The physician-assisted suicide is a controversial issue in the current world. Different opinions with regard to this issue emanate from different cultural beliefs, modernity and people’s religious belief. It has equally offered a hard time to the law makers on whether such an act should be legalized or not. This especially relates to the authority given to the physician when they have to assist patients to die. They are, for example, expected to provide substantial information regarding the patient’s terminal illness, enlighten the patients as to the final alternatives and the difficult part of the decision making to assist patients into death by providing the lethal dose. To weigh the suitability of the law on Death with Dignity Act being enacted in all the states, I will evaluate the position and arguments given by both the proponents and opponents of this act.
Where enacted the law provides a framework within which the assisted suicide process should take place. To start with, there must be two physicians who certify that the patient is suffering from a terminal illness and that the patient has less than six months to live (Mitchell, 2007). There should be no signs of impairment to awareness and this is achieved by ensuring that the patient is not depressed. The patient should also make a formal request which should be witnessed by two persons who are not related to the patient. The patient should also be given adequate time before execution of the process within which he may revoke the decision.
The proponents of the law believe that everyone has a freedom of choice. They view freedom of choice as the right to choose and the right to create to oneself the alternative choices. A man without the right to choose or denied in a choice is viewed as a “thing” or an “instrument”. The Right to Self-determination provides the patient with the authority to decide on how to die and when to die. This is based on the fact that it relates to their body, life and pain and, therefore, it would be appropriate to grant them their wish, if they do not see the purpose of life by themselves. Assessing the legality surrounding the condition of patients suffering from a terminal illness, proponents argue that it is legal for the patient to refuse or require withdrawal of any treatment; require adequate painkillers for comfort irrespective of shortening his/her life and where an imminently dying patient is in great discomfort, it is legal to be sedated till the discomfort is relieved.
For the proponents who appeal to sympathy it is the idea that it is inappropriate to expose the terminally ill people to excessive pain without any value addition to their health. On this ground, hastening the natural timetable of death by some days or hours should not only be acceptable but made mandatory in the modern medical care (Gorsuch, 2006). By enacting the law therefore, we would give the choice to the patients to decide when they had enough and would want to terminate the insults to their depreciating bodies.
There is also a proposed economic argument in support of legalizing the assisted suicide. It is expensive to maintain a patient on life support machines. They argue that it is not prudent to hold them there whereas it is beyond doubt that death will catch up with the patient in a short while. This way, the health facility would be efficiently allocated given their scarcity.
There are others who are in support of the physician-assisted suicide due to the loss of autonomy associated with the terminal illness. These patients can no more rely on themselves but depend on the help of their friends and families. In this case they view themselves as a burden to the society and may choose to have physicians assist them to die. To remove the guilt of seeing others take care of them they should be granted the possibility to comply with their wish.
Some proponents justify their views based on the current technologies. The technologies are such that though they may not assure the terminally ill of any life, they can be able to prolong life for unduly long time. This way, the patient dies slowly. They argue that the patients die slowly in hospital in the midst of technology instead family and friends. Some patients would prefer immediate death rather than be hooked up with tubes in every orifice of their body.
There is a great emotional impact when physicians participate in physician-assisted suicide. They find it excruciating especially on the basis of priorities of life. This evidence shows that physicians would be prepared to sacrifice their jobs to assist a patient in great pain rather than help him die. The Hippocratic Oath is more than a millennial tradition and prohibits on assisted suicide and euthanasia (Torr, 2000). It has provided a framework of core values which guide the physicians on what to do. Ideally, doctors are trained to treat and not to kill. This will always leave a strain of guilt to the physician, if he plays a major role in ending a patient’s life. The physicians, as the patient’s agents, are required to be professional. The Oath states that they should execute their art solely for the cure of the patient and that they should not give drug, perform operation for a criminal purpose. This makes the physician feel that, the Death with Dignity Act would be inappropriate if enacted.
The legal systems also seem to be held in between the alternatives. According to the court of appeal in the U.S., American Association’s Code of Ethics is against the physician-assisted suicide as being contrary to the physician ultimate role as a ‘healer’. To make it difficult for such a law, the Supreme Court added a statement of its own with regard to the physician’s commitments to care being a professional commitment to medical science progress. The court therefore found such attempts to legalize the medically assisted suicide to be a blind alley.
There are those who believe in the existence of higher power which is in charge of life. Man is viewed as just a trustee of his body and would act against God, the rightful owner, when he chooses when to die. He is also seen as violating the commandment to hold life and not to ever remove it without a compelling. In any case, one of the major goals in life is survival. Engaging in a decision that terminates this goal, we would be going against the natural dignity. There is an argument that for those who believe in something after death, they would wait until their time comes (Humphry, 1991). They would have no reason to interfere with the God exit plans.
