By Emily Lau (NHS ’17)
Brittany Maynard made news for moving to Oregon to take advantage of the Death with Dignity Act that allows terminally ill patients to be prescribed lethal medication for the purpose of ending their lives. She became the face of the right-to-die movement and her decision has brought the conversation about physician-assisted suicide back into the national spotlight. The topic is undoubtedly controversial because it compounds the already charged topic of suicide with the ethical obligations that doctors have. While this is an important issue to discuss, I think that ultimately the choice should be up to the individual who has been given a terminal diagnosis which is why steps should be taken to pass legislation that will make it easier for patients to consider the option of physician-assisted suicide.
Many people given terminal diagnoses suffer from intractable pain that causes severe, extended states of stress evidenced by abnormal concentrations of stress hormones in these patient’s blood along with elevated blood pressure and heart rate. Intractable pain is a subset of chronic pain due to chronic illness that is not responsive to treatments such as surgery, nerve blocks, physical rehabilitation, and weak opioids. Particularly in situations where one’s condition will continue to worsen, intractable pain can become completely untreatable; even in states that allow the use of opioids to treat pain, for some diseases, the pain can progress to a point where the dose needed to treat the pain is the same dose that would be used to end the patient’s life. This pain is not just experienced by the patient but also by the patient’s loved ones who are helpless to stop the pain. When a patient no longer wants to live because of their pain, it seems cruel to me to force these patients to continue living for the sake of others who wish for them not to die.
One of the primary questions regarding physician-assisted suicide is whether or not it is ethical. The problem with trying to parse out the ethical concerns is that there are many facets to the ethical quandary. While one can make an objection to physician-assisted suicide based on the Hippocratic Oath that physicians promise to uphold, one can also make an argument in favor of the practice using the Hippocratic Oath. One of the tenants of the Hippocratic Oath is to not play god when faced with the opportunity to take a life, however the Hippocratic Oath also warns doctors not to overtreat a patient. Additionally, the Hippocratic Oath tells doctors that at times sympathy and warmth may be a better treatment than surgery or drugs and that it is a doctor’s responsibility to consider the effects of the illness on the patient’s family and their economic status. Taking all of this into account, refusing patients the option of physician-assisted suicide could be considered mandatory overtreatment of disease, a lack of sympathy for the patient’s pain and wishes, and, considering the huge costs that terminal illnesses entail, a potentially irresponsible use of economic resources against the wishes of the patient. All of these points become moot if the patient wishes for treatment, but when this is done against the wishes of the patient, this hardly seems ethical.
This is a polarizing issue with proponents on both sides. There are doctors that claim that most doctors would not go through with the intense, costly treatments that they often recommend to their patients because they have a more realistic understanding of what can be done to treat terminal diseases. However, other doctors are strongly opposed to physician-assisted suicide because it is directly contrary to what doctors are trained to do: save lives. There are terminally ill patients who think that physician-assisted suicide is wrong and family members who feel that it can be the right thing., There is also the worry that such an option will be abused or that doctors are being dragged into a moral issue that they should have no part of. However, there is little evidence in Oregon that the act is being abused. In fact, in 2013, only 51.6% of patients who were prescribed the medications decided to ingest them and 22.9% died of their illness within the year that their medications were prescribed. For the patients who choose to seek these prescriptions, their reports on why they have sought the prescriptions show a common thread of concern over the loss of autonomy, the loss of the ability to enjoy life, and the loss of dignity. For these patients, the Death with Dignity Act and the prescriptions they are given by participating physicians are a way to reclaim dignity in the face of debilitating illness.
Given the clearly divisive opinions on the issue, I think that it is only right to allow people to make their own decisions on the issue. By banning legislation that would give patients the choice of patient-physician assisted suicide, we are forcing some people’s opinions on all people when the answers to the moral questions surrounding the issue are hardly clear. Dignity and bravery is individual to each person and when we take away that choice, we steal away someone’s dignity. By making physician-assisted suicide legal, we would preserve the dignity and morality of choice and, in the end, that is all that many people have.
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