Current end the patient’s life (Burdette et al., 2005,

Current Issues Surrounding Physician-Assisted
Suicide and Varying Perspectives

Cathy Swegart

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Denver College of Nursing

Abstract

This paper will explore physician-assisted suicide (PAS),
the current issues surrounding PAS, as well as general opinions and
perspectives that those in the medical community have about it. The terminology
and meanings of PAS will also be discussed, as there are several other
synonymous terms. Several articles discuss varying opinions on the subject, as
it can be very complex. It is important as not only a nurse, but a member of
society, to understand PAS and the impact it has on terminally ill individuals and
society.

Keywords:  Physician-assisted suicide

Current Issues Surrounding
Physician-Assisted Suicide and Varying Perspectives

Physician-assisted suicide remains not only one of the most
controversial topics in our country, but also in the medical community. Some
may argue that health providers pledged their lives to making patients better
and not harming them, yet, those who are terminal feel they unable to take
their lives into their own hands. There are ethical, legal, and social issues
surrounding the topic of physician-assisted suicide, as well as varying
perspectives.

It is important to discuss the process involved in
physician-assisted suicide. It usually entails a physician providing a
prescription for a lethal drug, to a patient in order for them to voluntarily
end their life (Burdette, Hill, & Moulton, 2005, p. 80). It is also significant
to note that this term may be synonymous with others out there, such as active
euthanasia. Active euthanasia is similar in that, a physician administers a drug
to end the patient’s life (Burdette et al., 2005, p. 80). This is important
because, both are similar in nature, yet the terms may skew thoughts on what
they may entail.

PAS may also be referred to as assisted death, or aid in
dying (Ersek, 2005, p.49). There is also the process known as withdrawing or
withholding life-sustaining therapy, or passive euthanasia. These two terms are
used to describe the process of discontinuing therapies that assist in keeping
a patient alive. These would include mechanical ventilation and artificial
nutrition therapies (Ersek, 2005, p. 49).

Some may be confused by the many end of life options that
are out there. There are several political, social, and ethical conflicts that
exist for each. It is also important to note that the words “suicide” and
“euthanasia” can be interpreted many different ways, thus impacting opinions on
these methods. This will be discussed later.

In order for PAS to be an option for a patient, the patient
must mentally capable to choose this option. Depending on the state, there are
additional policies that must be satisfied in addition to mental capacity (Ersek,
2005, p. 48). Currently, PAS is addressed at the state level and is legal in
California, Colorado, Oregon, Vermont, Washington, and Montana (Mazloom,
Jahromi, & Bastani, 2017, p. 2). The question of legality is only one part
of the puzzle. Many argue that even if it is considered legal, is it ethical?
It is important to look at what guides ethical principals.

Religion plays an important role in one’s stance on
physician-assisted suicide. Religion is one of the things that influences
ethical principals. As you can imagine, having a country of many different
religions leads to various opinions on PAS. According to Burdette et al. (2005),
those most supportive of PAS are associated with the Protestant, Jewish, and
unaffiliated religions, while conservative Protestants and Catholics are more
likely to be opposed (Burdette et al., 2005, p. 79).  Of these religions, Burdette et al. (2005)
found that those who were actively attending church on a regular basis is
positively associated with opposition to PAS (Burdette et al., 2005, p. 90).
This is important because, those in the medical field must be able to separate
their own religious beliefs, with those of a patient, family member, doctor, or
any other member of the situation at hand.

The term “suicide” has always had some sort of stigma
attached for many years. Mainly because from a religious perspective, this is
sometimes viewed as a sin. At times, there are also very different views of the
methods of suicide. Usually, one might think that it would include violent
means to and end such as hanging, overdose, or gunshot. In other words, this
may be seen as it always has been traditionally, “a bad death” (Faulconer,
2017, p. 316). With these negative connotations, it is easy to see why this
term may negatively alter views on PAS. The method of death with PAS is very
different from what may be associated with the term “suicide”.

 

In the states that PAS is considered legal, there are many
different ways it is presented. With the negative connotations described above
taken into consideration, they present PAS in a way that is not associated with
the term “suicide”. The terms “humane” and “dignified” are used to describe
PAS, thus potentially making it more favorable to the public or to those
considering it (Faulconer, 2017, p. 316). It is important that the patient feel
that they are not taking the easy way out, or disappointing others with
choosing PAS. Having the state identify this as humane and dignified can serve
to be a very strong comfort to a dying patient

In terminal patients, PAS may be considered a favorable
alternative than dying in a painful or unknown circumstance. The use of PAS is
far from the suicide descriptors described above. Smith, Goy, Harvath, &
Ganzini (2011) state that patients consider pursuing PAS in order to “avoid
poor quality of dying caused by symptom distress and impaired physical
function” (Smith, Goy, Harvath, & Ganzini, 2011, p. 445). It is interpreted
that, patient conditions and their manifestations towards the end of illness,
is very frightening to face.

