Physician Assisted Suicide Case Study

In today’s society, physicians are held to high moral and ethical standards in helping patients achieve obtainable and mutually agreed upon goals for their health. However, for the patients constantly suffering from unrelieved pain as a result of a terminal illness, the goals in place and the maximum quality of life they can achieve, may not seem worth the effort to remain alive. As it is the physician’s duty to insure patients are as comfortable as possible, an ethical issue arises when the patient seeks to have the physician assist directly or indirectly in the hastening of their death to achieve a painless and nonsuffering state. Currently, there are two dominant methods in which this can be achieved and that is by euthanasia or physician-assisted

dying.
In regards to euthanasia, which means “good death” or commonly referred to as a “mercy killing”, it is the direct involvement of a physician administering a lethal injection that will result in the death of the patient in order to relieve pain and suffering (Jonsen, Siegler, and Winslade 153). Euthanasia can be voluntary, involuntary, or nonvoluntary depending on the level of patient consent. Voluntary euthanasia describes the patient making the conscious decision to allow the physician to accelerate their death via lethal injection. Contrary to this would be involuntary consent, which is taking a patient’s life against their will. Nonvoluntary consent would apply to incapacitated patients who are incapable of voicing any opinion. Although all forms of euthanasia are considered unethical, the alternative expressed would be the giving of sedative medication for the goal of relieving pain, which may result in the death of the patient. This is commonly known as palliative sedation and this practice is considered legal because it falls under the principle of double effect. The other alternative would be physician-assisted dying, which is the legalized act of a physician prescribing medication that allows the patient to directly bring about their own death. Unlike euthanasia, this does not constitute as homicide. Also, it is not considered aiding a suicide due to it being within legal parameters.
Although some people consider physician-assisted dying morally and ethically acceptable, others argue against assisting a patient with hastening their death and consider the practice unprofessional and unethical. Organizations such as the American Medical Association and American College of Physicians reject the usage of physician assisted dying, stating that it is “fundamentally incompatible with the physician’s role as a healer” and there is a “risk of discrimination against vulnerable populations, including the elderly and disable” (Jonsen, Siegler, and Winslade 153-154). Some believe it’s usage is undermining the welfare of the patient and still consider physician-assisted dying to be homicide. The counterargument points out the discontinuation of life supporting measures such as hydration and artificial nutrition on patients in a vegetative state that are incapable to voice their opinion. This would appear less ethical than allowing patients who are completely competent to make the decision and exercise their right to autonomy to decide when and how they wish to die.
As opposition to physician-assisted dying, skillful pain management and positive measure for care by hospice is an option. There is the violation of the Hippocratic Oath of the physician stating, “I will never administer a deadly poison to anyone when asked to do so, nor suggest such a course” (Jonsen, Siegler, and Winslade 157). However, the oath is seen as outdated due to modern technology and medical practices that can extend life. Also, this does not address the decline in quality of life the person is destined to have due to their terminal illness. We can also never be fully aware of the pain and suffering that the patient is experiencing. By allowing patients to have a choice in their own deaths, this can be viewed as compassionate and having respect for a patient’s autonomy.
On the legal side of the manner, there are no federal law banning or granting the use of physician-assisted dying. Ultimately, states make the decision whether the practice is legal or not and currently, there are five states granting usage. In 1994, the state of Oregon was the first state to pass the Death with Dignity Act (DWDA). This allowed for a basis of who is eligible to receive physician-assisted dying and addressed the perceived notion that “doctors act simply as technicians and lose sight of the patient as a person” by disregarding their desires and beliefs (Purvis 272). In regards to the physician making the choice to actively participate, that is solely their decision. If the physician feels uncomfortable with the request, they can openly express their feelings and attempt to explore alternative solutions with the patient. If the patient insist, the physician may withdraw from the case. Also, if they choose to follow the patient’s wishes, there is the possibility of legal liability in regards to practicing within a state where it is considered illegal. In this case, the physician should seek counsel by other medical professionals, legal consultants, and ethic specialist before making the decision.
It is very important that patients communicate with physicians in regards to end of life care. A prime example of this would be the case of Terri Schiavo. Michael, Terri’s husband, argued in court against Terri’s parents to remove the feeding tube that kept her alive. On February 25, 1990, it was reported that Terri’s brain was oxygen deprived for five minutes after collapsing due to a heart attack. All physicians stated that she was in a vegetative state, which is understood as “eyes-open unconsciousness” where there is a “disassociation between wakefulness and awareness” (Fine 304). Her parents were convinced that she was still capable of interacting with people. Doctors argued that it was just reflexes that triggered her movements. After 13 years of Terri being on a feeding tube, Michael stated in court that his wife did not favor having tubes placed in her to live. According to Terri’s parents Michael had ill intentions. The Herald reported that her parents claimed he was engaged to another woman for years and information arose that Michael once stated to a former girlfriend that he was unaware of what his wife would have wanted because they never spoke about the subject. Terri’s parents believed Michael was seeking the money of a million-dollar malpractice settlement that was awarded to Terri. Michael filed the suite due to the doctors failing to notice her low potassium levels that caused her heart attack. Her parents considered it to be cruel to allow her to starve until it caused her death.
After Michael had won the case, Florida Governor Jeb Bush stepped in and passed “Terri’s Law”, which allowed Terri to be placed back on life support and the reinsertion of her feeding tube. People in support of euthanasia stated that, “death by starvation is just like going to sleep.” Terri’s parents rejected this notion and still considered it an inhumane and cruel act. Michael went on to sue Governor Bush due to him quickly passing a law that allowed the reinsertion of the feeding tube. Bush’s attorneys attempted to appeal the case, which the judge did not allow. Michael’s attorney and the judge viewed the appeal as a delay tactic and the judge ruled against Governor Bush. Finally, Michael had won and his wife Terri was taken of life support permanently. This triggered Governor Bush wanting to do a full investigation into the case.
There could have been an avoidance of having to go to court if Terri would have had advance planning before the incident occurred.

