Like any good story, life has a beginning, middle, and end. Fortunately, individuals in the United States have the opportunity and legal right to author their own stories. However, death--the end of one’s life story--comes in many forms, sometimes unexpectedly from an accident or medical condition, and sometimes expectedly due to terminal illness. For individuals who face death expectedly, options are available that assist in ensuring death is dignified and humane. One such option enables a mentally competent terminally ill patient to request assistance from a physician to ensure death occurs at the right time and in the most humane and dignified way possible. Shockingly, however, the United States continues to uphold laws that prevent a terminally ill patient from seeking this type of assistance from anyone. For some, these laws result in a shorter and more terrifying end of life with a painful, inhumane, and undignified death. To eliminate this type of horrific conclusion, individuals must have the right to author the end of their story as freely as they authored the rest of their story. Terminally ill patients need the legal option of physician aid-in-dying to achieve a longer, healthier, and happier life with a dignified, safe, and humane death.
Physician aid-in-dying enables certain terminally ill patients to end their suffering with the help of a qualified physician. Once it is determined that a painful death is imminent, and the mentally competent patient makes the request for aid-in-dying, the physician provides the patient with a prescription for a lethal number of barbiturates. This prescription takes control over the patient’s last days of life away from the terminal illness and gives it back to the patient. With this control, the patient is able to concentrate on living the last days of his or her life in a humane and dignified way. Whether or not the patient chooses to ingest the barbiturates, having the prescription is what gives the patient control over the situation. Thus enabling him or her to embrace family and make final arrangements in a dignified and productive way instead of allowing the fear of an incapacitating, embarrassing, painful, and prolonged death to overpower the patient. Additionally, physician aid-in-dying reduces patient suffering by medically treating death as equally as every other medical condition. After all, death, birth, and everything in between, define life; and all parts of life must receive equal care and consideration.
Patients who disagree with the option of
physician aid-in-dying are in no way obligated to receive it. Consideration of
the lethal prescription occurs only if the patient makes repeated requests for
aid-in-dying over a prolonged period. Furthermore, physicians may only provide
aid-in-dying after the patient has received adequate counseling from
professionals. Additionally, the patient must be mentally competent. Finally,
both the patient and doctor must agree that the patient’s life is complete and
nothing more than pain and suffering will result from living longer. Physician
aid-in-dying is a carefully monitored prescription provided only to those who
desire this treatment for certain incurable and unmanageable symptoms of death.
Nevertheless, the Supreme Court has
ruled that assisted suicide is not a constitutional right. However, the Equal
Protection Clause of the Fourteenth Amendment says that no state shall “deny to
any person within its jurisdiction the equal protection of the laws.” Since
similarly situated individuals have a constitutional right to be treated
similarly, it makes sense that doctors who are permitted to remove
life-sustaining treatments, knowing that the removal will result in death,
should also be permitted to prescribe barbiturates to a terminally ill patient
in a similar position facing the same result. The Fourteenth Amendment also says
that no state shall “deprive any person of life, liberty, or property without
due process.” However, when physical health no longer permits a terminally ill
person to pursue liberty, humane life, or property (his or her body), there is
no further reason to continue enforcing the impossible or protecting rights
that cannot be restored. As McGee (1997) concluded, “The Supreme Court
decisions on physician-assisted suicide were wrongly decided” (p. 47). Furthermore,
since 1996, the following gallop poll question consistently shows that a
majority of Americans believe physician aid-in-dying should be legal. In a country
built on the opinion of majority, it is difficult to understand why the
majority of states continue to treat physician aid-in-dying as a crime.
“When a person
has a disease that cannot be cured and is living in severe pain, do you think
doctors should or should not be allowed by law to assist the patient to commit
suicide if the patient requests it?”
(Gallup, 2008,
para. 8)
As Dr. Preston (2007) stated, “The
paramount state interest should be in promoting compassion for, and reducing
the suffering of, dying patients” (p. 122). Ironically, pet owners in America
have the legal obligation to assist with the death of their terminally ill and
suffering pets. It is rightfully considered inhumane, and therefore illegal, to
force a pet to suffer a prolonged and painful death. However, this type of
humanity is not legally available to most humans. As shown in the below
depiction of current laws in the United States, all states, with the exception
of Oregon, prohibit doctors from assisting terminally ill patients with this
dignified treatment for death. Despite the fact that current laws protect a dog’s
humanity, the constitution touts equal rights, and the majority of Americans
feel physician aid-in-dying should be legal, physician aid-in-dying remains a
crime in all but one state.
