Death allows for any state residing and critically

 

 

 

 

 

 

 

 

 

Death with Dignity: An
Investigation of Physician Assisted Suicide

Nick Leon

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Sociology 450

University of Delaware

 

 

 

 

 

 

 

 

 

 

 

 

 

Death with Dignity: An
Investigation of Physician Assisted Suicide

In
the past few decades Physician assisted suicide (PAS) in the United States has
become a controversial yet increasingly applicable concept. The debate falls
between whether or not a dying individual has the right to die with the
assistance of a physician through calculated and painless lethal injections. Factors
including moral, religious, medical, and political have all played a role in influencing
society’s relationship with this practice.

It
is difficult to distinguish between relief from suffering, with simply killing.
One of the most substantial concerns with assisted suicide lies with the
competence of the terminally ill. More people are discussing and considering
physician assisted suicide as a viable option than ever before (Bruinius, 2015).
Essentially it is a series of calculated injections or pills administered by a
medical professional to purposefully induce a painless death. In the U.S. it
varies by state law, but as of today only four of fifty states have legalized
the “Death with Dignity Act” (including Oregon, Vermont, Washington, and
California with Montana allowing it only under a court ruling) (Bruinius,
2015). The patient also has to be a mentally competent individual at least 18
years old and be diagnosed with a terminal illness that would otherwise result
in death within the next 6 months. In all other states and scenarios, aiding in
suicide is considered a felony, however public pressure is rendering certain
states either undecided or in legislation review. California is such as state, most
recently adopting a “death with dignity act” that allows for any state residing
and critically ill individual to partake in physician assisted suicide
(Bruinius, 2015).

PAS
has also made a significant mark internationally. In April 2002, the Netherlands became the first
country to legalize assisted suicide. Countries such as the
Switzerland, Germany, and recently Canada have made profound strides in
supporting these practices as well. In 2013, according to the latest data, 4,829 people
across the Netherlands chose to have a doctor end their lives. That’s one in
every 28 deaths and triple the number of people who died this way in 2002.
Here, people can choose euthanasia if they can convince two physicians they
endure “unbearable” suffering, a definition that expands each year. Residents
can choose euthanasia if they’re tired of living with Lou Gehrig’s disease,
multiple sclerosis, depression or loneliness. In contrast, within the few
states that allow for it, the U.S. has much stricter regulations as to what
constitutes reason for PAS. Other countries are now edging closer to the Dutch
model. On February 6, the Supreme Court of Canada struck down a ban on
physician-assisted suicide, joining Luxembourg, Belgium and Switzerland on the
list of Western countries where PAS is fully legal. This has undoubtedly encouraged “suicide
tourists” from other countries to book one-way tickets there. Since a limited
number of nations allow it, those with the financial means and physical ability
have been skirting around their own nation’s bans and utilizing the freedom to
kill themselves in foreign places (as long as they meet the standards set forth
by the nation they travel to). The march toward euthanasia mirrors a trend
spanning continents today: a growing number of countries are placing more value
on individual freedom. This worries religious leaders, ethicists and disability
advocates. Assisted suicide may ease suffering, they say, but it threatens our
most vulnerable citizens—the elderly and the disabled, who already struggle to
justify their lives.

Financial considerations could also creep into
discussions that should never involve money. In the Netherlands, as in many
developed countries, the number of elderly citizens is expected to increase by
30 to 40 percent in the coming two decades. Euthanasia, critics say, adds a
dangerous option in this context: a way for societies to nudge the elderly to
quicker deaths. In the U.S., euthanasia opponents contend the profit-driven
health care system and its slow takeover by cost-cutting managed-care companies
pose major ethical risks. “There’s a lot of pressure in the system already,”
says Diane Coleman, the president and CEO of Not Dead Yet, a disability rights
group that lobbies against the legalization of assisted suicide and euthanasia.
“We see people denied the care they need for economic reasons. Assisted suicide
is the cheapest kind of treatment that could be offered by the system. These
pressures are a reason for concern” (Not Dead Yet).

