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The physician-assisted suicide is a controversial issue in the current world. Different opinions with regard to this issue emanate from different cultural beliefs, modernity and people’s religious belief. It has equally offered a hard time to the law makers on whether such an act should be legalized or not. This especially relates to the authority given to the physician when they have to assist patients to die. They are, for example, expected to provide substantial information regarding the patient’s terminal illness, enlighten the patients as to the final alternatives and the difficult part of the decision making to assist patients into death by providing the lethal dose. To weigh the suitability of the law on Death with Dignity Act being enacted in all the states, I will evaluate the position and arguments given by both the proponents and opponents of this act.
Where enacted the law provides a framework within which the assisted suicide process should take place. To start with, there must be two physicians who certify that the patient is suffering from a terminal illness and that the patient has less than six months to live (Mitchell, 2007). There should be no signs of impairment to awareness and this is achieved by ensuring that the patient is not depressed. The patient should also make a formal request which should be witnessed by two persons who are not related to the patient. The patient should also be given adequate time before execution of the process within which he may revoke the decision.
The proponents of the law believe that everyone has a freedom of choice. They view freedom of choice as the right to choose and the right to create to oneself the alternative choices. A man without the right to choose or denied in a choice is viewed as a “thing” or an “instrument”. The Right to Self-determination provides the patient with the authority to decide on how to die and when to die. This is based on the fact that it relates to their body, life and pain and, therefore, it would be appropriate to grant them their wish, if they do not see the purpose of life by themselves. Assessing the legality surrounding the condition of patients suffering from a terminal illness, proponents argue that it is legal for the patient to refuse or require withdrawal of any treatment; require adequate painkillers for comfort irrespective of shortening his/her life and where an imminently dying patient is in great discomfort, it is legal to be sedated till the discomfort is relieved.
For the proponents who appeal to sympathy it is the idea that it is inappropriate to expose the terminally ill people to excessive pain without any value addition to their health. On this ground, hastening the natural timetable of death by some days or hours should not only be acceptable but made mandatory in the modern medical care (Gorsuch, 2006). By enacting the law therefore, we would give the choice to the patients to decide when they had enough and would want to terminate the insults to their depreciating bodies.
There is also a proposed economic argument in support of legalizing the assisted suicide. It is expensive to maintain a patient on life support machines. They argue that it is not prudent to hold them there whereas it is beyond doubt that death will catch up with the patient in a short while. This way, the health facility would be efficiently allocated given their scarcity.
There are others who are in support of the physician-assisted suicide due to the loss of autonomy associated with the terminal illness. These patients can no more rely on themselves but depend on the help of their friends and families. In this case they view themselves as a burden to the society and may choose to have physicians assist them to die. To remove the guilt of seeing others take care of them they should be granted the possibility to comply with their wish.
Some proponents justify their views based on the current technologies. The technologies are such that though they may not assure the terminally ill of any life, they can be able to prolong life for unduly long time. This way, the patient dies slowly. They argue that the patients die slowly in hospital in the midst of technology instead family and friends. Some patients would prefer immediate death rather than be hooked up with tubes in every orifice of their body.
There is a great emotional impact when physicians participate in physician-assisted suicide. They find it excruciating especially on the basis of priorities of life. This evidence shows that physicians would be prepared to sacrifice their jobs to assist a patient in great pain rather than help him die. The Hippocratic Oath is more than a millennial tradition and prohibits on assisted suicide and euthanasia (Torr, 2000). It has provided a framework of core values which guide the physicians on what to do. Ideally, doctors are trained to treat and not to kill. This will always leave a strain of guilt to the physician, if he plays a major role in ending a patient’s life. The physicians, as the patient’s agents, are required to be professional. The Oath states that they should execute their art solely for the cure of the patient and that they should not give drug, perform operation for a criminal purpose. This makes the physician feel that, the Death with Dignity Act would be inappropriate if enacted.
The legal systems also seem to be held in between the alternatives. According to the court of appeal in the U.S., American Association’s Code of Ethics is against the physician-assisted suicide as being contrary to the physician ultimate role as a ‘healer’. To make it difficult for such a law, the Supreme Court added a statement of its own with regard to the physician’s commitments to care being a professional commitment to medical science progress. The court therefore found such attempts to legalize the medically assisted suicide to be a blind alley.
There are those who believe in the existence of higher power which is in charge of life. Man is viewed as just a trustee of his body and would act against God, the rightful owner, when he chooses when to die. He is also seen as violating the commandment to hold life and not to ever remove it without a compelling. In any case, one of the major goals in life is survival. Engaging in a decision that terminates this goal, we would be going against the natural dignity. There is an argument that for those who believe in something after death, they would wait until their time comes (Humphry, 1991). They would have no reason to interfere with the God exit plans.
