Physician Assisted Death
Death, like birth, is a natural part of the life cycle, the circle of life. The majority of people turn to doctors for help in birthing babies, the beginning of life. We should be able to ask our doctors to help us die at the end of our life. Physician-assisted death should be a legal option in Wisconsin for terminally ill patients. Personal freedom of choice about how and when to die without debating moral dilemmas for the patient or doctor, free of religious judgment, or the risk of legal ramification . The right to choose is the most humane option to give a terminally ill person who would otherwise die in great pain and suffering.
According to critical care nurse Theresa Brown, “I find watching a patient panting for air very difficult; for family members, the experience is agonizing. Morphine is the usual treatment because it tricks the brain’s oxygen receptors out of panic mode, giving the patient some relief from that feeling of suffocation.” (Brown) Of course, morphine will also increase confusion that will come and go. Ativan is another medication used frequently to help people relax but it can be sedating.
A “good death” is – dying alert and without pain, comfortable and having completed the tasks of saying goodbye. It is the time to settle grudges and accomplish life goals. This could include having the financial portfolio in order, a current will, and a funeral planned. Family may want to discuss preferred service music and bible verses. Decisions could be made about which funeral home or church. Honest and open discussions with family and friends at the end of life are imperative. Making well thought out decisions before you are forced to decide quickly will make the end of life easier for everyone.
What is the difference between palliative care and hospice? Palliative care is aimed toward providing care rather than toward curing treatments. Palliative care patients know their disease is terminal but may have time to fulfill their life dreams. On the other hand, hospice care is for patients with less than six months to live. Hospice care can be done at home, a long term care facility or inpatient hospital. In hospice, some doctors prescribe pain medication that will have the effect of hastening a patient’s death. That is not considered unethical. If a patient is suffering, a doctor can administer medication, in whatever doses are required to obtain relief. This might hasten that patient’s death, but the intention is to ease symptoms, not to kill someone. Ethically, giving good symptom relief is appropriate and right. If symptom relief leads to an early death, that’s an unfortunate second, unwanted effect; it wasn’t the intention. Among virtually all medical ethicists, that’s considered acceptable. And it is legal. (Jaret)
What is the difference between euthanasia and physician assisted death? Physician assisted death is distinctly different from euthanasia. Some people prefer the term physician aid-in-dying simply because the word suicide has negative connotations. Suicide isn’t illegal, but some people consider it immoral. In states that have approved physician assisted death, physicians provide patients with medications or prescriptions that will end their lives, assuming they meet certain strict criteria, but they don’t administer the medication. A patient has to be able to take it on his or her own. Euthanasia is where a doctor administers the medication and it is illegal in the United States, although euthanasia is legal, with certain restrictions, in the Netherlands, Belgium, and Luxembourg. (Jaret)
The national debate on the right to die came to forefront in the early 1990s when Dr. Jack Kevorkian made a public practice of helping his patients end their lives, which violate Michigan’s law against physician-assisted suicide. He claimed to have assisted at least 130 patients to their death. Dr. Kevorkian was known as “Dr. Death.” There was support for his cause and he helped set the platform for reform. In 1999, Kevorkian was arrested and tried for his direct role in a case of voluntary euthanasia. He was convicted of second-degree murder and served eight years of a 10-25 year prison sentence. He was released on parole on June 1, 2007 with extreme parole conditions of not advising or participate in any euthanasia activities. He died June 3, 2011 of liver cancer, kidney problems and pneumonia. (Wikipedia)
There are currently seven states that allow physician assisted death, Oregon, Washington, California, Vermont, Colorado, Hawaii, and the District of Columbia. The current Wisconsin law reads: Whoever, with intent that another take his or her own life, assists such person to commit suicide is guilty of a Class H felony. In Wisconsin, state Representative Frank Boyle introduced 1993 Assembly Bill 755 in the midst of the controversy. He noted that the state needed a “compassionate process” for people facing end-of-life decisions. (Jackson) This issue has been debated for 25 years.
