Moral and Ethical Issues in Physician-Assisted Suicide

Health care institutions are faced with many ethical and moral issues. It is a duty of practitioners and doctors to use ethical decision making while they are being faced with certain issues during their practice. When there are fewer beds in the hospital compared to the number of patients that require the admission, it is the duty of nurses and other hospital staff to determine the patients which will be admitted to the particular hospital and the ones which can be treated as outpatients.

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Such decisions require nurses to have high ethical and moral standards. One of the issues bringing an ethical and legal dilemma on healthcare practice is the issue of physician-assisted suicide. This paper focuses on some moral, ethical, and legal issues facing physician-assisted suicide. It also highlights the professional role of doctors and other medical practitioners on the issue of physician-assisted suicide.

Physician-assisted suicide is the voluntary termination of the life of a patient through the administration of a lethal substance-using indirect or direct assistance from a physician. The proponents of physician-assisted suicide argue that it violates most of the fundamental principles of medical practice (Paterson 2008). They argue that doctors should not assist in suicide since it violates the critical role of doctors as healers. However, people supporting physician-assisted suicide argue that it helps to end the suffering that patients might be going through. The next section of this paper summarizes the case of Terri Schiavo that had involved physician-assisted suicide.

Summary of Terri Schiavo’s Case

The case of Terri Schiavo can be used to illustrate whether physician-assisted suicide is moral, ethical, and legal in healthcare practice. Terri died when she was 41 years old after 14 days when doctors had disconnected her feeding tube (Goodman, 2008). This tube had kept Terri alive for about 15 years. On 25 February 1990, Terri suffered a cardiac arrest that was brought about by her eating disorder. Extreme hypokalemia triggered the cardiac arrest that she had suffered. Doctors conducted a scan on her brain; and they revealed that she had suffered severe atrophy on her cerebral hemispheres.

In addition, the studies also conducted on her brain showed that she did not have any functional activity on her cerebral cortex. She was in a persistent vegetative state. She experienced the reflexive responses to noise and light. In addition, doctors indicated that she had shown no swallowing responses. She did not exhibit any signs of emotions. In 1994, doctors started giving her speech and physical therapy. This is because they believed that such therapies would return Terri to her initial state of awareness.

In 1998, Michael Schiavo, a husband of Terri, filed a petition to remove Terri’s feeding tube. Terri’s parents opposed this petition. Michael argued that Terri had been in pain. It was, therefore, necessary to remove the feeding tube. The physicians taking care of Terri informed the court that she had been in a persistent vegetative state based on the statues of Florida (Schindler et al. 2013). The doctors argued that Terri did not show any signs of voluntary action. Also, she was unable to communicate and interact with purposefully. However, the court denied the petition since they found out that Michael might have made the decision to remove Terri’s feeding tube since he wanted to inherit her property.

In 2000, Michael presented a case before Judge George Greer arguing that Terri would not have wished to be kept in a machine where her chances for survival were very minimal. 18 witnesses participating, in this case, gave their testimony arguing that Terri would not have wanted to be supported by the machine. However, her parents challenged this case arguing that Terri was a devoted Roman Catholic girl. She would not go against the teachings of her church. Terri’s parents wanted the court to allow her to be given oral feeding since it would prolong her life.

However, the decision was denied since medical reports revealed that Terri required feeding tubes as she was not responsive to swallowing tests. In October 2002, doctors conducted the CAT scan on the head of Terri. This scan revealed that Terri had severe cerebral atrophy. Scans also revealed that she did not have any brain activity. Her feeding tube was removed in March 2005. She died on 31 March 2005 at Pinellas Park Hospice (Goodman 2010).

In healthcare settings, doctors and nurses may be faced with the dilemma of whether to commit physician-assisted suicide or not. A patient may be in a persistent vegetative state with no hope of the full recovery. The physician may be asked to give his/her opinion on whether the patient should be taken out of life support machines. Ethically, a doctor is supposed to protect the life of his patient. It is, therefore, not morally right for the doctor to assist in the suicide of a patient who may be in a persistent vegetative state.

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Exploration of a Supporting Theory

Ethical decision-making can be used to explore whether physician-assisted suicide is accepted by medical ethics or not. Researchers argue that physician-assisted suicide falls into four categories. These categories include active involuntary suicide, active voluntary suicide, passive involuntary suicide, and passive voluntary suicide (Hawkins 2002). When a physician engages in active involuntary suicide, he/she kills the patient intentionally without receiving consent from the patient. In case a doctor engages in active voluntary suicide, he/she kills the patient after following the wishes of the patient. In passive voluntary suicide, the doctor lets a patient die by not intervening in order to fulfill the wishes of the patient. When a physician engages in passive involuntary suicide, he or she allows the patient to die by not intervening in any way, which is contrary to the wishes of the patient.

