PHYSICIAN-ASSISTED SUICIDE.   Term Paper ID:24085 Click to get this paper

Essay Subject: Legal & ethical issues & theories, patient rights & autonomy, doctor's duties, court decisions, medical futility, compared to euthanasia, psychological aspects.... More...

12 Pages / 2700 Words 14 sources, 25 Citations, APA Format $48.00 Return to List of Papers

Paper Abstract: Legal & ethical issues & theories, patient rights & autonomy, doctor's duties, court decisions, medical futility, compared to euthanasia, psychological aspects. Paper Introduction: PHYSICIAN-ASSISTED SUICIDE Introduction Physician-assisted suicide currently exists in spite of it's unsanctioned status. Requests for assisted suicide and euthanasia are made and doctors comply. The debate for and against assisted suicide includes ethical and legal aspects, and perceived rights and duties of the doctor, nurse, and patient. Additionally, conflict involves moral, political, social, cultural, economic, and practical administrative issues. Relevant ethical theories help participants arrive at individual conclusions. Ethical & Legal Aspects; Rights & Duties Studies show that patient requests for physician-assisted suicide and euthanasia are common. Back, Wallace, Starks, and Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. (1997). Curtin (1995) reports that confusion exists regarding the termeuthanasia. It must be clear that the patient's judgement is notdistorted. If the patient is mentally competent, the physician is bound to honor therequest (Angell, 1997). It is pointed out that currently, there is nostate law that makes suicide or attempted suicide a crime; this is viewedby some as an indication of acceptance of individual self-determinationregarding the taking of one's own life which is analogous to therequirement for voluntary active euthanasia (Kamisar, 1993). The physician is prohibited from knowingly and directly causing deathwithout respect of the patient's wishes, quality of life, or prognosis,however, no such consensus exists regarding the legality of assistingsuffering patients in the act of suicide by providing medical advice or byprescribing the means. Still others view the situation as acceptable in exceptionalcases. Nurses are involved in assisted suicide; theyface the same moral, ethical, and legal decisions which consider thepatient's values and best interests. Others findthis position to violate the ethical imperative of doctors to provide carein the best way to serve the patients' interests and wishes. A.(1996). Hendin, H., & Klerman, G. However, this reference does not end theobligation of the nurse to provide proper care which includes promotingcomfort and the alleviation of suffering; this may include pain control andin some instances foregoing life-sustaining treatments. Normative ethics consists of two concepts, deontological ethics andteleological ethics. State laws in Washington and New York that ban doctor'sassistance to their patients in suicide were held as unconstitutional byCircuit Courts of Appeals. Professional ethics innursing. (1995). Some argue that assisted suicide would not be necessary if caregivers were sufficiently skillful and compassionate; others state that goodcare is not relevant and does not exclude assisted suicide. Requests for assisted suicide and euthanasia are madeand doctors comply. Normative ethics is considered the most useful in a program ofstudy in bioethics for the professional nursing curriculum; the nurse iscontinually debating regarding what is good or right, as a general concern,or in a particular patient situation (Thompson & Thompson, 199 ). Consultation with anotherphysician should be required to ensure that all conditions are met. The New England Journal of Medicine, 336 (1), 5 -53. Cleardocumentation supporting each condition should be required (Quill, Cassel,& Meier, 1992). G., et al., & Orentlicher, D. The role of the nurse is to promote,preserve, and protect human life; the nurse is not to act deliberately toend the life of a person. Residencyis required although residency requirements are not defined by the act(Alpers & Lo, 1995). Futility isconsidered a professional judgment and the duty of the physician that takesprecedence over patient autonomy and permits the physician to withhold orwithdraw treatment that is futile, without patient approval (Friedman,1992). Drickamer, M. Another consideration is thatdepressed patients might seek assisted suicide instead of help fordepression. In a study of a group of physicians caring for HIVpatients, acceptance of assisted suicide was found to increase between 199 and 1995 (Slome, Mitchell, Charlebois, Benevedes, & Abrams, 1997). It is argued by some that physician-assisted suicide should remainillegal so that doctors would think twice before assisting; this argumentis said to wrongfully shift the focus from the rights of the patient toconcern for the doctor. The Supreme Court and physician-assisted suicide- the ultimate right. O. (199 ). Physicians may be willing or not to assist patients in dying based oncomplex factors such as religious beliefs, personal values, medicalspecialty, age, practice setting, and financial resources. American Journal of Psychiatry, 15 (1), 143-145. Although thesepractices are currently illegal in Washington State, physiciansoccasionally comply. Supreme Courtwill decide whether to let decisions by two appeals courts stand; thedecisions permit doctors to help the