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hsa4431_individual_ppt.pptxPhysician Assisted Death
Alexandra Preston
HSA4431
What is Physician Assisted Death?
One may ask what is Physician Assisted Death, its the act of a physician intentionally providing a patient with the means necessary to commit suicide, which can include counseling about lethal doses of drugs, prescribing lethal doses or supplying the drugs.
Interesting Background About Physician Assisted Death
There are only 5 states where physician assisted death is legal ( Oregon, Washington, Montana, Vermont, California)
Oregon was the First State to allow Physician assisted Death on November 8, 1994
California was the most recent to legalize it on October 5, 2015
Montana is the only state where it could be mandated by court ruling for a physician to be able to proceed with assisting a patient to die.
The specific method in which assisted death is done in each state varies, but mainly involves a prescription from a licensed physician approved by the state in which the patient is a resident.
Difference Between Physician Assisted Death and Euthanasia
Although they may have similar goals, physician-assisted suicide and euthanasia differ
In Physician-Assisted Suicide:
The physician provides the necessary means or information
The patient performs the act In Euthanasia: The physician performs the intervention
Euthanasia is defined as the act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy
Timeline of Physician Assisted Death
June 1997 - The U.S. Supreme Court rules that state laws banning physician-assisted suicide do not violate the Constitution in the case Washington v. Glucksberg. The court left the matter of the constitutionality of a right to a physician's aid in dying to the states.
October 27, 1997 - Oregon's Death with Dignity Act becomes law. Passed in a 1994 election with 51% of voters in favor, the law was delayed initially because U.S. District Judge Michael Hogan issued an injunction and then ruled it unconstitutional. The Ninth Circuit Court of Appeals reversed the ruling and the injunction was lifted when the U.S. Supreme Court referred the matter back to the state in 1997.
November 1998 - American pathologist and assisted suicide advocate Jack Kevorkian, known as "Dr. Death," videotapes the death of Thomas Youk, submits it to CBS's 60 Minutes and it is broadcast on television. The airing prompts murder charges against Kevorkian, rather than assisted suicide charges, because Kevorkian injected the drug into Youk, who had Lou Gehrig's disease.
March 26, 1999 - Kevorkian is convicted of second degree murder and delivery of a controlled substance. He serves eight years of a 10 to 25 year sentence. November 4, 2008 - Washington's initiative, the Death with Dignity Act, is passed with 57.91% of voters in favor. March 5, 2009 - The Washington Death with Dignity Act goes into effect.
Timeline cont’d
December 31, 2009 - A Montana Supreme Court ruling in the case Baxter v. Montana decides that the Rights of the Terminally Ill Act protects a physician who prescribes aid from liability.
November 2012 - In Massachusetts, a death with dignity initiative appears on the November 2012 ballot. It is defeated by a slim margin with 51% voting against it.
May 20, 2013 - Vermont signs the Patient Choice and Control at End of Life Act into law.
January 13, 2014 - New Mexico Second Judicial District Judge Nan Nash rules in favor of an individual's right to die in the case Morris v. Brandenberg. In appeal by the Office of the New Mexico Attorney General, the case is assigned to the New Mexico Court of Appeals/Supreme Court. The ruling remains in effect but only for Bernalillo County, according to the attorney general's office.
Perspective Of Those Against Physician Assisted Death
Those that are opposed to physician assisted death have many reasons as to why, One of them being allowing the terminally ill and disabled to commit suicide and allowing doctors to assist them reduces the value of human life. Religion also plays a role because allowing physician assisted suicide may cause religious issues since several religions disallow suicide and believe it to be a sin. Another very strong reasons as to why doctors would be against it is Helping patients to commit suicide would be asking doctors to violate the Hippocratic Oath, along with that the legalization of physician assisted suicide may encourage doctors to give up on patients even when there is a chance of a cure after all because some patients have been cured at the last minute.
