PHYSICIAN-ASSISTED SUICIDE (PAS): MORAL AND SOCIAL IMPLICATIONS

One of the most publicized cases of PAS was the story of Brittany Maynard. Brittany was diagnosed with a serious type of brain tumor in January 2014. She had undergone a series of treatments, but the tumor remained aggressive. Brittany’s health continued to deteriorate.  She experienced an increasing intensity of pain and bouts of seizures. She then decided to move to Oregon with her mother and her husband so that she could avail of PAS, which was not available in her home state of California at that time. Brittany picked November 1, 2014, as the day of her death when she believed that she was heading for the worse. She could not afford to see her family, especially her husband hold their lives to care for her. Brittany’s story attracted a renewed public sympathy and new set of followers, who advocate for the legalization of PAS in many states.[1]

PAS is different from Euthanasia. In PAS, the patient is actively involved in ending his/her life. Patients with a terminal diagnosis formally request a prescription from their physician for a dose of certain drugs, which they can administer at a date, time, and place of their choosing. This is not necessarily true in euthanasia. Euthanasia is when a physician or other healthcare provider does something to intentionally kill the patient, such as administering a lethal dose of a drug or withdrawing a ventilator to deliberately kill a patient, with or without the patient’s consent.  Euthanasia is not legal anywhere in the United States.

A handful of states have pending legislative bill legalizing physician-assisted suicide. The US Supreme Court has ruled in June 1997 that state laws banning physician-assisted suicide do not violate the Constitution. The court left the matter of the constitutionality of a right to a physician’s aid in dying to the states. They may legislate either to prohibit or to permit it.[2]  The states that approved physician-assisted suicide include Oregon, Vermont, Washington, California, Colorado, Hawaii, and Montana. Each state may have different ways of dealing with the issue.

 Only individuals with terminal illness are candidates for PAS

The law, in general, allows individuals to qualify for PAS when they are diagnosed with a terminal illness and are capable of making decisions. The first physician must also refer the individual to a consulting physician for medical confirmation of the diagnosis and for a determination that the individual is competent and voluntarily acting.  It is also important that physicians must discuss other alternatives including hospice care, comfort care and pain control for patients.

PAS advocates believe that PAS will bring a positive impact to those who are diagnosed with terminal illnesses.  It will uphold their rights and personal autonomy to choose how they will end their lives in the same way they manage to live it.  This gives the comfort of having the choice available within reach when pain and crisis brought about by illness is unbearable for the patient and his/her loved ones.

However, not all terminally ill patients have positive remarks on PAS. Some patients expressed apprehensions that this law will open up other options that a choice is available for them to end their life.  It will be tempting to consider claiming one’s life during the internal pressure of not wanting family members to sacrifice for their care and for the hopelessness of their diagnosis and prognosis.

James “J.J.” Hanson, a veteran who was diagnosed with an inoperable brain tumor testified against physician-assisted suicide in Alaska. He said that had the law become available in his state at that time when he and his family were under a great deal of distress in coping with the illness, the choice to end his life would have been an easy choice. He had a serious conversation with his doctors who told him that he had only four months to live. It was a piece of devastating news. However, with his will to live a little longer to spend as much time with his one-year-old son, he chose to proceed with the treatments.  Hanson lived for a few years after his diagnosis.  He was able to use his personal experiences in dealing with cancer. His life was an inspiration for people to live with love, determination, and faith. He worked to prevent passage of legislation permitting PAS in different states. 

The case of Hanson shows that medicine should focus more on healing and the preservation of life. Dr. Jeanne Anderson, a medical oncologist in private practice in Anchorage who received her medical degree from Stanford, said that cancer is very unpredictable. There are changes in its nature and aggressiveness and response to treatment. Moreover, there are breakthroughs and newer treatment options available.  On top of all these, there’s also the patients’ inherent will to live.”[4]

Any interventions that intentionally cause death lies outside the standards of medical practice. A physician’s participation in any form of suicide is tantamount to doing a serious evil to achieve good. Physicians cannot serve the patient’s good by deliberately eliminating the patient.[5]

In this circumstance, Pope John Paul noted that “to concur with the intention of another person to commit suicide and to help in carrying it out through so-called assisted suicide means to cooperate in, and at times to be the actual perpetrator of, an injustice which can never be excused, even if it is requested.”[6] While it may seem reasonable and compassionate, it is, in fact, an act of injustice to take it upon ourselves to determine who should live and who should die. Genuine compassion leads to sharing and helping alleviate another’s pain; “it does not kill the person whose suffering we cannot bear.”[7] PAS can also fall into the so-called “slippery slope” and would become a threat to the lives of our vulnerable populations, such as the elderly and the disabled.[8]

Two prestigious medical associations namely, the American Medical Association and the American College of Physicians reject physician-assisted suicide. PAS is fundamentally incompatible with the physician’s role as a healer. This practice might undermine patient trust and undermine medical initiatives at the end of life care. The focus at the end of life should be geared toward efforts to alleviate suffering and pain.  Both groups advocated for a stronger,  more improved and accessible palliative and hospice care.

