End of Life Care – an Ethical Dilemma, Essay Example
Life is a beautiful thing because of all the different experiences it gives us. All the religions in the world as well as agnostics/atheists may not agree upon the life after death or whether it even exists but they do mutually believe that suicide is not a desirable act since it devalues life. Many of us desire to see better human rights record in the world is because we believe there are some universal human rights that should be available to everyone including the right to live with dignity and the freedom to make important life decisions without any unjust outside interference. This is why it has been such a challenge to find common ground on the rights of terminally ill patients or individuals with life changing disabilities to end their life. Such a dilemma pits two universally accepted human rights against each other which are the right to life and the right to make important life choices with absolute freedom.
The first high-profile case to turn attention towards the ethical dilemmas represented by use of technology to artificially prolong life occurred in 1976. Parents of Karen Ann Quinlan, a young woman in her mid-20s, sought a court order to get the right to discontinue all of Karen’s life-sustaining medical interventions so that she could die a natural death. Karen became comatose as a result of ingesting a mixture of drugs and alcohol. The courts have used this case as well as other cases as precedents in recognizing a patient’s right to refuse medical treatment, terminate treatment in special instances, and determine when and under what conditions medical interventions to sustain life could be terminated (Clark, Lucas and Stephens).
27 year old Nathan Crews wants to die because according to him he has no quality of life or a future (Ghose). He is aware of the financial burden on his family and his personal dignity doesn’t want him to cause any more hardships to his family even though his parents have never complaint. He was expected to live twenty years and has already exceeded it by four years. There are various ethical issues that arise in Crews’ case. First of all, even though Crews has the legal right to refuse treatment, his doctors can choose to ignore his wishes if they deem him incompetent to make a decision. In essence, it is basically denying Crews his legal right to refuse treatment. The society is displaying a hypocritical behavior because it wants Crews to live but fails to guarantee him income for life despite the fact that Crews would never be able to work.
Crews has not been able to recover from his condition in over twenty years (Ghose) which should convince most people that his chances of recovery are next to none. Ethically, most people may oppose the right-to-die but a better decision should weigh the moral values of the society which oppose voluntary death against the pain and sufferings of the patient. In this case, Crews doesn’t only have to deal with physical suffering but also emotional hardships which include money being running out and the guilt that he is unable to take care of his personal and financial needs.
The struggle between the patient’s right to get ride of agonizing pain and hardships and the society’s right to preserve human life seems to be universal in nature as the case of Zhang Jianbo shows. Zhang Jianbo had been suffering from late-stage throat cancer and pleaded with doctors to assist with suicide but they refused. Unable to take the pain anymore, he jumped out of the five-storey window of Shuguang Hospital in Changsha. The proponents of doctor-assisted suicide in China argue that it is inhumane to prolong the suffering of the patient which also creates hardships on the family and results in waste of medical resources. The critics argue that people should be encouraged to live and patients are often not in the best state to make decisions for themselves (China Daily).
Many critics are also concerned that the legal system may be abused if doctor-assisted suicides are allowed. The public opinion poll showed that over 85 percent overwhelmingly favor legalizing doctor-assisted suicides. Zhu Tiezhi, a media commentator, suggests requiring prerequisites such as terminal illness that cause agonizing pain and the diagnosis must be verified by two doctors. In addition, the patient must apply twice to ensure he is competent and understands the implications of his decision. Like the U.S., doctors in China also hesitate to honor patients’ wishes due to lack of legal guidance and fear of running afoul of the regulations (China Daily). Thus, it seems that the best solution to this issue may be developing a proper legal framework whether in China or the U.S. because it leads to conflicting ethical questions which leave the doctors in a puzzling situation.
Addressing the issue of patient’s right-to-die, Phillip J. Miller at the University of Tennessee at Martin, made convincing arguments in a paper written for the Journal of Medical Ethics (Miller). Mr. Miller gives the analogy of a food that we have an obligation to eat healthy food as citizens of the society but we also have a right to eat junk food. The junk food may not be good for us but the government cannot stop us from eating it because it has a duty to protect our rights. Similarly, when it is time to die, the medical profession has an obligation to help us achieve our end as dignified and autonomous individuals. The technology should be used for the benefits of the patients and not denying them their right through undue efforts to forestall death.
Mr. Miller argues that most people would prefer to die as thinking, dignified human beings rather than dying as vegetables. Mr. Miller emphasizes that he is not opposing the use of technology in healthcare but only its misuse (Miller). Mr. Miller does succeed in reminding us that many patients in vegetal state such as Dan Crews owe it to technology to have artificial means of breathing. If there were no technology, individuals like Dan Crew may have gotten their wish a lot sooner. The ethical question here is that even though life is a precious thing and worth fighting for but should it still be treasured when prolonging it only results in unnecessary suffering for the individuals.