Also allowing physicians to assist patients to commit suicide could encourage abuse of the system such as, helping the chronically ill to commit ill to commit suicide, or in encouraging rather than discouraging patients from committing suicide.
Proposed Changes In Hospital Ethics Committee
I believe having Physician Assisted death be legal would cause for many changes to be considered in a
Hospitals Ethics Committee. Many question will arise along with issues. Does one’s autonomy depend upon a
doctor’s diagnosis or misdiagnosis of a terminal illness? If a person is not terminally ill, but is suffering – whether
physically, psychologically or emotionally – why isn’t it up to that person to decide when, why and how to
die? Does a person only have autonomy if he or she has a particular condition or illness? Is autonomy a basis
for the law? When you think about the hospital ethics committee will be facing Why is a medical treatment
that has Been deemed appropriate to end suffering available to an 18-year-old, but not to a 16-year-old or
17-year old? Why is a person only eligible to have his or her suffering ended if he or she has reached an
arbitrary age ?And, what of the adult who never was, or no longer is, capable of decision-making? Should
that person be denied medical treatment that ends suffering? Are euthanasia and assisted-suicide laws
based on he need to eliminate suffering, or not?
Physician Assisted Death and Religion?
When it comes to physician-assisted death, there are many moral and ethical issues presented. Religious beliefs plays a major role as the idea of killing is considered a sin. There are others who base this issue on the rules of medical ethics. Some believe that the terminally-ill should not be penalized for taking their own lives. It goes against all laws of medical ethics for a doctor to assist in the death of a patient, even if the patient request it. The purpose of a physician is to aid in saving lives and respect the autonomy of the patient no matter what.
Reasons Why Those Are In Favor
Physician’s moral responsibility to help patients avoid pain and suffering no matter what it takes to help them do so.
The right to commit suicide should be considered a basic human right.
By assisting a patient to leave the world peacefully and with dignity the physician can relieve the patient of watching their lives and bodies decay as they become sicker and their families of having to watch them suffer.
Allowing physicians to assist terminally ill or disabled patients would reduce health care costs both to the family and the medical system.
Helping terminally ill or disabled patients will allow doctors and nurses to focus more on patients that have a better chance of recovery
The Future for Physician Assisted Death
Physician Assisted Death has been a controversial issue for many years and will still be in the future. Everyone is entitled to their opinion and beliefs and because of this, there will always be controversy. Advancements in the future will allow for more cures to disease and treatments, therefore physician assisted death will seem less of an option for someone who is ill. Even with that being said this topic will still remain a source of concern due to it being such a serious decision for someone to make.
My Current Position
As an educated member of the moral community, I am very understanding of all beliefs and opinions. I am well aware there are those who strongly believe it should be legal, and I can comprehend why they see it that way, I also understand those that are against physician assisted death. The way I see it to be in favor or not has to do with your life experiences and beliefs, someone who has seen or taken care of a close relative who has suffered through a tragic illness or accident and no longer can live a regular life might say they would rather die than go through that themselves. Then you have someone who if they ever became ill they would do anything to stay alive, for their family, or for religious reasons. Personally I see It both ways, I believe you don’t know what one would do when really put in the situation. In our culture today so many people love using the expression “I would rather die” but when it comes down to actually being put in the circumstance to have to chose, I believe death would not be such an easy choice.
Raised as a Christian death would never be an option, assisting with death would be seen as suicide and to Christians that’s considered a sin. In the eyes of religious followers Doctors are meant to aid the ill in staying healthy and alive as long as time allows. From my religious perspective I understand why physician assisted death would be considered morally unethical.
Life Experiences do also play a role as to why I would maybe consider physician assisted death, seeing my best friends aunt deal with Huntington's was very traumatic for me, by the age of 37 she was confined to a bed and couldn’t move or talk. Visiting her at the hospital with my best friend allowed me to realize I would never want to be in that situation and possibly would rather just be dead.
