Should Medical Practitioners Help Patients Die?

 Defining words like Death and dying is currently a lot more complicated than in times past, this is largely due to advances in medicine.

To help us understand the ethics surrounding assistive suicide, below are some general definitions.

  1. Death –  There are several definitions of death, medically this is the cessation of all vital bodily functions, and there are stages, a person can be brain-dead but still be breathing.  The definition of death is different depending on culture, religion, and ethnicity.
  2. Dying – This is the process that leads to death, for example, an individual with end-stage bone cancer is eventually going to die.
  3. Assisted suicide – Is suicide that is done with the aid of another person, sometimes a physician and this is an important distinction, a doctor does not have to be present
  4. Active Voluntary Euthanasia – This is when medical intervention is put in place at the express interest of the patient with the view of ending life. Passive euthanasia is when death is brought about by an omission – i.e. when someone lets the person die. 

1 in 5 patient dies at home in America. Most patients fear to outlive death itself. Research has shown that while the general public is in favour of physician-assisted suicide, most doctors are against it. The resistance is due to the understanding of the hypocritical oath, but do no harm is becoming hard to distinguish.

The Australian Medical Association statement says that “doctors should not be involved in interventions that have as their primary intention the ending of a person’s life. This does not include the discontinuation of treatments that are of no medical benefit to a dying patient”. An important distinction should be made here, if a doctor who is caring for the terminally ill patient gives medication to alleviate pain and the patient dies, the doctor will not be charged with homicide. But if a doctor gives medicines with the intent of ending a patient’s life and the patient dies then that homicide.

With modern advances in medicine, we can keep people alive for a long time even when there is no quality of life. The main reason given for pro-euthanasia and assistive suicide for the legalisation of assistive suicide is; people with terminal illnesses should be able to die a painless death. However, a study that was published in the New England Journal of Medicine found that most people who ask for assistive suicide do so out of fear of losing autonomy. Other studies have shown that when people are treated for depression, they do not ask for assistive suicide. Moreover, even when people are given medication to end their life, there is no guarantee that the medication will work as intended.

Currently, the law as it stands in Australia only the northern territory has provisions within its constitution for doctor-assisted suicide. It passed the law in 1995 which allowed doctors to end the life of a terminally ill patient. In doing so, the law permits both physician-assisted suicide and active voluntary euthanasia in some very strict circumstances. In other states it is illegal, patients can still refuse treatment, Doctors cannot force treatment on anyone. Physicians still have to consult with families about the wishes of a patient, especially when dealing with the elderly. In a case where the family does not want to pursue any treatment or the treatment is deemed futile, patients are placed on palliative care.

In 2017 the state of Victoria voted to legalize physician assistive suicide, the law will not take effect until mid-2019. For people to qualify, they have to be of sound decision-making mind and the disease or condition they are suffering from must be expected to cause death within 12 months. Under the guidelines, people with dementia will not qualify and while having a mental health issue and disability is not a reason for accessing the scheme, they can access the scheme if they have a  separate terminal illness.
Only the patient can initiate the request for assistive dying, the person seeking the scheme must be assessed by two doctors, one of which must be an expert in the particular illness.

The question then is who gets right to decide when medical treatment is futile? Because how patients react to treatment is dependant on several factors, such as age, gender, and genetics. There have been cases where people have been given a short time to live because of cancer or other terminal illness, but to everyone surprise, they surpass the time given.

In conclusion, considering how medicine used to be before the hypocritical oath, doctors then were allowed to both end life or preserve life. My view here is legalizing euthanasia will change the way medical practitioners interact with patients. Doctors have a fiduciary responsibility to first do no harm. Cases, where treatment can be deemed futile is when aggressive treatment is causing more damage than good.

Dr Philip Nitschke shows us that these laws should not be taken lightly and if passed they should be tightly regulated.

Written by Paul Mukube

 

 

References

Malina, D., PhD., Li, Madeline,M.D., PhD., Watt, S., Escaf, Marnie,H.B.B.A., M.H.A., Gardam, M., M.D., Heesters, A., M.A., . . . Rodin, G., M.D. (2017). Medical assistance in dying — implementing a hospital-based program in canada. The New England Journal of Medicine, 376(21), 2082-2088. Retrieved from http://ezproxy.ecu.edu.au/login?url=https://search.proquest.com/docview/1902164165?accountid=10675

Kasman, D. L. (2004). When Is Medical Treatment Futile?: A Guide for Students, Residents, and Physicians. Journal of General Internal Medicine19(10), 1053–1056. http://doi.org/10.1111/j.1525-1497.2004.40134.x
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