TERMINATION OF LIFE AND PHYSICIAN-ASSISTED SUICIDE: AID IN DYING 8
Terminationof Life and Physician-Assisted Suicide: Aid in Dying
TheMargret Howard Case (Assisted Suicide)
Dyingcan be described as a painful and fearful natural part of life thatmany dread to face. However, many wish to die with dignity and infull control of their situations. As a result of this desire, fivestates have legal frameworks that permit patients to go for physicianaid as a means of ending their lives when faced with differentoptions. These states include Oregon that legalized the procedure in1994 through the Death with Dignity Act, Montana, Washington D.C,Vermont and recently California that voted to acceptphysician-assisted suicide(Frellick, 2016, p1).However, the debate on the issue leads to different ethical and legalramifications, especially in states where legal frameworks do notexist, a good example being the case of Margret Howard in Maryland.The paper gives a position on Margret Howard`s case concerning theissue of assisted suicide.
Physicianaid-in-dying (assisted suicide)
Suicide,by all means, is illegal in various parts of the world. This isviewed from both ethical and legal perspectives. As a medicalpractitioner, one needs to protect life at all costs as stated by theHippocratic Oath (Starks, Dudzinki & White, 2013, p.1). In thecase of Margret Howard, I believe that recommendingphysician-assisted suicide is both legally and ethically wrongdespite her pain and condition. For the purpose of this paper, I willuse the term physician aid-in-dying in describing the reasons for mystance.
Aid-in-dyingis an end-of-life care choice where mentally competent and terminallyill adults request their doctors to give them the prescription thatthe patient can, once they decide, self-administer so as to have apeaceful death. Ethically, assisted suicide can never be morallyjustified (Starks, Dudzinki & White, 2013, p1). According toImmanuel Kant, suicide violates our moral duty to honor and valuerational creatures. When viewed from this perspective, as humans, wehave an obligation to respect both our lives and that of others asthe inherent value of humans. It is, therefore, wrong to aid thedestruction of life in any form, including aid-in-dying, even if inessence, the death would result to more happiness or improve one’squality of life. Aid-in-dying practice nullifies human’srelationships and violates one’s duty to the Divine(Johnson & Cureton, 2016, p.1).While doctors have noticed that Margret wishes to end her life, noone has the moral authority or freedom to choose either when or themanner in which they want to die. Such decisions degrade the inherentvaluable life that people have and therefore we as a people cannotchoose when to take our lives. The implication of such freedom isthat it would be deemed morally permissible to end a life at anypoint when one wishes.
Thedebate of death with dignity suffices when one looks at the moralaspect of the situation. While we all want people to die withdignity, aid-in-dying may not be the only option when pursuing thatdignified death. Proponents argue that the last moments of one’slife should not be consumed by suffering from severe pain anddependence on others for virtually everything. Indeed, the aboveargument is legitimate and rational (Starks, Dudzinki & White,2013, p1). However, it presents potential and critical underbellies.For example, it fails to address the issue of the sanctity of lifeand the possible adverse effects that may arise out of legalizationof this medical procedure. Again, the narrative that theseindividuals wish to end their lives because of physical pain is notresearch-based and supported. Studies have consistently indicatedthat depression and hopelessness brought about by pain are the mainfactors that motivate patients in their wish to have aid-in-dyingprocedures(Johnson & Cureton, 2016, p.1).Most terminally ill patients state that they fear to lose both theirphysical and mental functions as well as their independence.
Furthermore,such actions are tantamount to legalizing euthanasia because of theslippery slope aspect(Somerville, 2014, p10).If Physician aid-in-dying is legalized, the inevitable outcome willbe a direction headed towards legalizing euthanasia. Given thateuthanasia is illegal, any attempts to move closer to itslegalization should not be entertained(Frellick, 2016, p1).Therefore, in legalizing physician aid-in-dying for terminally illpatients like Margret, people with life-debilitating malfunctions andchronic conditions will be able to access this option and states likeMaryland will have to provide the necessary framework to address thesaid issue.