(Public Agenda,
2008, para. 1)
Physician aid-in-dying is neither
euthanasia nor murder. “Euthanasia usually refers to active intervention such as lethal injection [performed by a doctor] to bring
about death”
(Follin, Stacey A., 2004, p. 319). Euthanasia may occur after the patient
is no longer able to communicate his or her wishes. Murder involves one or more
persons ending the life of another person unexpectedly and without the consent
of the person whose life has ended. Conversely, physician aid-in-dying occurs
only after the patient has requested the physician’s assistance. Additionally,
it is the patient, not the doctor, or anyone else, who determines when, if
ever, to ingest the lethal dose of medication. Unlike murder and euthanasia,
physician aid-in-dying puts control over the patient’s death where it
rightfully belongs--with the patient.
Moreover, physician aid-in-dying is not
suicide. The commonly used term, physician
assisted-suicide is inaccurate. Suicide is the result of a person choosing to die rather than live. Terminally
ill patients do not want or choose to die but are dying. If terminally ill patients
could choose life, they would. However, life is not an option. Death is
imminent. The only choice the patients have is how much pain and indignity to
endure before embracing the final chapter of their life. Thus, physician
aid-in-dying is not the avoidance of life but rather the treatment of
unavoidable death.
For some, legal alternatives to
physician aid-in-dying are inhumane. Terminal dehydration, e.g. starvation,
forces the patient to deny him or herself food and water until death occurs. The
self-denial of life sustaining nourishment is emotionally and physically painful
for both the patient and his or her loved ones. Additionally, terminal
dehydration can require patients and their families to endure the heartache and
pain for as many as three weeks. Suicide is another alternative to physician
aid-in-dying. Without assistance or counseling from anyone else, a patient may
attempt to commit suicide as a means of avoiding a painful and inhumane death.
A failed attempt to commit suicide may make the patient’s condition worse than
it was prior to the attempt. Additionally, a suicide attempt by an
unknowledgeable patient with lackluster means may result in a painful, lonely, and
premature death. An illegally assisted suicide by a friend or family member has
the same risks as self-inflicted suicide and may result in criminal charges
against the assistant. Another alternative is locating a doctor who will honor the
patient’s wishes for aid-in-dying. However, because this assistance is illegal,
the doctor is not able to consult other physicians nor is the patient able to
consult openly with mental health specialists to ensure the request is viable,
timely, and appropriate. Doctors can legally administer terminal sedation,
which results in the patient’s death after entering a coma. However, the amount
of time it takes for the patient to die is long, the care and treatment of the dying
coma patient is expensive, and the family’s inability to visit with the patient
directly or to begin finding closure since the patient is not yet dead, is
emotionally taxing. Of course, a patient may choose to endure the suffering
until death is finally able to overcome the obstacles of unnatural
life-prolonging treatment. Regardless, “for some fatally afflicted persons,
even a few days of lingering in stupor or unconsciousness makes these processes
unacceptably demeaning” (Cantor, 2005, p. 28).
Though it may seem unnatural for a
physician to prescribe a lethal dose of medication to assist with death, one
must remember that the alteration of the natural stages of life started when
the treatment for the terminal illness began. Medical advances simply prevent
natural death which would normally occur much sooner. Though treating illness
alters the natural stages of life, it is humane. Likewise, the treatment of
death via physician aid-in-dying alters the natural stages of death; however,
it too is humane. If America wishes to continue moving forward in medicine, all stages of life that require
treatment must be able to receive it. Obviously, the goal of modern medicine is
to prolong life. However, death remains a part of life. Thus, humane treatment
options for death must be legally available. Legalizing all available options
ensures patients are able to choose the best and most humane option for their
death rather than forced to choose the second
best option because of legal restrictions. As Wellman (2003) concluded, “Those
who will die within hours or a very few days will soon obtain relief without
taking any action, and those who are on life-prolonging intensive care can
often end their lives simply by refusing continued treatment. [However,] others
are condemned to continuing severe suffering by any legal system that confers
no legal right to physician [aid-in-dying] (p. 23). In other words, when the
law does not allow physician aid-in-dying, the law is forcing some individuals
to suffer a painful, inhumane, and prolonged death.
Although physician aid-in-dying is not a
treatment for depression alone, a side effect of physician aid-in-dying is the
successful treatment of the symptom
of depression caused by terminal illness. The feeling of
having no control over a situation often causes situational depression. Someone
diagnosed with situational depression that is otherwise healthy will not qualify
for physician aid-in-dying. However, pain and suffering with no relief
available is just cause for depression and this type of depression is a symptom
of the disease. Having the option of
physician aid-in-dying, whether or not used, successfully treats the depression
caused by terminal illness because it gives control over the situation back to
the patient. Statistics provided by the Oregon government show that not all
patients who receive a prescription for aid-in-dying choose to ingest the
lethal dose of medication. For some, it is not a prescription for death, but
rather a prescription for peace of mind.
