EHICAL ISSUE SCHOLARLY PAPER

EHICAL ISSUE SCHOLARLY PAPER
Ethical Issue Scholarly paper: Physican Assisted Suicide
Christine Zuwe
Athabasca University
NURS 324: Concepts & Theories in Nursing Practice
Lorraine Thirsk
Aug 20 2021
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Physician Assisted Suicide
Physician assisted suicide (PAS) is simply a more medical terminology of suicide. There
are a lot of dilemmas that surround the subject of physician-assisted suicide (PAS) or in
other terms physician assisted euthanasia (PAE). Although there is similarity between the
two, the major difference is that physician assisted euthanasia would entail the physician
actually doing the act, whilst physician assisted suicide would be the physician providing
the instruments and medication (lethal dose) to the patient for them to perform the act
themselves According to Radbruch, Leget, Bahr, Müller-Busc, Ellershaw, Conno, &
Vanden Berghe (2016) . Physician assisted suicide has a lot of controversy surrounding it,
some are for it and some against, both side believe they are in the right. The question that
most ask is whether we have the right to play God and decide how and when someone is
to die. Physician assisted suicide has time and time again been brought before The
Supreme Court of Canada (Parliament of Canada, 2013). “A number of the Criminal
Code provisions are related to euthanasia and the cessation of treatments, with Section 14
of the Criminal Code stating no person is entitled to consent to have death inflicted on
him, and such consent does not affect the criminal responsibility of any person by whom
death may be inflicted on the person by whom consent is given. Medically this means
that any medical professional at the request of the patient that gives or provides a lethal
injection or dose would be held criminally liable under the Criminal Code (Parliament of
Canada, 2013). The one thing that needs to be clarified is that the answer on whether
physician assisted suicide should be allowed needs be based on the independent cases and
the circumstances surrounding it. The importance of physician assisted suicide in society
also needs to be discussed.
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Importance of Physician Assisted Suicide in the Society
With the baby boomers becoming senior citizens, making already tight budget
health system even more strained, due to end of life cost. Many of them would rather not
have to suffer end of life pain, they would say that they have already been through too
much during the Second World War. They would rather die with dignity and on their
terms. Claxton-Odenfield states that “in Canada, most cancer diagnoses happen after age
50, and most Alzheimer’s patients are diagnosed after 65. This puts the aging baby
boomer generation (who count for roughly 30 per cent of the population) in a bind. As
they watch their parents die, they are also feeling the affects of their declining health and
facing their own end of life” (2014, p.1).
Argument for Physician Assisted Suicide/Euthanasia
In my nursing practice, working a long-term care, I have come to terms in
agreement with physician-assisted suicide. Some patient are being put on dozen of
medication just to keep their heart pumping just a little longer, some have multiply
hospital visits due to their body not wanting co-operate. This can extend their suffering.
Most of my patients are there in body but gone in spirit. According to Evan, sometimes
not taken into account patients’ quality of life, the implementations of chemotherapy,
surgery, and development of new medications, are pushed on patients to extend their
lives. The ethical framework outlined by The Canadian Nurses Association (CNA) in
which they state the nurse must provide dignity, and promote and respect informed
decision-making (2008).
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According to Claxton-Odenfield Physician assisted suicide is fully justified by the
fact that it is honoring a patients “autonomy, personal freedom, independence, dignity,
self-determination, and relief from unremitting pain and prolonged suffering” (2014, p.1).
As stated in Canadian Nurse Association, 2008 “ From a nursing standpoint and in
keeping in line with our nursing duty, we are ethically employed as nurses, and as
humans, to create an environment in which our patients can thrive and become their own
idea of health, whatever that might be; it is a decision that must be that of the patient if
we are to maintain their feeling and right to autonomy.” Hence if the patient believes the
only way they could end their suffering and pain is death, then the nurse caring for that
patient to respect the patients wishes. According to Claxton-Odenfield & Miller, 71% of
Canadians agree with PAS/PAE in the case of a terminally ill patient in order to relieve
suffering; that all terminally ill patients have a “right to die” (2014, p. 2).
According to Yang (2016), the most common reasons for patients wanting to
participate given by 36 participants in PAS/PAD at the Research done at the Seattle
Cancer Care Alliance showed that 97.2 % were scared of losing their autonomy, 88.9%
are worried of being unable to engage in enjoyable activities and 75% are worried of
losing dignity (p. 247). The report goes on to say; the reasons why people opt for PAS
reflect concerns about autonomy, dignity, and functional status rather than disease-related
symptoms or depression. Looking at these findings should people be given the right to
choose while they still can? According to Margaret P. Battin “we should not wait for
nature to take its course in a slow and painful way but be merciful and “the duty to act to
end pain or suffering already occurring’” (as cited in Boetzkes & Waluchow, 2002,
p.363).
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Physician assisted suicide is also looked on as a financial strain relief, some say
that if patient were allowed to chose to die, there would be less need for the machines to
help keep them alive (Young & Ogden, 2000). A fine example of these would be a patient
that has been paralyzed from the neck down due to motor vehicle accident that suffers
from constant pneumonia due to auto immune system failing, and keeps having to be
hospitalized. This would mean cost of medication, hospital stay, one on one staffing,
security assistance, supplies etc. Some people would say that these resources would be a
better benefit to someone with a higher level of health.
Argument against Physician Assisted Suicide
There are many people that would argue against physician-assisted suicide.
