Currently in the United States there are eight states in which physician-assisted suicide or death is legal. Around the world this physicians’ aid in dying protocol is practiced in the Netherlands, Belgium, Luxembourg, Columbia, and Canada as well (Emanuel, EJ et al, 2016). While the push to legalize this practice in the U.S. and other countries around the world is becoming more frequent, actual cases of medically assisted patient suicide are rare, even in countries where this practice has been legal for decades.
The aspect of death is universal but the definitions differ in many ways both socially and medically (Crane, 2018). Generally one is declared dead by a doctor one there is complete stop of the heart resulting to the rest of the body ceasing to function. However, sociological approach to death is when the person considered dead stops working and become functionless (Emanuel, EJ et al, 2016). What many might not understand is that social death can preempt even before the actual biological death. This is explained in the context that social death is witnessed when individuals are treated in a manner that presumes they are already dead in medical and social setting (Ganzini, et al,. 2000).
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The factor of social death refers to the circumstance in the experience of sickness and death and the responses and death and mourning which is further described by a sequence of cumulative activities that lead to death (Downar & St Godard, 2015).. The aspect of death in sociology is measured using the following parameters: loss of identity, the function to participate in daily normal activities, social relationships and ultimately the biological death of a human being. Death with dignity seeks to help one transition from the physical life without having to experience terrible circumstance sin the hour of death (Hizo-Abes et al,. 2018).
The period between social death and the biological death is very crucial for the patient and his family (Emanuel, EJ et al, 2016). The most common cases involved in dignified death is the utility of euthanasia to warrant quick death to alleviate suffering and save the social image of the patient. It is argued that patients who are brain dead, those with cancer or other painful terminal diseases seek for a dignified death that is less painful both socially and physically (Crane, 2018). Most patients with these conditions already have lost the ability to function on normal social activities as well as their personhood due to their debilitating conditions. Thus people already get that notion that their patient is already socially dead and the impact is irreversible and experience less acknowledgement due to being distanced from social life and depersonalizing activities in the hospital (Ganzini, et al,. 2000).
It is clear that death both social and biological involves the loss of ones persona and identity in such a way that one can no longer influence own lives and those of other people (Emanuel, EJ et al, 2016). The witnessing of how a patient loses their ability to be independent becomes turmoil to the family, the medical personnel and even to one self. The involved risk of one ceasing to have a social life even before the actual death brings out the fact that the patient might undergo the loss of moral authority and right from people around them (Downar & St Godard, 2015). For instance, patients who are brain dead are treated as though they already ceased to exist and even while people visit, they might talk about them in the past tense. This might also affect how the medics respond to the patients’ medical attention reluctantly since they already know the ultimate end of the patient (Hizo-Abes et al,. 2018).
Social death is not only determined by people around you but also oneself (Ganzini, et al,. 2000). This is displayed when a patient who is terminally ill withdraws from the social activities of their surrounding thus deciding to have social death even before the actual biological death occurs. The family on witnessing the woes of their patient might chose a dignified death for instance by allowing the life support machine to be switched off. In addition, the patient might also request to be given a death shot to ease his or her pain through death. However, various questions arise on use of euthanasia as a form of dignified death and who decides it time to die (Crane, 2018).
Euthanasia is also known as mercy killing and can be defined as a person deciding to end their life or is helped to die with the intention of alleviating pain and intense suffering (Emanuel, EJ et al, 2016). Euthanasia mainly involves the giving of a lethal injection of drugs to a willing patient and the giver of the lethal administration is not the patient. This is also termed as assisted suicide which involves giving the lethal knowledge to a person with the intention of ceasing their own life (Ganzini, et al,. 2000).. What sets apart the assisted suicide and euthanasia is that for euthanasia, it is the medical personnel who administer the lethal drugs to the patient while in assisted suicide; the patient is mostly given information on lethal prescription to end their life (Downar & St Godard, 2015).
There are laws in existence in allowing a person’s choice of death and the various steps one needs to follow to warrant their dignified death. However, there is obscurity in differentiating the use of euthanasia to help one die and the concept of suicide. The question is if the use of euthanasia is really dignified in its utility (Ganzini, et al,. 2000). Those who advocate for the use of euthanasia on patients suggest that on ground of the extent of pain experience or the extent o which the patient already experiences social death. The argument is that it is better for a patient to die than live the remaining part of their life experiencing intense pain which even the medical health workers cannot alleviate. This prompts the patient to settle for euthanasia rather than suffer intensely (Crane, 2018). The other reason is that for a case of a brain dead person on life support, their life is as good as dead and thus their continued life support does not make them better thus it’s rather switched off.
There are countries whereby euthanasia is legal based on the patients request. Laws regulating the use of euthanasia state that a patient who is terminally ill and is suffering under intense pain is allowed mercy killing to alleviate the pain (Emanuel, EJ et al, 2016). However, the opposing side of euthanasia argues that if it is allowed of or made legal, other forms of euthanasia such as involuntary euthanasia may be misused especially on patients with disabilities or mental incompetence (Downar & St Godard, 2015). They further their plight on the fact that most of the pain experienced by terminally ill patients can be alleviated by medical procedures and painkillers. Furthermore, they argue that the Hippocratic medical oath is much against medics killing or aiding any form of killing as they are nurtures and protectors of life (Ganzini, et al,. 2000).
