Ethanasia; the argument against physician-assisted suicide.

This really is a question of one's philosophy. Many credible arguments have been made and are being made on this topic. Is physician-assisted suicide morally right or not? Is it in the best interest of the patient?

Unfortunately, the medical ethical code has been shown to support both arguments. Opinion E-5.7 powerfully expresses the perspective of those who oppose physician-assisted suicide. Opinion 1.1.7 articulates the thoughtful moral basis for those who support assisted suicide.₁

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Quite a number of valid points have been made to discourage legalizing physician-assisted suicide. The trials studied in Oregon, USA, have been key in these deliberations.

The argument made in support of euthanasia is cornered on the anecdote of pain and the inhumanity of letting the suffering linger. The focus, which is the argument against, is discussed.

Ethically appropriate options are being sidelined

Many believe there are more options at physicians’ disposal and assisted suicide increase, as improper. Proper sedation has been proposed to ensure almost no pain in a patient’s final hours. The WHO has recommended palliative treatment be efficiently delivered before the question of euthanasia. ₂

Discrimination against Disability

Unfortunately, surveys made support the notion that people opt for euthanasia less for the pain and discomfort and more for the drop in quality of life. Loss of dignity and body function is the paramount indications according to the study.₃

A bad System Made Worse

Healthcare is an expensive institution and optimum service is seldom achieved as most cannot afford it. This has always been a problem generally and governments have tried to reduce or manage this problem.

If euthanasia is mad eventually accepted generally, some believe it would become a more comfortable and deleterious option for both physicians and patients. In the US, the total cost of executing physician-assisted suicide is about $300 while the cost of palliative treatment is way more.₄

The concern here is, due to cost, a good number of patients will be denied more time and palliative treatment since a rather swift option is available.

The Indirect Impacts on Health Care

Some physicians believe it stands against the very core of the profession's creed... to do no harm. And may also, have a damaging effect on the physician-patient relationship. The physician’s role is to safeguard life and render comfort, and in no way does euthanasia fit the description.

The Illusion of Choice and Self-Determination

Contrary to the made argument, physician-assisted suicide diminishes the patient's choice and autonomy. This is supported by the study done by elder law specialist, Margaret Dore.₁

*During the election, proponents touted [assisted suicide] as providing “choice” for end-of-life decisions. A glossy brochure declared, “Only the patient—and no one else—may administer the [lethal dose].” The Act, however, does not say this—anywhere. The Act also contains coercive provisions. For example, it allows an heir who will benefit from the patient’s death to help the patient sign up for the lethal dose.
…The Act also allows someone else to talk for the patient during the lethal-dose request process, for example, the patient’s heir. This does not promote patient choice; it invites coercion.
By comparison, when a will is signed, having an heir as one of the witnesses creates a presumption of undue influence. The probate statute provides that when one of the two required witnesses is a taker under the will, there is a rebuttable presumption that the taker/witness “procured the gift by duress, menace, fraud, or undue influence.”
Once the lethal dose is issued by the pharmacy, there is no oversight. The death is not required to be witnessed by disinterested persons. Indeed, no one is required to be present. The Act does not state that “only” the patient may administer the lethal dose; it provides that the patient “self-administer” the dose.
…Someone else putting the lethal dose in the patient’s mouth qualifies as “self-administration.” Someone else putting the lethal dose in a feeding tube or IV nutrition bag also would qualify. “Self-administer” means that someone else can administer the lethal dose to the patient. … Indeed, someone could use an alternate method, such as suffocation. Even if the patient struggled, who would know? The lethal dose request would provide an alibi.
This situation is especially significant for patients with money. A California case states, “Financial reasons [are] an all too common motivation for killing someone.” Without disinterested witnesses, the patient’s control over the “time, place and manner” of his death, is not guaranteed.
If one of your clients is considering a “Death with Dignity” decision, it is prudent to be sure that they are aware of the Act’s gaps. By signing the form, the client is taking an official position that if he dies suddenly, no questions should be asked. The client will be unprotected against others in the event he changes his mind after the lethal prescription is filled and decides that he wants to live.₅

The Ambiguity of a Terminal Prognosis

Terminal Illness Prognosis is an estimation and not a fact. There have been several instances where a patient out lives the predicted time expected by physicians or better still, when patients have unexpected recoveries or health boosts.

Some of them unexplainable. If euthanasia is made the order of the day, it would result in more harm than good because Prognosis, as earlier pointed out, is just an estimation.₆

Options: Presented But Not Provided

All options are required to be presented by the physician to the patient, but at times, these alternatives are not even made available, and euthanasia ends up being the most logical option.

Or maybe how they are presented. For example, it's like going to get coats and you see 2 different ones and don't know which is better, and the staff there nudges in a direction, that coat suddenly becomes a better option. That's how it's presented.

