Euthanasia – the Case of Patient XL, Essay Example

There is no doubt that the question about the amount of time the patient from the case XL has to live is ethically relevant. Six hours, a week and a year are different periods of time. On one hand, the longer her life is, the more things she would be able to do, see and experience, but on the other, the more time the patient has to spend suffocating, the more her sufferings would be.

At the situation described in the case description, the patient’s physician believes that her life is coming to an end in a short period of time. In fact, the woman is dying at the moment, not in a week or a year, and her death is clearly a painful one. Dying itself is a very frustrating condition, and suffocation frightens the patient, makes her feel helpless; in fact, the patient’s condition makes her suffer both physically and morally. As it was mentioned, the patient was not expected to live through the month, and is worried about the pain in her final hours. The patient herself asks the physician to give her diamorphine; therefore, it is clear that the patient does not have the motivation to live as long as possible despite all the suffering.

The situation would look different if the physician believed the patient had chances to live about a week. A week is a period of time when certain affairs can be finished. The patient may read books, watch movies, communicate with family and friends, provided her physical condition allows it. In the case when the physician cannot provide the patient any opportunities to alleviate her problem without putting her under risks of overdose, there is not much difference between six hours and a week. Therefore, if the decision were to be made in this situation, it should depend from the patient’s own free will. The crucial element to consider in this situation is that leaving person to die in pain and suffering is immoral regardless of the duration of her agony.

The situation with a year time period is different. At first, ALS does not make the patient suffocate in a year before the supposed death date, as the inspiratory muscles are able to contract at that stage of the disease. Even if such a situation occurred, ethical concerns would emerge other than the ones described above. A year is quite a prolonged period of time. During a year, a patient may get the chance to enter some experimental treatment program, her response to specific drugs may alter. In other words, some factors may appear that would allow the patient to live longer, or make the quality of her life better, or worth. Exposing a patient to the threat of narcotic overdose would mean depriving her of chances to live longer and better.

The right for self-determination allows the patient to request a supposedly lethal doze of medicine from the doctor, but it does not create an obligation for the physician to perform the injection. As it was mentioned in the text of the assignment, euthanasia is “the act of ending the life of a person suffering from either a terminal illness, or an incurable disease”. In this case, the first part of this definition is to be emphasized. Giving the patient supposedly lethal doze of diamorphine is “the act of ending life”. In other words, it means killing the person, though in the most humane way. It is up to the person to make a decision about either choosing euthanasia, or assisting someone to perform it.

Most world religions label ending human’s life as a sin, and moral norms in most societies support this viewpoint. Deciding about the propriety of such an act is a personal decision, and neither patients nor doctors should be forced to make decisions about euthanasia, or perform it. The Oregon Death With Dignity Act identifies that it is up to the doctor to determine whether she is willing to give prescriptions about lethal drugs. The FAQ about Death With Dignity Act on Oregon state website states that “physician must … be willing to participate in the Act. Physicians are not required to provide prescriptions to patients and participation is voluntary”(FAQs about the Death With Dignity Act, 2010).

Nowadays there is no legislation that would require the doctor to prescribe or give her patient a lethal doze of drug, or help the patient pass away in any other way. Moreover, the terminally ill patient’s right to choose the manner and time she dies, is protected only in two U.S states – Oregon and Washington. Therefore, in most U.S states, and in most other countries (except for Netherlands), the patient’s right for self-determination is not powerful enough to let her decide about her own life, not to mention obliging other people to assist her.

The only appropriate decision for the patient from the case XL would be finding a person who would voluntary help the patient to relieve her suffering. The moral obligation of the physician, if he agrees with the very idea of giving diamorphine to the patient, but is not ready to perform the injection himself, would be making sure that the procedure would go in the safest way. In case the physician is against the very idea of euthanasia, the patient, or his family should search for the doctor who would be willing to help the patient.

Provided the fact that the patient from the case XL is expected to pass away in six hours, searching for another doctor is not a acceptable choice for her. Nevertheless, the doctor should not be forced to give her the drug, as it would undermine the physician’s right for self-determination.

In my opinion money should not be taken into consideration when helping this woman. Financial issues are one of the favorite arguments of the opponents of euthanasia. They state that “suicide laws” have significant financial interests behind them, and prove that insurance companies and the government are lobbying such legislations in order to save money (Clair, 2009). This argument does not look valid, as it is clearly seen on the example of Oregon, where 460 people have used their right to take lethal drug in 12 years (2009 Summary of Oregon’s Death with Dignity Act) that assisted suicide is not very common. This 460 people have not made any significant difference for the financial well-being of their insurance companies, and the rates of people requesting lethal drug prescriptions are not likely to increase much.

