Analyzing the Death With Dignity Act … Essay
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Medical Law or Ethics Issue
Euthanasia or physician-assisted suicide is one of the more controversial issues in medical practice. The issue framed in a number of ways, from being an issue about the individual right to self-determination to an issue of the Hippocratic Oath. In Oregon, physician-assisted suicide has been legalized, with the Death with Dignity Act of 1997. Oregon remains one of the few jurisdictions in the United Nations, or even the world, where this practice has been legalized. But this has not quelled the controversy, and many key issues remain.
Overview of Ethical Issues
The conflict over the right to die is typically understood as an ethical or moral one. Western philosophical tradition outside of religion has generally held that people are autonomous beings capable of self-determination, including the right to choose how they live or die (Young, 2014). The concept is juxtaposed with moral strictures defined by religion, which typically hold that both suicide and killing are immoral acts. It also contradicts the Hippocratic Oath to which most doctors swear, which explicitly addresses the issue: I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan." Thus, there is an ethical conflict at work, where one has the right to determine one's own fate, but physician-assisted suicide inherently involves other people. The need to involve physicians derives from euthanasia's need for a pain-free, peaceful death, which is not what would normally occur during a suicide.
There are a number of particular ethical issues for physicians in particular. A physician is sworn to offer treatment for physical illness. Any undertaking to facilitate patient dying runs counter to that objective. This is true even when the patient has terminal illness, given the high quality of palliative care and the strength of pain-relieving drugs available for such care. The concept that suicide is the only way for a terminally-ill patient to be free from pain runs counter to medical fact in this day and age.
However, there are those, both patients and physicians, who argue that the duty of the doctor is to ensure that the patient is free from pain. A terminally ill person is inherently in pain, and unable at some point to lead any quality of life. At that point, it may be justifiable for that patient to end his/her life, and given the realities of drug procurement this typically involves a physician to at least facilitate, if not actively administer the drugs.
The Death with Dignity Act
With enough momentum behind it, the movement to legalize euthanasia scored some victories, most notably in Europe, in the 1990s. The state of Oregon became one of the early adopters in the U.S., in 1997, but remains one of the few jurisdictions where physician-assisted suicide is legal. The point of the law is to enforce that a physician will not be charged with any form of homicide should he/she assist a patient to fulfill the patient's own wish to control the circumstances of his/her death. The Death with Dignity Act has built in a number of provisions in an attempt to define the circumstances where this practice is allowable and the procedures that need to be undertaken. These steps are necessary in order to ensure that both doctors and patients are protected. The latter is an important consideration given how little is known about the cognitive responses to learning that one has a terminal illness -- there is the risk that such individuals could be coerced into accepting euthanasia, for example (Nielsen, 1998).
The Death with Dignity Act requires that the patient must be 18 years or older, a resident of Oregon, diagnosed with a terminal disease that will lead to death within six months, and capable of making his/her own decisions with respect to care and treatment. There are further steps that need to be undertaken as part of the procedure, including various waiting periods and that the physician has explained the alternatives to the patient. At least two physicians need to be involved at various stages of this process. These safeguards are critical to ensuring that the patient is making this decision on his/her own, but they are imperfect. Still, the point of the Act is to provide Oregonians with the option, should they wish to avail themselves of it.
The state provides annual reports on the outcomes of the Act. In the 18 years since the Act came about, physician-assisted suicides have increased steadily. From an initial 16 deaths in 1998 to 132 in 2015. In each year, there are more prescriptions written for these drugs than there are patients who actually take them, perhaps indicating that many patients ultimately choose not to end their lives in this manner. Even the patients who go through the steps may find that they mostly just want to have the choice should they wish to pursue it.
The DWDA has been used mainly by those 65 or older, some 78% of deaths in 2015. The median age of death was 73 years. Throughout the history of the Act, most recipients of DWDA drugs were white (93.1% versus 83.6% statewide) and over 40% have been well-educated with at least a baccalaureate degree. Of 991 DWDA patients since the law came into effect, only 31 deaths were from ages under 44.
Of those who opted for this avenue, 77.1% were cancer patients, the largest group being lung cancer. ALS patients were the second largest group, followed by chronic lower respiratory disease, heart disease and AIDS. In 93.% of cases, the patient informed his/her family of the decision. The three most common reasons cited for wanting physician-assisted euthanasia were a loss of autonomy, loss of dignity and being unable to engage in activities that made life enjoyable. Most respondents cited all three of these. Just under half were concerned about the loss of bodily functions and 41.1% cited a desire not be a burden on family or caregivers. There are some points of concern in there, notably the desire not to be a burden, and being concerned about a loss of quality of life. People lose quality of life for all kinds of reasons, and feelings of guilt about being a burden do not see adequate cause to end one's life. Yet, many of the other concerns are fairly legitimate, especially since one's autonomy is a central issue at the heart of the ethical debate around euthanasia.
The key impact for medical professionals is the legal ramifications of such an act. In Oregon, a health care professional can choose not to participate in physician-assisted suicide, but for those who do, the Act provides the procedures that must be followed, and also provides legal protection in the event that those procedures have bene followed. In many other jurisdictions, such protections are not afforded. There are many instances outside of Oregon where physicians have been prosecuted for assisting suicides. The state offers this protection so that physicians who agree philosophically with the practice can offer this to terminally ill patients in the open, without fear of prosecution, which they would otherwise face.
For healthcare administration, the Act's framework helps those who work in healthcare at all levels understand the issue, how to work with terminally ill patients who have expressed an interest in euthanasia and the presence of these guidelines again provides a pathway and legal protections. For the most part, there are certain medical practices that facilitate this and have specialized in it, but many other medical practices in Oregon do not do so. Somebody in healthcare administration that wishes to assist others in their deaths has the opportunity to do so.
For many, this issue is a moral dilemma. The point of the law is to offer choice, both to patients to exercise their rights as autonomous beings, but to physicians as well, to offer whatever care for their patients they feel is best. The patient needs to have a terminal diagnosis in order to be eligible, which helps medical practitioners, but in practice only those who agree with assisted suicide and wish to offer that to clients are doing it. Many others are not. From the perspective of a medical practitioner in Oregon, this seems a good compromise, where the doctor can decide for himself/herself whether this is something he/she wants to do. Just because the law is in place does not obligate any medical practitioner to assist with suicides. It simply means that if they choose to do so, that they will not face prosecution.
There are flaws, certainly, in a system that allows somebody to be killed simply so that they will not be a burden, even when they have terminal illness and will not live long anyway. One could argue that the Oregon law is not sufficiently robust to offer the right protections against abuse. However, by granting the right for patients and physicians to make their own choices, Oregon's law sets a powerful precedent. I recommend… [END OF PREVIEW]
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