In the modern clinical world: Physician Assisted Suicide (PAS) or Physician Assisted Death (PAD)
In the modern clinical world, one of the most important ethical issues is physician-assisted suicide (PAS) or physician-assisted death (PAD). The situation in which Dr. Timothy Quill had to choose between saving lives and upholding the right to die under the law is a prime example. Diane, Dr. Quill's patient, and both of them are crucial figures in the case. Distinguished Professor of Medicine and Palliative Care Timothy E. Quill resides in Georgia. The professor has further expertise in nursing, medical humanities, and psychiatry at the University of Rochester School of Medicine (URMC). Dr. Quill admitted in a journal in 1991 that he assisted a woman named Diane in killing herself by using drugs. This paper discusses the facts about the case, the ethical issues involved and the take on the issues and the facts (Munson, R. 2013).
Facts about the case:
The first fact the case is 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, Timothy 691). This procedure is described by Dr. Quill as Sound.
The second fact, according to Quill, Timothy (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. In the article, Dr. Quill admitted 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.
The third fact is that Dr. Quill did not suggest the drugs to the patient. Doctor Quill directed Diane to Hemlock Society he realized Diane was in constant pain and could consider suicide as she had constantly requested. Hemlock Society is a group that advocates the right to die. 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. 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.
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.
Ethical issues:
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) and Euthanasia
Physician Aided Death (PAD) is the practice where a physician provides a competent, terminally ill patient with a prescription for a lethal dose of medication upon the request of the patient and in which the patient has decided to use to end his or her life. 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.
There is a narrow difference between PAD and euthanasia. Euthanasia is when the patient may request for medication, but a third party is the one who administers, for instance, by injecting the lethal drug. A perfect example is the 1998 "It's Over, Debbie," case where the doctor-in-training did give a morphine injection to a patient dying of ovarian cancer (Singer, Peter A 2096). However, PAD is when the doctor proves the medication but allows the patient to self-administer the medication.
Ethical permissibility 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 choose by determining the timing and manner of death. 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 terminally ill patients to refuse treatment that will prolong their lives. Three, personal liberty comes before state interest, and in as much as the society has a great interest in 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 the 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 sanctity 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 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 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, R. 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. 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.
Works 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.
