Physician-Assisted Dying (PAD) is a term used to refer to physician-assisted suicide or euthanasia, a Greek word to mean the painless killing of patients suffering from a terminal and painful disease. PAD is not a new trend, in ancient Rome, the act was commonly practiced among those of high social ranks to spare them from prolonged pain and suffering (Ardelt 2003). Of course, not all the Greek residents were for the idea, those who opposed were but a minority of the Greek physicians at the time. In present times, the issue of PAD continues to gain popularity, especially in the United States. Out of the 50 states in the US, seven states have legalized physician-assisted suicide, either through legislation or court ruling.
These states are:
Oregon
Washington
Montana
Vermont
California
DC
Colorado
In the order of the oldest in practice (Euthanasia – ProCon 2017). For all the states, PAD can only occur if the patient has six or fewer months to live, for most states, the patient has to be above 18 years.
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Physician-Assisted Dying can happen in three main ways that are, voluntary, involuntary, and non-voluntary. Under voluntary PAD, the patient requests the intervention; Involuntary entails withdrawal of life-supporting machine or therapy without the patient’s consent. Non-voluntary occurs when the preferences of the patients are unknown, and the illness has rendered communication with the patient impossible. The point of controversy with the PAD subject is where some people firmly believe that under no circumstance is man allowed to take the life of another. Those for the culture, on the other hand, believe there is no point of suffering a slow painful, undignified death under medical care, which doesn’t cure one, rather, it prolongs death. This controversy brings us to the question of whether caregivers should assist patients in ending their lives.
Arguments for Physician-Assisted Dying
Those in favor of Physician-Assisted Dying argue that patients have the right to relieve themselves from suffering, and nurses or caregivers have a responsibility to help ease that pain. Many people don’t see the need to undergo unbearable pain at the last moments of their lives. Being forced to exist in cases where death is inevitable is a fate worse than death to the terminal patients. If the person is eventually going to die, PAD is a patient’s only chance of getting the dignified death they want, at a stage when life hasn’t lost all meaning. A study carried out concluded that patients who suffered mentally and psychologically were more likely to request for PAD, compared to those undergoing physical pain. At certain stages of the treatment, patients may consider themselves a burden to their families both financially and emotionally. These patients might be hooked to life-supporting machines, which is the only bridge between death and themselves; their families might be spending a fortune on the machines or drowning in debt just to prolong the patient’s death. The patient might be draining their family members and friends emotionally whenever they come visiting because they refuse to make peace with the fact that the patient will not leave the hospital alive. In such cases, situations where the patients have had closure and made peace with their death, some people argue that it is just and kind to help the patients end their pain.
Arguments against Physician-Assisted Dying
The arguments in contradiction of Physician-Assisted Dying are mostly based on ethical, moral and religious concerns. Opponents of PAD have argued that the practice compromises the Hippocratic Oath, which guides the physician in their day-to-day operations. The oath requires that a physician doesn’t give or suggest a deadly drug to anyone even if they ask for it. Being compassionate of the patient’s predicament doesn’t mean they are to assist the patients in suicide, rather, it implies that the physician should remain with the patient throughout the fight, and help them in any way possible to end the pain. Also, PADs contradicts and demoralizes nurses’ roles as healers; nurses are respectable figures in the society associated with giving and improving life. Making PAD legal would strain the patient-nurse bond – the patients won’t have complete trust in their nurses knowing that the nurses have the power to take lives. Regarding religion, most Christians are against this practice since it undermines the fifth commandment. Reverent Macauley discusses in his article that God is the Lord of life and death; he encourages his congregation that through faith, meaning can be found in death and suffering. Suicide should therefore not be an option (Macauley, 2013).
Those who oppose the Physician-Assisted Suicide are also worried that legalizing the practice might expand possibilities for abuse and misuse. The practice may not be restricted to just the terminally ill patients, but be further extended to include disabled, elderly, or any other members of the vulnerable groups who are distressed or under pressure and feel the need for an early death.
As a nurse, I have seen and witnessed patients’ undergo excruciating pain and suffering. There are always those cases so extreme that they stick to your memory, haunting you daily. At times I admit into the hospital, these happy, confident faces, incredibly full of hope and the will to fight, only to see them a couple of weeks later, completely drained of life with zero will to live. Those are the moments that I am tempted to break my moral judgment and ethical obligation and assist the patients in whichever way they may need. But before I let my emotions drive me to that point, I usually ask myself, what if a cure for that terminal disease is invented or realized the next day? What if during their last breaths the patients realize they still want to fight for their lives? How will the patients’ friends and families feel, that he/she just gave up even with their support? Assisting a patient in taking their life is one of those things that feel right at the moment, but after some time you realize it was a mistake. The hardest thing as a person and as a care provider is when that error cannot is irreversible, and you have to live with the guilt.
Nurses have the ethical obligation to provide a cure and not assist in taking life. There are always other means and options to try before considering PAD. For instance Hospice and Palliative Care or Terminal Sedation. Death, therefore, should not a responsibility put in a human’s hands. Even the Constitution recognizes only the right to be allowed to die, but not to be actively assisted in taking one’s life.
References
Ardelt, M. (2003). Physician-assisted death. Handbook of death and dying, 1, 424-434.
Macauley, R., MD. (2013, September). Physician-assisted suicide. Retrieved from http://stpaulsvt.org/
State-by-State Guide to Physician-Assisted Suicide - Euthanasia - ProCon.org. (2017, February 21). Retrieved from https://euthanasia.procon.org/view.resource.php?resourceID=000132#legal_states