The most unfortunate thing that may arise with the enactment of this law would relate to false claims. People may have different motives to end life and may request for the physician assistance in doing it. The external pressure may arise from the loss of autonomy. For example, the elderly people may opt for assisted death rather than become a burden to their families and friends. According to the Oregon’s third year Report, 63% of those who chose the suicide cited the fear of being a burden to their families. On the other side, it appears very difficult for friends and members of the family and lovers to make a decision that supports death of their beloved ones. This is due to the guilt for participating in such an act. The dilemma, however, is that if such a decision is not made then they will have to withstand the anguish of watching someone suffering (Battin, 1998).
There are economic reasons that would make it inappropriate to have such law operate in different states. This is based on the deadly mix that arises between the assisted suicide and the profit-based managed healthcare. Generally, the lethal medications used in assisted suicide range between $35 and $50. This is to a greater extent lower than the treatment cost for most terminal diseases. This acts as an incentive to prefer death so as to save money. By legalizing assisted suicide, the trade between wealth and treatments may cause the problem.
The economic motives of the physicians are equally dangerous. To this effect, the assisted suicide is likely to compromise the quality of the existing health care systems. The study conducted by the Georgetown University Center for the Clinic of Bioethics revealed a strong link between revenue-driven managed healthcare systems and the assisted suicide. The research identified cost-cutting pressure among the physicians and hence bias towards prescribing a lethal drug, were it is legally acceptable. For such situations, a sobering of vigilance in legalizing the assisted suicide should exist where pressure to hold costs low among the physician is high.
When legalizing the assisted suicide, the impact would fall hardest on economically and socially disadvantaged members of the society. This is because the existing healthcare systems have discriminated them and they may not get as many alternatives as the rich people would do when suffering from a terminal illness. This puts the law in question with respect to the security of the poor.
The law would be expected to result in different distribution of gains and losses. Obviously, there is a small group of individuals who may benefit from the law including the white, affluent and those in possession of better insurance covers (Egendorf, 1998). However, the less privileged will find themselves confronted with a significant risk of impairment. Though there are those who would prefer death to loss of autonomy, those living with disabilities have developed the liking of others’ assistance and may not prefer death to life. For this reason everybody should fill protected by the existing laws regardless of their circumstances.
The assumption that physicians can be able to determine the cases where a terminally ill person will die in less than six month with an adequate precision is equally dangerous. The assisted suicide is based on the assumption which may leave some loopholes to unscrupulous practitioners. Studies indicate that it is only the cancer cases which one can be able to predict accurately on the occurrence of death (Engdahl, 2009). This, however, is only possible for the last few weeks of life. Use of general statistics for a particular specific case may not be appropriate.
This issue poses a great dilemma to the society. I have found more evidences against the enactment of the Death with Dignity Act among the states. To start with, the physician role is basically to protect life and not to kill. By giving them the authority to decide on the patient’s death would be forcing them against their moral guidelines as provided by their Oath. Also, neither the mental or physical decline, nor diseases or loss of autonomy, nor the pain should undermine the basic value of human life. A patient does not become valueless just because he is chronically ill or dying.
Terminating a patient’s life does not provide a humane solution to the suffering and pain tragic circumstances. The goal of the physician should be aimed at killing the pain and not the patients. It will lead to lack of confidence to the medical science progress by physician proposing euthanasia. The physicians should maintain their focus on the use of the accessible, multiple, increasingly developing and sophisticated techniques of managing pain and sufferings and not to recommend suicide.
Given the varying opinions with respect to the Death with Dignity Act, there may be situations where such laws may be allowed. Assuming that the law was enacted in all the states, the major burden of ensuring that the law is not abused lies solely on the society (Balkin, 2005). The clear evidence from Oregon Health Department is that as much as 79% of those who chose the physician assisted suicide did not have to wait to be bedridden. This necessitates the strict control on when the process should be an option.
First, it is important for the society to be enlightened on the value of life. Evaluation should be made more rigorous to ensure that the patient is not under depression and the decision is well informed given the mental condition of the patient. The grace period before the execution of the request should be prolonged to provide for a greater chance of revoking it.
The profit motive of the physicians and the patient should be evaluated adequately so that it may not dominate in the decision making process. The emphasis should be placed on encouraging physicians to accommodate the patients’ reliance on them so as to reduce the feeling of guilt for the illness. It is done by the U.S. Supreme Court in adding a clause that would make it more difficult to choose the euthanasia, but more amendments should be made. For example, given the difficulty in determining the natural death, assisted death should be allowed as long as the patient is expected to die within less than two months or less.
The decision to accept physician-assisted suicide should be approved by more than two physicians who should act independently to determine the appropriate course of action. This may lower chances of collusion which may be common among the profit-oriented physicians.