Physician-assisted suicide is one of the highly contested issues in medicine. The mantra “All life is precious,” versus desperate medical situations might justify physician-assisted suicide. Nonetheless, it is imperative to state that some states in the United States of America have laws and regulations that allow physician assisted suicide (Arnold, 2017). However, opponents argue that life is sacred and should not be terminated. This assertion conflicts with proponents who argue that certain diseases are not only debilitating but also expensive for the families of the sick. Consequentially, the scope of this paper revolves around the ethical issues surrounding the dilemma of assisted suicide and the creation of a care plan.
Summary of Dilemma and Context/Facts of the Case.
Despite Mrs. S having a successful career that leads to her retirement in the rural stateside, she is always alone with the cats. She lived frugally but comfortably in a glasshouse suspended between two trees. Additionally, Mrs. S was not lucky to have children, and she stays in her estate alone.
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One evening she stumbled and fell, hitting her head. Nonetheless, despite the severity of the concussion, she was able to call for help from the local medical center. The 911 dispatcher sent medical assistance to her home, where she was found unconscious and taken to hospital. However, upon being stable, the doctors realized that Mrs. S’s fracture of the cervical spine required specialized attention. This injury necessitated her move to the high-level academic hospital that had a neurosurgery unit.
After a couple of surgeries, Mr. S has lost hope in ever attaining the ability to be independent again. She believes that more surgeries will not rectify her conditions but will only drain her accounts. Furthermore, the environment in the hospital is unbearable and contributing to psychological stress. Consequentially, she asks her medical officers to assist her in taking her life. She suggests that it is the best option for her since she cannot depend on herself and will continue staying at the institution until her injury healed.
Ethical issues/Ethical Principles.
Golligher et al. (2017) indicate that patients admitted to the Intensive Care Unit often grapple with the issue of physician-assisted suicide (PAS) and euthanasia. Additionally, the scholars note developments in social and legal frontiers have been the basis of arguments and discussions on the matter, especially in the US and Canada. The scholars indicate the difference between PAS and euthanasia, noting that the former allows for the patient to administer a lethal dosage of medications themselves, whereas the latter death is a direct causation of the physician or nurse. Nonetheless, these are the ethical issues that revolve around PAS:
a) Patient Autonomy.
McEnroe (2018) notes that the legalization of PAS in some states in the US and Canada emboldens the idea of patient autonomy. The basis of autonomy prioritizes the patient’s wishes in determining the outcome of medical intervention. Nonetheless, with regards to PAS, the patients will be exercising their right to make decisions on their health and future. Hence, Mrs. S’s wishes take precedence on how the healthcare officers handle her case onwards. Alternatively, Sulmasy and Mueller (2018) note that despite the need for providing care being equally important, autonomy remains the most significant ethical issue that protects the rights of the patient. Additionally, the scholar also indicates that death is ethically unjustified, whereas the need to exercise one’s autonomy in making healthcare decisions remains ethically justifiable.
b) Physician Duty to Relieve Patient’s Pain.
Nurses and physicians have a duty to alleviate the pain and suffering experienced by their patients. Notably, pain and suffering might takes both physical or psychological form. Mrs. S suffers from the inability to eat due to the paralysis of her pharynx and vocal cords. Additionally, she has a hard time maintaining her stitches that keep coming off. Furthermore, the patient has been in and out of the operating room a couple of times. These continued interventions and the extended stay at the hospital is contributing to her pain and frustrations. Consequentially, it remains the ethical duty of the healthcare officers to intervene in her situation.
c) Life is sacred, and Medical Officers should not harm.
Religious and pro-life supporters argue that life is not only precious but also sacred. They indicate that overwhelming evidence exists in both religious and cultural contexts supporting the sanctity of life. Furthermore, the doctor’s mantra on the preservation of life through not harm validates the opposition towards PAS. Doctors aiding patients in assisted suicide is a gross violation of the ethical obligation of doctors. Furthermore, “moral justification and legal regulation” of PAS is a violation of the belief of God and sanctity of life (BANOVIĆ, Turanjanin & MILORADOVIĆ, 2017 p. 176).
The Process of Solving the Ethical Dilemma/Course of Action.
