Oregons Death With Dignity Philosophy

This paper will mainly focus on the discussion over Physician-assisted suicide under the context of Oregons death with dignity act which was officially made legal in Oregon, one of the state in the United states of America, in November 1994, which allowed some patients who are terminally ill, determine the time of their own death. The features of the legislation are analysed and the ethical and moral values related to the practice are discussed. Eventually a conclusion is established confirming and explaining the rightfulness and defensibility of the practice. Background: Physician-assisted suicide and Oregon's death with dignity act.

Physician-assisted suicide (PAS) can be defined as catering of a means, by a physician for a terminally ill competent patient, to terminate his or her own life. this happens when the physician facilitates or prescribes a lethal medication to the patient for self administration which eventually results into his or her own death, this differs with Euthanasia, in which a physician or some other person is involved in providing a lethal drug to end another's life. There has been a lot of controversy surrounding PAS but it was legalized in Oregon, USA, on November 8 1994 and is called as the death with dignity act. Since then, 246 Oregon residents have committed PAS.

Features of the Death with Dignity act:

For the patient to receive the prescription, the following conditions must be satisfied,

1) The patient must be eighteen years and older and a resident of Oregon.

2) The patient should be competent and should have the capability to make his or her own health care decision.

3) The patient should be diagnosed as terminally ill which is going to lead to his death within six months.

4) The physician must receive two verbal requests from the patient, at least fifteen days before.

5) Request in a written form must be given by the patient and it should be witnessed by two people. One of those witnesses must be:

a) An individual who is totally unrelated to the patient by blood, marriage or even adoption.

b) An individual who is facilitating no sort of health care or medical attention to the patient.

c) An individual who is not qualified or desirable to take over the patients land or property.

6) The capability of the patient must be identified by the two physicians, namely, the prescribing and the consulting physician.

7) All the conditions and important information and alternatives must be provided to the patient.

8) If at any point the doctor feels that the patients judgmental and thinking abilities are altered because of a psychiatric disorder, the doctor should then refer the patient to a psychological consultant.

9) None of the physicians are obliged to participate in this practice and they have the right to say no to the patients for ending their lives (Altmann, Collins), (2007).

Arguments against PAS

1) Medical ethics: Professional integrity and Fallibility of the profession

Physician-assisted suicide works in no harmony with the medical ethics, a doctor is considered to be as a healer and an infallible personality. Though sometimes it is acceptable in dire conditions of the terminal illness that the patients choose death over life, PAS still is absolutely incompatible with the code of ethics and with the doctors role as a healer, who is also called as god. Doctors who would participate in PAS would worsen the situation causing societal risks which would be very difficult to control Thus physicians participation in this practice would do o good to the ethical ideals of medicine (Nelson, Ashby). (2011).

The doctor, in fact, should act in a more benevolent manner, rather than abandoning the patient, there are other options that he should consider like hospice or palliative care, providing special care through other interventions, emotional and moral support should be provided in leaps and bounds along with the necessary comfort and pain relief which is very important for the patient at the end of his life (JAMA), (1996).

2) Potential for abuse: Some people might reach a point of vulnerability because of shortage of finances for health care, PAS might be chosen as an option to save that money. Certain family members who are burdened due to lack of finances or some the providers of health care may promote their loved people to choose PAS. Thus, the death with dignity law might not sight such occurrences of misuse (Brock), (1999).

3) The battle between Passive and active killing: There is a thin red line between passive and active killing. Based on moral values, PAS is wrong because it is basically bringing about or intending the death of a patient whereas giving up palliative care and life support accelerates death, in this case the patient's death is not the intention. In short, there is a controversial difference between killing someone and letting die (Brock), (1999).

Passive and active killing are two moral distinctions. People who oppose PAS see bright lines between active and passive abetment in dying and between intending and foreseeing death and therefore they see giving up life support as a clear case of letting die whereas PAS is given the title of intentional killing (Quill, Timothy), (2000).

Difference between Terminal sedation and PAS: Terminal sedation is a process through which the patient is sedated to produce unconsciousness in order for the patient to escape unbearable suffering. Slowly then, the food and fluids are withheld. This process can be called as a double effect where suffering is relieved not to cause death, but death is foreseen and not intended which makes terminal sedation a more passive and an indirect way in causing death whereas PAS is an active or a direct way of causing death to the patient in which the physician provides the means to the patient (Quill, Timothy), (2000).