terminally ill patients commitsuicide. In this case,to deny the patient's request to help with suicide, would be a form ofabandonment (Angell, 1997). n.p.: AmericanHospital Publishing, Inc. During the past year, 12 percent of respondingphysicians reported one or more requests for physician-assisted suicide and4 percent received one or more request for euthanasia. Florida: Robert E. M., &Abrams, D. Hendin and Klerman (1993) report that 95 percent of those whokill themselves have a psychiatric illness and most suffer from depression. Regarding the economically and socially vulnerable, it is argued thatassisted suicide might pose a threat; poor, disabled, and elderly might becoerced into this choice. Care of the hopelessly ill. It is further arguedthat if physicians judge a treatment to be futile, they are entitled towithhold the procedure, in concert with other health care professionalswithout the need for consent from the patient or family members. K., & Meier, D. A., & Ganzini, L. However, this act isalso considered active by others, since the patient is dependent on thetreatment and to end treatment without the consent of the patient or aproxy, would be considered homicide. Miller, F. The nurse and the physician must make ethical decisions that aregrounded in some general theory; ethical foundations can be grounded inreligious traditions, a secular world view, or an explicit normativeethical theory. The ethics of compromise. The suicide should be carried out in the context of ameaningful doctor-patient relationship. Conflicting Principles The withdrawal of life-sustaining treatment is considered a passiverole, the cause of death is the underlying disease. The New England Journal of Medicine, 327 (19), 138 -1384.----------------------- 3 Efforts that address palliativecare options and reliable prescribing information will also be needed(Drickamer, Lee, & Ganzini, 1997). Standards regarding comfortcare do not include the permitting of death to be caused intentionally.Regulation of the physician-assisted suicide is viewed as necessary due toits nonstandard medical practice and its potential for abuse. One of the most important ethical principles in medicine is respectfor the patient's autonomy. Back, Wallace, Starks, and Pearlman (1996) reportedthe results of their study regarding assisted suicide and euthanasia inWashington State. This principle is incorporated in lawsgoverning medical practice and research. Patient autonomy andself-determination, important ethical principles in medicine, argue infavor of assisted suicide. Are laws against assisted suicideunconstitutional? Many patients are physically unable tocommit suicide by themselves, others do not have the resources. Nonrational elements are found to be present with the wish to die inreaction to serious illness. The patient must of free will, request to die rather thancontinue suffering. The lackof available physician-assisted suicide leaves others to manage their ownsuicide with passive methods such as starvation, or violent methods such asshooting oneself, that can be considered to cause additional harm andsuffering to the patient and the family (Angell, 1997). Legal and ethical rights, duties, and obligations can and doconflict. Physician-assisted suicide and euthanasia in Washington State.JAMA, 275 (12), 919-925. Physician-assisted suicide in Oregon.JAMA, 274 (6), 483-487. The actprohibits active euthanasia, mercy killing, and lethal injection;assistance is not granted to physicians for those too incapacitated to taketheir own lethal medication. All three groups agree that national efforts are needed to improvethe care of the dying (Foley, 1997). Professionals will need to developguidelines for exchanges of information regarding the physician-patientrelationship, the evaluation and treatment of reasons for requests such asdepression, the handling of referrals, and the addressing ofconfidentiality and reimbursement issues. Legal obligations and duties are defined by law; ethical duties andobligations may not be clearly legislated and at times may be based onmoral codes. However, any treatment with the purpose tocause death is outside standard medical practices which aim at promotinghealth, healing, and alleviating suffering. An inalienable right cannot be waived or given up evenwith voluntary consent and it cannot be transferred or waived with respectto someone else; an agreement to give up the right is unenforceable. Arguments against these concerns state thatterminally ill patients do tend to be depressed or sad, and that althoughantidepressant treatment may be suggested, this should not be a requiredcondition of receiving suicide assistance (Angell, 1997). Curtin, L. Since1976, the right to stop treatment has been repeatedly recognized; it wasaffirmed by the U.S. In this case to aid a patient indying is to abandon that patient; instead the doctor should see it throughto the end. Choices and conflict. The physician is faced with relying on attitudestoward legal risk versus the compelling nature of the patient's request(Miller et al., 1995). Orentlicher further points out problems with physician-assistedsuicide; it violates ethically and legally, the right to life as aninalienable right. Practicalissues in physician-assisted suicide. Relevantethical theories help participants arrive at individual conclusions. Euthanasia is subdivided at times into voluntary (patientconsent), involuntary (patient refuses), and