virtual class room excercise

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Chapter 12

Ethical Issues Concerning Physician-Assisted Death

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Key Definitions

• Assisted suicide is ending one’s life intentionally with the help of another person.

• Voluntary active euthanasia means that the patient freely chooses to have a lethal agent given by another person.

• Assisted death includes both assisted suicide and active euthanasia.

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Key Definitions

• Physician-assisted death means that a physician uses his or her knowledge and skills to hasten the death of an individual.

• The term does NOT include not starting futile treatment or withdrawing it.

• It does not include the use of high dose opioids for pain.

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Ethical Argument: Autonomy

• Supporters say that physician-assisted death honors integrity and allows the patient to define a “harm”.

• Opponents say that autonomy should be present in treatment, but it does not justify the decision to take a life.

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Ethical Argument: Compassion

• Proponents feel that discussing assisted death often prevents suicide.

• Opponents remind us that suffering is unique to each person.

• To relieve suffering by ending the life of the sufferer is not acceptable.

• Physicians need to listen for the real reason for a request for assisted death.

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The Slippery Slope

• Proponents support the need for guidelines to increase trust and the healing relationship.

• There is a need to consult with another physician on the matter.

• Documentation is essential.

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The Slippery Slope

• Opponents feel that the slippery slope is a real concern.

• Once the rules are relaxed, the vulnerable will not be protected against the physician.

• The guidelines and second opinions could actually be a hypocritical façade.

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Professional Integrity

• Physicians are supposed to be healers. • Assisting in suicide is opposed to that role and

destroys moral integrity. • The same could be said for other health care

professionals.

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Professional Integrity

• Those who support this option feel that the definition of integrity is too narrow.

• Professional integrity should also include relieving suffering and respect for a patient’s choices.

• Integrity could also include assisting patients to have a peaceful death.

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Substituted Judgment

• What about patients who are no longer able to make decisions about end of life treatment?

• At present, physician-assisted death proposals exclude those who are not able to make their own decisions.

• Opponents worry that physician-assisted death could include even those who no longer can voice their preferences

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Table 12-2: Suggested Steps for the Clinical Management of a Request for Assisted Death

1. The provider should listen to the request for assisted death in an open and sympathetic manner and evaluate the issues underlying the request.

2. Providers should share their personal stance with patients in an open and professional manner, always assuring patients that they will be supported throughout this personal decision-making process.

Table 12-2: Suggested Steps for the Clinical Management of a Request for Assisted Death

3. All providers should take appropriate steps to process their personal emotional reactions to the patient’s request (e.g., hospice team meetings).

4. The provider should have a continuing dialogue with the patient and appropriate family members or support persons concerning the development and implementation of the therapeutic treatment plans, including a request for assisted death, in a manner that is consistent with the provider’s moral values and belief system.

How Does One Manage This?

• Listen and evaluate what you are hearing. • What are the underlying issues? • Be sincere and candid about your stance on

this issue. • Assure that there will be adequate comfort

care.

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How Does One Manage This?

• Look for the nature of the request and how it was made.

• Make sure the patient is making a decision based on the facts

• Make sure the patient shares his/her decision with family members

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Placing the Debate in Context

• What is the physician’s professional obligation? • Should physicians be helping people live life to its

fullest potential? • Should the quality of care at the end of life be

improved? • Should we provide a balance between what

technology can do and a peaceful death?

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In Summary…

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