The sociological perspective on the given knowledge in mercy killing and euthanasia as forms of dignified death challenge the fact in many ways as well as support it (Ganzini, et al,. 2000). In the social perspective, human beings strive to preserve and uphold life with the ultimate efforts they can. This follows a negative approach towards dignified death as actions deliberately hastening death are mostly prohibited socially (Crane, 2018). However, some people agree to the aspect of dignified death through administering euthanasia on grounds that, artificially prolonging the suffering of a terminally ill person is cruel thus leading to withdrawal of treatment. It is argued that the pain will be immediately alleviated if the person is allowed to die (Hizo-Abes et al,. 2018).
Dignified death through euthanasia can be used by different groups of social set up. For instance, the mere mention of euthanasia brings up ill feeling for the German speaking nations. During the Nazi regime, euthanasia was systematically used as a term regarding the annihilation of more than six million Jews and 200,000 disabled people either physically or mentally (Downar & St Godard, 2015). In some countries, this led to prohibition of euthanasia in regard to what it portrayed in the holocaust. To the Nazi regime, they find it relieving to kill and exterminate people with the intention of wiping out an entire group by “dignifying” their death which on the contrary was not dignified death. This therefore evokes ill feelings on dignified death on some people (Emanuel, EJ et al, 2016).
Dignity is defined as the standard of worthy to gain respect; it is the value attached to the person that leads to other people respecting them due to their personal qualities and character. If a person lives according to the values and laws of the land while helping other people, that person is considered dignified based of their actions (Emanuel, EJ et al, 2016). Due to this fact, a patient cannot be conferred dignity by the nurses and doctors or even dignified death. However, the only way in which they can ensure a patient has dignity in their death bed is ensuring that the last days of the patient are less painful and eventual death without indignity (Ganzini, et al,. 2000). A patient’s experience of astronomical pain can most times than not degrade their life. The forms of indignities likely to be experienced by the patient include extensive pain, social exclusion, lack of involvement in decision involving their own life and death. The concept of death with dignity evades the loops of being too subjective in viewing the patient as helpless (Crane, 2018).
Generally, it is presumed that health attendants should make sure that the people who are terminally ill are given dignified care so that if they die, they do so having protected their dignity (Downar & St Godard, 2015). There are two schools of thought employed in this context. One, patients’ lives without due dignity should be ended. This is achieved by withholding and withdrawal of the treatment towards the patient or administering lethal medication to their life which is termed as involuntary euthanasia. Extent of dignity here is measure by less pain experience till death. Two, the involved patient should be accorded with the ultimate decision to procure their death with dignity. What fails to come out clearly is how death whether natural or forced increases dignity to a life (Hizo-Abes et al,.2018).
Death is ultimately inevitable and sociology describes that all people are obviously destined to die. Most people in the society work towards dignifying the circumstances of death by various means (Emanuel, EJ et al, 2016). For instance, people who are terminally ill due to a sexually contracted disease, their relatives and family will most likely eulogize their cause of death as a “long illness” with the intention of covering up the shame attached to such a disease thus dignifying the death of the victim (Crane, 2018). This brings up the issue that does the circumstances or things done before and after death really dignify a person or dignify an undignified life? Perhaps the concept of death is the definition of undignified neither can the word dignity be applied to death (Westefeld et al 2009).
The term death with dignity is relative in meaning in such a way that we can claim to say that, people like Malcolm X, Abraham Lincoln, Martin Luther King Jr. or even Jesus Christ lived lives of dignity. They were the pinnacle signature of proper people in the society. However, due to the circumstances of their deaths filled with indignity, their deaths were undignified (Downar & St Godard, 2015). Christ had the term INRI just above his head at the cross mocking him as the king of all nations, Malcolm X and Martin Luther were assassinated thus their deaths are termed as undignified but their reputation was never undignified. It is unjustified for people to believe that a dignified person being going through an indignity simply derails their dignity. Some scholars argue that the extent of dignity in death is only important to one self and not applicable to all. For instance if one believes that it is undignified to die in a brothel or when in a vegetative state then it is surely undignified for them (Hizo-Abes et al,. 2018).
People pass away with their dignity due to their values and qualities they possess no matter the circumstances that lead to their deaths (Crane, 2018). However, indignity is a culmination of the suffering a human can experience while alive but dignity is worked for. For this reason we can understand that the hospitals cannot assure that a person dies with dignity but they can put effort to lead to a death without indignity (Emanuel, EJ et al, 2016). This can be achieved by acknowledging the patients choice on their life and doing away with pain at all cost. But on the far end, painful ailments in patients should be seen as serious battles and that if such patients pass away, their indignities in pain gave them the energy to demonstrate their dignity through the adversity (Porter & Warburton, 2018).