nonvoluntary (patient isunable to consent). Ethical & Legal Aspects; Rights & Duties Studies show that patient requests for physician-assisted suicide andeuthanasia are common. (1997). Supreme Court in 199 and by the U.S. This irresponsible type of reasoning is alsoreflected in statements such as people can do it themselves and do not needassistance to commit suicide. In 1994 Oregon became the first state to legalize physician-assistedsuicide for the terminally ill; the Death With dignity Act allows qualifiedpatients to legally request and obtain a dignified death. Nursing Outlook, 37(3), 152. Foley, K. Angell (1997) reports that later this year the U.S. Hastings Center Report, 23 (3), 32-4 . (1989). The courts base their decisions on fundamentalrights rather than the political process; suicide, like abortion, is apersonal choice protected by the Constitution and forbidding doctors toassist would nullify these rights. Regulatorypolicies would need to include the following: promotion of comfort care asstandard treatment for the dying patient; physician-assisted death bepermitted only for competent patients who volunteer to die; standardpractice guidelines for last resort lethal treatment of unrelievablesuffering; a committee review mechanism; and public accountability. (1992). Integrity-preserving moral compromise is proposedas a method of reaching ethical decisions which respect the conflictingvalues of all parties involved. References Alpers, A., & Lo, B. E., Cassel, C. E., & Pearlman, R. Proposed clinical criteria for physician-assisted suicide. Clinical criteria are proposed for physician-assisted suicide. (1997). Compromise settles differences; decisionsare arrived at that respect and preserve each person's integrity and noneare forced to give up their own interests or their moral integrity (Fry,1989). Everyday decision making by nurses requiresthe use of bioethical pluralism which simultaneously concerns itself withthe means and the end (Thompson & Thompson, 199 ). Theproblem and the solution may lie in the definition of futile. Teleologicalethics judges an act as morally right or wrong by judging the consequences;the consequences of the action alone determine its moral worth.Utilitarianism is a form of teleological ethics that states that rightaction is that which produces the greatest amount of pleasure or good forthe greatest number or people. Slome, L. Although it might be accurate that cost-burdenedfamilies might feel pressured into requesting suicide, it is also statedthat this wrongdoing is just as likely to happen with the withdrawal oftreatment, and this has not taken place. For example the physician has a legal privilege to prescribemedication, the patient has the legal right to accept or refuse, and thenurse's legal right to teach may not be protected from interference (nurseshave been fired for patient-physician relationship interference). Active euthanasia is stated as referringto someone other than the patient who commits an action to end thepatient's life. I. Some physicians view physician-assisted suicide as acompassionate response to a medical need. Krieger Publishing Co., Inc. The patient has the right to be free ofunwanted bodily invasion. If the decision is upheld, doctors would havethe option of prescribing a lethal dose of a drug and advising the patienton its use for suicide. Sounding board. Of the 58patients requesting euthanasia, 14 (24 percent) received parenteralmedication and died. Thompson, J. E. Orentlicher(1995), physician and lawyer, reports on two conflicting principles:physician-assisted suicide violates the principle of the inalienable rightto life; and restrictions of the availability of physician-assisted suicideto only certain persons is in violation of another principle, the equalstatus of each under the law. (1997). Since the problemexists regardless of its legal status, it is logical to persist in theresolution of conflicting issues that continue to result in needlessongoing suffering for those remaining terminally ill. Others believe that although the future holds unknown possibilities,this fear does not make the proposed decisions inevitable and should not bea determining factor. Physician-assisted suicide, bysupplying necessary drugs, is viewed as in between active and passive; itis more active than switching off a machine and less active than injectingdrugs (Angell, 1997). PHYSICIAN-ASSISTED SUICIDE Introduction Physician-assisted suicide currently exists in spite of it'sunsanctioned status. Ethics in management. Conclusions Studies show that patient requests for physician-assisted suicide andeuthanasia are common and many times doctors comply. report that relief of suffering and self-determinationallow for physician-assisted death to be a permissible option since comfortcare no longer is effective. (1993). Quill, T. Others morally oppose assistedsuicide with a commitment to do no harm. Kamisar, Y. Nursing Management, 26 (6), 64-67. I., Starks, H. Physician-assisted suicide and patients with humanimmunodeficiency virus disease. Bioethical pluralism is an ethicaltheory which simultaneously concerns itself with the means and the end.Within this context, voluntary physician-assisted suicide serves the moralgoal regarding relief of suffering and patient self-determination; itallows for death with dignity. Euthanasia is considered active,directly causing the patient's death. (1995). M. Practical administrative application