Wisconsin lawmakers keep introducing proposals for a change in legislation. In 2015, three Madison-area Democrats introduced a proposal to allow dying patients the choice of ending their lives with medical help, calling it the “compassionate choice” bill. Sen. Fred Risser, D-Madison, said this will be the seventh time he has introduced the proposal in the past 20 years. The idea has only gone to hearing twice, he said, and has never been heard by either the full Assembly or Senate. (Hall) Wisconsin lawmakers need to recognize the need and want for legalization of physician assisted death.
Per the final exit network survey,
How many people support voluntary euthanasia for the terminally ill?
Opinion polls show average support of 70 percent in the USA, 74 percent in Canada, and 80 percent in Britain. When actually voting in official ballot measures, the support has been 46 percent in California (1992), 51 percent in Oregon (1994), 60 percent in Oregon (1997), and 59 percent in Washington State (2008). (finalexitnetwork.org) It is obvious that Americans want the choice.
This is also evidenced by numerous recent Gallup polls:
Results for this Gallup poll are based on telephone interviews conducted May 4-8, 2016, with a random sample of 1,025 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia.
One main argument for allowing doctors to hasten a patients’ death is one of autonomy. It is my life. Terminally ill people should have the right to take their life when that seems like the proper and best thing to do. The most important thing that all Americans must consider is that every person has an individual right to make decisions about their life. Suicide isn’t illegal. Doctors control the means – drugs that end life painlessly.
On the other hand, the role of physicians is not simply to preserve life but also to apply expertise and skills to help improve their patients’ health or alleviate their suffering. The latter includes providing comfort and support to dying patients. The patient asking a physician for assistance in suicide best reflects their interest, preferences and it is their choice in states where it is legal. Is it reasonable for compassionate physicians to refuse to administer lethal medicines to their patients in order to “do no harm.” The same doctor prescribes chemotherapy that will do harm to their body but may stop the cancer.
Doctors are called upon to make expert diagnosis and offer advice but they often differ in their opinions. Dr. Alva Weir responded to Dr. Thomas Strouse’s article from the Journal of Community and Support Oncology by stating “even though precautions within the laws attempt to demonstrate that no vulnerable population is abused are important. The result is the same: the death of a patient. This is the central problem with aid in dying.” We are all going to die. What is the role of the doctor, do no harm, medicate to end suffering which could hasten death, prescribe medication that will hasten death. If the doctor feels they cannot prescribe the life-ending medication should they be forced to refer their patient to someone who will? (Weir)
“Many aspects of physician-assisted suicide breach physicians’ long-standing ethical norms. For instance, the 2011 annual report on the Death with Dignity Act in Oregon shows that physicians were present at fewer than 10% of “assisted deaths.” Why might they want to disconnect themselves from what they have enabled? Perhaps they have a moral intuition that intentionally facilitating or inflicting death is wrong. Patients expect an empathic presence from their physicians, and authentic healers commit to accompanying patients throughout the illness trajectory.” (Boudreau and Somerville ) These authors don’t understand that doctors are called after death has occurred. A nurse is the one who takes care of the patient and will call the doctor. A nurse is the one who comforts the family, prepares the body, calls the funeral home, and fills out endless paperwork.
Perhaps the medical community is not in touch with the percentage of Americans who want choices at the end of life.
The largest group of doctors and medical students follow the AMA’s guidelines about physician assisted death. American Medical Association has an Ethics Policy titled “Decision Near the End of Life”. It was last modified in 2016 and it has five parts.
1. The principle of patient autonomy required that physicians must respect the decision for forgo life-sustaining treatment of a patient who possess decision-making capacity. Life-sustaining treatment is any medical treatment that serves to prolong life without reversing the underlying medical condition. Life-sustaining treatment includes, but is not limited to, mechanical ventilation, renal dialysis, chemotherapy, antibiotics, and artificial nutrition and hydration.
