Against Physician Assisted Suicide

Tuesday, December 21, 2021 7:03:41 PM

Against Physician Assisted Suicide

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Senior advocate Dr. Ronald Bayne receives medically assisted death

To protect against these abuses, it is argued, physician-assisted suicide should remain illegal. Physicians Make Mistakes: These may include: errors in diagnosis and prognosis, failure to diagnosis depression, inadequate treatment of pain, etc. Since these types of mistakes may result in unnecessary death, the State has an obligation to protect human lives from these inevitable mistakes. Arguments in support of Physician-Assisted Suicide. Decisions about time and circumstances of death are very personal. Competent person should have right to choose death.

For some patients, treatment refusal will not suffice to hasten death; their only option is suicide. Justice requires that we should allow assisted death for such patients. It is not always possible to relieve this kind of suffering. Thus physician-assisted suicide may be a compassionate response to unbearable suffering. A complete prohibition on assisted death excessively limits personal liberty. Therefore physician-assisted suicide should be allowed in certain cases. For example, morphine drips ostensibly used for pain relief may be a covert form of assisted death or euthanasia.

That physician-assisted suicide is illegal prevents open discussion, in which patients and physicians could engage. Legalization would promote open discussion. Arguments against Physician-Assisted Suicide 1. Patient autonomy. A patient should have the right to control the circumstances of his or her own death, and to determine how much suffering is too much. Wrongness of killing. Purposefully helping a patient die is categorically wrong under any circumstances; excellent palliative care does not include PAD.

Physician integrity. Physicians take a sacred oath never to knowingly harm a patient, and PAD would violate professional standards and undermine trust between physician and patient. Risk of abuse slippery slope. Allowing PAD poses too high a risk to vulnerable patients. Their lives could eventually be ended against their will or when alternative approaches to relieve suffering might be expensive or the suffering difficult to treat.

Whereas most experienced clinicians acknowledge that there are relatively rare cases that might justify PAD, there are two main empirical questions about the effect of legalization. Would an open, legally regulated approach make the practice of PAD safer, more predictable, and relatively rare as appears to be the case so far in Oregon? Or would it erode the gains made in hospice and palliative care, making the environment riskier and more frightening for our most vulnerable patients as the cases of involuntary euthanasia and voluntary euthanasia for vague psychosocial distress in the Netherlands appear to suggest?

Physician-assisted death: the practice of a physician providing the means for a person with decision-making capacity to take his or own life, usually with a prescription for barbiturates that patient takes himself or herself; sometimes also called physician-assisted suicide, physician aid-in-dying, and patient administered hastened death. Euthanasia — painlessly killing or permitting the death of individuals who are ill or injured beyond hope of recovery.

Passive euthanasia — hastening death by withdrawing life-sustaining treatment and letting nature take its course. Involuntary euthanasia — causing or hastening the death of someone who has not asked for assistance with dying, such as a patient who has lost consciousness and is unlikely to regain it or who lacks decision-making capacity for other reasons. State-of-the-art palliative care remains the standard of care for any end of life suffering, and last resort options should only be considered when such treatments are ineffective. Good palliative care services are not available in all locations; efforts to increase education and proliferation of these services are being made by medical and other professional groups, state initiatives, progressive health care systems, and patient advocates.

Prescribing medication for aggressive management of pain and other symptoms, even in doses that might unintentionally hasten death, has wide ethical, legal, and professional acceptance. Another last resort option with wide acceptance is for patients to stop or not start any potentially life sustaining therapy if it does not meet their goal, even if their purpose in refusing treatment is to escape suffering through an earlier death. The decision by patients to voluntarily stop eating and drinking to escape intolerable suffering is accepted by many hospices and has considerable ethical and legal support.

A last resort response to some of the more complex and difficult cases is for physicians to sedate a patient potentially to the point of unconsciousness to enable the person to escape otherwise intractable physical suffering at the end of life. Legal support for this practice includes the Supreme Court decisions in Washington v. Glucksberg and Quill v. Vacco, which recognized the right to good pain management, even if it requires doses that could hasten death.

Justification of this practice invokes a combination of the rule of double effect and the right of bodily integrity. Giving doctors and patients more open access to, and awareness of, last resort options could have several beneficial effects. One potential effect is increased opportunity for patients to get second opinions from skilled palliative care clinicians to be sure that other less extreme avenues to address seemingly intractable suffering have been considered. Another benefit is reassurance to severely ill patients who fear end of life suffering that there are some avenues of escape that can be pursued openly and predictably.

These other last resort options may lessen the desire and need for PAD. Some patients in Oregon and in the Netherlands are choosing these other last resort alternatives even though they have access to PAD because, in some circumstances, these approaches are better able to address their particular needs and may be more congruent with their personal values. Timothy E. Search The Hastings Center. Events Upcoming Events Previous Events.

Receive Our Newsletter Email Address. Bot Field. Other Ways To Give. Hastings Center Bioethics Briefings. Highlights Physician-assisted death PAD refers to the practice where a physician provides a potentially lethal medication to a terminally ill, suffering patient at his request that he can take or not at a time of his own choosing to end his life. It is also called physician-assisted suicide, physician aid-in-dying, and patient administered hastened death. In this chapter, we will use the term physician-assisted death. State-of-the-art palliative care should be the standard of care for treatment of suffering at the end of life. Physician-assisted death should only be considered if ever as a last resort when such treatment has failed.

Most states prohibit physician-assisted death, though there has been a recent flurry of legal activity. The practice was first legalized in Oregon in , followed by Washington, Vermont, California, and Colorado, and more recently Washington, D. Two Supreme Court cases challenged the constitutionality of the prohibitions against physician-assisted death: Washington v. The American public and the medical profession both remain deeply divided on the question of whether to legalize PAD. Last resort alternatives to PAD, including allowing patients to voluntarily stop eating and drinking and sedating patients to unconsciousness, have gained increasing acceptance to ease otherwise intractable end-of-life suffering.

Both PAD and voluntary active euthanasia were openly permitted for over 30 years in the Netherlands and were legalized in Support our work. Pope, Ben A.

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