In the case of Terry, the doctors were engaged into the passive voluntary suicide. They removed the feeding tube since the court declared that Terry had made oral statements that she would have liked her life to be discontinued in case her life was under machine support. Medical ethics do not allow active involuntary suicide, active voluntary suicide, and passive involuntary suicide (Paterson 2008).

People are against suicide due to several reasons. They argue that suicide is morally wrong even if it is conducted on a patient being too ill. This is because it amounts to a self-murder even if it is done to end the suffering of another patient. Physician-assisted suicide should not be conducted in order to eliminate the pain of patients since the advancement in medicine has introduced drugs that are able to reduce pain patients may be experiencing (Kopelman & Ville 2001).

It is also wrong to conduct physician-assisted suicide since religion condemns this act. According to Saint Augustin, it is never illicit to kill another one even if he/she wishes this. Catholics argue that if a patient requests for physician-assisted suicide, he/she does this because he/she hangs between life and death (Carr 2010). This feeling is brought by the fact that the patient begs for his/her soul to be released from its bonds. Catholics, therefore, believe that a doctor will be ethically wrong by engaging in physician-assisted suicide. They will be going against the teachings given by religion. According to Christians, God gave them the commandment, “Thou shall not kill” (Carr 2010).

If doctors commit physician-assisted suicide, they will be breaking the commandments that God had given them. Thus, this is a sin. Terri’s parents were strict Catholics. They believed that disconnecting the feeding tube that supported the life of Terri was an act of murder. It was, therefore, not ethically right that the doctors had removed the feeding tube since they took away the life of Terri.

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It is also unethical to conduct physician-assisted suicide since it gives doctors too much power. Patients put too much trust in doctors when they seek medical services from them. In case a patient is in critical condition, the families of the patient trust in the judgment that the physician taking care of the patient gives them. In some cases, the physician may have made a wrong diagnosis.

In such cases, the physician would be participating in the suicide of a patient who could have been saved. Physician-assisted suicide is also unethical since it undermines the value of human life. Life is sacred. That is why people mourn when a person dies. Physician-assisted suicide also contradicts with a medical principle of autonomy. According to the principle of autonomy, patients have the right of making their autonomous decisions without being coerced by anybody (Marzili 2004).

In addition, patients should have the full knowledge and understanding of the particular issue affecting them so that they are able to make the correct decision regarding their health. This principle helps to move the provision of health care services from a paternalistic approach to a client-centered approach. Due to this, a patient is able to play an active role in his/her wellbeing and personal health. When the physician engages in physician-assisted suicide, he/she may be going against the principle of autonomy. This is because some patients undergoing this form of suicide are in a persistent vegetative state. It is, therefore, not possible for the patient to decide that they want to undergo physician-assisted suicide.

Physician-assisted suicide is also against the Hippocratic Oath of doctors. According to this oath, doctors should act in the best interests of their patients. It means that whatever decision a doctor arrives at should be centered towards the recovery of the patient. This oath also states that doctors should always strive to correct all the injustices that might be causing harm to their patients (Paterson 2008). Doctors are also not supposed to give a drug that is deadly to anyone. By practicing physician-assisted suicide, doctors break this oath since they sometimes use lethal drugs in order to end the life of the patient. Physician-assisted suicide gives doctors the right of killing patients. This is contrary to their oath that requires them not to harm their patients in any way.

Other people argue that most patients who request physician-assisted suicide are medically depressed. Due to this, they may seek physician-assisted suicide so that they may be able to overcome the pain they might be feeling. If doctors apply the proper medical and psychological techniques, they may be able to convince the patients not to consider the option of undergoing suicide. Researchers have established that patients who seek physician-assisted suicide mostly suffer from such conditions as severe body wasting, urinary and bowel incontinence, total dependence, and immobility (Hawkins 2002). Such conditions can be managed medically; therefore, eliminating the need for a patient undergoing physician-assisted suicide.

Some doctors argue that it is ethical to perform physician-assisted suicide. They argue that it should be granted to any patient who may be suffering from a fatal, painful, or degenerative condition. Such conditions would make it hard for these patients to enjoy their lives as normal and healthy people enjoying their lives. If the patient does not have any possibility for recovery, doctors and other medical practitioners have a duty to end the life of such patients in order to eliminate the suffering such patients may be going through (Jeffry 2008).

