Death is inevitable; whether you are sick or healthy one day we are going to experience a cessation in life. There is a lot of suffering towards the end of life especially for terminally-ill patients, they experience lots of pain and their continuous care has enormous financial and emotional implications to the families involved. The suffering informed most of the campaigns for death with dignity legislation to allow terminally-ill patients with a confirmed prognosis of less than or 6 months to live. Allowing the patient to exit on his/her terms is the most prudent decision to making as a health care professional. This decision prevents further suffering experienced by the patient and the caregivers, it provides dignity, control, and peace of mind to the patient. This paper seeks to deconstruct theories and ethical principles which are pro and anti-death with dignity legislation while exploring the importance of death with dignity actions.
Over the last two decades, we’ve witnessed tremendous milestones in death with dignity movements. Different states across the United States are keenly considering this debate and allowing mechanisms for the enactment of the same. Oregon Death with Dignity Act of 1994 remains the pioneering legislation on physician-assisted death legal frameworks. After overcoming the huge uphill of legal process and challenges, Oregon state managed to enact and implement its legislation of the death with dignity act in 1997 (Hedberg, 2017) and provided a framework on how to approach this issue to make credible decisions, while observing healthcare ethical issues and principles.
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The criteria of dispensing death with dignity act are set in Oregon’s death with dignity act as follows; After the patient’s prognosis confirmation, he/ she should wait for at least 15 days before making the first verbal request and second written request for physician-assisted death. The patient’s written request ought to be confirmed by two witnesses; these two witnesses should not be; entitled to inherit the patient’s wealth, not the patient’s physician, and not employed by the health care facility the patient is admitted in (Sperling, 2018). Once the patient’s request has been made, the second physician has the responsibility to evaluate the patient’s medical records to confirm the diagnosis. The patient's mental health and stability should be evaluated and judged to be competent to warrant autonomous power to make such a request (Sperling, 2018). At this stage the physician must reveal to the patient all the available options for end of life care, this will enable the patient to make informed decisions regarding his death with dignity request.
Death with dignity debate has attracted a lot of attention over the years. However, Oregon Death with Dignity Legal Defense and Educational Center (ODLDEC) designed a robust campaign towards the legislation of the act with the help of the Political Action Committee (PAC) (Hedberg, 2017). This action led to the legislation and implementation of the act in 1997, the movement went beyond other states though; the partnership of ODLDEC with activists of death with dignity movement in Vermont and a non-profit organization (Death with Dignity National Center) headquartered in Washington D.C opened more platforms for this debate and thirst for its legislation across different states. These activism movements led to the introduction of death and dignity governing regulations in both Vermont and Washington D.C.
Currently, there are 8 states with death and dignity legislations, namely; California with End of Life Option Act, which was approved in 2015 and implemented from 2016. Colorado has End of Life Option Act 2016, District of Colombia (D.C) 2016.2017, Hawaii, 2018/2019, Death with dignity act of Maine 2019, Aid in dying for the terminally ill New Jersey 2019, Patient Choice and Control at the End of the Life Act, Vermont 2013 and death with dignity act 2008, Washington D.C (Smith, Harvath, Goy, & Ganzini, 2015). The states have allowed patients to choose how they would prefer to exit the imminent death with less pain, suffering, and avoidance of prolonged struggle and burden to the patient and his/her families.
Pro Death with Dignity Perspective
Death with dignity also referred to as Physician-Assisted Dying (PAD) conforms to different bioethics and principles to allow terminally-ill patients to choose how they wish to end their lives and put an end to the suffering. Death with dignity gives patients the right to choose when, how, and where to die. Just like the right to medication, right to life; right to physician-assisted death is gaining more momentum in different states across the U.S. Provisions of such a right to the patient to make decisions conforms to medical ethics and more specifically the autonomy ethic (Dugdale, Lerner, & Callahan, 2019). Death with dignity act requires the physician to provide the patient with information detailing the risks, benefits, and different options of physician-assisted death care, for the patient to make an informed decision (Dugdale, Lerner, & Callahan, 2019). The ability of the dignity act to conform to this bioethics, makes it a better option for the patient and the appropriate recommendation health care professionals should provide, as it stops suffering experienced by terminally ill patients.
The choice of death with dignity does not replace the quality health care nor overwrite the beneficence ethic, which is among the significant bioethical issues guiding health care. Patients with less or six months to live are still entitled to palliative care. Health care professionals are obligated to show kindness and compassion for terminally-ill patients during this stage of their lives. This is shown through adherence to the health care provisions the patient was accorded before requesting for death with dignity procedure (Oakman, Campbell, & Runk, 2015). So whether the patient decides to stay in the hospital as he/she awaits his eventual physician-assisted death or chooses to stay at home, surrounded by their loved ones, the health care facility should accord him the care, kindness, support, and compassion to enhance the smooth transition of the patient.
