Being a member of the hospital Ethics Committee, it is my responsibility to make policy recommendations on end-of-life issues. Due to my intellect and reputation as a clear thinker, my ideas on this matter carry a lot of weight with the other members of the committee. Within this paper I will make a strong and convincing case for my position and recommendations on this topic. This paper will address the following question: What, if anything, should be done to help people who are dying?
First I must start off with the obvious question: Is the patient an adult of 18 years or older who is terminally ill and of clear and sound mind to authorize assisted death intervention? If the answer is yes, then we should follow the wishes of the patient. Ultimately, it is their body; their life and they should have the right to choose. That being said, I do believe that guidelines should be established and followed in order to assure that the welfare of the patient is the only priority.
Such guidelines should be made that reflect the three states that currently have laws in place for assisted death, which are, Oregon, Washington, and Montana. The law should include but not limited to, a capable adult who has been diagnosed, by a physician, with a terminal illness that will kill the patient within six months may request in writing, from his or her physician, a prescription for a lethal dose of medication for the purpose of ending the patient’s life. Exercise of the option under this law is voluntary and the patient must initiate the request.
Any physician, pharmacist or healthcare provider who has moral objections may refuse to participate. The request must be confirmed by two witnesses, at least one of whom is not related to the patient, is not entitled to any portion of the patient’s estate, is not the patient’s physician, and is not employed by a health care facility caring for the patient. After the request is made, another physician must examine the patient’s medical records and confirm the diagnosis. The patient must be determined to be free of a mental condition impairing judgment.
If the request is authorized, the patient must wait at least thirty days and make a second oral request before the prescription may be written. The patient has a right to rescind the request at any time. Should either physician have concerns about the patient’s ability to make an informed decision, or feel the patient’s request may be motivated by depression or coercion, the patient must be referred for a psychological evaluation. The law protects doctors from liability for providing a lethal prescription for a terminally ill, competent adult in compliance with the statute’s restrictions.
Participation by physicians, pharmacists, and health care providers is voluntary. The law should also specify a patient’s decision to end his or her life shall not “have an effect upon a life, health, or accident insurance or annuity policy. ” These physician assisted suicide guidelines are within the “Death with Dignity Act. ” The Death with Dignity Act is the philosophical concept that a terminally ill patient should be allowed to die naturally and comfortably, rather than experience a comatose, vegetative life prolonged by mechanical support systems.
Currently there are two ways of assisted suicide, one is when the patient is given a prescription medication of a fatal dose that will cause them the loose consciousness and die shortly after. The other, which is not legal in the United States, is known as “Active Euthanasia” which is a type of euthanasia in which a person who is undergoing intense suffering, and who has no practical hope of recovery is induced to death. It is also known as mercy killing.
Generally, a physician performs active euthanasia and carries out the final-death causing act. Active euthanasia is performed entirely voluntarily, without any reservation, external persuasion, or duress, and after prolonged and thorough deliberation. A patient undertaking active euthanasia gives full consent to the medical procedure and chooses direct injection, to be administered by a competent medical professional, in order to end with certainty any intolerable and hopelessly incurable suffering.
My second question: Is the patient an adult of 18 years or older who is suffering? In rare cases some patients who are very ill do not respond to pain medications or may be suffering in other ways that make comfort impossible. In these circumstances there is a last resort therapy that can be used: terminal sedation. With terminal sedation, a patient will be given medications that induce sleep or unconsciousness until such time as death occurs as a result of the underlying illness or disease.
The intention with terminal sedation must be to relieve suffering only, not to cause death. These measures are often accompanied by the withholding of artificial life supports like intravenous feeding and artificial respiration. * * Also, the physician may use medications that cause a “double affect. ” This has been defined in medical journals as: “the administration of opioids or sedative drugs with the expressed purpose of relieving pain and suffering in a dying patient.
The unintended consequence may be that these medications might cause either respiratory depression or in extreme sedation, might cause to hasten a patient’s death.” What does this mean? In the simplest terms it means that the medication required to abate suffering cannot be given without the probable result of hastening death. While this may sound vague and quasi-discomforting, it is a legal, medically accepted practice, as long as the intention is only to relieve suffering and not cause death.
The death is attributed to the disease or complications of the disease, combined in some circumstances with the withdrawal of life-sustaining treatments such as intravenous liquids, nutrition, and artificial respiration. While the patient need not be unconscious during this process, unconsciousness is often the result. * * The last question I ask is: in cases when a minor, a person under the age of 18, is either terminally ill or suffering, who has the right to make the final decisions, the parents/legal guardians, the state, or the patient?
I believe that all three need to have a united decision. If one or more of the three votes differ, then neither intervention stated above may be used. These policy recommendations I have stated within this paper regarding end-of-life issues have been explained thoroughly and in detail. I have successfully made a strong and convincing case for my position and recommendations on this topic. I hope that the members of this Ethics Committee agree with my findings and support my recommendations and that my reputation as a clear and trustworthy thinking member is evident.