Violation of the Sanctity of life: Sanctity is a state of being totally sacrosanct or inviolable. Based on traditions, religion, opponents of PAS who respect and support the sanctity of life have banned PAS by saying that it is absolutely wrong because it shows total disrespect towards the sanctity of life (Starks, Dudzinski, White), (2009).

Christianity preaches that life is the most precious gift given by god to mankind. Every individual has certain value from god which is very unique. The dignity of an individual is in built as it is conferred by god and it cannot be explained as it lies beyond any merit, this gives meaning to our life and death and gives us the allegory for understanding the moral issues, when hard decisions are to be made at the end of our life, which can be made more complicated due to the advancement of medical technology. Therefore, Christians look at PAS as a highly immoral act, it is treated as an insult and lack of faith towards god, it is regarded as a total lack of gratitude towards god and denial of the most cherished gift called life, because it is only upon god to make that decision (Massachusetts Council of Churches), (2000).

Arguments favouring PAS

Assuming the patients consent: If the physician has the patients consent, then the he or she might relieve the patients pain by giving a pain killer like morphine, even if the physician knows with absolute certainty that this is going to cause the death of the patient soon in the near future, because in this case death is the lesser evil and pain alleviation is a greater good. Similarly a doctor, with the patients consent might cause other lesser evils with intention for the sake of his medically pertaining greater good, for example, the physician might cause pain to the patient on a temporary basis, if only it would keep the patient from going into a constant or permanent coma. Basically, if the lesser evil is death for a person, then it is morally permitted to treat it in a way we treat other lesser evils. Thus, for the same person, when death is the lesser evil and pain relief is the greater good, then it is also permissible to cause death with intention or assist in causing death to stop pain. Also we need not assume that a shorter life with less suffering is better than a longer life with more suffering, it is only in the interest of that particular person to die a little sooner when death is about come soon anyway and dying sooner definitely reduces all the suffering. Also there is a deontological way of reasoning to this issue, which says that there are some things a person has to do to promote the best possible consequences or maximum happiness. This argument is important because it is argued that according to the professional ethics it is not permissible for a physician to involve in PAS, it can be called as the duty argument (Kamm), (1999).

Indeed, the physicians duty is to promote health of their patients but it can't be said as their 'only duty'. A terminally ill patient is a person who cannot be treated and their death is imminent, also the treatment in that case would be medically futile if handled by any physician. This means that if the physicians 'only duty' is to promote health then they would have no role to play in the caring of the patients who are going to die. But it is true, that the physicians play a crucial role in caring for the dying patients, they play the role of god in alleviating the pain and suffering, when healing is no longer possible in a patient, suffering begins. Thus, it morally correct on the part of the physician to reduce the suffering in ways to which the patient consents, or even give him or her assistance if the patient chooses death as a choice (Gill), (2005).

Poor Pain Management: According to an estimation, 95% of the pain experienced by the patient can be taken care of or avoided by health care professionals specialised in palliative care but the fact is that majority of the manageable pain among the patients goes untreated. Few doctors do not understand the pain, their patients are suffering from, some of them also lack the clinical knowledge and skills in palliative care. the medical education system too is at fault to some extent because they failed to provide adequate training in pain relief. Interestingly, some doctors are hesitant while giving the pain relief medication because they think it will make the patient addicted to the drug and also there are possibilities that it might hasten the patient's death. Moreover, palliative care is very expensive, it basically attention from highly skilled and specialised doctors and nurses plus large doses of pain relief medication. So, given the current situation of pain management, hospice care is the best and reliable source for palliative, but palliative care is an expensive affair in most of the countries and cannot be afforded by all the patients. Thus, effective pain management is unavailable and unaffordable to most of the patients. Eventually, PAS becomes a more ethical and practical option based on the circumstances because the patient just wants to get freed from his or her unbearable suffering and deteriorated health (Curran), (1998).

Oregon's Law and PAS: Importantly, according to this law, the doctors confirm two important aspects - the terminal illness of the patient and the other one is the patients competency which are the most important medical judgements. The doctor is not supposed to think about the religious, traditional matters pertaining to life neither does he have to decide, ask or tell the patient whether life is worth living or not, it is the sole decision of the patient, it is the patients autonomy which is respect here. Therefore, the doctor has to make those two judgements, make sure that the patient meets the specific criteria and then assist the patient in what he or she has decided about. Also the law gives liberty to the doctors to refuse the patient for PAS and they can refer the patient to a psychiatrist if they feel the patients judgemental and thinking ability is hampered due to a psychological disorder (Altmann, Collins), (2007).

