Because of the controversy surrounding providing assistance to a patient in ending their life as a result of their traumatic experiences with a terminal illness, physician assisted suicide (PAS) or physician assisted death (PAD) is one of the key ethical concerns in the modern clinical world. One ideal instance of a situation when a doctor must choose between saving lives and upholding the constitutional right to death is the case of Dr. Timothy Quill. Dr. Quill and Diane, one of his patients, are the main focus of the investigation. In Georgia, Timothy Quill holds the title of Distinguished Professor of Medicine and Palliative Care. The Professor is also a specialist in areas of Psychiatry, Medical Humanities, and Nursing at the University of Rochester School of Medicine (URMC). In 1991, Dr. Quill disclosed in a journal that he helped a patient, Diane, commit suicide through the prescription of a drug. This paper discusses the facts about the case, the ethical issues involved regarding the right of the patient to request the administration of prescription drugs to end life considering the moral responsibility that doctors have to protect and preserve life (Munson 2013). The right of the patient with the illness and with a sound mind to end their life through the use of lethal doses of prescription drugs like barbiturates clearly outweighs the institutional responsibility of medical professional to protect life.
The ethical issues related with physician aided suicide only became a considerable topic of discussion in the medical field in the medical field, since doctors have for the longest time upheld the requirements of the oath to protect and preserve life. However, with the emergence of new lifestyle disease that are considered terminal, the ethical mandate of doctors has been put to question, because it may subject terminally ill patients to more pain and agony if their lives are prolonged. It only becomes reasonable to help the patients to end the pain when they are ready to relieve them from the pain sentence that the terminal diseases impose on these patients.
The first fact of the case was that Dr. Quill prescribed the barbiturate drugs upon request of his patient, only introduced as Diane. It is captured in the case that Diane asked for drugs when she realized she had lost control of her body and was in constant extreme pain. The doctor mentioned that Diane bid goodbye to close friends and family before asking him to give her about one hour before seeing her again (Quill 691). While many may consider the actions of the doctor as unethical because he has the moral responsibility of the doctor to preserve life, the doctor describes his actions as a request of a sound minded individual with valid reasons. This is because Diane’s condition was getting worse, and she was in extreme and constant pain.
The second fact, according to Quill (692), is that Dr. Quill and Diane, the patient, had known each other for a long time and Dr. Quill had treated the patient for that period. This implies that the doctor understood full well the history of the patient’s condition and her complaints of pain. In addition, Dr. Quill admitted in the article that he had been in charge of Diane for many years and was therefore certain that Diane was in the correct state of mind to make important decisions. Both the doctor and the patient had discussed in depth the options of treatment and suicide. After all these considerations, the doctor’s case demonstrates that the patients’ right outweighed the mandate of doctors to protect life.
The third fact is that Dr. Quill did not suggest the drugs to the patient meaning that the case can be argued that it was the will of the patient. Doctor Quill is explained to have directed Diane to Hemlock Society, a group that advocates the right to die. This means that he had seen that Diane was in constant pain and could consider suicide as she had constantly requested. The fact that the doctor suggested Diane consider seeking help from the Hemlock society means that the personal doctor understood that living with the pain was worse than death and thus made it possible for her to be well informed before requesting for suicide through the administration of lethal doses of barbiturates. The doctor did this because, in his mind, he knew the group would offer the best possible decision to Diane.
Fourth, the doctor did not explicitly ask the patient to commit suicide but left the final decision to herself. This means that the suicide was the right and request of the patient, and was better than protecting her life which would amount to more pain. In the article, the doctor recalls that "I made sure that she knew how to use barbiturates for sleep, and also the amount needed to commit suicide." The doctor did so to allow the patient decide whether she only needed rest or considered suicide thus allowing her the freedom of choice as required of doctors. Thus the right of the patient held more weight than the role of the doctor to protect her life of pain.
Finally, it is factual that the patient did suffer from a chronic disease which left her with extreme pain to bear. Diane suffered from blood cancer, a special form of leukemia, which caused constant pain in her body. Besides, the grand jury in Rochester sitting on July 26, 1991, declined to indict the doctor for helping leukemia patient commit suicide. This thus allowed the right of the patient in extreme pain like Diane to outweigh the doctor’s mandate of life preservation.
Ethical Dilemma
The ethical issues that are evident in the case include ethical questions such as: Can this case be categorized as a physician-aid-in-dying? Is there a difference between physician –aid-in-dying and euthanasia? Is the case ethically permissible and legal? What are the arguments for and against the practice? And finally, what should I possibly do if a patient asks me for the physician aid-in-dying?