People are said to often have the ends of their lives in death without dignity since in most incidences the absence of dignity boils up from within the persons an error in character (Downar & St Godard, 2015). However, in some cases, the lack of dignity id due to external uncontrollable factors such as dementia, Parkinson’s, Alzheimer which in such condition, they cannot be criticized (Crane, 2018). But for a person who did not work through his life to shape his or her character and attain values and virtues, they are to be judged because they could but didn’t. The lesson in this context is that indignities such as pain could be reduced but there is no reason possible that should warrant anyone to be contemptuous towards pain or diseases that patients cannot control.
Death means the series or the sequence of losing life biologically while the term dignity accrues to values and virtues present in a person (Downar & St Godard, 2015). Therefore, dignity is the achievement one can attain while alive and not a quality that is given. On the flipside, indignities are the factors that impedes a person from enjoying a life of dignity which act so by preventing a person from active social life of own decision making and independence, the role of doctors and the healthcare staff is to make sure they do not impose indignities to a patient and they should also reduce indignities at all cost (Hizo-Abes et al,. 2018). The sociological concept of death with dignity includes the methods of empathizing with dying people, which must be appropriate in the perspective of society’s values concerning death and right to death. The sequence of events prior to death must also be acceptable with the normal standards of the society (Porter & Warburton, 2018).
The right to die is refers to the circumstances surrounding ones decision to die or continue living while being supported by medical equipment. Right to die in backed up by the concept that a person suffering from a terminal disease should be allowed to die by inducement prior to the natural cause of death or refuse to extend his or her life through medical means in such a case, medical attention and aid is withdrawn (Crane, 2018). The right to die in subtly means death with dignity. This right can be granted to a patient in countries that allows mercy killing and if they, the patient is willing to die. Normally the will of the patient to die is made prior to exercising the right to die. It is argued that equal measure given to the right to life should be given to the right to die thus one can dispose their life if they so wish.
Various countries offer clear laws and guidelines on conducting the right to die in death and dignity laws. They allow medically diagnosed patients with terminal illnesses to request voluntarily the prescription drugs to fasten their demise (Downar & St Godard, 2015). The states that allow death with dignity in the US include Hawaii, California, Oregon, Vermont, and District of Columbia which have statutes regulating physician assisted death. The first requirement to end one’s life is to have a discussion with the doctor so that you discuss your death wishes the earliest time possible which takes three to four weeks to thoroughly go through the needed requirements under death by dignity laws to fill out the initial oral request (Hizo-Abes et al,. 2018).
Some of the states will require that one be a citizen of the state, have the legal age of 18 years and above, mentally stable and competent, capable of communication and the existence of a terminal illness that can reasonably on medical evidence lead to death within three months before the mercy killing is administered (Crane, 2018). Most statutes on euthanasia do not allow a patient to be aided to thus they are given the prescribed medicine to in gest it themselves as their personal decision. Advancement in age or any sort of disability does not warrant one to qualify for the dying laws. Finally, there must be confirmation from two doctors on whether all the laws are met before proceeding with the procedure (Downar & St Godard, 2015).
Sociologists have not had a wide study and research on the concept of death in the society. Most tend to focus other social aspects of a society with little regard to the eventful end of a human life (Crane, 2018). Death as a concept is surrounded by many things ranging from mourning, ceremonial burials and the circumstances leading to the event of death. Socially, various social units in the society strive to maintain and preserve life but the aspect of death by will on grounds of suffering is subjected to both indifference and acknowledgement. The rights to die ultimately depend on the person and thus are entitled to a death with dignity.
References
Crane, D. (2018). The sanctity of social life: physician’s treatment of critically ill patients. Routledge.
Downar, J., & St Godard, E. (2015). Is physician-assisted death in anyone's best interest? Canadian Family Physician,61 (April), 314-317.
Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. Jama,316(1), 79. doi:10.1001/jama.2016.8499
Ganzini, L., Nelson, H. D., Schmidt, T. A., Kraemer, D. F., Delorit, M. A., & Lee, M. A. (2000). Physicians Experiences with the Oregon Death with Dignity Act. New England Journal of Medicine,342(8), 557-563. doi:10.1056/nejm200002243420806
Hizo-Abes, P., Siegel, L., & Schreier, G. (2018). Exploring attitudes toward physician-assisted death in patients with life-limiting illnesses with varying experiences of palliative care: A pilot study. BMC Palliative Care. doi:https://doi.org/10.1186/s12904/-018-0304-6
Porter, K., & Warburton, K. G. (2018). Physicians' views on current legislation around euthanasia and assisted suicide: Results of surveys commissioned by the Royal College of Physicians. Future Healthcare Journal,5(1), 30-34.
Westefeld, J. S., Doobay, A., Hill, J., Humphreys, C., Sandil, R., Tallman, B. (2009). The Oregon Death of Dignity Act: The Right to Live or the Right to Die, Journal of Loss and Trauma 14:161-169.
