Autonomy in Death Essay
Physician-assisted suicide is a controversial topic with only a few states having legalized it; however, many groups are advocating for its approval. Physician-assisted suicide has ethical limitations that only allow a doctor to prescribe, not administer, a lethal dose of medication for a patient who has been deemed terminally ill with less than six months to live by two physicians. The prescription allows the patient to choose both the timing and setting of death and the physician’s only role is provision of medication. This gifts patients with autonomy in their death and relieves the doctor of any moral burden in participation with death keeping this action an ethical practice. Oregon was the first of few states to have legalized physician-assisted suicide but I would like to argue its potential advantages to the entire United States. Ball (2010) said, “In Oregon — the one state in the U.S. where assisted suicide is legal – doctors are allowed to help only state residents who are expected to die within six months” (p.1). Giving terminally ill patients the power to choose a peaceful death demonstrates empathy toward the ill patients and their families.
Terminally ill patients without this empowerment face the difficult choice of using limited resources to end their lives if not given the legal freedom to choose how and when they die. The Code of Ethics for Nurses provision 1.4 is the right to self-determination and it states that Respect for human dignity requires the recognition of specific patient rights, particularly, the right to self-determination. Self-determination, also known as autonomy, is the philosophical basis for informed consent in health care. Patients have the moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed judgment; to be assisted with weighing the benefits, burdens, and available options in their treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or penalty; and to be given necessary support throughout the decision-making and treatment process. Such support would include the opportunity to make decisions with family and significant others and the provision of advice and support from knowledgeable nurses and other health professionals.
Patient should be involved in planning their own health care to the extent they are able to choose to participate (American nurses association, 2001, p.148). Giving this added right to chose physician assisted suicide allows patients the autonomy described in the Nursing Code of Ethics. The purpose of this paper is to argue that physician-assisted suicide is ethical and beneficial because it allows for patient autonomy. “I would argue that by denying terminally ill people recourse to death with dignity via physician prescribed medication, they are inflicting their own brand of coercion and abuse. The concept of a “merciful death” needs to be part of this discussion. It is a sad commentary that our society responds to our pets’ terminal suffering more humanely than to our fellow human beings’ end-of-life struggles”(“Death is best approached”, 2012, p. 1). Many feel that denying patients the right to choose is not advocating for their best interest and is a form of abuse. We wouldn’t leave our ill family pet alive to suffer so why wouldn’t we consider letting our loved ones put themselves out of their misery in a peaceful way? The entire point is to give the public a choice. It would still be up to each individual to decide whether or not to exercise that right if their physician deemed their situation appropriate.
The Code of Ethics for Nurses says that “Respect for human dignity requires the recognition of specific patient rights, particularly, the right of self-determination” (American nurses association, 2001, p.148). This statement implies that the patient should have the right to make end of life decisions on their own. When terminal patients are in pain and suffering, they may not have the strength or will to fight any longer. It is cruel to prolong a patient’s pain and suffering and deny their autonomy to make the decision of having a peaceful death. Also, it can be argued that when patients have their mind set on ending their lives, they tend to follow through on their own even if their physician cannot assist them. This may lead to a more traumatic death and a scene that can be quite traumatizing for the family member or friend who finds their loved one’s remains. The alternative is a prescribed medicine that the patient may take home, choosing the preferred place to die, to allow the patient to die peacefully without sustaining disfiguring injuries thus allowing them a more dignified burial if the family chooses to view the body one last time.
However, in most of the United States, physician-assisted suicide is still illegal so very few Americans are afforded the right to choose to end their life when they are terminally ill. Because physician assisted suicide was brought to the public’s attention as an option by the unconventional tactics of Dr. Jack Kevorkian, the idea of legalizing this was tainted from the beginning, making many states hesitant to allow assisted suicide. Miller (2011) notes that “Jack Kevorkian rose to national prominence as “Dr. Death,” a physician who insisted that sometimes a doctor’s first duty to his patient was to help him die. The retired pathologist, who became an assisted suicide advocate claiming to have had a hand in 130 deaths in the 1990s, helped spark a national debate over euthanasia” (p. A5). Jack Kevorkian’s tactics were questionable because he publicized the deaths of elderly, disabled, and terminally-ill patients using inhaled carbon dioxide or using his self-made suicide machine.