considerations for physician-assisted suicide are proposed. Physician-assisted suicide and euthanasia arestill not accepted; assisted suicide is illegal in most states andeuthanasia remains illegal in all states (Angell, 1997). Of the 156 patients who requested physician-assistedsuicide, 38 (24 percent) received prescriptions, and 21 died. The New England Journal of Medicine, 336 (1),54-58. In 1994, the American Nurses' Association Board of Directorsmade a statement regarding the term euthanasia; it is reported as definedand characterized in many ways. Physician-assisted suicide: Thedangers of legalization. (1993). The AMA, and others, appear to object to assisted suicide as if itviolates the professions's ethical mission to sustain life; they believethat doctors themselves should not provide the assistance. Nurses facemoral, ethical, and legal decisions which consider the patient's values andbest interests, as well as empirical knowledge regarding proposed treatmentplans. Friedman, E. Studiesdemonstrate that the physician's preference strongly influences that of thepatient. The New England Journal of Medicine, 336(6), 417-421. Ethical Theories & Concepts Bioethical theory considers new foundations for ethical decisionmaking in health care. Annals of Internal Medicine, 126(2), 146-151. Deontological ethics is the ethics of formalism withno exception, regardless of consequence, that includes duties andobligations such as payment of debts and truth telling. (1992). Medical futility is a point to consider; no law or ethical principlerequires physicians to offer or accede to demands for futile treatments.If a medical treatment has been useless in the last 1 cases, thattreatment is considered futile; similarly, if a treatment only preservespermanent unconsciousness or cannot end dependence on intensive medicalcare, that treatment should be considered futile. Physicians areto decide whether they are willing to participate or not, if a case fitsthe provisions of the act, and how to resolve practical issues. The principal axiom that directs ethical judgments fornurses is respect for persons, which is extended to patients, families,nurse colleagues, and team members. There are three ways to assist with the death of a dying patient.Life-sustaining treatment can be withdrawn, the doctor can assist withsuicide, and the doctor can administer a lethal drug (euthanasia). Euthanasia: aclarification. Back, A. Should physiciansbe allowed to assist in patient suicide? F., Charlebois, E., Benevedes, J. Additionally, conflict involves moral, political,social, cultural, economic, and practical administrative issues. Miller (1995), a bioethicist, states that voluntary physician-assisted suicide serves the moral goal regarding relief of suffering andpatient self-determination in cases where care is inadequate. (1995). Thepatient must have an incurable condition associated with severe,unrelenting suffering, and all types of comfort care must be understood.It must be clear that the death request is not a result of inadequatecomfort care. Culturally, it is also said thatto permit physician-assisted dying, is to undermine the high value andmoral worth that society places on life. L., Wallace, J. Congress in 199 (Patient Self-Determination Act). It is fearedthat permitting assisted suicide would lead to immoral decisions tolegalize euthanasia or assisted suicide for patients who are not terminallyill. R., Mitchell, T. T. Active euthanasia in this case refers to actions thatare inconsistent with the ANA Code for Nurses and are therefore ethicallyunacceptable. A., Lee, M. Fry, S. The nurse is involved in assisted suicide as well. Nursing Management, 26 (6), 11 -125. The debate for and against assisted suicide includesethical and legal aspects, and perceived rights and duties of the doctor,nurse, and patient. Normative ethics ask what is right, good, or obligatory;concern is for the rationale for action and an appraisal of the decision-making process before the action. From an egalitarianism point ofview, physician-assisted suicide should not be limited to certain peopleonly. L. E., & Thompson, H. Angell, M. Descriptive ethics is concerned with howpeople behave, with a goal to describe and explore the ethics of a givensituation. Furthermore, reports from the Netherlands, whereeuthanasia and physician-assisted suicide are allowed, demonstrate thatthese dreaded decisions have not taken place (Angell, 1997). Patients must have decision-making capacity;advance directives or surrogate decision makers are not granted. Thephysician is faced with the decision to continue or stop treatments, andwhether this decision should be brought to the patients or their agents;the nurse does more than simply follow orders and must also face thequestion of whether to intervene or to collaborate in the decision to stoptreatment (Fry, 1989; Thompson & Thompson, 199 ). Metaethics is a tradition that isconcerned with the semantics of meaning rather than the action; it isdescribed as analytical thinking. Aninalienable right can however be forfeited, for example, people who commitmurder are subject to capital punishment. Miller et al. Competent care for the dying instead ofphysician-assisted suicide. The requirement of informedconsent to any treatment is an example of this principle; patients exercisethis right when they ask to have life-sustaining treatment to be withdrawn. If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.