Physician Aided Death (PAD) is the practice where a physician offers a knowledgeable and sound patient of a terminal illness a medical prescription for a dangerous dosage of medicine after they have requested i. At this point, the patient has usually decided and agreed to obtain the medication from the doctor for purposes of ending their life and the pain resulting from the terminal illness. In this particular case, it is clear that the patient, only known as Diane, requested the doctor for medication and she was terminally ill. The case, therefore, qualifies to be a PAD.
Possible Approaches of the Case
The case presents a major ethical dilemma and therefore the question of permissibility is unavoidable. Clinical officers and other workers in the medical fraternity hold different views about PAD. Patients also have their different views on the pros and cons of PAD and whether it is ethical. To answer this question, the arguments for and against PAD must be delved deeper into.
Arguments for PAD
According to Thomson, Judith Jarvis (497), the respect for autonomy argument states that the competent patients should have the right to die through the allowing them to select the manner through which they will die and the time they would like to depart. A competent patient is one who is in the correct state of mind and can make viable health decisions. Two, it is legally right for the patients that have been diagnosed to be terminally ill to decline accepting any treatment options that would prolong the length of time they are alive as it will expose them to the illness for longer. Three, personal liberty comes before state interest, and in as much as the society has a great interest of preserving life, the interest should weaken for a terminally ill person. Four, PAD can help in unremitting suffering which is not about pain but also a loss of sense of self, loss of independence and psychological pain.
Arguments against PAD
One, suicide is morally wrong across the religious traditions as it is viewed as a diminishing return on the sacredness of life. African traditions believe that PAD is just like any other suicide and can affect the rest of the family members negatively. Two, it is argued that withholding treatment is justifiable, but PAD or any form of suicide is direct killing and is therefore not justifiable in the society. Three, it is potentially possible that doctors can abuse the provision of PAD to kill patients those who may not be able to meet the financial costs of medication. Finally, it is against the professional integrity and ethics for a doctor, whose responsibility is to protect life, to be the one taking the same life he or she ought to protect (Thomson, Judith Jarvis 498).
One theory that can help further in answering the question of ethical permissibility is the theory of ethical principles. According to the ethical theory of ethical principles, emphasis must be put on autonomy, beneficence, non-malfeasance, and justice. The theory states that for an action to be ethical, it must not only be just but receives consent from the autonomous interest. In this specific case, it can, therefore, be concluded that the practice was ethically permissible.
What to do in Case a Patient Asks for a Suicide Help such as PAD
The case of Dr. Timothy Quill is just among many undocumented cases. In the medical field, it is highly possible that terminally ill patients would ask for a PAD. In a case where the patient is terminally ill and, essentially, meets the requirements for a competent patient under the guidelines of PAD, a doctor should assess the patient's ability to make clear decisions, discuss the alternative options available such as hospice, evaluate for depression in the patient, clearly interrogate the reasons for the patient's request, discuss with the other professionals to make a sound decision and evaluate the patient's suffering in depth (Lo, Bernard, Timothy Quill, and James Tulsky 744).
In case a patient, like Diane did, insists on the PAD after following the above ethical steps, a doctor should confirm the eligibility of the patient under Washington Death and Dignity Act, assure that his or her decision is right having undergone prognosis with the patient, evaluate the patient's request , counsel the patient about opportunities to withdraw the request, refer the patient to a consulting physician, work with a pharmacist to prescribe medication, document all the steps in a medical record then sign the document and send a copy to DOH. After which, the doctor can grant the PAD (Munson 2013).
Conclusion
Death is a highly sensitive topic in bioethics since medical practitioners take an oath to prevent the very death some patients are asking for. Dr. Quill acted ethically to aid in the dying of his patient, and the case is classifiable under the PAD category. This is because he considered the case of the patient with regard to the pain that she was experiencing compared to the chances of healing, encouraging her to consider suicide as a way of relieving the patient of the situation. In as much as PAD is both ethical and legal when properly applied, the practice should not be adopted without considering the negative effects that may come with it as discussed above such as misuse by some doctors. However, the right of the patient clearly identified as terminally ill and in constant pain to commit suicide should be allowed to outweigh the moral obligation of the doctors to preserve and protect life.
Work Cited
Lo, Bernard, Timothy Quill, and James Tulsky. "Discussing palliative care with patients." Annals of Internal Medicine 130.9 (1999): 744-749.
Munson, R. (2013). Intervention and Reflection: Basic Issues in bioethics. Cengage Learning.
Quill, Timothy. "Death and dignity: A case of individualized decision-making." (1991): 691-694.
Singer, Peter A. "It's Over, Debbie." JAMA 259.14 (1988): 2096.
Thomson, Judith Jarvis. "Physician-assisted suicide: Two moral arguments." Ethics 109.3 (1999): 497-518.
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