The most unfortunate thing that may arise with the enactment of this law would relate to false claims. People may have different motives to end life and may request for the physician assistance in doing it. The external pressure may arise from the loss of autonomy. For example, the elderly people may opt for assisted death rather than become a burden to their families and friends. According to the Oregon’s third year Report, 63% of those who chose the suicide cited the fear of being a burden to their families. On the other side, it appears very difficult for friends and members of the family and lovers to make a decision that supports death of their beloved ones. This is due to the guilt for participating in such an act. The dilemma, however, is that if such a decision is not made then they will have to withstand the anguish of watching someone suffering (Battin, 1998).
There are economic reasons that would make it inappropriate to have such law operate in different states. This is based on the deadly mix that arises between the assisted suicide and the profit-based managed healthcare. Generally, the lethal medications used in assisted suicide range between $35 and $50. This is to a greater extent lower than the treatment cost for most terminal diseases. This acts as an incentive to prefer death so as to save money. By legalizing assisted suicide, the trade between wealth and treatments may cause the problem.
The economic motives of the physicians are equally dangerous. To this effect, the assisted suicide is likely to compromise the quality of the existing health care systems. The study conducted by the Georgetown University Center for the Clinic of Bioethics revealed a strong link between revenue-driven managed healthcare systems and the assisted suicide. The research identified cost-cutting pressure among the physicians and hence bias towards prescribing a lethal drug, were it is legally acceptable. For such situations, a sobering of vigilance in legalizing the assisted suicide should exist where pressure to hold costs low among the physician is high.
When legalizing the assisted suicide, the impact would fall hardest on economically and socially disadvantaged members of the society. This is because the existing healthcare systems have discriminated them and they may not get as many alternatives as the rich people would do when suffering from a terminal illness. This puts the law in question with respect to the security of the poor.
The law would be expected to result in different distribution of gains and losses. Obviously, there is a small group of individuals who may benefit from the law including the white, affluent and those in possession of better insurance covers (Egendorf, 1998). However, the less privileged will find themselves confronted with a significant risk of impairment. Though there are those who would prefer death to loss of autonomy, those living with disabilities have developed the liking of others’ assistance and may not prefer death to life. For this reason everybody should fill protected by the existing laws regardless of their circumstances.
The assumption that physicians can be able to determine the cases where a terminally ill person will die in less than six month with an adequate precision is equally dangerous. The assisted suicide is based on the assumption which may leave some loopholes to unscrupulous practitioners. Studies indicate that it is only the cancer cases which one can be able to predict accurately on the occurrence of death (Engdahl, 2009). This, however, is only possible for the last few weeks of life. Use of general statistics for a particular specific case may not be appropriate.
This issue poses a great dilemma to the society. I have found more evidences against the enactment of the Death with Dignity Act among the states. To start with, the physician role is basically to protect life and not to kill. By giving them the authority to decide on the patient’s death would be forcing them against their moral guidelines as provided by their Oath. Also, neither the mental or physical decline, nor diseases or loss of autonomy, nor the pain should undermine the basic value of human life. A patient does not become valueless just because he is chronically ill or dying.
Terminating a patient’s life does not provide a humane solution to the suffering and pain tragic circumstances. The goal of the physician should be aimed at killing the pain and not the patients. It will lead to lack of confidence to the medical science progress by physician proposing euthanasia. The physicians should maintain their focus on the use of the accessible, multiple, increasingly developing and sophisticated techniques of managing pain and sufferings and not to recommend suicide.
Given the varying opinions with respect to the Death with Dignity Act, there may be situations where such laws may be allowed. Assuming that the law was enacted in all the states, the major burden of ensuring that the law is not abused lies solely on the society (Balkin, 2005). The clear evidence from Oregon Health Department is that as much as 79% of those who chose the physician assisted suicide did not have to wait to be bedridden. This necessitates the strict control on when the process should be an option.
First, it is important for the society to be enlightened on the value of life. Evaluation should be made more rigorous to ensure that the patient is not under depression and the decision is well informed given the mental condition of the patient. The grace period before the execution of the request should be prolonged to provide for a greater chance of revoking it.
The profit motive of the physicians and the patient should be evaluated adequately so that it may not dominate in the decision making process. The emphasis should be placed on encouraging physicians to accommodate the patients’ reliance on them so as to reduce the feeling of guilt for the illness. It is done by the U.S. Supreme Court in adding a clause that would make it more difficult to choose the euthanasia, but more amendments should be made. For example, given the difficulty in determining the natural death, assisted death should be allowed as long as the patient is expected to die within less than two months or less.
The decision to accept physician-assisted suicide should be approved by more than two physicians who should act independently to determine the appropriate course of action. This may lower chances of collusion which may be common among the profit-oriented physicians.