|
In Oregon, where aid-in-dying is legal, physicians
wrote 65 prescriptions for lethal medication to qualifying terminally ill
patients. Of these, 35 patients took the medication, 19 died of their
underlying disease, and 11 were still alive at the end of the year. (Oregon.gov,
2007) |
(Oregon.gov,
2007) |
By treating the depression symptom, the
patient’s last days of life may be longer, happier, and healthier than it would
otherwise be. Therefore, physician aid-in-dying may prolong life by detouring
the patient’s desire for a premature suicide. Additionally, physician
aid-in-dying ensures the last days of life are happier by decreasing the amount
of fear and uncertainty the patient would otherwise face. Finally, without
thoughts of suicide and fear looming overhead, the health of the patient is far
better than it would be with the added ailments that depression, anxiety, and
fear, inflict. The option of physician aid-in-dying gives the patient the
control required to enable him or her to live his or her last days in the most
dignified way possible. Without the option of physician aid-in-dying good
viable days, or even months, of the patient’s life fill with torment and
emotional distress instead of acceptance and dignity.
Moreover, physicians have a duty to
honor patient wishes, provide comfort, and relieve pain. Physician aid-in-dying
does not contradict the physician’s role as a healer and reliever of pain. Death
is as much a part of life as birth, thus, providing comfort during the dying
stage of life is part of a physician’s duty. When a competent, terminally ill
patient feels his or her physical health prevents the continuation of a
dignified, humane, and painless life, and the doctor agrees, then the doctor
has a duty to honor the patient’s request for aid-in-dying. As Dr. Nicolaidis,
explained, “In her final months, my mother was the
epitome of selflessness and control. She became obsessed with four things:
minimizing the pain for her loved ones, savoring every good moment, ensuring
our family’s happiness, and dying a good death.” Dr. Nicolaidis continued to
recall her mother’s final days saying, “I never could have predicted what a
positive effect that little vial of barbiturates would have over her life in
the next few months” (p.907). Dr. Nicolaidis concluded, “[H]elping ensure a
good death is just as much a part of being a physician as prolonging life” (p.
908). As shown by Dr. Nicolaidis’ mother, the immediate ingestion of a
lethal prescription is not required for the patient and his or her family to
have immediately positive and healing results. Preventing a doctor from doing
his or her job is an insult to modern medicine, a denial of human rights, and
it prevents modern medicine from doing all it can for the humane preservation
of a dignified humanity.
In
conclusion, patients must be able to trust that their physicians may legally
provide the best treatments possible throughout life--from birth to death, and
everything in between. Moreover, when modern medicine offers no cure or relief
from a terminal illness, and the patient can no longer endure the pain and
indignity of his or her death, the option of physician aid-in-dying must be
legally available because this is the only way to ensure the individual
maintains rightful control over his or her entire life. Everyone should have
the right to choose the best
treatment for his or her death legally and with the assistance of a trusted and
qualified physician. In fact, it is the legal option of physician aid-in-dying that enables a terminally ill
person to live fully and as happily as possible, while remaining in control and
dignified without the terror of an inhumane, painful, and undignified death
looming overhead. Physician aid-in-dying does not change the underlying cause
of death. Instead, it affects how a terminally ill person experiences the most
precious days of his or her life.
References:
Cantor,
Norman L. (2005). On hastening death without violating legal or moral
prohibitions. Rutgers Law School (Newark) Faculty Papers, (Working
Paper 27), 1-30. Retrieved February 10, 2008, from Social
Science Research Network database.
Follin,
Stacey A. (2004). Nurses legal handbook (5th ed.). Ambler,
PA: Lippincott Williams & Wilkins. Retrieved January 26, 2008, from Ovid database.
Gallup. (2008). Public
divided over moral acceptability of doctor-assisted suicide. Retrieved February 13, 2008,
from http://www.gallup.com/poll/27727/Public-Divided-Over-Moral-Acceptability-DoctorAssisted-Suicide.aspx
McGee,
Robert W. (1997). Suicide is a property right; Assisted suicide is a
contract right. Commentaries on Law & Public Policy, (), 1-47. Retrieved
February 12, 2008, from Social Science Research
Network database.
Nicolaidis
MD, MPH, Christina. (2006). My mother's choice. The
Journal of the American Medical Association, 296 (8), 907-908. Retrieved January 26, 2008, from Ovid database.
Oregon.gov. (2007). Summary
of Oregon’s Death with Dignity Act - 2006. Retrieved February 26, 2008,
from http://www.oregon.gov/DHS/ph/pas/docs/year9.pdf
Preston,
M.D., Tom (2007). Patient-directed dying. Lincoln, NE: iUniverse
Star.
Public
Agenda. (2008). Right to die: Fact file. Retrieved February 17, 2008,
from http://www.publicagenda.org/issues/factfiles_detail.cfm?issue_type=right2die&list=11
Wellman,
Carl. (2003). A legal right to physician-assisted suicide
defended. Social Theory & Practice, 29 (1), 19-38. Retrieved January 20, 2008, from Academic
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