Exploring the Issues behind Patient-Assisted Suicide Essay

shoe creaters last is as much a part of valet existence, of human development and development, like birth. All homo need to undergo all these processes as they journey through career. However, oddment sets a lay on our cartridge stick uper in this world, and bread and butter culminates in death. However, when we intervene with or so of these natural processes, problems emanate because it get ins in lifes natural processes. This is why, self-annihilation is non unspoiled digd as a health check checkup problem because it withal involves legal, good, hearty, soulfulnessal, and m whiztary considerations.It is non just less sole(prenominal) reprehensible for a doctor, or some(prenominal) medical pr wreakitioner, to assist the uncomplaining to conduct this procedure because it negates their responsibility to go along up life, suicide also devalues the life of the patient as its fate is nonplus entirely in the makes of a human being to intrude with the na tural process of things. For this causal agent, the debate over mercy sidesplitting (or patient- support suicide) involves many passe-partouts, as surface as the patients and their families.The arguments now grow to do with the hauteur of the patients, the step of their lives, their mental state, and sometimes their usefulness to society. For example, the patient who is in a vegetational state is considered dead by some but non by others, and this reason presents substantial good and logistical problems. The Oxford Dictionary of English (2005) defines mercy killing as the easy killing of a patient suffering from an incurable and painful affection or in an irreversible coma. However, mercy killing means much more than a painless death, or the means of procuring it, or the action of inducing it.The definition specifies only the flair of death, and if this were all that was implied a murderer, reverenceful to drug his victim, could claim that his act was an act of eu thanasia. We find this ridiculous because we take it for granted that in euthanasia it is death itself, non just the manner of death. How can someone administer a medical procedure to the one who dies in the end? If a psyche requests the termination of his or her life, the action is called voluntary euthanasia (and a great deal also assisted suicide).If the someone is non mentally commensurate to make an aw ar request, the action is called non-voluntary euthanasia. Both innings should be distinguished from involuntary euthanasia, which involves a person capable of making an informed request, but who has not through with(p) so. goaded euthanasia is universally condemned and plays no role in current moral controversies. A final set of distinctions appeals to the diligent peaceful distinction passive euthanasia involves letting someone die from a disease or injury, whereas sprightly euthanasia involves taking fighting(a) steps to end a persons life.All of these distinction s suffer from borderline cases and various forms of ambiguity. The point of new-fashioned public and philosophical controversy has been over voluntary participating euthanasia (VAE), especially physician-assisted suicide. Supporters of VAE argue that on that point are cases in which remainder from suffering supersedes all other consequences and that admiration for autonomy obligates society to respect the decisions of those who elect euthanasia.If efficient patients begin a legal and moral declinely to refuse discourse that brings well-nigh their deaths, there is a similar right to enlist the assistance of physicians or others to help patients cause their deaths by an active means. Usually, supporters of VAE primarily look to circumstances in which (1) a condition has engender overwhelmingly consignmentsome for a patient, (2) pain management for the patient is in comme il faut, and (3) only a physician seems capable of bringing relief (Dworkin, Frey & Bok, 1998).One w ell-kn confess(a) incident that VAE came into the headlines was when it was provided by the bizarre activities of Dr.Jack Kevorkian in early nineties (or Dr Death as the media obtain dubbed him) in the USA. Dr. Kevorkian, a retired pathologist, assisted over forty raft to commit suicide in recent years in circumstances which were somewhat removed from regular medical practice. These tidy sum travelled to Kevorkian from all over the USA to seek his assistance in suicide. He assisted them, sometimes by attaching them, in the back of his crumble Volkswagen van, to his suicide machine, which injected them with lethal drugs when they activated it.Despite being prosecuted for assisted suicide on several occasions, Kevorkian escaped creed and continued his own(prenominal) campaign for relaxation of the law in his peculiar way. It was only when he moved from assistance in suicide to euthanasia that he was ultimately convicted. He filmed himself administering a lethal injectant, an d the film helped secure his conviction for murder (Keown 2002, p. 31). Of course, his actions provoked discussion of the thin line separating passive euthanasia, which is legal in this country, and active euthanasia.Opponents of Kevorkians actions state that he is practicing assisted suicide, which is illegal. Proponents of Kevorkians actions argue that the patients right to control his or her medical