Death assistance by physicians

This investigation's goal is to identify the moral conundrums raised by Diane, a patient who chooses physician assisted suicide over acute leukemia treatment. Diane is the patient of Dr. Timothy Quill. The terms "physician aided death" (PAD) and "physician assisted suicide" (PAS) refer to suicides or deaths that are assisted by doctors who prescribe fatal drugs at the patient's request, following verification that the patient is of sound mind. The moral conundrum persists even though it is permitted and legal in some parts of the world. Using a doctor to end your life is unethical and needs to be outlawed completely. When a person whose job it is to stop suicide attempts supports such behavior, assists such activities, the integrity of medical ethics and the people related to it becomes questionable. Governments and law enforcing agencies should ensure that physician assisted death should not occur anywhere at any cost and that all kinds of support should be provided to people suffering from terminal diseases.

Physician Assisted Death

Physician Assisted Death (PAD) or Physician Assisted Suicide (PAS) is an artificial method of inducing death with the aid of a physician, which is a major ethical dilemma in the medical ethics. It is acceptable and legal in some areas of the world but ethically and morally questionable. It should be made illegal all around the world, no matter what. A person (the doctor) who is responsible for preventing suicide, should not be assisting in such acts. The case revolves around two people Doctor Timothy Quill and Diane (the patient). Doctor Timothy Quill is a distinguished Professor of Medicine and Palliative Care in Georgia. The Professor was a specialist in areas of Psychiatry, Medical Humanities and Nursing at the University Of Rochester, School of Medicine (URMC). In 1991, Doctor Timothy Quill disclosed in a journal that he helped a patient, named Diane, to commit suicide by prescribing her a drug.

This paper discusses the facts about the case, the ethical issues involved regarding the rights of a patient to request the administration about drugs that will assist them to end life, considering the moral responsibility that doctors are supposed to protect and preserve life. (Munson, 2013).

Introduction

Doctor Timothy Quill, on the request of a patient, Diane, who was terminally ill and had a sound mind, prescribed barbiturates on request, to end her life. She was diagnosed with a deadly disease due to which she was losing control over her body and was suffering from constant extreme pain. This completed questions about the responsibility of a physician and the medical ethics which relates to saving a person’s life instead of assisting them to ending it. Diane had already been suffering from vaginal cancer previously and was now diagnosed with acute leukemia which is a type of blood cancer. Taking the disease into consideration, Diane was informed about the treatment options available and the after effects of the treatment. Diane decided not to undergo the treatment because she was afraid of the after effects that included losing control over herself and her body, extreme pain, fever and lastly the violent death during the treatment. Doctor Timothy Quill talked to Diane and her family regarding the treatment options available and all the related after effects, with the hope she might change her mind and undergo treatment instead of considering death. Post conversation and multiple tries Doctor Timothy Quill had no other option left except considering Diane’s will to assist her death. Since he had been treating Diane’s case since long and he knew her well for which he considered her mentally fit to make decisions for herself, for not seeking the treatment. Diane called Doctor Timothy Quill asking for barbiturates after which he inquired the reason for wanting them. She told him that she was insomniac. The doctor counselled to ensure she wanted the drugs only for treating her insomnia and informed her that increasing the dose could be lethal. The doctor mentioned, Diane said goodbye to close friends and family before asking him to give her about one hour before seeing her again (Quill, 691). Besides, he did not suggest Diane to consider death as an option, it was her own will. He kept counselling with the belief that she might change her decision and opt for treatment as an option. Doctor Timothy Quill directed Diane to Hemlock Society, a group that advocated the right to die, which suggests that Doctor Timothy Quill understood her situation and 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 suggestion to Diane. Moreover, after directing her he left the decision to Diane, which according to him was right and request of the patient that he could not deny. Nevertheless, the grand jury in Rochester which sat on July 26, 1991 declined to indict Doctor Timothy Quill for helping Diane to commit suicide. This allowed Diane to outweigh doctor’s ethical mandate of life preservation. Diane stuck to her decision and took her life when she felt her condition go even worse and pain became unbearable.



Ethical Dilemma

The ethical dilemma that lies in this case is that whether physician assisted death is ethical or not? Doctors are supposed to help and prevent suicide in every possible way. Whereas, in this case doctor assists the death which is a big question mark on the face of medical ethics. The question arises, physician aided death ethical, permissible and legal? Is it against the morals of a doctor? Does this practice obey the medical ethics?

