1-2). The AMA's definition of assisted suicideis the situation in which a physician gives a patient either means orknowledge to commit suicide but does not perform the act. . The relevance of this view of pain management to PAS is thedistinction that most physicians make between assisting in a suicide andproviding patients with "maximal pain relief and flexibly adjusted effortsto minimize suffering. Beauchamp and Robert M. PAS in particular remains a crime. New York: Macmillan, 1933.Wolf, Susan M., Philip Boyle, Daniel Callahan, Joseph J. Another view is that the "Nazi Albatross" is mischaracterized aseuthanasia and more properly referred to after the German form aslebensunwerten Leben, meaning life not worthy of life: There is no record of the Nazis assisting in a suicide or killing anyone suffering intolerably from a fatal illness. "Report of the Council on Ethical and Judicial Affairs of the American Medical Association." Issues In Law & Medicine 1 (Summer 1994): 91-97.Hendin, Herbert. Adventures of Ideas. Brock, Rebecca Dresser, et al. What people are left with,alas, is the disquieting fact that the moral debate over PAS may never end.Accordingly, competing and adversary ethical constructs may remainstubbornly in place to fuel publication and conference controversy, if forno other reason than to keep the discourse and praxis of both opponents andproponents of PAS honest. Ed. Implicit or expressed in anti-PAS advocacy is the slippery-slopeargument, that voluntary active euthanasia (= PAS) could easily slidetoward involuntary euthanasia. . . Tom L. The plan of theresearch will be to set forth the major arguments on both sides of thedebate and then to discuss the distinctions between allowing a patient todie and aiming at death vis-а-vis the limits of autonomy, with a viewtoward identifying the strongest pro and con arguments in the controversy. . "Ethics and Pain Management: Respecting Patient Wishes." Journal of Pain and Symptom Management 9 (April 1994): 16 -5.Dyck, Arthur J. Rights and Responsibilities. The operators liked to call their work "mercy killing," but the quality of "mercy" was something they--and only they--decided. Institutionalization of PAS as a social normcould exacerbate this process as end-of-life law has the effect ofpersuading the aged, the depressed, the terminally ill against the ideathat life implies hope and that hope implies meaningful life worthy ofpreservation. . The idea that patients may also be entitled to liberty, to sharing the burdens of decision with their doctors, was never part of the ethos of medicine (Katz 386). 1666ff). This, too, doesviolence to social and communitarian cohesion. A key to successful accomplishment of the objective of death withdignity is the competence and foresight to plan to meet the contingentsituation in which the potential of death without dignity might arise.Advocates of PAS employ the term rational suicide for PAS, which Battin(15, 17-2 ) describes as a rational structure for the terminally ill:actively assuming control over one's own death; waiting for a cure, timingone's death during the predictable period of terminal decline, especiallyin AIDS cases; and the interests of others. Barondess, Dan W. Meanwhile, inthe decade 1975-1985, as the mixed blessings of high-technology medicinehave emerged in the information age and as a tendency to overuse high-techintensive-care instrumentation entered institutional medical practice,murder-suicides, double suicides, and assisted suicides of the terminallyill "increased forty times as desperate elderly people felt obliged to takethe law and fate into their own hands" (Humphry and Wickett xi). Despitemisgivings within the medical profession and despite what can be seen aspotential pitfalls to implementation of self-determination policies, thePSDA gives statutory sanction to the principle of patient autonomy. [and]identify[ing] patient wishes," particularly when patients are unable tospeak for themselves (162). "Sounding Board--Death and Dignity: A Case of Individualized Decision Making." New England Journal of Medicine, 324 (7 March 1991): 692-4.Whitehead, Alfred North. This view of terminal illness dominates hospice advocacy as analternative to PAS. 2d ed. In other words, individual autonomyasserted as a right actually imposes an obligation on others; hence,autonomy for PAS presupposes an obligation of others to cooperate in death,which is antithetical to the very notion of life-sustaining community onwhich the autonomous agent relies to complete the suicidal project.Autonomy-as-right is therefore a troubling contradiction in conceptualcontradiction. Katz makes thepoint that, as a group, even compassionate doctors have "failed to addressphysicians' lack of commitment to patients' decision making needs" (387),concluding that the notion of patients' "informed consent" and self-determination lacks real meaning, partly because of the persistentpaternalism of the medical profession, but that it has a strong perceivedvalue that, of itself, can facilitate the treatment process. "Physicians and Patients: A History of Silence." Contemporary Issues in Bioethics. "Physicians, Partners, and People With AIDS: Deciding About Suicide." Crisis 15 (1994): 15-21.Cain, Joanna M., and Bernard J. Palliativetreatment is the name given to the act of providing increasing drug dosagesfor pain relief that may have the so-called double effect of ending thepatient's life (Pellegrino 24 ). Some believed that the conceptof patient autonomy was fundamentally flawed and limited: patients actuallydid not want to discuss future incapacity; they lacked