2. There is no ethical distinction between withdrawing and withholding life-sustaining treatment.
3. Physicians have an obligation to relieve pain and suffering and to promote the dignity and autonomy of dying patients in their care. This includes providing effective palliative treatment even though it may foreseeably hasten death. More research must be pursued, examining the degree to which palliative care reduces the requests for euthanasia or assisted suicide.
4. Physicians must not perform euthanasia or participate in assisted suicide. A more careful examination of the issue is necessary. Support, comfort, respect for patient autonomy, good communication, and adequate pain control may decrease dramatically the public demand for euthanasia and assisted suicide. In certain carefully defined circumstances, it would be humane to recognize that death is certain and suffering is great. However, the societal risks of involving physicians in medical interventions to cause patients’ deaths is too great to condone euthanasia or physician-assisted suicide at this time.
5. Our AMA supports continued research into and education concerning pain management. (American Medical Associan Ethics H-140-966)
Another reason a person may choose physician assisted death is not wanting to be totally dependent on others, especially strangers if they have to go into a nursing home or other hired-care situation. They don’t want to lose control. Per a website Euthanasia Debate-Pros & Cons, “To keep someone alive against their wishes is the ultimate indignity.” (Lewis) We are forcing people to eat to stay alive and we are forcing people to be changed like babies while they lay in bed 24 hours a day. It would be safe to say that this is not life; the majority of people would not want this.
Those who oppose assisted right-to-die laws propose that medical advances and palliative care are viable options to ending life. However, they often overlook the quality of life experienced by the patient or the costs of such treatment which can bankrupt their families. The question of whether the Nation has the will or ability to cover such costs through programs like Medicare or Medicaid is rarely considered. (Lewis)
Another argument comes from people who work in palliative care and hospice. Many say that if good palliative care – controlling pain, shortness of breath, or nausea-were widely available and offered, patients wouldn’t choose physician-assisted suicide. And it’s true that palliative care medicine is very good at controlling these symptoms. But the experience in Oregon shows that nearly all of the people who received a prescription for aid-in-dying were in hospice at the time and had access to palliative care. Most people who seek out aid-in-dying don’t do it because they are in pain or have other physical symptoms. They do it because they want to have control over how and when they die.
Under Oregon’s Death with Dignity Act, 155 prescriptions were written for physician aid-in-dying in 2014. That’s the most ever, but it’s still not a lot. Typically, between 27 and 42 percent of the prescriptions are never taken. So a very small percentage of dying people in Oregon choose physician aid-in-dying – around 3 out of 1,000. Most are white, well-educated, and over 65. In 2014, 90 percent died at home. Ninety-three percent were on hospice care. (Jaret)
My survey monkey results:
63 responded to my survey.
Q1-Are you familiar with hospice or palliative care? 94% yes 6% no
Q2-Do you know someone personally or professionally that was in hospice care?
88% yes 12% no
Q3- Physician Assisted Death (PAD) is legal in several US states and other countries. PAD gives terminally ill patients with six months or less to live the option to end their own life with a prescription from the doctor.
If Wisconsin brought this to a vote would you agree or disagree? 81% yes 19% no
I added a comment section and had 47 responses. The majority of the comments were in favor of choice.
Religious arguments – sanctity of life- the belief that life is precious and death should never be hastened. If a person decides to end chemotherapy that they feel is no longer helping and they are sick all the time. Some may say he’s giving up; he is committing suicide. The patient is letting the inevitable happen. Life and death are in God’s hands.
A Pew Research article’s sampling of the faiths include:
Assemblies of God: God is the giver of life, not us.
Roman Catholic Church: We don’t have the authority to take into our hands when life will. That’s the Creator’s decision.
Episcopal Church: In 1991, the church passed a resolution that stated it is “morally wrong and unacceptable take a human life in order to relieve the suffering caused by incurable illness.”