Moral Values, Ethical Principles and approaches

Compassion: Compassion can be defined as a sympathetic pity, it is an internal value which almost can be a replacement to the virtue of Christian charity. Charity on one hand is related to a man's eternal soul whereas compassion is concerned with his physical estate. charity is of god but compassion is of man and based on his fundamental need, felt by everyone, for the sake of relief from suffering. When we see someone suffer, we instinctively realise that it could be us, we feel compassion for him or her. We can feel that persons pain because based on our instinctive sense, we feel that it could have been our pain. In extreme conditions, compassion can lead us to attend the needs of those who suffer by doing away with them, in fact, it does happen sometimes. It has an evocative power which totally works in harmony with physician assisted suicide without any formal arguments. Patients with severe forms of AIDS, Cancer, physical disabilities defy imagination, these diseases can eat them alive. Compassion demands that we comply to their demands, if they choose death as a choice.

Compassion is a very important virtue which can be a defining element in explaining praise, blame, guilt and innocence. It creates in roads and makes a platform for making crucial decisions in taking a life and prepares a logical principle for absolution. When a physician is motivated by compassion for a terminally ill patient who requests for help and chooses death as a preference, the act can be considered as ethical and moral but if the physician is motivated by some other passion, then PAS becomes unethical and immoral.

Example of Robert Latimer and Tracy - Ethics of Pure Compassion: Tracy was suffering from Cerebral Palsy, Latimer wanted to put an end to Tracy's sheer pain and suffering. he felt Compassion for Tracy. He kept her in the cab of his owned truck and the engine was kept running until Tracy reached a point where she was totally toxicated by carbon monoxide. She died. Latimer was tried for the killing of Tracy, Canadian public was highly supportive of Latimer, so the judge in this case gave him a one year prison sentence solely on the grounds that, Latimer was totally motivated by compassion and love for his daughter and he thought emotionally for here in the sense that he wanted to end her pain and suffering (Wolfson, Adam), (1998).

Death with Dignity and Autonomy: Western culture has a belief in individual human dignity suggesting that a person has a moral right and responsibility to analyse the most fundamental questions relating to the meaning and value and answer their own inner feeling and beliefs. dignity can also be equated with autonomy, implying that individuals have a right to make choices for themselves, no matter what that choice is, be it PAS or abortion or whatever. the importance of dignity can be explained by a very popular phrase - 'pro choice'. Therefore, in short, death with dignity is a sovereign right of an individual to choose what is best for oneself (Wolfson, Adam), (1998).

Stuart Mills harm principle: It says that power can be exercised on any individual of a civilized community against his will, but, only on the sole purpose that should not harm others. Basically, the actions of an individual should be limited only to prevent harm to other individuals. It is a libertarian rule saying that all individuals are sovereign over themselves, over their mind and body. This principle works in total harmony with PAS where the patient is not causing harm to any other individual, it is his individual liberty that he or she has chosen death has the preference (Ripstein), (2006).

Justice: Fairness is an important term as far as PAS is concerned. Those patients who are terminally ill have the right to say no to assisted suicide, it will just postpone their deaths, but those terminally ill patients who are suffering unbearably and also are not on life support like the respirator, refusing treatment to such patients is not going to accelerate their deaths. Under such circumstances, it is fair and ethical on the part of the physician to engage in PAS under the patients consent (Starks, Dudzinski, White), (2009).

Conclusion

Generally, it is argued that we ourselves are responsible and somewhat obliged to help those individuals who are experiencing pain, suffering and to respect their dignity. There would be so many people in this world suffering from diseases which have eaten their lives and brought them to a state of total mental incapability, such people can only see more deterioration and degradation to their health in the future. If such people pleadingly request to end their life of absolute indignity and suffering, refusing them to do so would be an act of cruelty and inhumanity. Compassion says that we should comply to their demands and requests.

Thus, based on the overall analysis and taking into consideration values of compassion towards the suffering patient, fairness, dignity, autonomy of the patient and the harms principle which are very intriguing and practical, I strongly think that physician-assisted suicide is an ethically correct practice and considering all the features of the Oregon's death with dignity act, I feel it is an appropriate, defensible and a morally acceptable legislation which has been passed that restricts the practice to a certain limit but also understands the misery of a terminally ill dying patient.