Although the patients had asked for Dr. Kevorkian’s assistance to end their suffering by assisting in their suicide, he received a lot of negative attention because he publicized his assistance in this process by encouraging CBS to broadcast a video of himself injecting a cocktail of lethal drugs into a patient suffering from Lou Gehrig’s disease (Miller, 2011). After much backlash from the public over the fact that he actually injected patients with lethal drugs, he developed a suicide machine which allowed the patient to press a button that caused the machine to administer a mixture of sodium pentothal and potassium chloride which was first used on Janet Adkins, a 54 year old sufferer of Alzheimer’s disease (Miller, 2011). “The last thing Janet Adkins said was, ‘You just make my case known,’” Dr. Kevorkian told the Associated Press” (Miller, 2011, p. A5). Although his tactics were extreme and caused a lot of public controversy, his patients wanted to end their suffering and his actions caused others to advocate for ethical standards to be put into place for legal physician assisted suicide while at the same time completely turning others away from the concept of legalizing euthanasia.
Dr. Goodwin, a general practitioner, said he began advocating for the right to help terminally ill people die after listening to his patients (Miller, 2012). “They want autonomy at this time, to be allowed to die at home with the comfort and support of their families,” Dr. Goodwin said in a 2001 interview (Miller, 2012, p. 1). Because of the extreme tactics used by Jack Kevorkian, who initiated the debate on legalizing euthanasia, many people view those who advocate for the client’s right of physician assisted suicide as cruel or lacking in empathy for patient and families. However, “Peter Goodwin, a family physician who wrote and campaigned for Oregon’s right-to-die law in the 1990s, died after taking a cocktail of lethal drugs prescribed by his doctor, as allowed under the legislation he championed. Dr. Goodwin, 83 years old, had been diagnosed with a degenerative brain disorder similar to Parkinson’s disease and had been given less than six months to live.”(Miller, 2012, p. 1).
Dr. Goodwin believed in a patient’s autonomy in death so much that he chose to exercise his own rights in the same fashion in order to end his own suffering. In an interview with the Oregonian, the local newspaper in Oregon, Dr. Goodwin said that his health was deteriorating and he would soon end his life. “His family gathered to bid him farewell. ‘The situation needs thought, it doesn’t need hope,’ he said. ‘Hope is too ephemeral at that time’”(Miller, 2012, p. 1). This clearly articulates the feelings of a terminally ill man towards the importance of autonomy in concern of his own death. “End-of-life decisions are not arbitrary or impulsive. Why shouldn’t a person choose to end his or her life with dignity if it is obvious that all options for leading any kind of meaningful life are non-existent? I would think any modicum of compassion would respect such a momentous, personal decision. Suffering, physical and mental, and the anguish it causes should produce empathy for the patient’s wishes and desires, even if they run counter to our own sense of rectitude. It is not about us. It’s about the patient’s right of autonomy.
We need to understand that it is ultimately his or her decision to make, not ours”(Death is best approached, 2012, p. 1). In this statement, an unknown author expressed the utmost sympathy for those suffering from terminal illness. Physician assisted suicide is ethical as it demonstrates compassion and empathy towards someone else’s pain, suffering, and rights. There is nothing cruel about autonomy over the decision to die. These kinds of laws need to be considered using a deep emotional understanding of the terminally ill’s feelings and problems. Other countries have legalized euthanasia and have less restrictive laws which allow them to provide services for foreigners. Because of this, if all United States citizens aren’t granted the autonomy they desire in their own country they will still be able to get the results they so desperately want but the outcome may be more painful to family members whose loved ones would end up dying in other countries and in less desirable conditions. Mr. Minelli, who is head of Dignitas, a Swiss company that provides euthanasia services only to foreigners, said that “a memory of his seriously ill grandmother’s pleading in vain with her doctor to help her die left him with a particular interest in Switzerland’s growing right-to-die movement, and he joined one of the main groups. In 1998, he quit to found Dignitas”(Ball, 2010, p. 2).
