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A Merciful Alternative for the Terminally Ill

In normal everyday life, we do not really think
about how we are going to die. We try to live our days one day at a time.
Rarely do we ever plan or look forward into the future unless something
abnormal or unpleasant forces us to. For many people,
terminal illness is one of those circumstances that force them to think about
what lies ahead. In a season of the show American
Horror Story, a man by the name of Edward Philippe Mott tells a couple who are running
for their lives: “The living cling to
life above all, but the trophy misprized is to die in peace” (“So, Is It
Over?”). This quote strongly supports the idea that humans spend too much time
trying to live longer, that they forget to think about how they wish to die. Death
is inevitable and we all want to die peacefully, whether that is in our sleep
or by a sudden heart attack. We might be suffering in some way as we prolong
our life and we might even find that our lives have
less value because of the specific kind of suffering that we are going through.
But there comes a time when we have to decide how we would like to go out. Do
we want to spend the last months of our lives suffering and in pain or do we
want to be able to control how and when it happens? Of course, we want to avoid
as much suffering as possible. What Edward did was give them a choice to let
them decide on a peaceful way to die compared to a death filled with agony.
Similarly, physician-assisted suicide should be a possible alternative for
terminally ill patients.

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Physician-assisted suicide (PAS) refers to when a physician aids a
competent, usually terminally ill, patient end their life with a painless
lethal dose of medication. The patient then decides when and if to take the
lethal dose to end their life. For the past half century the topic of PAS has
become increasingly talked about and controversial. There have been various
court cases and public opinion disputes related to this topic. It has been so talked about that we have seen the
conventional stance become more challenged; so much that the state of Oregon
voted to fully legalize PAS. A couple more have followed then after and
now as of this year; PAS is legal in 6 American states (Oregon, Washington,
Colorado, California, Montana, and Vermont) and the District of Columbia. This
is a very controversial topic that seems to be almost divided in two by the
public eye. The main proponents of these disputes are individuals who are male,
young, and white, while the main opponents are religious organizations such as
the Roman Catholic Church and advocates for Disability Rights. Competency,
life, and abuse are at the very root of this debate. Life is a beautiful and
unique thing that should not be easily thrown away, but what is the purpose of living
if it is spent suffering? PAS is a merciful procedure which should be an option
for the terminally ill to pursue with the assistance of their doctors in the
United States because it can be compassionate, cost-effective, and it is a
civil right.

            The “right to die” movement in the United States has been
going on for quite some time. A hallmark of this movement was the Death with
Dignity Act (DWDA) which was passed by Oregon in 1994. As an article from the Southern
California Interdisciplinary Law Journal states:

                        “Oregon became the first state to allow doctors to
prescribe a lethal dose of                                 medicine to terminally
ill patients who request it. Under this law, those seeking                              assisted suicide
from a physician must be “18 years of age or older.” A patient                                 seeking
this assistance must be diagnosed with a terminal illness, which is a                                    determination made by an attending physician
and a consulting physician. For the                                    purposes
of this act, a terminal illness is
defined as “an incurable and irreversible                                 disease
that has been medically confirmed, and
will, within reasonable medical                              judgment, produce
death within six months” (Stillman 276).

            This quote helps us understand how specific this act is
meant to be since this is a serious topic. The rest of the Act is much more
detailed explaining the procedure and much more. The DWDA paved the way for
other states to develop their own Acts legalizing PAS with Oregon’s as a model.
California’s End of Life Option Act and Washington’s Death with Dignity Act
both parallel Oregon’s in the fact that the “patient seeking treatment is
eighteen years of age or older, that there are two doctor requests, and the
patient is six months away from death” (277). In addition, the “right to die”
movement has been heavily influenced by the type of language and terminology
people use to describe it. Both proponents and opponents change the terms for
or against their views. PAS is usually considered as physician aid-in-dying by the
proponents because death is usually already imminent and the option to choose
when and where is offered, while opponents focus on the negative connotation of
“suicide” because we usually perceive suicide to be negative. A common
misconception is that people do not think there is a difference between
euthanasia and PAS, however, euthanasia
involves another person, whether that be a physician or not, actively giving a
lethal substance to a patient. Muscle relaxants are a common form of the lethal substance in which a physician might
use.

            One of the first faces of the “right to die” movement was
Dr. Jacob “Jack” Kevorkian. He was a “humane hero who courageously fought for
the rights of suffering people to fulfill
their death wishes” (Stafford par. 2) by the methods of active euthanasia. Dr.
Kevorkian was compassionate for patients who had terminal situations and
believed in absolute autonomy of humans and specifically females when talking
about abortion. After Kevorkian’s passing, Brittany Maynard became the new face
for the “right to die” movement and gained increased media coverage and
attention. She was a young, 29-year-old
woman who was recently married and soon found out that she had terminal brain
cancer. After being diagnosed she decided to become an advocate for other
terminally ill Americans by joining the end of life choice organization,
Compassion, & Choices. She states
that:

“We had to uproot from
California to Oregon, because Oregon is
one of only five states where death with
dignity is authorized. I met the criteria for death with  dignity in Oregon, but establishing residency            in the
state to make use of the law    required a monumental number of changes. I had to find new
physicians, establish    residency in Portland, search for a new home, obtain a new
driver’s license,            change my voter registration and enlist people to take care
of our animals, and my husband, Dan, had to take a leave of         absence from his job. The vast majority of     families do not
have the flexibility, resources and time to make all these changes”

(Maynard par. 11-12).