As euthanasia
becomes more and more a prevalent aspect of human culture, it is important to
note the struggling dynamic between the public and private life of people
within society. What role should legislation and the state play in what some
consider a very private decision? How much power should the government have
over PAS? Activists often claim that laws against
assisted suicide are government mandated suffering. However, this is tantamount
to claiming laws against selling contaminated food are government mandated
starvation. We will all eventually die, but in an age of increased longevity
and medical advances, death can be suspended, sometimes indefinitely, and no
longer slips in according to its own immutable timetable. So, for both patients
and their loved ones, real decisions are demanded. When do we stop doing all
that we can do? When are we allowing wondrous medical methods to perversely
prolong the dying rather than the living? These intensely personal and socially
expensive decisions should not be left to governments, judges or legislators
better attuned to highway funding. The state would argue that assisted suicide
is not a private act – since it involves one person facilitating the death of
another. In this way, it is viewed as a matter of public concern that can
potentially lead to abuse, exploitation and erosion of care for the most
vulnerable populations.

Although the legality and ethics surrounding assisted suicide have been
pondered since the establishment of civilization, these issues were brought to
the forefront in the U.S. during the early 1970s (Pesch, 2015). The goal of
this movement was to increase the rights of people with terminal illnesses and
to give them more control over their own mortality. People with these advanced
and often vicious health problems seek refuge in the option of escape with the
choice of death peacefully (usually through a series of calculated injections)
by a physician. Brittany Maynard is a prime and topical example of how these
laws are changing the concern for Americans nationwide. She was diagnosed with
terminal brain cancer at age 26 and had six months to live, but instead chose
assisted suicide (Pesch, 2015). The issue of death with dignity is important
not just in our country but worldwide because of individuals such as Brittany.
As long as there is human existence, there will be human death. This death will
not always come neatly or comfortably and in some cases, such as this one, it
can drag out and be excruciatingly painful. This type of pain, both physically
and psychologically, can make living life just not worth it (Sweet, 2015). Our
willingness to accept or participate in something as unnatural as choosing to
die is the problem here. The option to escape this fate and the stakes at hand
is what makes assisted suicide an imperative issue worldwide. It is quite
literally a matter of life and death and at the end of the day, those tasked
with decided on these laws are not the ones that are suffering to begin with.
This disconnect even further complicates the relativity of purposeful death.

Euthanasia carries a
negative connotation, often being considered comparable to murder. Religious
and medical communities tend to firmly stand against the act of assisted
suicide. Articles such as the one published by the Australian news group “The
Daily Telegraph” use religion or medical references in order to build a case
against allowing this practice. This news group stated in their article title Dying with dignity is just a lie, “The
Judeo-Christian tradition has always claimed that every person is made in the
image and likeness of God.” (Comensoli, 2015). In this light, the issue of
assisted suicide and its allowance is framed in juxtaposition with religious
beliefs. Religion, a widely used and influential motivator towards reasoning in
many capacities, was used as a way to make an argument that assisted suicide is
wrong. It is creating a message that essentially says “if you believe and
follow religion (in this case Christianity) then you must believe that assisted
suicide is wrong and that a higher power is the only being that can take life
away” (Comensoli, 2015).

 While many faith
traditions adhere to ancient traditions and understandings of physical life’s
final journey, modern medical technology has opened the door for faith leaders
to actively reconsider some beliefs. Death with Dignity laws offer dying
individuals an opportunity to ponder an important final life question: “What is
the meaning of my life?” For many, this is a profoundly spiritual question to
which answers come, not when an individual is consumed by a flurry of doctor’s
appointments, treatments, or chronic disability and pain, but in the comfort of
solitude when an individual feels at peace. Death with Dignity is not only a
legal issue, but a cultural and spiritual one as well. This means that all care
at the end of life should bear in mind the patient’s spiritual well-being
alongside physical. Some faith traditions have embraced Death with Dignity as
an ultimate act of compassion, and others reject it is as morally bankrupt
practice. It is a perspective that varies from belief to belief all over the
globe; making a universal acceptance of physician assisted suicide a very
unlikely possibility in this context.

This
same framing is used from a medical perspective as well. Across the globe,
medical groups utilize the media to advocate against assisted suicide just the
same. From this standpoint, the act is wrong and that if you are a doctor, you
should not condone it. This supports the notion that doctors are meant to keep
people alive, not kill them, no matter what the circumstances are (O’Connell,
2015). Assisted suicide in the news is often seen as a problem, for which the
solution is to ban altogether and prevent more states and nations worldwide
from allowing it through legislation. This conjures up the question as to how
much power to our medical practitioners have? What is their role in society and
how do they fit in with the assisted suicide movement? Individuals specially
trained to prolong and sustain life now being asked to take it away. It seems
contradictory, however the greatest argument is that medical practitioners are
the only individuals with the experience and training that is sufficient enough
to make assisted suicide humane and even ethically possible. An overdose of
sleeping pills or a bullet to the head is just simply not appropriate for these
chronically ill people and it could resort to just that if physician assisted
suicide is not allowed for those with this type of suffering.