This case presents a major ethical dilemma and therefore the question of permissibility is unavoidable. Clinical workers and people belonging to medical field hold different views about it. Similarly, patients also have their different views.

We have taken different arguments into account for and against physician aided death, which are:

Arguments in favor of Physician Assisted Death

According to the theory of ethical principles, emphasis must be placed on autonomy, beneficence, non-malfeasance and justice. The theory states that for an action to be ethical, it must only receive consent from the person who is entitled to it. In this specific case, it can be concluded that the practice was ethically permissible.

According to Thomson, J. Jarvis (497), the competent patients should have the entitlement regarding their manner and time of death. A competent patient is one who is sane and is in the correct state of mind and is able to make viable health decisions. Therefore, it is a legal right for the terminally ill patients to deny the treatment. Personal choices and liberty stand before the state of interest that relates to preserving life of a terminally ill person. Besides, physician assisted death can help in reduction or elimination of suffering which is not only about pain but also a loss of sense of self, loss of independence, emotional and psychological pain and deterioration.

Arguments against Physician Assisted Death

Ethically, morally and legally suicide is wrong. Many countries, traditions, cultures, races and religions consider it wrong and strictly oppose suicide. Certain traditions of the world consider physician assisted death is just like any other suicide and can affect the rest of the family members and friends negatively. It is argued that the treatment for recovery is justifiable, but physically assisted death or any form of suicide is direct killing and is not justifiable in the society. Besides, it is possible that doctors can abuse the provision of physician assisted deaths to assists patients commit suicide who may not be able to meet the financial costs of treatments and medication. Most important thing is that, doctors bear the ethical responsibility of preventing people from committing suicide. If doctors assist such activities, there is a likelihood that the ratio of such incidences can increase. It is against the professional integrity and ethics of a doctor and the medical profession whose responsibility is to protect and preserve life not to take it. (Thomson, J. Jarvis, 498).



Possible Resolutions

Since physician assisted death is a serious ethical and moral dilemma in the medical ethics and integrity. Research proves that a person who is terminally ill for prolonged period also suffer from anxiety, depression, emotional breakdowns, mood swings, other mental health disorders, loss of motivation, lack of interest and sadness. There is a likelihood that such patients opt for dying. Similarly, if a terminally ill patient considers physician assisted death as an option instead of opting for treatment, in that case, the responsibility of life preservation and suicide prevention lies with the doctor. Counselling, rehabilitation, motivational talking therapies and other possible helps should be provided to the patient. Patient support groups should be made for terminally ill patients and for those who are reluctant to take treatments so that they could be provided with support, positive motivation and feeling of togetherness that they are not alone suffering and that it is easy to live than to die. Patients should be ensured that treatment and therapies will reduced pain and sufferings post-treatment, for sure. Stories of survivors should be told so that motivation to live and recover from the illness ascends. Besides, the governments and law enforcing agencies of every country should ensure that physician assisted death is made illegal because it is ethically and morally wrong in every aspect and is equal to killing and other ways of suicide. Each life is valuable, no matter what. Moreover, hospital welfare programs, medical expense insurance coverage and other financial benefits and options should be made available for the patients who cannot afford the treatment and medications. This way insurance of every precious life will be possible and physician aided deaths due to inability to afford treatments and medications will be eliminated.



Conclusion

Physician assisted is a major moral and ethical dilemma in the face of medical ethics and people related to that field. Even if a terminally ill patient opts for it with a clear state of mind, it is wrong and should be made illegal so that no doctor should assist it. Physician assisted death is equal to any other forms of suicide or killing. It negatively affects the patient’s family members and friends. Possible resolutions like psychiatrist treatments, patient support groups, motivational talking therapies, rehabilitation and other possible initiatives can eliminate the probability of patients opting for physician aided death. Government and law enforcing agencies should pass laws that make it illegal and welfare support programs, medical and health insurance programs should be initiate for patients who are unable to meet their treatment and medication financial expenses. Doctors are supposed to preserve and protest life, which therefore concludes that Doctor Timothy Quill did ethically and morally wrong by assisting Diane in committing suicide.



References

L. Bernard, T. Quill, and J. Tulsky. "Discussing palliative care with patients." Annals of Internal Medicine Vol. 130, No. 9, (1999) p.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): p. 691-694.

Singer, Peter A. "It's Over, Debbie." JAMA Vol. 259, No. 14, (1988): 2096.

T.J. Jarvis, (1999) "Physician-assisted suicide: Two moral arguments." Ethics Vol. 109, No. 3, p.497-518.