Impact On Healthcare Provider
Having to go through with physician assisted death as a provider would be something very traumatic for me. The thought of knowing I assisted someone in dying would stay with me forever. I admire doctors for what they do and their ability to save lives, but assisting someone to die is not something to admire on any level. I would not be able to live with myself knowing I aided someone in dying, no matter if it was someting they really wanted. That person has a family that might suffer because I assisted in their death.
The Most Important Ethical Principles and Theories
Autonomy, personal rule of the self that is free from both controlling interferences by others and from personal limitations that prevent meaningful choice. Now knowing that the question that comes to mind is can a person who is willing to basically commit suicide be allowed to make decisions for themselves.
Beneficence is action that is done for the benefit of others. Beneficent actions can be taken to help prevent or remove harms or to simply improve the situation of others. Physicians are expected to refrain from causing harm, but they also have an obligation to help their patients. But it becomes an issue when what is considered good can be seen differently to some when dealing with physician assisted deaths. To a person who's terminally ill and wants to end their suffering a good in their eyes might be a physician assisting them in death to end their pain. But in the eyes of a religious person that is not a good.
Principles
Egoism is the theory that one's self is, or should be, the motivation and the goal of one's own action, so when a patient is seeking physician assisted deaths it is possible they are practicing egoism because they are only looking at their own wants and needs but not know their decision to end their life could devastate their family members.
Virtue Ethics is the theory that focuses on what the individual should choose for his/her own personal self rather than the individual relying solely on the external laws and customs of the person's culture. So with that being said when this theory is applied to a person debating on going through with physician assisted death it wouldn’t be based off what others or religious beliefs say is right but what they as a person feel would be right and what they would want to do.
Ethical Theories
Current Policies and Changes Recommended
For the states that have passed laws allowing physician assisted death there are current policies that must be followed
The patient must be 18 years or older
The patient must have 6 months or less to live
The patient must be a resident of that state
The patient must have had two oral request and at least one written requesting physician assisted death
Policies
Recommended Changes
I believe the patient should be elder, I don’t believe a person who hasn’t fully lived should be even considered.
The patient should be more terminal than 6 months, I believe a lot can change in six months.
Along with two oral request and written request I believe there should be a mental evaluation to asses if the patients reasoning for wanting to go through with physician assisted death.
Possible Training for Future Healthcare Professionals
There would need to be laws and regulations and proper training put in place to make sure this type of treatment doesn’t get abused and used incorrectly. I believe Professionals should also have to go through mental testing to make sure they are mentally able to go through with assisting a patient in death.
Considerations for Insurance and Healthcare Reform
Insurance companies may increase the pressure on doctors and other medical professionals to refuse to perform all the possible things they can to save the patient
Encourage physician assisted death for the terminally ill in order to save money. This would be a reason why there would need to be laws and regulations in place when it comes to dealing with physician assisted deaths.
I believe physician assisted death should be a very costly treatment in order to prevent it from being an easy alternative for insurance companies to save money.
References
Four Problems with Physician-Assisted Suicide (The Heritage Foundation) http://www.heritage.org/research/reports/2015/03/four-problems-with-physician-assisted-suicide
Physician assisted suicide one of the most controversial topics | Law Teacher (Physician assisted suicide one of the most controversial topics | Law Teacher)http://www.lawteacher.net/free-law-essays/medical-law/physician-assisted-suicide-one-of-the-most-controversial-topics-law-medical-essay.php
Sample Chapter for Gorsuch, N.M.: The Future of Assisted Suicide and Euthanasia. (Sample Chapter for Gorsuch, N.M.: The Future of Assisted Suicide and Euthanasia.) http://press.princeton.edu/chapters/s8317.html
State-by-State Guide to Physician-Assisted Suicide - Euthanasia - ProCon.org (ProConorg Headlines) http://euthanasia.procon.org/view.resource.php?resourceID= 000132
The Ongoing Debate Over Physician-Assisted Suicide (Verdict)https://verdict.justia.com/2012/12/17/the-ongoing-debate-over-physician-assisted-suicide