Should Assisted Suicide Be Legal
Assisted suicide is a topic that is debated on social grounds and it above all else involves someone making a choice, whether to continue with life or give up the hope and die. This should be a choice that they make themselves. Assisted Suicide is when a physician supplies the information and/or any means of committing suicide to patients. This can be in form of a prescription for a lethal dose of sleeping pills or in form of dangerous gases such as the supply of carbon monoxide gas. In this paper we will examine whether assisted suicide should be legalized and the governments' stand on the matter.
Firstly, assisted suicide is seen as philosophical. The right to death should be perceived as equally significant as other values which exist in the community. Generally speaking, many people have a belief that their right to life is an absolute value, and to live as long period of time is a very important thing in all circumstances. For them, life is treated as if it is a valuable thing and nobody has a legal right to violate it and choose death option until nature ends the life. However, life is not an ultimate value to others. The weight of life always varies from one person to another. In other words, life is taken as a relative value and thus the right to death can be one of the options for the free citizens. I believe that patients who are undergoing any form of permanent torture of a certain disease may willingly prefer peaceful death as opposed to extended life. It doesn't mean that every person who is suffering from terminal cancer or any other serious disease demands death. For instance, some patients wish to cut their lives short rather than to continue suffering from the illness.
Due to these differences in values among the people, we are supposed to respect their choices. Secondly, some terminally ill patients need to escape from the unbearable persistent pains they usually undergo. They are supposed to be helped by the governments in a practical sense so that they die with reasonable dignity. Under the status quo, some patients suffer from pain 24 hours a day and seven days a week. In the cases of terminal cancer, when cancer cells reach your bones, they continue to damage your bone tissues and cause throbbing pain. Painkillers sometimes work, yet they are not perfect. Not all cancer patients can have their pain completely removed. Therefore, they continue suffering from the seriously aching diseases and they end up without the hope of regaining. In case the pains continue to persist, they get themselves in situations where they think that the only option is to wait for their death. Since they have no other helpful way in this kind of situations, their only preferable remedy is to choose death in which they believe to gain everlasting happiness about their life.
Because of this reason, they should be allowed to pursue their joy by legalizing assisted suicide and euthanasia. It is said conclusively that they do not find happiness in living for long time. Instead the happiness is achieved when the physicians helps them to die in a peaceful manner. In the case where their life is terminated by means of injections, they escape the mental torture and the uneasy moments. They don't have to lead painful life or keep on depending on clinical machines which support life but attain painless death and they gain everlasting happiness (Pretzer, M.).
Thirdly, poor quality life leads to a sufficient justification of assisted suicide or euthanasia practice. Some patients may feel that they are burdens to others. This may be due to financial constraints a factor which makes patients not to raise the required hospital bills to enable him/her access the sufficient medical care. Also some patients do not access the important national health insurance covers which sometimes help people in supplementing their hospital bills. For this reason patient s are at the liberty of taking death option as a short cut of escaping from their problematic situations.
Finally, the practice of assisted suicide should be treated as other practices such as the use of tobacco and alcohol. In some liberal democratic states citizens are allowed to take these dangerous options as long as they are fully aware of the associated consequences which are always negative. Since people are allowed to take these risky choices, death should not treated as an exceptional because it is one of the options associated with the benefits of minimum risks.
On the other hand the society does not give proposition to above actions which results to assisted suicide because of the following considerations. First, the observational based assertion rests on one sensational and hypothetical description of one state of the terminal illness. It is not anchored in any of the evidence-based researches. The truth of the matter is that many patients who are terminally ill do not live in a permanent state of the hell because the modern medicine can actually eliminate numerous bodily pains to an extent where the body regains back to its functional state with the possible happiness in life (David A.).
With the advancing technology, the terminal illnesses cases can be taken from unbearable to somehow bearable states. Therefore the proposition above is being quick in regarding terminal with hell where life doesn't exist. Those patients who suffer from terminal cancer live very productive and inspirational lives that are very desirable and sometimes their condition of terminal illness becomes a catalyst for the full and successive existence. If we fully support and apply the aspect of an early death, many of the terminal ill patients may not go an extra mile to realizing the human will to live, negligently denying themselves of the possibility of deriving inspiration from their medical hopelessness (Cohen, S.).
Secondly, proposition is seen as philosophically perplexed because death is not a value in the ideal community at all. It should be viewed as a non-existence state. To my opinion, values are the attitudes and principles which exist in society, and which we portray in the kinds of the lives we live, and the choices we always make. More importantly, however, all people value life, not because they think it is an inevitable naturally good, but rather for the significant reason that positive attitudes towards being alive are necessary to live a most worthwhile life at all. On the other hand, dead people cannot even take part in choosing the kind of the lifestyle they want to lead. So if proposition is as joyous - excuse the playing with words - as they seem to be about proselytizing the world to care more about the worthwhile lives, then they had the better value existence itself. But sometimes doing that in the logic way requires a legal acceptance that the policies promoting death such as active euthanasia is in serious conflict with the spirit of proposition's own practical correctness (Materstvedt, L., Pg 97-100).