That is why she wanted to make it easier for others who have been
diagnosed with a terminal illness so that they do
not have to go through all of the difficulties that she had to go through.
Brittany Maynard’s story inspired and aided California in the legalization of PAS.

The lives of terminally ill patients change drastically after they
are diagnosed, and more change soon follows. More often than not patients are
going to be going through a lot of difficulties. A group of bioethics and
humanities professors from the University of Washington School of Medicine
published an article which states: “Suffering
means more than pain; there are other physical, existential, social and
psychological burdens such as the loss of independence, loss of sense of self,
and functional capacities that some patients feel jeopardize their dignity” (Starks
et al par. 13). As healthcare providers
physicians need to focus on their patient’s
well-being and how they can best ease their pain. It is important to have good
communication skills to understand the needs of the patients and their
families. Through listening, physicians will be able to accurately understand
and comfort patients if needed. Similarly, compassion is an important part of
any healthcare job and giving patients options helps immensely. Giving
compassionate medical care not only means that you are a kind and respectful
healthcare worker who values the wishes of the patient, but it also means that
you do not treat people as if they are just a number or “the next patient”.
Physicians should be able to understand and empathize with their patients and
put themselves in their patient’s shoes while also being sensitive to the way
that they may be feeling. Physicians must be ready to offer the patient a wide
variety of options for them to choose from, thus giving them a greater sense of
agency. This will help the patient feel more independent during a time when he
might feel like he is not in control. PAS can be
a compassionate alternative for the sake of reducing all manner of suffering.
Modern day medical technology can do a great job at elongating a patient’s lifespan for a certain amount of time, but the
pain persists. Terminally ill patients must live with the continuous pain and
suffering until they pass away. Physicians must then respect and properly
assess the wishes of the patient to determine if it is justifiable.

Furthermore, this alternative is also immensely
cost-effective. As we all know, life is expensive and so the technology that
medical facilities use to prolong life can also be very expensive. The process
of identifying the cause and treating the illness is also a long one. There are
usually many tests and examinations which all might not be essential,
especially if the diagnosis is terminal. An article from The Journal of Law, Medicine & Ethics informs us that

“persons with chronic
illnesses require more health care services, are costlier to treat, and are a
significant factor in the rise of health care spending. And the likelihood of
incurring an additional chronic illness increases with age.” (Artnak et al
140). This increase of more and costlier health care services makes it
financially difficult for families to keep their loved ones alive and relieved
of suffering. To be more specific, “nearly $7,900 is spent each year for every
American with a chronic disease such as diabetes, cancer, or heart disease” (141).
All throughout America, there are
hundreds of people who have spent tens of thousands of dollars in the last few
months of a loved one’s life. Sadly, they may have prolonged their life but
there might have been no quality of life. This alternative will save patients
families large amounts of money from end-of-life care. Patients would
essentially be easing their families financial burdens and suffering in the
process.

            Above all, we should all be able to choose how to live
our lives. The pursuit of happiness is one of the fundamental rights that our
founders declared for us. The rights of competent adults should not be limited
when it comes to the right to die. Accordingly, Dr. Kevorkian agrees that terminally
ill patients should be allowed the right to pursue the motives they believe
will be best for themselves and their families. In one of Dr. Kevorkian’s court
cases, attorney Geoffrey N. Fieger stated that:

                        “This is not a right to commit suicide, it is
about the right not to suffer. At the                                end of
life when the disease process has won, death is certain, and pain cannot be                                 controlled,
how the state has an interest in prolonging suffering is beyond me.                                  Saying that
a law which does not make anybody do anything, that gives people                             the
right to decide, and prevents the state from prosecuting you for exercising                                    your
freedom not to suffer, violates somebody else’s constitutional rights is                         insane”
(Cotton 364).

If competent terminally ill adults have the right to refuse
medical treatment then they should also have the right to have a physician aid
them in painlessly ending their lives. Similarly, many believe that in the 9th
Amendment of the U.S. Constitution, the people have the right to do whatever
they want with their bodies as long as it does not affect anybody else or
anyone else’s property. Additionally, an
article from The New York Times
recalls a U.S. District judge stating: “like the abortion decision, the
decision of a terminally ill person to end his or her life involves the most
intimate and personal choices a person may make in a lifetime and constitutes a
choice central to personal dignity and autonomy” (Egan par. 10). This
alternative is not an easy one to make but it is an option that must be offered
to those who require it. Competent terminally ill patients deserve to die with
dignity if they so choose to.

