Physician-Assisted Suicide: Confronting End-of-Life Issues

in Uncategorized
October 16th, 2013

Last year, citizens of Massachusetts defeated a referendum on physician-assisted suicide.  In an editorial which advocated a “no” vote on the referendum, the Boston Globe lamented the lack of sufficient high-level debate and public information on the issue.  It argued:  “Massachusetts should commit itself to a rigorous exploration of end-of-life issues, with the goal of bringing the medical community, insurers, religious groups, and state policy makers into agreement on how best to help individuals handle terminal illnesses… The [lack of] seriousness with which the state is approaching [this ballot question… is, in itself, an indictment of the current state of end-of-life care.”

In the last year, the Globe’s concern about what people know about this issue has only become more pertinent:  although the measure failed in Massachusetts, a similar one passed earlier this year in Vermont.  In putting together this year’s lecture series on “The Contemporary Face of Suffering,” the Institute for Philosophy and Religion wanted to contribute to broadening and clarifying the public discussion of physician-assisted suicide and of related end-of-life concerns.  IPR invited Prof. Dan Brock, a leading medical ethicist and Frances Glessner Lee Professor of Medical Ethics in the Department of Social Medicine, the Director of the Division of Medical Ethics at the Harvard Medical School, and the Director of the Harvard University Program in Ethics and Health, to speak on the topic.  His Oct. 2 lecture prompted many thoughtful comments, including those of IPR seminar students Mac Loftin and Julian Julian Lijtszain, who are this week’s featured bloggers.

Mac Loftin writes:  “Around two years ago, my grandfather fell very ill.  He was over 80 years old, and while it was expected he would survive the illness, it was also expected he would need full-time assitance for what little time he would have left.  He was a proud and stubborn man, and the thought of spending his life in a wheelchair having someone help him use the bathroom was too much to bear.  I do not believe he would have hesitated to ask a doctor to end his life, but physician assisted suicide is illegal in Texas, so he looked into private organizations like the Hemlock Society.  He ended up passing before he was able to do anything, but my grandfather’s experience made me a strong supporter of patients’ rights to determine the ends of their own lives.  The entire time my family was going through this ordeal, however, our thoughts were on my grandfather and his desires.  Dan Brock’s writings and lecture brought to light an issue in the assisted suicide debate I hadn’t thought of before: the feelings of the physicians towards taking a life.  While my grandfather was ready to die, and my family supported his decision, not once did we consider the desires of any outside agent that would play a role in the ending of his life.  A family’s decision on PAS (Physician-Assisted Suicide) or VAE (Voluntary Active Euthanasia) should also take into account the wishes of the doctor, who may not be comfortable with performing the procedure.  The physician arguably has the most difficult role in the matter.  The patient passes on from a life they determined was no longer worth living, but the doctor must live on after having taken the life of a fellow human being.  The enormous weight on the shoulders of the doctors who perform PAS or VAE must be taken as seriously as any other factor in the debate.”

Julian Lijtszain writes:  “In his talk entitled “Physician-Assisted Suicide and End-of-Life Issues”, Dr. Dan W. Brock presented and developed his views on the controversial topic of physician-assisted suicide (PAS). During his talk, Dr. Brock established that the American States of Oregon, Washington and Vermont had legalized PAS under the conditions that the patients meet certain safeguards implemented to limit the abuse of this practice. Among these list of strict safeguards, there where two that captured my attention in themselves and on how they relate to each other:  1) The requirement that the patient must sustain a 15-day waiting period after he has filed for PAS in order to re-assure himself of the decision.  – This particular requirement captivated my attention because it forces the patients to undergo the only thing they wish to avoid; more time. 15 days might seem like a reasonable period from an outside perspective, yet they could feel like an eternity under extreme conditions of pain and suffering.

2) The requirement that the patient must be in full use of his mental capabilities in order to be granted PAS.  -I really question the legitimacy of this requirement. It seems to me unreasonable to demand full mental capabilities from a person who is struggling with intense pain, traumas and illnesses that will most likely have a negative effect on the patient’s mental health.

3) The interaction between the first and second requirements seems to me to lead to a catch 22. Requirement 1 asks for time, yet requirement two asks for a condition that will likely get lost with time. Thus, it seems reasonable to ask for either condition 1 or 2, but not both.  -In turn, requiring patients to fulfill both the first and second conditions is not a fair assessment of the patient’s desires. This is clearly seen in the state of Oregon, as we find that “Only one in ten patients who request a lethal prescription actually die by this method. Barriers include …  not meeting the legal requirements, and some die during the fifteen-day waiting period.”(Oregon Encyclopedia) Thus, if the aforementioned requirements where changed or even eliminated, the number of deaths from PAS could potentially increase by 1000%. Some solutions could be reducing waiting times or limiting  the request of full mental health to the time of the original petition, yet, the sensitivity of this topic requires a lot of debate before making any kind of decision.”

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