Euthanasia or assisted suicide should not be anyhow related to financial matters. The reason is that the object of the debate is human life, and its value cannot be measured in any of the world’s currencies. Nevertheless, the conflict of interests between the patient and the doctor is possible, as financial concerns may become one of the reasons in support of taking a lethal doze of drug. Though the statistics shows that financial implications of treatment bothered only 2,6% of patients who got their lethal doze under the Death With Dignity Act, I believe that economic issues may affect the patients’ decisions. Finding out about the real reasons that made the patient request lethal prescription is one of the tasks of the physician, who is responsible for the patient’s treatment.

On the other hand, most people, who used their right to obtain a lethal doze were educated and more or less well-off. The majority of them (69,1%) had a private medical insurance, and only 1,3% did not have any insurance at all. Therefore, the medical costs of most of the patients were covered by the insurance companies, and they did not have to take money from their families.

The crucial points to take into consideration when deciding about the propriety of euthanasia and assisted suicide are: the patient’s right for self-determination, autonomy and quality of life. Allowing financial issues to influence such decisions means creating the vast field for abuse and fraud. Allowing a person to die from lethal injection is about rescuing her from pain and suffering, regaining ones dignity and autonomy, and not about saving money. In case financial issues would enter this field, our society would become no better than Nazis were, when they murdered and spayed mentally ill people.

If I were the physician, I guess I would give the woman the doze of diamorphine. In my opinion, the patient, provided she is adult and sane, has the right to make decisions about her life. Deciding to terminate ones life in case of incurable illness, is, as for me, no more and no less significant than deciding to get married, have a child, or choosing a career. Nowadays no one can deny the woman’s decision to terminate her pregnancy, or give her baby for adoption. Thus, in case our society allows mother and father to determine whether their kid will live or die, why should they be deprived of the right to decide about their own destiny?

I believe that people should not die in suffering and pain, especially when they explicitly state they do not want it. Depriving terminally ill patient of the opportunity to commit legal painless suicide makes her search for the other ways to kill oneself, which usually are painful and unreliable. In case the patient is unable to end ones life by herself, like the patient from the case XL, refusing her the doze of painkillers means making her suffer in the last hours of her life.

Contemporary medicine has introduced a concept of the quality of life, which is now one of the measurements of the effectiveness of treatment. In my opinion, life of some hospice patients lacks quality because of constant pain, helplessness and disability. Keeping human dignity may be problematic when one is unable to perform the basic actions, like eating, going to the toilet or taking a bath on one’s own. This moral issue is described in detail in Tuesdays with Morrie, a book that describes the last month of an old sociology professor dying from amyotrophic lateral sclerosis, the same illness the patient from case XL suffered. The author describes the feelings of the person, who gradually loses the ability to take care of herself in detail. The protagonist of this story managed to keep dignity even when the disease made him totally helpless, as he was an exceptional person. Most people feel humiliated in such a situation, and would often choose death with dignity instead of such an existence.

I strongly believe that euthanasia should be available to every terminally ill patient. At the same time, for me euthanasia means assisting in a suicide, which is, basically, a morally wrong action. Both the doctor and the patient have to decide, whether he or she is willing to accept responsibility for this decision. I suppose I would be ready to help a suffering person to pass away, but, to be honest, I do not know it for sure. I know I am not alone, as while 60% of Oregon citizens voted for Death With Dignity Act (DWDA), there were 58 physicians throughout the state who actually gave the lethal prescription in 2008.

Even if I had to pass the patient to another physician, knowing he or she would either help the patient die, or not, this would not release me from my moral obligations towards the patient. In my opinion, passing this woman to another doctor (provided I knew what decision the other doctor would be likely to make) would mean deciding about her fate.

According to the biopsychological model, there are three types of factors that play their part in human functioning in the context of disease. These are biological, psychological, and social factors. On the biological level, the patient from the case XL has a terminal condition, which destroys her motor nerves, making it impossible to control ones movements. In fact, the patient’s body loses the ability to function properly.

On the psychological level, the patient is dying. The woman knows that her condition is terminal. She has been aware about her diagnosis for five years, therefore, she should have passed all the five stages of grief, and has accepted her condition. It is indicated in the case description that the patient is worried about the pain she will face in her last hours. The fact that she asks the doctor to inject her diamorphine proves that she is not afraid to pass away. Pain is her main concern. Therefore, on the psychological level the patient is ready to die, but is frightened with the perspective of suffering in her last hours.