Another important concern in patients of this population is
that of autonomy. Spence, Blanke, Keating & Taylor (2017) describe autonomy
as “the ability to discern, understand, and decide among options without
coercion or the undue involvement of others, either in accordance with moral
law or with the individual’s discerned preferences and values” (Spence, Blanke,
Keating & Taylor, 2017, p. 696). From a patient perspective, it has been
shown that many patients requesting PAS were motivated more by the prospect of
potentially losing autonomy, rather than experiencing the physical symptoms of
their illness (Faulconer, 2017, p. 315). So not only may the actual physical
and psychological symptoms be worrisome, but the thought of losing autonomy
drives the use and/or inquiry of PAS. In fact, one of the most common reported
concerns made by patients in the 2007 State Health Division report on Oregon’s
Death with Dignity act was the possibility of losing autonomy (Lachman, 2010,
p. 123).

In addition to loss of autonomy, more control over the dying
process is an important aspect of PAS. In a study by Smith et al. (2011) It was
found that, of the patients who received prescriptions to end their lives,
their families reported better quality of dying for their loved one (Smith et
al., 2011, p. 449). Family members also reported that choosing PAS had “greater
symptom control, particularly in regard to control over surroundings, better
functions, better energy, and better control of bowel and bladder” (Smith et
al., 2011, p. 449). This also led the family to believe there was much more
control over the dying process, than there would have been without the option
of PAS.

In general, it appears that PAS is a favorable option in
patients suffering from terminal illnesses. It is much more complicated from
the medical community perspective. With physicians in mind, there are varying
opinions on the matter. Mazloom et al. (2017) argues that it is still a common
practice for graduating physicians to take the Hippocratic oath, or similar
type of code (Mazloom et al., 2017, p 2). One of the first principals of this
is to “do no harm”, and that should not open to interpretation. (Mazloom et
al., 2017, p. 2).  Obviously, there are
physicians who feel differently on the issue and provide prescriptions that may
end a patient’s life.

The involvement of a physician in PAS is extremely thorough.
If physicians are presented with a patient requesting information on PAS, there
are likely numerous responses that come before writing that final prescription.
It is usually viewed and understood as a last resort. Some methods typically
taken when presented with a PAS inquiry include addressing the patient’s
concerns, mental status, reviewing the illness and prognoses thoroughly, trying
to understand the patient request in the context of the patient’s illness and
prognosis, taking a multidisciplinary approach and enlisting the help of other
professionals or family members, obtaining a mental health evaluation, and addressing
the patient’s ability to consent (Spence et al., 2017, p. 698). It is important
to note, physician involvement is taxing emotionally and ethically, so it is
important that they also prioritize self-care.

            Nurses are also presented with PAS situations,
but are not usually involved in the process itself. According to the American
Nurses Association (ANA), participation in PAS is strictly prohibited as it is
in violation of the code of ethics (“Euthanasia, Assisted Suicide, and Aid in
Dying”, 2013, p. 1). It is possible to be supportive of the idea of patient
autonomy, without necessarily supporting the idea of PAS. Providing supportive,
culturally appropriate, and unbiased care is of utmost importance for the
nurse.

           Some
good strategies to tackle this situation according to Ersek (2005), are to ask questions
such as “how your views are influenced by your religious or spiritual beliefs?”
and “how do you define a good death?” (Ersek, 2005, p. 51). It is also
important to think about ways that the nurse may respectfully treat patients
and their families when their opinions may differ.

           Physican-assisted
suicide remains a controversial topic in the country, as well as the medical
community. Ethically speaking, it is hard to comprehend how one might react to
such a request. However, patients typically view it as a favorable option, and
it is a great comfort to some knowing that it is available. In the medical
community, it may be a long time before it is more widely accepted, if at all.
What is important, is treating the patient with dignity and respect, and to provide
appropriate care.

References
American Nurses
Association (ANA). (2013). Euthanasia, Assisted Suicide, and Aid in Dying.
Retrieved from http://www.nursingworld.org/MainMenuCategories/
HealthcareandPolicyIssues/ANAPositionStatements/Et hicsandHumanRights.aspx
Burdette,
A. M., Hill, T. D., & Moulton, B. E. (2005). Religion and Attitudes Toward
Physician-Assisted Suicide and Terminal Palliative Care. Journal for the Scientific Study of Religion, 44(1), 79-93.
Ersek, M. (2005). Assisted Suicide:
Unraveling a complex issue. Nursing, 35(4),
48-52.
Faulconer, A. W.
(2017). Rebranding Death. BYU Journal of
Public Law, 31(2), 313-332.
Lachman, V.
(2010). Physician-Assisted Suicide: Compassionate Liberation or Murder? Medsurg Nursing, 19(2), 121-125.
Mazloom, S.,
Hamidian, A. J., & Bastani, B. (2017). Legalization of Euthanasia and
Physician-Assisted Dying: Condemnation of Physicial Participation. Online Journal of Health Ethics, 13(1),
1-4.
Smith, K. A.,
Goy, E. R., Harvath, T.A., & Ganzini, L. (2011). Quality of Death and
Dying in Patients who Request Physician-Assisted Death. Journal of Palliative Medicine, 14(4), 445-450.
Spence, R. A.,
Blanke, C. D., Keating, T. J., & Taylor, L. P. (2017). Responding to
Patient Requests for Hastened Death: Physician Aid in Dying and the Clincal
Oncologist. Journal of Oncology
Practice, 13(10), 693-699.
 

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