LegalizingPAD implies that insurance companies will have few incentives withwhich to pay for high-quality end of life care and palliativeintervention, thereby leading to low-quality life and inadequate carefor those in conditions like Margaret’s’. Additionally, providinglegal framework means that patients may feel obligated to requestaid-in-dying in case their insurance does not cover the end of lifecare. However, the cost of such requests may be prohibitive to manypatients (Starks, Dudzinki & White, 2013, p1).Legalizingphysician aid-in-dying, especially in states like Maryland, willtherefore disproportionately affect poor people and lead to justiceviolations. One critical component of fair justice is that allindividuals have similar choices provided to them. If the end of lifebecomes expensive and prohibitive, then many people may opt to choosephysician aid-in-dying in order to cut the cost of insurance that maycover them(Somerville, 2014, p11).
Fundamentally,legalizing physician aid-in-dying may make society perceive thenotion that the lives of terminally ill patients, like MargretHoward, are not as important and such people do not deserve to live adignified life. The slippery slope is such a serious legal issue thatI believe opens a "Pandora`s Box” that would simply legalizeeuthanasia. In its ruling, the Supreme Court expressed concerns thatthe legal permissibility of aid-in-dying could set the path to bothvoluntary and involuntary euthanasia since the tendency to expand thelegal limits are so prevalent in law (Starks, Dudzinki & White,2013, p1). Therefore, based on these aspects, I believe that moreoptions exist in respect to Margret Howard’s case and none of theseoptions is assisted suicide.
Vermont,Oregon, Montana, the state of Washington, and lately California havelegal frameworks that legalize assisted suicide. However, in the caseof Mrs. Howard, I believe that my stance will not change even if shewere a resident in these states(Frellick, 2016, p1).Aid-in-dying is morally wrong and as a physician I have a moralobligation to report to the family that different options can beexplored to ensure that Margret`s quality of life improves despiteher condition. While the argument for aid-in-dying borders onlessening pain and discomfort and offering a dignified death,different options exist that can help relieve pain. Again, the mostcited reasons for seeking physician aid-in-dying include the desireto have control over one`s circumstances of death and to die at home(Somerville, 2014, p10).Furthermore, others select this option because they fear losingindependence and to experience pain. However, studies conductedbefore Oregon legalized assisted suicide by physicians showed thatcurrent symptoms like pain, fatigue, and dyspnea were not the primaryreasons why people sought for the procedure(Smith et al., 2011, p446).Moreover, depression and lack of social support were not consideredas the major reasons for the service. From these findings, it provesthat Margret`s pain and her inability to move her hands does not meanthat she should be assisted to die.
Margret’ssons do not agree that she should end her life as she wishes becauseof her suffering. While proponents would argue that Margret has theautonomy and independence to make decisions over her life, I believethat in her condition and based on her age, the ability to makecompetent decisions has been affected(Youngner & Kimsma, 201, p35).She is suffering a terminal illness and has less time to live.Furthermore, she is suffering from severe pain and may have lostindependent decision-making ability. It is possible that Margret isunder pressure and the deteriorating physical and mental capabilitiesmake it difficult for her to have independent decisions(Smith et al., 2011, p445). Therefore, the argument that such an individual should have thefundamental right to control the manner and timing of their deathignore the possibility that it is highly unlikely that such people,faced with these issues, can make an independent decision.
Imperatively,Maryland state laws do not permit aid-in-dying and any form ofassisted suicide. As a result, an attorney practicing in the stateunderstands that the existing legal framework does not allow for thedecision and cannot press on having Margret go for physicianaid-in-dying. Consequently, the moral decision taken given this casecannot be altered by any legal argument within the state since suchdecisions will be illegal.
Deathand suffering that comes before it are uncomfortable and painful, ifnot fearful. However, ethical principles, particularly theHippocratic Oath, cannot allow physicians to unilaterally decide fora patient, especially when such patients are terminally ill. MargretHoward’s case presents a unique situation that needs a closerexamination of all existing options based on legal and ethicalperspectives, particularly in the state level.
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