On the social level, the patient is the human being, who is leaving this world. In fact, there are no specific rules that would regulate how dying people should be treated; therefore, they often arise fear, sorrow and even disgust in those, who surround them. Human beings remain members of the society even on their deathbed, at least in the eyes of others. At the same time, the patient is, in fact, leaving the social system she has belonged to for all her life. Nevertheless, the opinions of the others are still vital to the dying person. Part of her fear of pain in her last hours is due to concerns about her behavior and appearance at that moment, and about the reaction of her surroundings to it.

In my opinion, the key to easing this woman’s condition may be found either on physical or psychological level. On the psychological level, she needs help to overcome the fear of pain and suffocation. This fear can actually be conquered, as the example of the Tuesdays with Morrie protagonist’s shows, but it requires a considerable amount of time and effort.

In the situation, described in the case XL, acting on the physical level would be the best decision. Giving the patient the doze of the drug she asked for would calm her pain, and, therefore, her fear of pain. She would also keep her dignity on the social level, as she would pass away without prolonged agony, which frightens other people and makes them suffer.

Oregon Death with Dignity Act

The requirements for the request are designed in order to prevent any abuse of the legislation. Nevertheless, there actually are some problems with them.

At first, getting the prescription for the lethal drug is quite a prolonged procedure. It takes at least two weeks to start processing the request, as the patient has to make at least two requests, and at least fifteen days have to pass between them. Two weeks may seem a small amount of time, but these days might be terribly long for the patient who suffers from the pain that cannot be eased. The patient’s records are examined, he is checked for adequacy, and it turns out that getting the doze is a rather complicated and prolonged procedure.

The second weak point is the requirement that the physician should ensure that the patient’s request is not motivated by depression. Depression is a normal human reaction to the fact that one is dying. In case the patient is suffering from pain, or other physical problems, the probability of developing a depression is even higher. The patient from the case XL had five years to reconcile with the idea that she was going to die. At the same time, there are patients who get to know about their conditions several months, or even weeks before passing away, and they do not have time to live through depression. Therefore, these people are deprived of the opportunity to get a lethal doze even if they want it.

Another issue, which is extremely controversial, is the requirement to the age of the patient. Oregon legislation allows people aged 18 and older to complete a request. Nevertheless, children also have terminal illnesses. There is no opportunity for them to pass away painlessly, as their parents and guardians cannot make a request for them, and terminally ill children suffer no less than adults do. In fact, depriving people under 18 of this opportunity, is age discrimination.

The woman from the case XL seems to qualify for the program, as she has less than six months left to live. Nevertheless, there is no information in the case description about her social status, psychological condition, and state of residence (only the citizens of Oregon qualify for the program); therefore, there is not enough data to identify whether she can get the lethal doze.

All the guidelines set in by the Oregon legislation are designed to prevent abuse of the right for euthanasia. When one gets to know he or she is terminally ill, the idea of taking a lethal doze of medication for passing away painlessly may seem a great one. Nevertheless, the person needs time to accept this news, and make an informed and deliberate decision his or her life. The guidelines are designed so that the doctor can make sure that the decision to take the lethal doze was not a sudden one and that it is not caused by depression or coercion.

The legislation also requires that the request for the lethal doze should be witnessed by two people, and one of them should not be anyhow related to the patient, be entitled to any portion of the patient’s estate, or be his healthcare provider. This guideline is designed in order to prevent any pressure from the side of relatives or other persons, who would benefit (or come to harm) as a result of patient’s death.

The Oregon law, regulating euthanasia requires that the patient must be diagnosed with a terminal illness that will kill him or her within six months in order to qualify for the program. I presume that this restriction was introduced in order to prevent people, who have some chances for curing, or, at least, improvement of their physical condition, from committing suicide. Many people, diagnosed with HIV, confess that their first idea after getting to know the diagnosis was committing suicide. Nevertheless, today HIV patients have a chance to live a long life with minimal physical restrictions and suffering. Letting them kill themselves would be inhumane.

Finally, the Death With Dignity Act requires that the patient should be the resident of Oregon. This limitation was introduced in order to prevent the pilgrimage of terminally ill people from other states to the Oregon clinics.

In my opinion, all the guidelines, maybe except the age of the patients, who qualify for the program, are justified. I presume that parents or legal guardians should be given the right to request the prescription for patients under 18, provided the patient can make an informed consent for it. Sure enough, the other restrictions in some way limit the patient’s right for self-determination, but, at the same time, they protect the patient from making an unweighted decision, or being forced to take the lethal doze by their relatives or healthcare providers.