In the case of Terri, medical doctors had tried all forms of speech and physical therapy in order to try pulling her from a persistent vegetative state. After Terri suffered the cardiac arrest, Michael Schiavo took her to the University of California so that the experimental nerve stimulation could be performed on her. Although the treatment had taken several months, it was unsuccessful. In 1994, she was transferred to Sabal Palms Skilled Care Facility and received neurological testing, regular occupational therapy, and speech therapy. During these tests, Terri contracted a urinary tract infection. Since there was no hope for the recovery of Terri, it was necessary to end her life so that the suffering that she might have been undergoing could be ended (Goodman 2010). All reports from the doctors revealed that Terri was in the persistent vegetative state. She did not show any voluntary action.

Medical practitioners argue that it is conducted physically assisted suicide to a patient with no hope of survival. It helps the family of patients to save high medical costs. According to the research, terminally ill patients consume 40 percent of their total health care costs in the last months of their lives compared to other medical costs (Paterson 2008). It is expensive to pay for the medical costs of the patient whose life is being supported by machines. Such patients require constant medical care and attention leading to the inflation in their medical costs.

Families end up borrowing huge loans in order to support the life of a terminally ill patient. It is, therefore, ethically right for a doctor to end the life of such a patient so that he can help the family of the patient in saving huge costs that they incur while taking care of the terminally ill patient. Dying patients incur huge costs caused by many X-ray reports, lab tests, and other hospital overheads. Patients supported by machines may end up incurring high medical costs that may range between $50,000 to 100,000. It would be ethical for this money to be used to save another patient with the hope of survival (Paterson 2008).

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Some doctors support physician-assisted suicide since they argue that it allows a patient to die with dignity. Patients being terminally ill and under the support of machines may lose their ability to take care of themselves. They may constantly vomit on themselves, drool, or even urinate on themselves. In such cases, doctors find it ethically right to end their lives so that they are able to die in dignity (Hawkins 2002). In some instances, doctors conduct physician-assisted suicide in order to save vital organs that a dying patient may be having. Long waiting lists exist for such organs as livers, kidneys, and hearts. If physician-assisted suicide is conducted, such organs are saved. These organs can be donated to patients from a waiting list that may be requiring them urgently.

In the United States, physician-assisted suicide is illegal in most states. According to the laws of most states in America, Americans do not have the right of refusing or ending life with sustainable methods of treatment such as feeding tubes and ventilators. It is, therefore, illegal for a doctor to disconnect the feeding tubes of a terminally ill patient (Behuniak & Svenson 2003). Laws in most states of America also emphasize on the importance of controlling pain for dying patients. According to the Laws of Kansas, it is a crime when a doctor assists a patient to commit suicide.

It is also wrong for a physician to provide any physical means that will help the patient to attempt to commit suicide. Recently, Washington passed laws that allowed physician-assisted suicide. The laws of this state allow patients to be mentally competent and terminally ill to obtain the prescription of doctors in order for them to get a dose of lethal medication. In 2009, 63 patients filed for the prescriptions of legal medication. 36 patients died after taking lethal medication. Some of the patients that died from the legal medication were suffering from cancer.

In 1997, Oregon passed the Death with Dignity Act. According to this Act, terminally ill patients being mentally competent can request prescription medicine to hasten their deaths (Snyder & Caplan 2002). Before a citizen qualifies for physician-assisted suicide, he/she must be eighteen years or older, a resident of Washington or Oregon, and be capable of communicating and making healthcare decisions for him/herself. Such patients should be diagnosed with the terminal illness that may cause them to die within six months (Snyder & Caplan 2002). The physician-assisted suicide of Terri was legal. According to the laws of Florida, a person may allow another person to die if the conditions of the case let this. Terri had stated that she would have liked to die if her life was supported by medical machines.

The professional values doctors require that they take care of patients in order to ensure that they do not suffer due to the medical conditions affecting them. By carrying out physician-assisted suicide on patients that may be in extreme pain and suffering due to terminal illnesses that they might be facing, the doctors will be committing suicide to their patients (Jeffry 2008). In addition, doctors are required to fulfill the wishes of patients and trust the decision that the patient has arrived. If the patient wishes to engage in physician-assisted suicide due to suffering that he/she may be going through, then the doctor should fulfill this duty.