In 2008, his neighbors’ complaints forced Dignitas out of his rented apartment that he had been using to conduct the assisted suicides and Zurich city officials refused permission for a new venue. In response to this Mr. Minelli organized suicides in cars, a hotel room, industrial sites, and his own home which drew the attention of local officials. “Someone who is used to a five-star hotel can’t come to Dignitas and expect the same,” says Mr. Minelli”(Ball, 2010, p. 2). Is it really beneficial to force terminally ill patients into a foreign country to a harsh environment to grant them the freedom to end their own lives? If terminally ill patients really want a physician assisted suicide, they will find another setting in which they can achieve one but allowing patients to have one in their own country optimizes the setting and allows for more family support near the time of death. It also saves the family the trouble of getting the body of a loved one from a foreign country after the time of death and allows the family to begin funeral arrangements sooner so that they can go through the stages of grieving that they need to in order to move forward with their own lives.
This act of ending the life sooner also spares the family the pain of watching their loved one suffer longer than they want to. Another benefit to approving physician assisted suicide is that just know that the option is available can be therapeutic for terminal patients. “Mr. Minelli argues that making assisted suicide available removes a taboo around suicide, helping people who want to kill themselves open a dialogue and seek help. About 70% of people who get the green light from Dignitas for an assisted suicide never contact the group again, proving the palliative effect of knowing help is available, he says”(Ball, 2010, p. 2). This clearly proves that just knowing that euthanasia is an option is enough to help patients carry on with terminal illness. Even if a patient chooses never to exercise the right to a physician assisted suicide, the knowledge that they have an option for a way out of their suffering is comforting in itself. Craig Ewert was a retired university professor who suffered from Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s disease.
He decided to end his life because he wanted to make this decision before he lost the ability to decide his own fate, overcoming the resistance of his doctors (Ball, 2010). “When you’re completely paralyzed and can’t talk, how do you let someone know you are suffering?” he told a television interviewer before his death in September 2006. “This could be a complete and utter hell” (Ball, 2010, p. 3). Mr and Mrs. Ewerts were from the U.K. but they traveled to Switzerland and chose Mr. Minelli’s group, Dignitas, because it accepts foreigners. Mrs. Ewert said that had she not been able to travel to get her husband the assisted suicide services that he desired she may have been forced to help her husband die and she worried that she wouldn’t have known exactly what to do (Ball, 2010). She defended Mr. Minelli saying “Sure, there have to be some protections for people, but I think we’re going way beyond what there needs to be, I admire Minelli for being willing to take the heat” (Ball, 2010, p. 3).
Because Craig Ewert was allowed to make his own decision to die, his wife was spared the pressure that he may have put on her to help him end his life. Furthermore, had he been denied the right to make his own decision and his wife Mary had been coerced to help him commit suicide, there would have been extreme emotional and possibly even legal consequences to her action despite the fact that it was her husband’s wish. This is a situation that may Americans are also threatened with because physician assisted suicide is illegal in most of the country. All United States citizens should be afforded the right to choose a physician assisted suicide if they have been deemed terminally ill because this freedom shows compassion and empathy towards the patient’s suffering. If patients aren’t allowed to legally choose death here, they may travel to another country to receive services or chose to carry out suicide on their own.
If patients chose to take matters into their own hands this would be harder on the patient as the death would probably not be as peaceful as the lethal injection that the physician would prescribe and if would also be harder on the patient’s loved ones. If patients decide to go to another country to achieve the death they desire they would lose the privilege of dying in their own comfort zone and the distance would make the death harder on the family to make funeral arrangements and move on with their own lives.
The Code of Ethics for Nurses stated that “Respect not just for the specific decision but also for the patient’s method of decision-making is consistent with the principle of autonomy” (American nurses association, 2001, p.149). Regardless of whether or not we understand an individuals motivation for seeking a physician assisted suicide, nurses should support the autonomy that patients needs to make this choice on their own. Giving terminally ill patients autonomy in their death, by making physician assisted legal for every United States citizen, is only giving patients additional rights that they may or may not chose to exercise and is the most compassionate way to show empathy for those who are dying.
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