In my opinion there is a distinct difference between prescribing a drug and administering it to the patient. In 2008, 88 prescriptions for lethal drugs were given to terminally ill Oregonians, but only 54 of them actually took the doze (2008 Summary Of Oregon’s Death with Dignity Act). I suppose that if the legislation provisioned that the lethal doze had to be administered by the physician, the amount of DWDA death would be greater. In case the drug is administered by the doctor, the act of suicide, which is usually a thing one does alone, gets one more participant. I believe that physician, even the most professional and compassionate one, would affect the patient’s actions and decisions in such a situation.

In the case when the physician’s role is prescribing the drug, he or she just gives the patient the opportunity to pass away in such manner, and decision whether to use this opportunity is up to the patient. When the doctor actually administers the drug, he or she becomes the accomplice of the suicide. It is, in fact, much more culpable than giving a prescription.

Requiring that the physician should administer the lethal doze is inappropriate with respect to both the doctor and the patient. Choosing people he or she would like to spend his/her last hours with is one of the basic rights of the patient, and it is often that the patients prefer not to see the doctors near their deathbed. At the same time, requiring the doctor to assist in suicide is totally immoral. As it was already mentioned, the decision about the appropriateness of euthanasia is a immensely personal one, both for the patient and the doctor, and there should not be any pressure in this matter.

I presume that the regulations were put in order to protect patients from the pressure that would inevitably arise if the doctor would have to administer the drug, and allow the patients for privacy in the last moments of their lives. Physicians, in their turn, are protected from any legal prosecution, and, what is more important, from the obligation to end their patients’ lives by themselves, thus breaking The Hippocratic Oath, and their moral or religious principles.

There indeed are diseases that last for more than six months, are terminal and cause pain to the patient. Nevertheless, I believe that the physician should not help the patient die in such a case. Nowadays medicine is developing rapidly, and new drugs and methods of treatment emerge. Therefore, there is always a chance that the patient could use the opportunity to get some new treatment that could cure him, or, at least, give him more time to live.

Another argument to consider in this case is that nowadays lots of painkillers exist that allow to alleviate the suffering of the patient. Most people, who are terminally ill, but not dying, can get the drugs that can actually reduce the pain. Pain that cannot be eased by morphine painkillers is usually the attribute of the last month or days of patient’s life.

As for me, HIV is not a diagnosis that should qualify for the DWDA program. Contemporary drugs provide HIV patients the opportunity to live for years without feeling any physical discomfort except for the necessity to take the pills regularly. HIV-infected patients live, work, get married and give birth to health children. I believe that when there is a chance to grant patient years of normal life, euthanasia is not an option to consider. DWDA may become an option for the patient at the terminal stage of AIDS, but not for a HIV-infected person, as HIV itself usually does not generate any physical discomfort at all. This diagnosis sometimes ruins the patients’ lives on the psychological and social levels, but these problems should be solved by psychologists and social workers, and not by prescribing the lethal doze.

As for the cases when there is severe pain, and a desire to die, but no exact time requirement, I suppose that the duty of the physician is to design the best possible medication program in order to reduce the pain, and ensure that the patient has access to psychological help. In fact, such cases should be investigated and solved by a multidisciplinary team, which would help the patient on all levels. Letting patient receive a lethal doze in this case would, as for me, mean depriving him of chances to consider all the options available for fighting his or her disease.

The requirements for eligibility to DWDA act are the following: “an adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die…”(Oregon Death With Dignity Act). The Oregon DWDA does not allow people, who are not terminally ill, request assisted suicide. As a matter of fact, contemporary social norms strongly disapprove of suicide. That is one of the main reasons, which cause such a debate around the issue of euthanasia. Oregon and Washington legislations, permitting terminally ill patients to get lethal doze of medications emerged in response to the movement for the right of terminal patients for autonomy, dignity and self-determination. In fact, the society allowed people, who suffered from unbearable pain, which could not be eased by medications, pass away with dignity. This does not mean that the society approves suicide as a way out of the complicated situations.

The majority of people have thought over the option of suicide at least once in their lives. Life can sometimes be hard, and passing away seems to be the only way out, especially in teenage years. Nevertheless, our society does not approve such an approach. This is one of the reasons that make the DWDA system so complicated. The creators of DWDA, and people, who voted for it, agree that it should be an option only for those, who would die inevitably, and who suffer from pain and other manifestations of their disease. DWDA provisions for careful investigation of the patient’s medical history and psychological condition, before deciding about the appropriateness of giving him or her prescription for the lethal doze. Of course, the person who is not terminally ill, but wishes to get the lethal doze of the drug, may attempt to mislead the physician about his or her condition, but it would doubtfully work.