Future Practice

The number of patients requiring physician-assisted suicide is increasing each day. According to the statistics released by the Cancer Research Institute, patients suffering from cancer may want to commit physician-assisted suicide (Kopelman & Ville 2001). This especially happens to the patients that may be suffering from terminal cancer. The studies have revealed that patients suffering from cancer may seek physician-assisted suicide due to clinical depression. Patients suffering from this form of depression exhibit symptoms such as a change in their appetite, low energy levels, and the loss of weight.

In addition, they may be filled with a lot of anxieties making their levels of depression worsen. Terminal ill cancer patients may also experience psychosocial suffering making them choose the option of committing suicide. They may have a strong feeling of shame and the notion that people do not want them since they are a burden to them (Carr 2010). It may cause them to experience tension with the people that they love, thus, hindering their relationships. Such patients may also experience the physical suffering caused by dehydration, constipation, cachexia, sleep deprivation, and breathlessness.

Terminally ill cancer patients also request physician-assisted suicide since most of them may have a great fear regarding their future. Some patients worry that they will end up losing their independence due to the severity of their illnesses. In addition, some patients fear that they may end up being a burden to other people in society. Due to this, they may end up requesting physician-assisted suicide since they fear that their self-image may be lost. Therefore, they prefer to die with dignity by committing physician-assisted suicide.

The number of patients suffering from AIDS that seek physician-assisted suicide has also been on its rise in a health care setting. According to the study conducted by the Regional Coordinating Centre for Aids Policy, 26 percent of patients suffering from AIDS ask their doctors to assist them in committing suicide compared to 7 percent of patients suffering from cancer. 34 percent of doctors attending to patients suffering from AIDS have revealed that they would comply with the request for euthanasia if they had the power to grant this request (Snyder & Caplan 2002).

According to the study conducted in health care institutions in California, 53 percent of doctors stated that they had performed at least one physician-assisted suicide especially to patients suffering from AIDS. Fifteen percent of nurses interviewed in this study also have revealed that they had helped patients suffering from AIDS to commit suicide (Snyder & Caplan 2002). Doctors have revealed that most patients suffering from AIDS requests for physician-assisted suicide since they experience a lot of pain. In addition, these patients may have some psychological problems making them contemplate committing suicide.

Doctors give different opinions on whether physician-assisted suicide should be allowed in future practice. Doctors who support the legalization of physician-assisted suicide argue that this procedure should be allowed to the terminally ill patients being competent. Physician-assisted suicide is a compassionate response to help them to avoid the pain they may be experiencing due to the particular terminal illness affecting them (Paterson 2008). However, these doctors state that this procedure should only be used if all the options for a particular treatment are being exhausted. In addition, they should only be allowed when all palliative care efforts have failed to relieve the unbearable pain that the doctors may be engaging.

 

If physician-assisted suicides are allowed, family and patient anxiety that would be brought about due to the death of patients would be reduced. In addition, the care and comfort of patients at the end of their lives would be improved. In 1998, the study was conducted in Michigan to find out whether the physicians in this state-supported physician-assisted suicide. From the study conducted in this state, 56 percent of doctors have revealed that they would support the legalization of physician-assisted suicide (Hawkins 2002). 66 percent of citizens said that they would also support the legalization of physician-assisted suicide. 49 percent of doctors interviewed in Iowa have revealed that they would support physician-assisted suicide if it occurred in narrow conditions.

Massachusetts wanted to introduce physician-assisted suicide in order to ensure that health care institutions in this state provided this form of service to the patients requesting it. However, the vote for the legalization of this form of suicide was rejected when citizens of Massachusetts voted in November 2012. The voters rejected the question 2 of the Death with Dignity Act. Question two of this act would have proposed some measures that would have allowed patients to be terminally ill to be given lethal drugs to end the life of patients.

According to this Act, a terminally ill patient refers to the patient who may be having six or fewer months to live. Before being granted the request for physician-assisted suicide, the patient is seeking this request orally twice. This request also has to be witnessed in writing. Two doctors have to confirm the capacity of patients to make health care decisions. From the election results, 51.9 percent of Massachusetts’ voters opposed the provisions defined by the question two of the Death with Dignity Act. In contrast, 48.1 percent supported question two of this act (Mukherjee 2012).