As of 2005, Oregon was the only U.S. state that had legalized physician-assisted-suicide. The law was passed in 1994 but didn’t go into effect until 1997. The law known by its official name Death with Dignity Act of Oregon goes a step further by allowing patients to hasten their own death with a prescribed lethal dose of medication from a physician. The critics oppose similar laws in other states on the basis of the following arguments:
- Terminal illness is still not clearly defined
- Assessing mental competency is difficult and potential abuses of incompetent patients need to be adequately safeguarded against
- Depression and fear leads to feelings of despair and hopelessness
- Socioeconomically disadvantaged people may be unfairly pressured to accept the option of physician-assisted suicide (Center for Bioethics)
Washington State’s Death with Dignity Act was passed in 2008 after 58 percent of the voters in the general election of 2008 voted in favor of it. The Act took effect on March 5, 2009 and 152 people had received lethal medication under the law by July 5, 2011. Washington State’s law seems to be well designed and takes various measures against a potential abuse and possible provide a good draft to other states who may want to follow the suit. To be eligible, a person must be a state resident, at least eighteen years old, be diagnosed with an illness that will cause death within six months, be mentally and emotionally capable of making the decision to end life, and able to take the pills without aid. In addition, two oral requests and one signed and dated written request must be made to the doctor. Two witnesses need to confirm a person is eligible when the written request is signed. At least one witness cannot be related to the person, stand to financially gain from the person’s death or work in a facility where the person received care. Moreover, there must also be a waiting period of at least fifteen days between the two oral requests. Primary doctors are required to get a second doctor to confirm a person is eligible and doctors must offer a chance to reconsider before writing a prescription. Other states such as Vermont, Massachusetts, Pennsylvania, and Hawaii are also considering similar measures (Marczynski).
As far as religions are concerned, one can reasonably assume that most of them would be opposed to a patient’s right to die. Christian conservatives were opposed to removing the feeding tube of Terri Schiavo (Christianity Today) whose case was the focus of the whole nation. A BBC Religion and Ethics feature on euthanasia claimed that Christians are mostly against euthanasia because they believe life is given by God and human beings are made in God’s image. On May 5, 1980, the Sacred Congregation for the Doctrine of the Faith issued an official Declaration on Euthanasia in which performing euthanasia on another or allowing it for oneself was called a violation of the divine law, an offense against the dignity of the human person, a crime against life, and an attack on humanity (Religion Facts). Thus, religious ethics assume that we do not own our life, thus, we do not have the right to demand or support physician-assisted suicide because it is a crime against God. The following Bible verse may be used by some of the right-wing Christians to support their argument, “What? know ye not that your body is the temple of the Holy Ghost which is in you, which ye have of God, and ye are not your own? For ye are bought with a price; therefore glorify God in your body, and in your spirit, which are God’s” (1 Corinthians 6:19, 20) (Southeastern Mennonite Conference).
Over time, the public opinion has also been changing in favor of giving individuals the right to determine whether they want to live or utilize their right to die with dignity. In a Pew Research Center’s survey, 70 percent of the respondents said that there are circumstances when patients should be allowed to die while only 22 percent argued that doctors and nurses should do everything possible to save a patient. 69 percent who were married said that they had a conversation with a spouse about end-of-life medical care. 74 percent said that a family member should be permitted to make the decision whether to continue medical treatment for a terminally ill loved one who is unable to communicate his wishes (Pew Research Center).
The individual’s right-to-die remains a controversial issue though most of the opponents come from the right and hold deep religious views while those on the left with liberal leanings seem more likely to support the cause. Overall, public opinion is changing in favor of honoring an individual’s desire to halt treatment. At least two states, Oregon and Washington State already have laws authorizing physician-assisted suicides while some other states are currently considering similar bills. There are ethical arguments on both sides of the issue and a better solution may be to tackle the issue through legal framework.
Center for Bioethics. “End of Life Care: An Ethical Overview.” 2005.
China Daily. Euthanasia faces ethical and legal dilemmas. 27 October 2003. 12 December 2011 <http://www.chinadaily.com.cn/en/doc/2003-10/27/content_275728.htm>.
Christianity Today. Terri Schiavo. 12 December 2011 <http://www.christianitytoday.com/ct/special/terrischiavo.html>.
Clark, Gary D., Karen Lucas and Larry Stephens. “Ethical dilemmas and decisions concerning.” Journal of the American Association of Nurse Anesthetists June 1994: 253-256.
Ghose, Tia. Paralyzed accident victim fights for right to die. 28 November 2010. 6 December 2011 <http://www.jsonline.com/features/health/110948384.html>.
Marczynski, Evan. Death with Dignity Act may face amendment. 7 July 2011. 12 December 2011 <http://westernfrontonline.net/news/13629-death-with-dignity-act-may-face-amendment>.
Miller, Phillip J. “Death with dignity and the right to die:.” Journal of Medical Ethics 1987: 81-85.
Pew Research Center. Strong Public Support for Right to Die. 5 January 2006. 12 December 2011 <http://www.people-press.org/2006/01/05/strong-public-support-for-right-to-die/>.
Religion Facts. Euthanasia and Christianity: Christian Views of Euthanasia and Suicide. 12 December 2011 <http://www.religionfacts.com/euthanasia/christianity.htm>.
Southeastern Mennonite Conference. Ethical Issues Related to Life and Death. June 1988. 12 December 2011 <http://www.anabaptists.org/tracts/life-and-death-ethics.html>.
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