These “encourage individuals to inform their physicians about the persons they most trust to decide on their behalf and how they would wish to be treated at a future time when they might be unable to participate in decisions about their own care” (Jonsen, Siegler, and Winslade 86). In the case of Terri, there was no certainty of what her wishes would have been. If she would have had advanced directive documentation that existed, she would have been able to appoint Michael are her durable power of attorney or “designated decision maker” (Jonsen, Siegler, and Winslade 88). Another option would have been her having a living will that list who she wanted appointed as her power of attorney, but also address other circumstances that may include treatment when incapacitate or the need of life support and a feeding tube. Since Michael was seen as a surrogate and Terri did not express her preference to anyone else, his actions seemed contrary to her benefit in the view of her

parents.
During the case, the idea that discontinuation of life supports and feeding tubes constitute as euthanasia.

However, some individuals do not view it as such, because it is not the direct taking of a life by the physician. It would be considered a secondary cause, because she will die of dehydration or starvation rather than a lethal substance being injected into her veins. There is the appearance that certain acts of euthanasia would be deemed acceptable from a moral and ethical point of view. The ethical issue that arises from this is whether this form constitutes as a humane because ultimately it would still apply as nonvoluntary euthanasia. Yet, the end result is always the same and that is the death of the

patient.
In my opinion, if the patient would have had advance planning in place this could have been avoided. Ultimately, I believe it to be the court’s decision to decide whether Michael, who by default was believed to be the surrogate, was capable to make decisions on her behalf. Florida Governor Jeb Bush should have never gotten involved with the case because it is not his jurisdiction to judge a case, then quickly pass a law that would favor his own decision. In regards to whether the case would apply as euthanasia, I would agree. As stated before, it would seem less problematic and ethical to allow someone who is terminally ill to have a choice in when and how they die, rather than having to guess once the person is mentally debilitated and unable to make a decision.
Whether someone agrees or disagrees with euthanasia and physician assisted dying, we have to decide where to draw the line with patient autonomy in regards to doing less harm. Pain and suffering are negative effects on a person’s quality of life and should be factored in when making a decision on end of life treatment. We must keep in mind that the practice of autonomy is not always available when the patient is fully competent, so it should be preserved as legal documentation to avoid situations such as the case of Terri Schiavo. This case proved medical decisions will continue to be ethically and morally challenging to decide upon as a whole of society.