Lawmakers in New Jersey also want to introduce physician-assisted suicide in this state. This is because they believe that health care institutions in this state should grant patients the right to die with dignity and end any suffering that the patients may be experiencing. John Burzicheli has introduced this bill with the aim of making New Jersey become the third state to allow physician-assisted suicide. According to the study conducted by Fairleigh Dickson University, 46 percent of voters in this state would support the passing of the physician-assisted suicide in New Jersey (Schindler et al. 2013). Lawmakers in this state want psychologists to be included in the assessment of patients before they are prescribed a drug for committing physician-assisted suicide. On 09 February 2013, New Jersey State Assembly voted in the favor of physician-assisted suicide. This measure was passed with the vote of 7-2 with only two abstentions.

The above recent trend of states considering legalizing physician-assisted suicide has shown that healthcare institutions should focus on this issue. Oregon legalized it in 1997. The main drug that was used to conduct physician-assisted suicide was Secobarbital. Health care providers propose that the drug that people should be prescribed to commit physician-assisted suicide is Nembutal. In small doses, this drug is used as a sedative since it is a depressant of the central nervous system. Pharmacists have established that six grams of vet. Nembutal put in 100 ml bottles is lethal and can cause the death of a patient (Kopelman & Ville 2001).

Doctors who support physician-assisted suicide argue that it should be legal to all the patients suffering from multiple sclerosis in the future. In this disease, the immune system of the body eats away myelin sheath that covers the nervous system of human beings. When the myelin sheath of human beings is damaged, the interference of communication between a spinal cord, brain, and other areas of the human body occurs. This condition leads to the deterioration of nerves, and it cannot be reversed. When patients suffer from severe cases of multiple sclerosis, they may lose their ability to speak clearly or their ability to walk. Patients with this disease have such complications as muscle stiffness and spasms.

In addition, such patients may end up having problems in their bladder and sexual functionality. The mental health of such patients is also affected (Marzili 2004). They do experience some difficulties in their normal concentration. In addition, they may also lose the memory of important events in their lives. Doctors argue that future medical practice should allow physician-assisted suicide for such patients since there is no cure for this disease. Patients suffering from terminal illnesses due to this disease suffer a lot. It is necessary to end the suffering of such patients through physician-assisted suicide.

However, physician-assisted suicide will not be legalized easily in health care institutions since it faces huge opposition from the Catholic Church. According to Catholic teachings, it is critical to value human life if it leads to the happiness of life. In addition, it is also critical to value human life at the moments of death and suffering. It will be, therefore, wrong to participate in physician-assisted suicide (Carr 2010). Catholics believe that life is a present that God gives to every human being. By taking away this gift, people will be engaging in sinful acts and ignoring the gift of life given by God.

According to the Catholic Catechism, “An act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator”. Catholics strongly opposed the introduction of the Death and Dignity Act in Massachusetts. This factor led to the failure of the introduction of this act in Massachusetts. It shows that if the Catholic Church continues to oppose the introduction of physician-assisted suicide, it will be hard for health care institutions to introduce it in the future.

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It will be also hard for health care institutions since disability activists argue that it is not morally and ethically right for doctors to engage in this act. According to these activists, the life of people having disabilities is significantly devalued by society. They argue that people feel it is the duty of those with disability to die when they allow physician-assisted suicide to be carried out on the old people living in society (Carr 2010).

Some activists argue that people in a health care system discriminate and have a prejudice against people with disabilities. Since physician-assisted suicide will be conducted in health care institutions, it will be a big injustice towards disabled people. In addition, physicians misjudge the quality of life when they participate in patient suicide based on the disability of the patient. This is because they conclude that the fact that a person depends on another person for everyday needs is sufficient enough to make them be treated differently compared to other people in society.

Overall, physician-assisted suicide poses several ethical, legal, and moral issues in healthcare practice. In the case of Terri Schiavo, the court decided that it was right for doctors to remove the feeding tube that was supporting her life since she was in a persistent vegetative state. They argued that Terri had given the oral evidence that she would have liked her life to be ended in case medical machines were supporting it. Doctors removed the feeding tube, and Terri died. The ethical issue surrounding such a case is whether it is morally right for doctors to terminate the life of patients when they perceive that the particular patient is suffering.

In addition, questions arise whether it is morally right for doctors to follow the wishes of the patient that may want assisted suicide. Doctors have a duty of healing patients. It is, therefore, not morally right for doctors to assist patients to commit suicide since it would amount to murder. In most states in the United States, physician-assisted suicide is illegal. However, the number of states seeking the legalization of physician-assisted suicide is increasing. Such states include Massachusetts and New Jersey. This is because people argue that physician-assisted suicide should be allowed to terminally ill patients.

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