manipulation is sufficient justification for assisted suicide. Euthanasia is Not estimable According to Somerville (2006), there are two major reasons why people should not allow euthanasia to be legalized. One is based on rule it is wrong for one human to intentionally kill other (except in reassert self-defense, or in the defense of others).The other reason is utilitarian the harms and risks of legalizing euthanasia, to individuals in general and to society, far outweigh any benefits. time Mak, Elwyn & Finlay (2006) reasoned that most studies of euthanasia have been quantitati ve, focusing primarily on attitudes of health business organization professionals, relatives, and the public. Pain is usually identified as a major reason for requesting euthanasia other influences included functional impairment, dependency, burden, friendly isolation, depression, hopelessness, and humps of control and autonomy.This is why, Mak, Elwyn & Finlay (2006) thought that legalizing euthanasia is a premature move when query evidence from the perspectives of those who desire euthanasia is not further proven to be necessary. They said more qualitative patient based studies are call for to broaden our under supporting of patients. What needs to be done, they deemed, should be the inclusion of medical humanities, experiential learning, and reflective practice into medical education should help cover doctors have better communication skills and attitudes.By examining ways to improve care at all levels, healthcare professionals can eliminate the side set up of poor end of l ife care, then euthanasia would not be needed anymore. In 1988, the Journal of the American medical checkup Association promulgated a statement on its take about patient-assisted suicide when a gynecology resident agreed to conduct assisted suicide to a young woman, decease of cancer, whom he has neer seen before. Horrified by her repellent distress, and proceeding alone without consultation with anyone, the doctor gives her a lethal injection of morphine.The publishing of this gynecology residents letter caused media hype and was feature in the previous issue in JAMA, where it was titled as Its Over Debbie (1988). This is how the JAMA took its position regarding the matter 1. ) On his own admission, the resident appears to have committed a felony premeditated murder. Direct intentional homicide is a felony in all American jurisdictions, for which the plea of merciful motive is no excuse. That the homicide was clearly intentional is confirmed by the residents act of flint publ ication.Law aside, the physician behaved altogether in a scandalously inexpert and un honourable manner. He did not know the patient he had never seen her before, he did not study her chart, he did not converse with her or her family. He never spoke to her physician. He took as an unambiguous education her only words to him, Lets get this over with he did not twainer finding out what precisely she meant or whether she meant it wholeheartedly. He did not consider alternative ways of bringing her relief or comfort instead of comfort, he gave her death.This is no humane and thoughtful physician succumbing with fear and trembling to the pressures and well-considered wishes of a patient well known to him, for whom there was truly no other recourse. This is, by his own account, an impulsive yet cold technician, arrogantly masquerading as a knight of compassion and humanity. (Indeed, so cavalier is the report and so cold-blooded the behavior, it strains our credulity to think that the write up is true. )Law and professional manner both aside, the resident violated one of the first and most hallowed canons of the medical ethic doctors must not kill. Generations of physicians and commentators on medical ethics have underscored and held fast to the distinction in the midst of ceasing useless interventions (or allowing to die) and active, giveful taking of life at least since the scourge of Hippocrates, Western medicine has regarded the killing of patients, even out on request, as a profound violation of the deepest meaning of the medical vocation.The Judicial Council of the American Medical Association in 1986, in an opinion regarding treatment of dying patients, support the principle that a physician should not intentionally cause death. neither legal tolerance nor the best bedside manner can ever make medical killing medically ethical (Baird & Rosenbaum 1989, p. 26). Indeed, the laws of most nations and the codes of medical and search ethics from the Hipp ocratic Oath to todays major professional codes strictly prohibit VAE (and all forms of merciful hastened death), even if a patient has a good reason for wanting to die.Although courts have often abideed the rights of patients in cases of passive euthanasia, courts have rarely allowed any form of what they judged to be VAE. Those who defend laws and medical traditions opposed to VAE often appeal to either (1) professional-role obligations that prohibit killing or (2) the social consequences that would result from changing these traditions. The first argument is unambiguous killing patients is inconsistent with the roles of nursing, care-giving, and healing. The second argument is more complex and has been at the center of many discussions.This argument is referred to as the wedge argument or the slippery huckster