In
contrast, a common argument that many opponents of end-of-life rights bills
have is that it leads physicians and the health care system to devalue life. As
an article from the Arkansas Law Review
adds:

            “opponents of the
legalization of physician-assisted suicide contend that, in order                          to
reduce health care costs,
physicians
and insurance companies may aggressively                   encourage elderly and
disabled patients to request prescriptions for the lethal dose                         of
medication… moreover, if the disability requires long-term treatment, the                            insurance
company may be willing to cover the cost of physician-assisted suicide                               in
order to reduce costs” (Lewis 40-41).

This
is by no means a good way of empowering a patient. An example which strongly
relates to this topic is that “the insurance company of a woman in California stopped
covering her prescribed pain medications, and offered end-of-life medication
for just $1.20” (Chereb par. 13). We should never penalize patients who choose
or prefer pain management instead of end-of-life medications. To prevent this
we need protections for the vulnerable people, such as the elderly or disabled,
making these decisions. For example, just because someone is a certain age and
has a specific condition does not mean that they are eligible for PAS. These things need to be handled on a case-by-case basis due to varying
circumstances. Another possible solution would be the attendance of an
impartial third party member being in the room, such as another physician, when
conversations between the doctor and patient are occurring. In reality, PAS provides patients with another
choice in which they can decide when or if they would like to have a
conversation about PAS, but having it available is the point. Having this
alternative available would empower the patients even more and give them some
control over their illness and death. In the long run, PAS will be helping a lot more patients than it will be
harming them. Similarly, an article from The
Journal of the American Medical Association, which has been collecting data
from surveys, official state and country databases, interview studies, and
death certificate studies, states: “physician-assisted
suicide is increasingly being legalized, remains relatively rare, and
primarily involve patients with cancer. Existing data do not indicate widespread
abuse of these practices” (Emanuel et al 88). This tells us that very few
people actually go through with this alternative and that there has been no current widespread or major abuse
of PAS.

All
things considered, PAS is a merciful alternative to the pain and suffering
terminally ill patients can undergo. This alternative can
give patients the freedom and peace that they deserve after many of their
options have dwindled. It is also a cost-effective choice compared to the
expensive options that may not give patients the quality of life that they
deserve. For terminally ill patients expenses usually become a burden on the
whole family, even after the loved one has passed away. Additionally, the right
to the pursuit of happiness should also
account for those who would like to decide on whether to suffer or not. It is
for these reasons that PAS should be legalized in more American states compared
to the 6 few states that we currently already have. Currently, in four U.S.
states (Nevada, North Carolina, Utah, and Wyoming) there are no specific laws
that specifically involve or prohibit PAS. These states should be the next
possible legalization playing field for the “right to die” movement.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Works Cited

Artnak et al. “Health
Care Accessibility for Chronic Illness Management and End-of-Life Care:               A View from Rural America.” The
Journal of Law, Medicine & Ethics, Blackwell                            Publishing Ltd, May 11, 2011.

Chereb, Sandra. “Foes of
Nevada Right-to-Die Bill Turn Out in Force for Protest.” Las Vegas      Review-Journal, reviewjournal.com, April
12, 2017.

Cotton, Paul.
“Medicine’s Position is Both Pivotal and Precarious in Assisted Suicide
Debate.”               The Journal of the American
Medical Association, jamanetwork.com, 273:5, February 1,                       1995, pp. 363-64.

Egan, Timothy. “Federal
Judge Says Ban on Suicide Aid Is Unconstitutional.” The New York       Times, May
4, 1994.

Emanuel et al.
“Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the                     United States, Canada, and
Europe.” The Journal of the American Medical Association,                jamanetwork.com, 316:1, July 5,
2016, pp. 79–90.

Lewis, Browne. “A
Deliberate Departure: Making Physician-Assisted Suicide Comfortable for                 Vulnerable Patients.” Arkansas
Law Review, 70:1, March, 2017.

Maynard, Brittany. “My
Right to Die with Dignity at 29.” Cable News Network, November 2,                 2014.

Stafford, Ned.
“Obituaries: Jack Kevorkian.” British Medical Journal, June 29, 2011.

Starks
et al. “Physician Aid-in-Dying.” University of Washington School of Medicine.
April,                      2013.

Stillman,
Adam. “Moving the Needle: A Call to Change Age Restrictions in American                             Physician-Assisted Suicide Laws.” Southern California
Interdisciplinary Law Journal,                       26:1,
September, 2016.

“So,
Is It Over?” American Horror Story, created by Ryan Murphy and Brad
Falchuk,                              performance
by Evan Peters, season 6, episode 5, FX, 2016, time: 17:45.

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