According to Young and Ogden there might be hasted decision making for a patient to go
ahead with physician assisted suicide when there might be a chance of recovery, there
might also be an abuse of physician assisted death (2000). With the fact that some family
members and friends might push someone to choosing physician assisted suicide, it can
make the whole situation very slippery. Nicholas states “By making PAS available, some
people will be pressured into accepting assistance in dying by their families. This
pressure may sometimes occur in very subtle forms. This is an important argument in
favor of strict controls that would confirm that a patient is not being influenced by others.
Some feel that the potential for interference is so serious that all assisted suicide should
be banned” (2008).
Even though informed consent is fundamental to patient autonomy nurses it could
find it difficult to accept their patients choice of opting for death instead of facing their
pain. A patient has for no more pain is to end their lives. Fernandes states that nurses are
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meant to help restore their patients health, agreeing to the physician assisted suicide may
be seen as a nurse compromising on their trustworthiness and compassion (2015).
Being that we live in a multicultural country, we would have to take into account
that some religions are strictly against physician assisted suicide. According to Nicholas “
Many faith groups within Christian, Muslim, Jewish and other religions sincerely believe
that God gives life and therefore only God should take it away. Suicide would then be
“considered as a rejection of God’s sovereignty and loving plan”. They feel that
individuals are all stewards of their own lives, but that suicide should never be an option.
This is an important belief for members of these religious groups. They would probably
be extremely reluctant to choose suicide (including physician assisted suicide) for
themselves” (2008). It also states in the Bible that you shall not murder (Deuteronomy
5:17). Nicholas backs this statement up stating that religion believes that person should
not take his own life or not take anyone else’s life (2008).
According to Frank, insurance companies might be in support of physician
assisted suicide so that they would save money, hence hasting pushing for death even if
there is a chance of recovery (2016). “…increasing health care costs could influence a
patient’s decision to request an assisted death. Her concern was that patients experiencing
slow deaths, and/or, difficult symptom management, maybe vulnerable to social pressure
to end their lives prematurely because they feel expendable” (Young & Ogden, 2000, p
4).
According to Yang (2016) physician assisted suicide is inconsistent with the
physician’s role as a professional and a healer. Physicians’ are considered as healers
because by the medical profession declaring and accepting that physicians “are mere
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providers of services, to be guided only by the desires of individual patient” (p.1, 2016),
state or third parties. Physician assisted suicide might conflict with the doctors’ values
and beliefs meaning that it will be violating the “ injunction not to kill”. Physician
assisted suicide puts innocent people at risk of execution especially in cases of errors in
prognosis and mistaken diagnosis. One of the philosophies of palliative care medicine is
that there is never a situation in which nothing can be done. Therefore by allowing the
authorization of Physician assisted suicide “declares to the patient and physician that
there are extreme, terrible circumstances where nothing can be done short of PAS and
that having the option of PAS/PAD is needed”(Yang, 2016, p. 248). By doing this we are
telling our patients that they are not worthy living thus giving them ideas to want PAS
instead of having doctors revisit their needs and help them distress through education,
support, and engagement with the patient.
Physician assisted suicide is fundamentally inconsistent with the physician’s role
as professional and trusted healer. The physician’s professional role is to use his or her
knowledge, insight, and healing skills to aid the patient, not to kill the patient. For
example, an order for physician assisted suicide is profoundly different from an order for
chemotherapy. The latter requires specific professional training and expertise, is
calibrated for the particular illness and circumstances of the patient, and has uncertain
toxicity that both the physician and the patient seek to minimize. Providing Physician
assisted suicide requires much less expertise, it is one size fits all, and the toxicity is
grade 5. Another example is pain relief. A medication administered to palliate symptoms
that inadvertently causes death is ethical and is profoundly different from a prescription
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designed to bring about death. The former is care for the living patient, and the latter
removes the patient from the world of the living.
Ethical Theories
The ethical theory that would go well with my position on physician assisted
suicide would be Deontology. “Deontology theories of ethics are based upon the
rationalist view that the rightness or wrongness of an act depends upon the nature of the
act, rather than its consequences” (Burhart, Nathaniel and Walton, 2014, p. 34). Meaning
that an action it’s self and why it was done decides if it is wrong or right, not the outcome
of the action. “Ethical decision making that entails a person’s choices, values and actions
begins in desire: people are inspired by a desire to pursue the good as they see it”
(Kozier, & Erb, 1987, p. 185). As Bergman Levy, Azar, Huberfeld, Siegel, & Strous, 2013
states PAS is not a light subject as it comes with many ethical underpinnings.
Conclusion
There are many people for and against physician assisted suicide, and each side
has great examples as to why they are correct. According to Margaret P. Battin although
physician assisted suicide is similar to other debates around the world, such as testing
embryos for genetic defects, genetic engineering, and abortion, Margaret P. Battin also
states that “But opponents of PAS argue that it is importantly different from other issues
in at least three ways: (I) It involves direct participation in the intentional killing of an
innocent person and thus would undermine a fundamental ethical prohibition; (2)
Legalized PAS would license professionals—professionals who have always been
dedicated to healing and preserving life—to kill. That would pervert the profession of
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medicine and also undermine the trust vulnerable people must have in order to seek the
services of a physician; (3) PAS will take place under cover of the confidentiality of the
physician-patient relationship, often in the privacy of the patient’s home, and will thus
prove impossible to regulate or control” (as cited in Boetzkes & Waluchow, 2002, p.363).
One needs to really look at the reason why a patient would ask for physician assisted
suicide, it is not just a simply yes or no answer.
References
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