Furthermore, the medical community generally sees
legalizing physician-assisted suicide as causing pressure on terminal patients
who fear their illness is burdensome–physically, emotionally, or
financially–to their families or caretakers. They see physician-assisted
suicide as going against thousands of years of medical ethics. The problem is
that physician-assisted suicide is seen as fundamentally incompatible with the
physician’s role as healer. This is where the social movement of assisted
suicide takes hold. It is here that it is important to rationalize and
normalize something like human euthanasia and to broaden society’s standards as
to what constitutes the duties of a healer. The euthanasia movement is asking
the medical, political, and public realms to include the taking away of life as
an option for healing. It is saying that the taking away of life is a viable option
that can coincide with other healing processes conducted by medical
practitioners.

Physician
assisted suicide, although a universal concept, is often seen to apply to
certain demographics. Due to the cost, availability, and education needed for a
such a new and arguably optional practice, it is only really available to the
middle and upper classes of people. 
Since it is an expensive and relatively new practice that has limited
sponsorship, most individuals within lesser socio economic statuses cannot
afford nor even consider assisted suicide as an option.  These factors are what keep people of varying
races and SES from partaking in assisted suicide.

         In 2013 alone, 0.39% of all deaths in Oregon were due to the Death with Dignity Act and the
PAS patients who took
advantage of it were 94.4 percent white and 53.3 percent held undergraduate
degrees (Oregon Death with
Dignity Act: Annual Reports, 2015).  While 65 percent
of white respondents said they would “cease all medical treatment” in cases of
incurable disease or extreme pain, sixty percent of African-American
respondents and 55 percent of Hispanic-American respondents prefer that doctors
save their lives at all costs. When religion is held constant,
there are still visible differences across race. The Pew Research Center
conducted a survey in 2013 and asked what Americans would do
“if they had a disease with no hope of improvement and were suffering a great
deal of pain.” Sixty-six percent of white Protestants preferred the option of
“stopping treatment so they could die.” Only 32 percent of black Protestants
preferred to stop treatment. Among Catholics, 65 percent of white respondents
and 38 percent of Hispanic respondents elected to stop treatment.

The
experts who often collect this data usually support the practice of assisted
suicide and feel as though every person should have the ability and choice to
end their own lives to escape serious terminal illness. However, from a rigid
medical standpoint, it opposes this and believes that a physician’s duty is to
keep the patient alive no matter what. Treating these patients is out of the
question since euthanasia in itself is a way to escape treatment to begin with.

The
issue of whether human beings have the right to help others die has been in public
discourse since before the birth of Christ. The Hippocratic Oath, which
scholars estimate was written in the fourth century B.C., includes the
unambiguous statement: I will not give a
lethal drug to anyone if I am asked, nor will I advise such a plan (Pickert,
2009). The idea of assisted suicide was something relatively uncharted in
American history. Whether it was due to a lack of technology or lack of demand
for the service, the right to die was not a common practice in medical and
public arenas. As medicinal technologies advanced over time and a tolerance for
such progressive ideas grew, so too did the opinions on the issue (Pickert,
2015). Practices such as abortion that were once punishable by death or jail
time, are now more common today and in many ways accepted altogether. As people
begin to loosen ties to what they considered as right and wrong, new ideas like
this become possible for those who need it.

It is important to point out that
banning a practice in our society requires greater effort and argument than
allowing one. This is a result of the value we place on the rights and
liberties of the individual, because individual liberty is so important, a
compelling reason must be given to override it. Because the result of a
decision on PAS is so intensely personal, this state of ‘innocent until proven
guilty’ must be emphasized. The individual has a basic right to determine the
course of their own life, and obviously death is a part of that course. So
then, in order to show that PAS should be legalized, one must simply show that
there is no reason for them to be deemed illegal.