Sure enough, the probability of making a decision about taking a lethal doze of drugs under the influence of family members exists. Nevertheless, this cannot be seen as a weakness of the Oregon legislation. The reason is that the purpose of DWDA is to give the patient the opportunity to pass away without suffering. Though many patients choose to take the lethal doze to avoid physical discomfort and suffering, the issue of moral suffering should also be considered.

There is no doubt that seeing ones loved one or friend dying in pain causes suffering. Indeed, 36,6% of patients who used their prescription were at least partly motivated by the desire to keep their loved ones from this site (2008 Summary Of Oregon’s Death with Dignity Act). As for me, this reason is no better and no worse than the desire to keep autonomy, dignity, or fear of pain and losing control of bodily functions. It is the right of the patient to do his best to protect his family and friends, as their feelings are often of no less importance to the patient than his or her own physical symptoms.

Nevertheless, there always is a possibility that the patient’s family or caregiver is putting pressure on him or her in order to make him pass away. The requirement that the request for the lethal prescription should be witnessed by two people, one of which should not be anyhow related to the patient, be entitled to any portion of the patient’s estate, or be his healthcare provider is designed in order to minimize the likelihood that the patient may be forced to request the lethal doze of drug. It is up to the patient’s physician to decide about the real reasons that make the patient request the prescription, and in case the doctor suspects someone is putting pressure on the patient, he should inform social services about this situation.

I believe that the DWDA act provisioned all the possible measures to prevent patients from taking the lethal doze under the pressure of their family, healthcare providers, and other people. After all, the decision whether to give prescription or not, is up to the physician, and he or she should make sure that the patient’s decision is independent and informed.

The Hippocratic Oath indeed requires doctors to do only good and avoid harm. The question is what should be considered “good” and ”harm” in the specific situation. Leaving patient, who is suffering from unbearable pain, to die in agony, does not look like a good thing to do. At the same time, letting a suffering person pass away with dignity, does not seem to be a harmful act.

There is no doubt that today medicine is much better than it was a century or two ago. Nevertheless, there still are diseases that cannot be cured. Despite of the progress of pharmacological industry, there still are situations when nothing can help the patient feel better. Contemporary medical ethics implicates that the patient’s life should be kept until it is physically possible, but his physical and moral condition is rarely taken in consideration in this process. The patients’ rights for dignity, autonomy and self-determination became the focus of attention couple of dozens years ago, but still many doctors put physical condition of the patient’s body in priority, forgetting about the other components of health.

The truth is that besides keeping the patient alive, the doctor must take care about the quality of life the patient gets. 87,3% of people who died under DWDA reported they were motivated to take the drug by the inability to engage in activities that make life enjoyable. Therefore, the truth is that most patients prefer death to the life, where they cannot do things that make them happy. My persuasion is that keeping a terminally ill person, who is deprived of opportunities to do things he or she likes, and actually wishes to die, alive, is cruel and inhumane, and has nothing to do with healing.

In my opinion, the physician should not be the one who performs assisted suicide. As it was mentioned earlier, my opinion is that suicide should be a personal decision and an intimate action. Patient should be the sole responsible for his or her decision to terminate his/her life with a lethal doze. Physician should not be the one who administers the drug, at least as long as the patient is physically capable of doing it by herself. Giving prescription for the lethal doze is granting patient the opportunity to use it, but administering this doze means assisting one in a suicide.

At the same time, in case the patient is unable to take the drug, but wants to pass away in such a way, the physician should be the one who administers the drug, just because he is qualified enough to do it right. Sure enough, the physicians should not be forced to administer the drug in any way in case this action goes against his or her personal moral or religious principles. In this situation, he or she should recommend another doctor.

References

Clair, J.(2009).30 Logical Reasons Against Physician-Assisted Suicide. Jane St.Clair Website. Retrieved from http://janestclair.net/30-logical-reasons-against-physician-assisted-suicide/

Department of Human Services. (2010) Characteristics and End-of-life Care of 460 DWDA Patients. Retrieved from http://www.oregon.gov/DHS/ph/pas/docs/yr12-tbl-1.pdf

Department of Human Services. FAQs about the Death With Dignity Act. (2010, May 10). Retrieved from http://www.oregon.gov/DHS/ph/pas/faqs.shtml#whocangive

Department of Human Services. 2009 Summary of Oregon’s Death with Dignity Act. (2010). Retrieved from http://egov.oregon.gov/DHS/ph/pas/docs/year12.pdf

Department of Human Services. 2008 Summary of Oregon’s Death with Dignity Act. (2009). Retrieved from http://egov.oregon.gov/DHS/ph/pas/docs/year11.pdf