argument, and proceeds roughly as follows although particular acts of active termination of life are sometimes morally justified, the social consequences of okay such p ractices of killing would run serious risks of abuse and misuse and, on balance, would cause more harm than benefit. The argument is not that these prejudicious consequences will occur immediately, but that they will grow incrementally over time, with an ever-increasing risk of indefensible termination (Dworkin, Frey & Bok, 1998).Refusal of Treatment When a patient refuses treatment, the physician is faced with a great dilemma. Doctors maintain that if the patient does not want treatment, physicians do not have a duty to start it. Once treatment is started, however, physicians have a duty to continue it if discontinuing it would lead to the patients death. They are not required to force a patient to go on a respirator if the patient refuses, but once the patient has gone on the respirator, doctors have a duty to keep him on it, even black eye to the patients wishes, if taking him off would result in his death.Suffice it here to point out one important limit a doctor is not ethic ally bound to assist a refusal of treatment which is suicidal, that is, made not because the treatment is futile or too burdensome but in order to hasten death (Keown, 2002, p. 253). actual suicide has been a felony in England in the past but today, suicide has been decriminalized in most part of the world. Attempting to take ones own life, however, remains criminal in some jurisdictions.In these as well as in those states where it is not a crime, the state has intervened in some cases to order life-sustaining treatment in the face of objection by a competent adult. The most widely cited case in which this was done is John F. Kennedy Memorial Hospital v. Heston (1971), where a twenty-two-year-old unmarried woman refused a blood transfusion because she was a Jehovahs Witness. She was forced to have one anyway on the theory that there is no dispute between passively submitting to death and actively seeking it. The state regards both as attempts at self-destruction and may prevent t hem.Since this case, however, the trend of cases has been forward from this reasoning and toward subordinating the states interest in the measure of suicide to the rights of patients to forgo or have withdrawn life-sustaining treatment (Berger 1995, p. 20). However, when the patient is terminal and death is imminent, no treatment is medically indicated, and the competent patients rightful refusal of treatment does not conflict with the health providers form of beneficence. There may be an horny problem in admitting defeat, but there should be no ethical problem.It should be noted that, although the patient may not be competent at the end, refusal of treatment may be accomplished through a living will or a surrogate, especially through a surrogate who has durable power of attorney for health matters. In the case when the patient is terminal but death is not imminent, for example when the disease or injury progresses slowly, and granted the consent of the patient or surrogate, it ap pears ethical to omit treatment on the ground that nothing can be accomplished in thwarting the progress of the disease.But it is not ethical to omit care, since human dignity is to be respected. To solve this dilemma, the AMA Council on ethical and Judicial Affairs (1996) takes a clear stand on the issue E-2. 20 Even if the patient is not terminally ill or permanently unconscious, it is not unethical to discontinue all means of life-sustaining medical treatment in accordance with a proper substituted image or best interests analysis. The treatments include artificially supplied respiration, nutrition, or hydration.In its recent opposition to physician-assisted suicide, the AMA has strongly endorsed a program to educate physicians to the appropriateness of slip from therapeutic treatment to palliative care. The group has gone from a tentative, negative position (not unethical) to a much stronger positive stand (AMA, 1996). On the other hand, we should also consider the reasoning behind the ethical correctness of not beginning or of stopping treatment in the case of the consenting patient who is terminally ill. First, the health care provider has no obligation to prolong dying merely for the sake of prolonging it.That is, it makes no sense to prolong life when the true result is the prolongation of the dying process. Furthermore, when treatment is only prolonging the agony of the patient, its continuation is unethical as an tease to human dignity (Cahill, 1977). In such cases, the health care provider would be ethically justified in discontinuing treatment, except when the patient insists on treatment. Even in this case, however, there can be exceptions. When there is a severe shortage of medical resources, the physician top executive be justified in stopping nonindicated treatment even over the protests of the patient.We say might be justified, since justification would depend, among other things, on a new social consensus about the duties of health care professionals and on a reasonable foregone conclusion that a shortage exists. There are also problems in discontinuing treatment when the patients surrogate(s) objects. It should be noted that cessation of life-sustaining treatment