Southern Baptist Convention: We believe assisted suicide is a usurpation of God’s prerogative because he is our creator and sustainer. (Lewis)
Judaism- We have a healthy respect for life and an understanding that life and death is not in our hands. We can handle pain, but euthanasia is considered an act of murder. Jewish tradition demands that patients be treated holistically to mitigate their suffering, while not hastening their death. (Rubin)
According to the Pro-life group, “Assisted suicide, no matter how compassionate it may seem on the surface, is nothing more than a cruel lie. To the terminally ill, it tells them that there is no meaning to their life and that when they become a “burden” to others suicide is the easiest answer for everyone.” (Pro-life) Some people may consider it a burden to help their loved ones at the end of life. It is time consuming and life changing but may people may consider it a way to give their parents in the end of life all the care given to them in the beginning of their life.
The alternative is choice. From the book Dying Right, “A concept introduced by patients and taken up by ethicists is the notion of “quality of life.” From a dying patient’s perspective, quality of life is more important than the criteria of death, the role of physicians as healers, or the state’s interest in preventing killing.” (Hillyard)
In Oregon, a group called Compassion ; Choices help families with their loved ones deaths or hastening. Hastening is done by volunteers who prepare the lethal medication. Hastening can also be done by not drinking or eating. Which is a choice also but you don’t know when death will happen. Hastening by this group can be done with a party atmosphere planned by family and friends who gather at the bedside.
Imagine a breast cancer patient from Oregon named Sue, who survived a double mastectomy but three years later cancer returns. Sue does not want to go through chemotherapy and radiation again. She quickly becomes terminally ill. Sue contacts a volunteer group from Compassion & Choice and decides a day and time to end her suffering. Sue and her family plan a party. The volunteer from Compassion & Choices arrive about 5 pm on the day of Sue’s hastening to prepare the medication and finds a party with 45 people there. It’s a party with tears. Family and friends spend hours talking, reminiscing, laughing and sharing their love with Sue. When she dies, she is at home, in her own bed, surrounded by her loved ones. Per an article by Elizabeth Landau, “It is almost like being at a birth, where you’re emotional about that, too, and it’s more joyous, of course, but it’s still that same wonderful awe-inspiring feeling of taking part in something that’s really important.”(Landau)
Change is coming as seen by Melodie Olson, PhD, Rn, author of Healing the Dying, “Society as a whole may sanction or withhold sanction for actions involving death depending on how the topic is addressed. For example, a physician may talk of euthanasia, a technical term, while a writer of novels terms the act a mercy killing. As euthanasia becomes linked with mercy, laws are more likely to change, and society seeks to find ways in which to implement the basic value of mercy.” (Olson)
From the Pew Research Center, “A compassionate society does not allow people to suffer unnecessarily. Death with dignity is really about living life, and not death. For the terminally ill, life is often medicalized, centered around doctors and treatments. This frees up people in the final stages of life to really focus on life and the meaning of life, rather than doctors and medicine.” (Masci)
Physician assisted death has been going on for decades, legally or not legally. Just like back alley abortions in the last 100 years, physician assisted suicide is happening in states where it is not legal. It is covert and frightening, not a peaceful end to life. Sigmund Freud September 23, 1939. He fought jaw and throat cancer for over fifteen years before asking his doctor to help end his suffering. He died of a physician-assisted morphine overdose. He was of sound mind, if not body, and made an informed decision.
In conclusion, the existence of a physician-assisted suicide law in Wisconsin is definitely related to the inadequacy of the present medical treatment at the end of life. Therefore, doctor-assisted suicide should be legalized to meet the needs of terminally ill patients and to compensate for the insufficiency of current medical practice. It is hoped that giving the informed choice of legalized assisted suicide will make terminally ill patients’ lives more meaningful.
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Hillyard, Daniel and Dombrink, John. Dying Right. New York: Routledge, 2001. Print.
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Landau, Elizabeth. CNN: Choosing Death can be like ‘Birth,’ advocates say. 30 August 2011. Web. 21 March 2018.
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Masci, David. Pew Research Center. 21 November 2013. Web. 26 April 2018.
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“Physician Assisted Suicide.” 2007. Prolife Wisconsin.org. Web. 21 April 2018.
Rubin, Debra. New Jersery Jewish News: Rabbis frown on assisted suicide legilation. 12 December 2012. Web. 12 March 2018.
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