Good Faith: A Safety for Doctors, Not Patients

There is one foolproof safeguard in the Oregon and Washington laws. Unfortunately, it is for physicians and other health care providers rather than for patients—the good faith standard. This provision holds that no person will be subject to any form of legal liability, whether civil or criminal, if they act in good faith.₇
This law has also been shown to be virtually impossible to disprove.

Depression and a Death Wish

Mental health specialists believe the eventual misuse of euthanasia on the anecdote of pain has depressed patients might even consider themselves in pain.

*… the psychosomatic literature [describes] … Demoralization Syndrome, which is very common in chronic, … life threatening illness, the features of which (hopelessness, helplessness, and despair) fit the profile of the victims of Oregon’s law, who are consistently reported NOT to be in pain or disabled by their allegedly terminal illness but request [assisted suicide] because of fears of what might come in the future: helplessness, dependency, becoming a burden.
Oregon in fact has proven that the only symptom driving requests for [assisted suicide] is psychological distress. Clearly the standard of care for depression and demoralization is not a lethal overdose of barbiturates.

Greene also stated:

*The wish for death is a “cry for help,” a reliable sign of depression. How absurd that it would be met with a lethal prescription. Such an act violates professional standards of palliative care as much as if I were presented with a suicidal patient and handed her a gun or drove her to the Golden Gate Bridge.
…What this legislation neglects is the fact that advances in palliative medicine have made it possible to relieve … symptoms in virtually all dying patients. The argument that five to ten percent of dying patients experience intractable symptoms relies on outdated data. (Of course, the victims of the Oregon law were not imminently dying or suffering intractable pain; they were suffering from depression and despair.) Those patients who are truly at the end-of-life need access to excellent palliative and hospice care, not a lethal overdose.8

Patient Abandonment

The law supporting euthanasia, as seen in Oregon, does not account for the protection and interest of Psychiatric patients. A case was made that a man with serious depression was a subject of physician-assisted suicide and when further inquiry was made, more patients who were involved were indeed depressed.

The Netherlands: Pandora’s Box

Using the Dutch as an observation tool, when euthanasia is made legal on a broad scale, it really becomes uncontrollable, like wildfire.

It was observed that in the Netherlands, lethal injection has become so rampant and is now the order of the day. Once a patient is diagnosed with a terminal disease, euthanasia is almost always the choice of management.₉

Conclusion

These are some of the arguments made against euthanasia, though very credible points, I believe it all still comes down to patients and their loved ones. But these concerns are valid and should be appropriately addressed.

References

1. https://www.ama-assn.org/delivering-care/ethics/physician-assisted-suicide
2. Herbert Hendin, M.D., “Commentary: The Case Against Physician-Assisted Suicide: For the Right to End-of-Life Care,” Psychiatric Times, Vol. 21, Num. 2, February 1, 2004, available at http://www.psychiatrictimes.com/display/article/10168/54071 (accessed July 8, 2009).
3. Karen Birchard, “Dutch MD’s Quietly Overstepping Euthanasia Guidelines: Studies.” Medical Post, Vol. 35, Num. 11, March 16, 1999.
4. https://dredf.org/public-policy/assisted-suicide/why-assisted-suicide-must-not-be-legalized/#few-helped
5. Dore, Margaret, “Death with Dignity”: What Do We Advise Our Clients?,” King County Bar Association, May 2009 Bar Bulletin, available at What Do We Advise Our Clients? (accessed July 13, 2009)
6. E.B. Lamont et al., “Some elements of prognosis in terminal cancer,” Oncology (Huntington), Vol. 9, August 13, 1999, pp. 1165-70; M. Maltoni, et al., “Clinical prediction of survival is more accurate than the Karnofsky performance status in estimating lifespan of terminally-ill cancer patients,” European Journal of Cancer, Vol. 30A, Num. 6, 1994, pp. 764-6; N.A. Christakis and T.J. Iwashyna, “Attitude and Self-Reported Practice Regarding Prognostication in a National Sample of Internists,” Archives of Internal Medicine, Vol. 158, Num. 21 November 23, 1998, pp. 2389-95; J. Lynn et al., “Prognoses of seriously ill hospitalized patients on the days before death: implications for patient care and public policy,” New Horizons, Vol. 5, Num. 1, February 1997, pp. 56-61.
7. (Or. Rev. Stat. § 127.885(1)–(3))
8. Greene, Letter to the Council on Ethical Affairs.)
9. “Doctors had reported that a total of 2,146 people were euthanised and 152 died in assisted suicides in 2008, while in 33 cases there was a combination of the two practices.” See “Dutch Court Jails Euthanasia Group Chairman For Aiding Suicide,” Expatica.com, May 30, 2009, available at http://www.expatica.com/nl/news/dutch-news/Dutch-court-jails-euthanasia-group-chairman-for-aiding-suicide_53107.html# (accessed July 13, 2009)