the training andcompetence to determine realistic treatment options, including life-supportsystems; advance directives could be ambiguous and open to unwarrantedinterpretation; physicians knew patient options and interests better thanpatients anyway; patients might change their minds while being putativelybound by a previous directive; a patient's third-party proxy might forvarious reasons violate either patient wishes or medical and institutionaltreatment preferences; and advance treatment directives might "reduce thediscussion of treatment options and directives to a bureaucratic processdominated by brochures and forms" (Wolf, et al. People can easily adduce all manner of situations in which PAS can orwould somehow so dominate medical practice with the terminally ill as toundermine its tradition of healing and palliation or to tempt theunscrupulous or overhasty away from nurturance and care. . Despite requests from terminally ill patients suffering prolonged painand degeneration and despite the legal sanction for passive euthanasia asan aspect of living-will directives, the patient's right to die remains anunresolved medical issue. Physiciansto participate in PAS violate their obligation, incurred by the HippocraticOath, to nurture and protect human life, especially such life as feelsdevalued in its dignity and worth. Veatch. Englewood Cliffs, NJ: Prentice-Hall, 1996. life-extending comfort care" (Dyck 3 ).Miller takes the view that a patient's desire for control of terminal-careissues varies inversely with his or her the level of trust that thephysician (or other caregiver presumably) will be committed to the comfortof the patient and that euthanasia "serves only to avoid dealing withdeath" (132). Another viewis that patient wishes, or autonomy, should be a high ethical priority inpain management, along with a rejection of arguments against pain reliefbased on negative side effects and an embrace of the view that health careproviders should function as advocates "for both individual patients andthose who would need care in the future" (Cain and Hammes 16 ). The Right to Die: Understanding Euthanasia. Law, Medicine & Health Care 2 (Spring-Summer 1992): 127-32.Pellegrino, Edmund D. The foundation of the death-with-dignity idea is the patient's desirefor autonomy in regard to a decision for suicide and in regard to theexpectation of a doctor's assistance that might be required to act on thedecision. In 1991, the Patients' Self-Determination Act (PSDA) requiredfederally funded hospitals to tell patients at the time of admission abouttheir rights to accept or refuse medical treatment and to create advancetreatment directives, which can take various legal forms, about theirpreferences for their own care should they lack the capacity to make suchdirectives for themselves "in the event of future incompetence" (Wolf, etal. New York: Harper & Row, 1986.Jones, H.H.S., trans. "Hospice Care as an Alternative to Euthanasia. It is a relatively recent innovation in the end-of-life discourse: Physicians have always maintained that patients are only in need of caring custody. A report by the American Medical Association's Council on Ethical andJudicial affairs identifies euthanasia as the physician's act ofadministering to a patient some means of death, such as "the death-causingdrug or other agent" (Glasson 91). First, he queries whether authentic autonomy is a valid conceptwhen as a matter of fact the idea of community entails networks ofinterdependence as a social rule (12 ). This whole matter wasirrevocably complicated in the twentieth century by Nazi Germany, wheremurder in the form of involuntary euthanasia of the mentally and physicallydisabled and the politically and racially undesirable became nationalpolicy, undertaken by protocols and at facilities designed for thatpurpose. Second, Dyck queries whether autonomy extends to "a choiceto take one's own life, which is, after all, paradoxically, a choice to endall further choices" (288). Quite the contrary, every killing was unexpected by the victim and involuntary. Beauchamp and LeRoy Walters. "Intending to Kill and the Principle of Double Effect." Ethical Issues in Death and Dying. On Death and Dying. One strategy of patient autonomy is the emergence of the advancedirective document, which Cain and Hammes see as important to the projectof accurately "assessing patient capacity to choose . This obligation, Dyck says, "is at thevery core of what is required to sustain communities, families,friendships, and human cooperation" (Dyck 293). The victims ranged from the grossly deformed to the mentally handicapped to the treatably neurotic (Humphry and Wickett 23). . The opposing viewpoints of PAS seem nearly irreconcilable, as far asthe active participation of physicians in enabling the death rather thanlife of a patient is concerned. The AMA distinguishes between thesedefinitions and a situation in which doctor, patient, or "patient's proxy"in the form of living will, durable power of attorney, or other advancehealth-care directive authorizes withdrawal or withholding of life-supporttreatments whose disadvantages outweigh the advantages; the AMA assigns noterm to such a situation, although it is commonly referred to as passiveeuthanasia. Miller sees PAS as a way of drawing attention away from"optimal palliation and more appropriate and compassionate terminal care"that may be available in a hospice environment while doing violence to themoral structures of civil society and to traditions of medical ethics andprofessional medical judgment. If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.