The direct involvement of the physician as the prescriber of the medication is questionable and is against the oath that they have taken.  Although a physician may not cooperate physically in the suicide of the patient, a physician cooperates morally in the suicide by approving the act of suicide by writing a prescription for the medication that causes a patient to die. The Hippocratic Oath states “I will not administer a deadly poison to anyone when asked to do so nor suggest such a course.”  The public may undermine physicians’ commitment to patient’s welfare and health promotion by physicians’ involvement in assisted suicide even if patients request for it.[9] Killing in whatever way including assisted suicide is always wrong, no matter what the intention of the agent is.[10]

The passage of PAS into law reflects the society’s lack of determination to care for its sick members. A society that is relieved of its responsibility to care for sick and suffering members risks of becoming increasingly indifferent toward the needs of its members, in general.[11] Apathy is a social condition in which people are so dominated by the goal of avoiding suffering that it becomes a goal to avoid human relationships and contacts altogether. As a theologian, Dorothy Soelle points out in her work titled, Suffering, this growing indifference has the capacity to destroy the community as well as the ability to form communities.[12]

Let us remind each other through our care for the sick that the nobility of human person is found in coping with suffering and treating suffering in a more humane way, not in surrendering to it through despair and suicide. The terminally ill patients’ attitude towards hardship reminds the healthy and well to continue to do the best and never give up amid adversity.[13]

Let us become witnesses and sources of inspiration to each other. Only through this bond of reciprocal give and take relationship can the community develop a mutual value of support and concern for its members across the whole continuum of life.[14]

We continue to support and pray for our seriously ill members and their families that they may not resort to taking their lives through PAS.  Additionally, let us deal with the utmost sensitivity the debate on PAS. May we be compassionate to those who have given up to assisted suicide, and to their families who have experienced tremendous grief. We pray for those died in tragic circumstances, including those who entrust death in their own will with trust in the One who came that we might have life and have it to the full.[15]

___________________________________________________________________________

[1]  Britany Maynard, A Video for my Friends, October, 19, 2014.

   https://www.youtube.com/watch?v=1lHXH0Zb2QI

[2]  Legal Information Institute, Washington vs. Glucksberg et al. Case: Chief Justice Rehnquist delivered   the opinion of the Court.

  https://www.law.cornell.edu/supremecourt/text/521/702#writing-USSC_CR_0521_0702_ZS,

[3] John Aronno, Death With Dignity’ Bill Heard for Second Time in House Committee, The Alaska Commons,

   April 17, 2017. http://www.alaskacommons.com/2017/04/07/death-with-dignity- 

   bill-heard-for-second-time-in-house-committee/

More of Hanson’s story:

[3]https://njrtl.org/op-ed-by-jj-hanson-i-was-given-4-months-to-live-assisted-suicide-isnt-the-answer/

https://www.timesunion.com/state/article/J-J-Hanson-opponent-of-assisted-suicide-dies-12464108.php

[4] John Aronno  Death With Dignity’ Bill Heard for Second Time in House Committee, Alaska Commons,

April 17, 2017. http://www.alaskacommons.com/2017/04/07/death-with-dignity-bill-heard-for-  second-time-in-house-committee/

[5] Pope John Paul II, Evangelium Vitae (The Gospel of Life), 25 March 1995, No.66

[6] Ibid.

[7] Ibid.

[8]  Albert Jonsen, Mark Sieger and William J. Winslade, Clinical Ethics: A Practical Approach to Ethical  and Clinical Medicine, 8th ed. New York: Mc Graw Hill, 2015, p 155.

[9] Kevin O’ Rourke, A Primer for Health Care Ethics: Essays for a Pluralistic Society, 2nd ed.

     (Washington DC: Georgetown University Press, 2000), 217.

[10] Ibid, 217.

[11] Ibid 217.

[12] Ibid, 221.

[13] Ibid, 217

[14] Ibid, 221.

[15] John 10:10

 

 

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