One of the arguments which is often
used in favor of banning PAS is that the state has a paternalistic interest to
keep its citizens alive. This is based out of the idea that all killing of
humans is immoral and unfair to the person who dies, and thus PAS is immoral
(Arras, p. 275). The disparity here is a result of differences in defining
paternalism. The traditional view of western society has been that paternalism
must always act to keep an individual alive, no matter what. But in fact, I
believe that paternalism must also consider the quality of the life which it is
forcing on the individual.

The United States government believes
all citizens should have rights to life, liberty, and the pursuit of happiness.
If these are indeed the rights which the state deems valuable for its citizens,
then a paternalistic cause must act in support of a majority of these rights.
Obviously, allowing PAS eliminates a patient’s right to life by killing them.
However, the banning of PAS and euthanasia may lead to the elimination of a
patient’s right to the pursuit of happiness. Happiness is not simply the state
of being happy, it also is the state of not being unhappy. In the case of many
of those who would seek PAS, ‘the pursuit of happiness’ involves removing the
physical or mental pain that causes them to be unhappy on a daily basis. It is
very difficult to pursue anything, much less happiness or even easing of
unhappiness, when you are lying intubated in a hospital bed against your will.
With the rights of life and the pursuit of happiness contradicting each other,
all that is left is liberty, and liberty demands that the patient be given a
choice.

This view of paternalism only supports allowing PAS if a
patient’s ability to pursue happiness is removed by their illness altogether.
As such, although it argues in favor of allowing PAS, it also inherently limits
the cases where they are legal. Paternalism insists that life be chosen unless
there is no cause to believe that happiness is possible, and so limits PAS to
terminal and incurable illnesses and injuries. Even in those cases, because
liberty is the deciding factor in the choice between life and happiness, the
patient must clearly indicate that they wish to die.

In an ideal ethical environment, each decision could be
made by the physician and the patient (or patient’s family) on a case by case
basis. The medical, psychological, and social complexities of any situation in
which PAS is seriously considered would demand this. Legislation can provide
only an approximation of where to draw the line between a patient eligible for
PAS and one who is not. The legislation would have to be open enough so as to
allow patients the freedom to act if necessary, but regulated enough to
minimize abuse. As such, it may take several rounds of legislation, review, and
refinement before the optimum level of constraint is found, although existing
cases where the practice is allowed in the Netherlands or Oregon would seem to
indicate that a good approximation could be made from the start. The
future of PAS seems to be increasingly progressive.

As more and more populations
adopt PAS laws and practices, it is becoming much more of a commonplace in the
public and private sectors. When we look at what the right-to-die movement has
achieved, against what it has wished to do, an honest person would agree that
there is still a long, long way to go. But the
euthanasia movement is strong and its organizations are well financed. Thus the
only sure thing about the future of assisted suicide is that there will be
political trench warfare over the issue for years to come. Happily, we do not
live in a country where our most contentious social issues are decided in the
ivory tower by courts or regulators imposing the views of “experts” on the rest
of society. For better or for worse, the future of assisted suicide and
euthanasia will likely be decided via democratic debate in the public square.

Like
any social movement, it takes time to be accepted. Despite growing medical
knowledge and lessened emphasis on religious ideals, a majority of people all
over the world would still strongly oppose acts of purposeful death in any
form. Assisted suicide is still seen as a new development that is breaking
boundaries in both positive and negative ways. An example of this is the notion
of suicide itself. Killing oneself purposefully is viewed as wrong for many
reasons. It is in human nature and in all life forms a desire to live and keep
living. When someone breaks this boundary by devaluing life or not desiring it,
it becomes hard for others to understand the action. Assisted suicide
challenges nature by saying to society that the individual has control over
whether they live or die. By involving another individual and assisting in the
death, it becomes harder for the public to distinguish what is suicide from
what is homicide. For these reasons, the practice of human euthanasia is still
a grey area in modern society; something that came from banishment or
nonexistence through history and has since grown into a viable option for those
who find themselves painfully trapped within their own bodies.

In
the end, physician assisted suicide and legislature such as the Death with
Dignity Act will continue to be pursued by all types of people worldwide. Death
can be a vicious and excruciating experience for all of those involved. The influences
of the assisted suicide movement worldwide and in the United States has been
taken to new heights. This practice is establishing itself in the medical,
political, and social worlds, proving that we can have control over our lives
no matter what disease or illness can inflict upon us. 

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