In many liberal societies, people consume some substances such as tobacco and alcohol not because of the proposition, but for other benefits. For instance smoking of tobacco in many places is partly constitutive of many people's conception that the act ethically good and it is associated with some prestige. The alcohol taking is taken as a relaxing practice and when these substances are moderately taken, they don't cause any irreversible harm i.e. alcohol taken in very small amounts can never ruin the people's lives. Because of these facts underlying the consumption of the above substances, the connection between them and euthanasia does not hold. Therefore, the proposition that relies on the analogy between the societies that allow the use of substances above and the cry out for the legalization of active euthanasia is invalid (Pretzer, M.).
The high response rate in many conducted researches clearly shows the significance of this topic to physicians in the entire world, who possess the practical issues about the legalizing physician-assisted suicide or euthanasia. The outcomes bring out a greater acceptance of physician-assisted suicide or euthanasia among the physicians. The greater percentage of the doctors in the world believes that physician-assisted suicide is ethical and should be legal in some special cases, and nearly half of the doctors might be willing and ready to write prescriptions for lethal doses of medication if they were legalized by the law. This physicians 'support for the concept of assisted suicide or euthanasia is however counterbalanced by the concern about its practical applications. This unreliable issue raises serious questions about the potential for the incomplete suicides which arises due to unreliable prescribing information. In current time, we are not in possession of any well published data concerning the effectiveness of the drugs and even doses that are orally used as the means of committing assisted suicide. Also most religions in the world do not allow euthanasia as they regard it as murder (killing) which is against their faith (Cohen, S.).
The high response rate in many conducted researches clearly shows the significance of this topic to physicians in the entire world, who possess the practical issues about the legalizing physician-assisted suicide or euthanasia. If any form of assisted suicide is allowed in any society, then some unlawful actions will emerge in that society.
Survivors of Suicide
According to Hoffman (2012), any survivor of suicide has to go through a really tough experience. He noted that even if their grief reaction may seem common to those experienced during other common forms of loss, they often have to go through a number of difficult and strong emotions. This write up seeks to explain the lived experience of being a survivor of suicide. It is a life characterized with confusion, quilt, shame, anger, trauma, and blame.
Anger by Gibson
The survivors of any suicide normally develop anger against the dead and ask themselves why they had to do it for them. Such questions often arise from the fact that the survivors normally feel that the dead had committed suicide to reject them because they may not have been worth being lived for. Some have even raised issues with God questioning why he allowed such a horror to happen (Gibson, Gallagher & Jenkins, 2010).
Shame by Hoffmann
Hoffmann (2012) identified shame as another strong feeling that the survivors of suicide have to battle with. He noted that shame is normally magnified by the stigma and the negative perception that is usually associated with suicide by the society. The majority of the victims have even interpreted the decisions by their friends to mean that they had failed in their role to be good friends to them. Such a group of people may want to keep the information of the death of their loved ones or live in the denial of the horrific reality, which is even worse because it may meet objections form other relatives of the deceased.
Guilt by Knaffo
Knaffo (2004) also identifies quilt as another emotional issue that the survivors of suicide have to battle with. He noted that survivors have remained guilty for a long time because of the feeling that they failed to prevent their loved ones from dying. They seem to own the blame for the death of the individual. They seem to believe that they are solely responsible for the death because they had failed to be sensitive or caring enough to know the intention of the diminished. This guilt may also result from the knowledge that the survivor had not established a really good relationship with the dead.
Confusion by Dyregror
Dyregror (2011) notes that because of the sudden nature of suicide, any suicide survivor usually experiences much confusion as it leaves the survivor trying to get into terms with what has happened. The confusion normally becomes even greater in situations where it was not clear whether the person had committed the act intentionally or not. For a long period of time, the survivors are asking themselves of what exactly had taken place and trying to imagine how it happened.
Blame by Denis
The survivors of suicide also normally blame themselves for having failed a responsibility. Blame is very common among survivors of suicide because it makes them feel like they are in control. It enables the survivors to seek answers to the many questions that disturb them, even though none of them may be answered (Denis, 2009).
Traumas of Survivors of Suicide
Finally, most of the survivors of suicide are normally traumatized. The memories of the site of the whole event normally keep on coming into their minds, especially in cases where they had witnessed the happenings. Knaffo (2004) notes that even in cases where the survivors did not witnessed the event firsthand, the imagination of how it may have happened is even more traumatizing.
In conclusion, it is clear that whether the survivor was an eye-witness or not, the impact of the event still remains tragic. Because this is an act that may continue in any society, there is a need to train the citizens on the coping measures to help them during such times. The societies must also be trained to enable them change their perception about the whole issue in order to reduce the resulting trauma on the survivors.