does not always bring about a swift and painless death, even though it may speed up the process of dying. For example, if kidney dialysis is discontinued, the person remains conscious and suffers vomiting, internal hemorrhage, and convulsions.The removal of a respirator does not lead to death immediately, and the patient suffers the pain and panic of suffocation. The obligation to care for the patient demands that every ethical effort be made to placate these sufferings with drugs and other methods that will not prolong life. Much recent look for suggests that physicians are particularly deficient in their willingness and ability to provide adequate pain palliation for dying patients (SUPPORT, 1995). This could be one of the main upkeeps that beat the interest in physician-assisted suicide.Beyond this, when such pain relief is not possible for the patient, or when the harm is not the pain, but the insult to dignity, there arises the difficult problem of actively cooperating in the suicide of the patient. Religious Issues some(prenominal) religions have a negative take on any form of suicide. Those who oppose active euthanasia on religious grounds, the basic concern seems to be the view that our lives are not ours but gifts from God. In this view, humans hold their lives as a trust. If this is true, then we are bound to hold not only the lives of others inviolate but also our own, since to take our life is to destroy what belongs to God.For Christians, in Exodus 347 and Daniel 1353, scriptures taken from the Old Testament, the doctrine of the sanctity of life principle is upheld, except in rare instances of self defense. Judeo-Christian doctrines generally condemn active euthanasia in any form, but allow some forms of passive euthanasia. The loss is that of omission and commission While the Judeo-Christian philosophy might get the allowance of death, acts that permit death, it draws the line in regard to acts that cause death. For Buddhists, they perceive it as an involvement of the intentional taking of life.This is why euthanasia is foreign to basic Buddhist ethical teachings because it violates the first of the Five Precepts. It is also contrary to the more general moral principle of ahimsa. This conclusion applies to both the active and passive forms of the practice, even when accompanied by a compassionate demand with the end of avoiding suffering. The term euthanasia has no direct equivalent in canonical Buddhist languages. Euthanasia as an ethical issue is not explicitly discussed in canonical or commentarial sources, and no clear cases of euthanasia are reported.However, there are canonical cases of suicide and attempted suicide which have a bearing on the issue. One concerns the monastic pre cept against taking life, the third of the four parajika-dharmas, which was introduced by the Buddha when a group of monks became disenchant with life and began to kill themselves, some dying by their own hand and others with the aid of an intermediary. The Buddha intervened to prevent this, thus apparently introducing a prohibition on voluntary euthanasia.In other situations where monks in great pain contemplated suicide they are encouraged to turn their thoughts away from this and to use their experience as a means to developing insight into the nature of suffering and impermanency (anitya) (Dictionary of Buddhism, 2003). Nonreligious arguments against active euthanasia usually follow a slippery slope or wedge line of reasoning. In some ways the arguments discard the parable of the camel who pleaded with his owner to be allowed to put his nose into the tent to keep it warm against the cold desert night.Once the nose was allowed, other adjustments were requested, and the owner f ound himself sleeping with his camel. Is there something so persuasive about set others to death that, if allowed, would become gross and commonplace? The Nazi final solution, which brought about the death of millions of Jews, gypsies, and other eastern Europeans, could be traced to compulsory euthanasia decree that, at the time of its enactment, included only mental cases, monstrosities, and incurables who were a burden of the state.Using the Nazi experience as a guide, critics of active euthanasia do see some seductiveness to killing that humans do not seem able to handle. Perhaps Sigmund Freud (1925) was right as he wrote What no human soul desires there is no need to prohibit it is automatically excluded. The very emphasis of the commandment Thou shalt not kill makes it legitimate that we spring from an endless ancestry of murderers, with whom the lust for killing was in the blood, as possibly it is to this day with ourselves. The religious take on euthanasia often focus on the sanctity/inviolability of life.In Western thought, the development of the principle has owed much to the Judaeo-Christian tradition. That traditions doctrine of the sanctity of life holds that human life is created in the image of God and is, therefore, possessed of an intrinsic dignity which entitles it to protection from unjust attack. With or without this theological underpinning, the doctrine that human life possesses an intrinsic dignity grounds the principle that one must never intentionally kill an innocent human being. The right to life is essentially a right not to be intentionally killed (Keown, 2002, p. 40).