The preservation of Mrs. S life takes precedence in solving the dilemma. She indicates frustration from staying at the hospital and the inability to carry out life duties independently. Additionally, the patient also suffers from loneliness as no family member has visited her. Therefore, psychological intervention is required to ascertain the needs and challenges that the patient experiences. Additionally, the removal of stressors, the two unbearable roommates at the neurosurgery observation wing, would be integral in changing Mrs. S attitude.
Suppose psychological intervention fails, Mrs. S’s autonomy in making a sound decision takes precedence. Typically, their legal and moral institutions protect the right to patient autonomy, especially with regards to PAS. Additionally, the doctors have a responsibility to respect the patient’s decision and wishes. Furthermore, it is imperative to state that the medical officers have an ethical obligation to inform the patient about the implications and repercussions of their decision. Mrs. S should be assisted in her death by her physicians and nurses.
Evaluation and Discussion.
The American Medical Association (AMA) and the American Nursing Association (ANA)(Olson & Stokes, 2016) indicate that it is the ethical obligation of the medical officers to respect patient fidelity and self-determination. Additionally, the bodies state that whereas the law and code of ethics allow the doctors and medical officers to facilitate PAS, their actions are stringently limited to prevent the violation of their obligation in the preservation of life. Nonetheless, the irony of this clause is based solely on respecting the patient's will and last respects.
Despite PAS being ethically acceptable, the act is limited by state and federal legal restrictions. State such as California, Maine, New Jersey, Oregon, Vermont, and District of Columbia have laws that support PAS. Additionally, the state of Montana in 2009 had a PAS case after a State Supreme Court ruled on the matter. Alternatively, countries like Canada, Luxembourg, Colombia, Switzerland, and Victoria Australia have laws that allow for PAS. Therefore, suppose Mrs. S is admitted in a state that does not allow for PAS, she can seek admission in another state with the provision ( Death with Dignity, 2015).
Amid conducive legislation that allows for PAS, the responsibility and duties of the medical officers stretch beyond providing the patient with medication. The AMA (2016) indicates that doctors and the medical staff administering the lethal dose should remain with the patient to offer support. Additionally, doctors should also ensure that the patient is comfortable and not in pain. Furthermore, the medical staff should not abandon the patient during the act.
Conclusion.
The issue of physician-assisted deaths remains a contentious issue in medical ethics. Whereas the priority of the patient takes precedence, societal laws pride the importance of life. In most cultures, life is not only considered sacred but also beyond the control of human beings. Therefore, such communities shun the issue of assisted death as a violation of the natural order. Furthermore, the beliefs of the doctors in such regions are biased based on these beliefs. Nonetheless, it is essential to state that certain countries like the US and Canada have adopted a restrictive socially revolutionary approach to selectively accepting PAS.
The debate for and against PAS is based on the superiority of the ethical principles in medicine. The principle of non-maleficence and beneficence account for the actions of the medical officers in the betterment of the patient. Nonetheless, fidelity and autonomy account for the significance of the patient’s decision on matters concerning their health. This lack of congruence in ethical issues on the PAS matters remains the reason behind the selective acceptance of the issue across the world. Nonetheless, Mrs. S’s PAS is justified as she lacks the support system to assist her after feeling better. Additionally, her injuries might be terminal; thus, continued medical interventions might lead to the loss of money, which would instead assist the extended family.
References
AMA. (2016, November 14). Physician-Assisted Suicide . American Medical Association. https://www.ama-assn.org/delivering-care/ethics/physician-assisted-suicide
BANOVIĆ, B., Turanjanin, V., & MILORADOVIĆ, A. (2017). An ethical review of euthanasia and physician-assisted suicide. Iranian journal of public health , 46 (2), 173.
Death with Dignity. (2015, November 6). How to Access and Use Death with Dignity Laws . Death with Dignity. https://www.deathwithdignity.org/learn/access/
Goligher, E. C., Ely, E. W., Sulmasy, D. P., Bakker, J., Raphael, J., Volandes, A. E., ... & White, D. B. (2017). Physician-Assisted Suicide and Euthanasia in the Intensive Care Unit: A Dialogue on Core Ethical Issues. Critical care medicine , 45 (2), 149.
Olson, L. L., & Stokes, F. (2016). The ANA code of ethics for nurses with interpretive statements: Resource for nursing regulation. Journal of Nursing Regulation , 7 (2), 9-20.
Sulmasy, L. S., & Mueller, P. S. (2018). Ethics and the legalization of physician-assisted suicide. Annals of internal medicine , 168 (11), 834-835.