The theory of utilitarianism provides that a health care professional should evaluate the situation and allow the implementation of decisions that provides more benefits, goodness, and value against those with damage, loss, badness, and great suffering. The outcomes of a decision are of great significance in this theory (Li & L, 2017). In light of the death with dignity act, health professionals in their analysis of the medical records and diagnosis of the patient to determine and confirm the patient prognosis; should conform to utilitarian theory in either allowing or denying physician-assisted death. Provision of physician-assisted dying after analyzing medical records and the patient’s diagnosis for terminally ill patients, recommends for death with dignity procedure as the option with a good outcome for the patient. Since the patient has the autonomy to make his/her decision as provided by the death with dignity act, then it behooves the health care professional to allow the death with dignity in conformity with the consequential theory of medical practice.
The action of a nurse or physicians to allow the death with dignity procedure to go through for terminally ill patients is supported immensely by deontological ethics (Oakman, Campbell, & Runk, 2015). The physician’s intention is pure and out of a point of concern on the patient’s suffering and pain; out of this standpoint, physician’s choose to act in their capacity to provide terminally ill patients with options of dying, to avoid death by suffering and give the patient powers to die on his/her terms. Different states have legal frameworks to support this action and the physician won’t be subject to any sort of justice because his/her intention was from a point of informed consent under the underlining regulations and bioethics (Oakman, Campbell, & Runk, 2015). Death with dignity gives the patients freedom and opportunities to arrange for goodbyes and farewells with their families and provides the fulfillment of dying peacefully, surrounded by their loved ones.
Counter Position
Cons to Death with Dignity Perspective
Physician-assisted dying has attracted a lot of political, religious, and legal challenges over the years. Despite this act doing good to the terminally ill patients, who are at the end of pain and suffering; people still believe that the action goes against the societal moral values and the value accorded to life. Death with dignity doesn’t end suffering but instills fear to other patients that they might be next in line or rather get to a point of making such decisions regarding their lives in the future (Kious & Battin, 2019). This action undermines the physician’s capacity to provide palliative care and the society’s compassion towards the terminally ill patients. It also goes against the societal moral obligation and human dignity as it creates a moral crisis.
Death with dignity compromises patient’s consent to treatment, in most cases terminally ill patients are incapacitated to make such decisions. This allows family and their loved ones to make or impose such decisions on the patient; this action goes against the provided principles of informed consent (Kious & Battin, 2019). This process provides loopholes for people with self-centered ambitions to utilize when it comes to terminating a patient’s life. Physician-aided death goes against the maleficence ethics of medical practice as required by the health care profession (Kious & Battin, 2019). The physician should avoid causing harm to the patient as much as possible (Plaisted, 2013). This principle points out that, the physician should first do no harm to the patient or perform any action which might worsen the condition of the patient and his/her immediate loved ones (Plaisted, 2013). Nurses’ code of ethics provides that nurses are tasked with the responsibility of developing an ethical environment of the work setting to enhance the provision of quality health care (Association, 2015). The administration of lethal drugs to execute physician-assisted dying negates such values and ethics of the nursing profession.
In respect to causing harm to the patient, physician-assisted suicide opposes the Hippocratic Oath held dear by physicians across the globe. Through death with dignity procedure, physicians inflict pain and administer lethal drugs to help the patient end suffering from a terminal illness (Plaisted, 2013). This activity goes against the oath’s specification of “I will not give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect” (Plaisted, 2013). Despite legislation in different states allowing the end of life options; this activity opposes the foundations of physician’s obligations to provide health care and compassion without causing any harm to the patient.
Religious principles hold life has sacred and God alone has dominion over human life. When human beings assume dominion over the lives of others, it creates harm, tyranny, and oppression. Religions like the Catholic Church believe that God alone can be trusted with human life and its destiny and things like death penal code, abortion, and death with dignity go against these very principles (Black & Campbell, 2014). Religious ethics doesn’t condone any act which takes human life administered by fellow humans, as this goes against the moral code and the value accorded to human life. (Black & Campbell, 2014) Apart from creating a moral crisis, physician-assisted death compels patients to choose such a procedure on the premise or fear that his/her suffering is burdening the family financially and emotionally. However, I disagree with the counter position regarding the death with dignity act and the role of a health care professional in such an activity (Black & Campbell, 2014). As far as virtues of physicians are concerned and their compassion; it behooves them to relieve their terminally ill patients from pain and suffering and allow a death with dignity procedure to cease their pain and give them control in the end. The legal provision regarding death with dignity is a green light for physicians to consider providing the death with dignity procedures to their patients.
Research shows that 7 out of 10 Americans support death with dignity act; this represents a significant percentage and provides confidence in the procedure (Johnson, Cramer, Conroy, & Gardner, 2014). Physicians understand the pain and suffering their patients undergo every single day from illness that they won’t make it out alive. The presence of options to choose for patients to stop suffering allows their patients to end their lives peacefully, properly planned and executed on a set date to allow the patients' bid farewell to their loved ones and put all affairs in order. This procedure puts a stop to financial and emotional implications experienced by the family in providing care as they watch every single day how the patient suffers from pain. There is a need to debate and deconstruct this legislation further to consider its extension to other states across the country.
References
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