Contact CU Independent Opinion Staff Writer Alexis Kantor at Alexis.Kantor@colorado.edu.
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Clinicians who work with terminally ill patients face one of the most ethically challenging decisions of the modern age. Their work requires them to confront death on a daily basis, and it can present even more of a challenge if a patient wishes to be put to death as a way out of an incurable disease — a practice known as euthanasia. This is a controversial topic, with ethical boundaries that are difficult to define. The article “Legal but Not Always Allowed: Physician Aid in Dying,” published by the American Journal of Hospice and Palliative Medicine in 2011, offers detailed yet varying perspectives on these boundaries.
The article addresses the various sides of the issue of physician-assisted death (PAD), including views by an expert in ethics, a medical doctor, a nurse, a chaplain and a lawyer. The patient referenced in the study is a 47-year old man named GH, diagnosed with amyotrophic lateral sclerosis, otherwise known as ALS, or Lou Gehrig’s disease.
ALS is a condition characterized by progressive muscle weakness.
The case takes place in Oregon, one of the three U.S. states to have passed the Death with Dignity Act. This law provides a legal way for terminally ill patients to end their lives through a lethal dose of prescribed medicine. The overarching problem with legalizing “Death with Dignity” in other states is that it paves the way down a slippery slope. Legal euthanasia would cause physicians to become desensitized to death, and routinely provide PAD to every terminally ill patient who desires it.
And to complicate things more, even in states where euthanasia is legal, physicians can still deny this procedure.
According to author of the study and ethics expert Dr. Matt Stolick, “Patient autonomy does not permit treating health care workers as vending machines for whatever treatment one cares to choose.”
One of the fundamental rights of a physician is to deny care, and this right extends to PAD. While a physician can respect patient autonomy by referring them to a different specialist or transfer of facility, they should not be forced to provide a treatment they feel requires them to cross an ethical line.
There is also a major flaw with the Death with Dignity Act: Euthanasia is only legal in an instance where a patient administers medication with his or her own hands. In GH’s case, he was physically unable to self-administer due to the conditions of his disorder. Given that he was in a church-sponsored hospital, the attending physician was also unable to administer the medication, leading GH claim he was discriminated against.
Dr. Stolick points to this as evidence that “the assisted suicide law seems to fail to allow for the type of situation it was meant to allow for, one of assistance in death as a demonstration of public compassion for patient self-determination in certain outstanding, especially futile and tragic cases of unrelenting pain and dire prognosis.” He added, “The distinction between legal and illegal suicide should not be dexterity in the index finger.” GH felt he was being discriminated against because he could have euthanized himself had he been physically able.
No one wants to see a human being suffer any more than that person wants to continue living in prolonged pain. However, providing PAD eliminates opportunities to study and research suffering in a way that could prevent it in the future.
Many times I have been witness to the suffering of others. Whether it be volunteering with the elderly, waiting for my father to come out of surgery or offering condolences to my grieving mother after her own father passed away. In my current life, I am witness the other side of this experience while shadowing a physician who does not try to hide the realities of his profession.
I am not claiming all who suffer should not be allowed to find relief so that medicine can advance. But drawing from my own experiences, death is hard enough. It does not deserve to be further complicated by legalities, paperwork and ethical committees. When allowed, time will take care of death much better than we can.
PAD, or any form of premature death, is a “fortune-teller” error. It makes the assumption that something will turn out badly, and presents this prediction as an already established fact. However, life is unpredictable, so we all inevitably run into the opportunity to fail if we try to play fortune-teller. By cutting corners on death, we are removing possibilities for growth, learning and inspiration. While there may no longer be a future in store for a terminally ill patient, there could be for someone else. Nor should the ties this patient has with loved ones be severed early, even if the suffering is hard to witness.
