The underlying question of Case 6.2 Sue Rodriguez: “Please Help Me to Die” seems to be: should physician-assisted suicide be permitted?

Facts to consider include the condition of the disease, laws and policies. In this case Amyotrophic lateral sclerosis aka. Lou Gehrig’s Disease gives the patient 2-14 months to live with the eventual loss of motor functions. Polices and laws to consider determined by the patient’s citizenship is the Canada Charter of Rights and Freedoms; we specifically observe the policies S.1, S.7, S.12, and S.15(I). While these are important, I focus this blog post more on the values in question.

Consider: rights

In class we discussed rights, which makes the claim people should do something for you. The two rights in consideration are negative rights and positive rights. Negative right is the right to live or not be interfered with. Positive right is the right to health care. We could argue health care professional are obligated to “harm” the patient and not interfere with the “life/living” of the patient. However, I suggest we consider in health care, “the right to life has traditionally been taken as a negative right… however, [it] seems to be moving towards a positive right, not just to remain alive, but to be enabled in doing what we want to with our lives, and thus disposing of them if we so choose” (Philos).

Consider: language

Case 6.2 Sue Rodriguez: “Please Help Me to Die” —I question why Beauchamp and Childress decided to title the case “please help me to die” and frame it with a negative connotation right off the bat. I wonder if this negative connotation influences the readers’ (our) opinions of whether assisted suicide is be “right” or “wrong” and should or should not be permitted. Would rephrasing make a difference? Perhaps we should consider some of the following titles:

• “Please help stop my suffering”
• “Please help me stop the continuation of my disease”
• “Please help me maintain my autonomy”
• “Please help me keep my dignity”
• “Please respect my decision”

Additional Considerations

Idea: Physician-assisted suicide is unnecessary because the suffering of dying patient can always be relieved through proper pain-management and palliative care (*Palliative: relieving pain without dealing with the cause of the condition)

My response: Perhaps physical pain can be alleviated, but does this take into account mental and spiritual pain and/or suffering? How can this type of pain be managed

“Mental pain is less dramatic than physical pain, but it is more common and also more hard to bear. The frequent attempt to conceal mental pain increases the burden: it is easier to say “My tooth is aching” than to say “My heart is broken.” —C.S. Lewis, The Problem of Pain

Idea: Physician-assisted suicide is unnecessary because individuals can always find the means to kill themselves without a doctor’s assistance.

*Trigger warning for suicide content*

My response: Is it ethical to deny patients physician-assisted suicide and force them to turn to other means of suicide that are potentially more dangerous, harmful, or painful? Some means of suicide include: inhalation of fumes, use of gun, knives, hanging, jumping from fatal heights, ingesting dangerous combinations of drugs, etc. Couldn’t providing physician-assisted suicide as a viable option help filter and catch individuals considering suicide? This gives healthcare professionals to opportunity to consult patients on the matter instead of them “impulsively” or “unreasonably” attempting suicide. The “most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs—thwarted belongingness and perceived burdensomeness (and hopelessness about these states,” (Orden) but with the opportunity to speak to patients considering suicide, physicians could make sure patients are thinking in a logical, reasonable manner and understand their options (future) and have all the facts. Wouldn’t this be a more responsible methodology? Through this filtering system, health care professionals could ensure the patients themselves, if they are the one making the decision, meet the qualifications for decision makers listed by Beauchamp and Childress:

1. “Ability to make reason judgments (competence)
2. Adequate knowledge and information
3. Emotional stability
4. A commitment to the incompetent patients’ interests, free of conflicts of interest and free of controlling influence by those who might not act in the patient’s best interests” (Beauchamp, 190). (In the filtration perspective, the patient remains free of controlling influence of others.)

Idea: physician-assisted suicide is a form of killing, which is inconsistent with a physician’s duty never to harm a patient

My response: Isn’t physician-assisted suicide a form of keeping patients from more harm? A way of preventing more pain? I personally agree with Angell, “The greatest harm we can do is to consign a desperate patient to unbearable suffering.” Beauchamp and Childress’s conditions justifying physician-assisted suicide include:

1. A voluntary request by a competent patient
2. An ongoing patient-physician relationship
3. Mutual and informed decision making by patient and physician
4. A supportive yet critical and probing environment of decision making
5. A considered rejection of alternatives
6. Structured consultation with other parties in medicine
7. A patient’s expression of a durable preference for death
8. Unacceptable suffering by the patient
9. Use of a means that is as painless ad comfortable as possible (Beauchamp, 184).

This list of conditions, in my opinion, is a more complete or holistic approach and exists as a “continuum of medical care” (Beauchamp, 188). This protects patients, especially patients deemed incompetent, by considering perspectives of “families, courts, guardians, conservators, hospital committees, and health professionals, which all merit consideration.” (Beauchamp, 188). I believe this is a good step towards combatting dehumanization of patients or reduction of patients to their disease or condition. This balances the non-human aspect of the science and medicine while still considering the emotion and reality of the human beings involved.

Citations:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2001. Print.

Lewis, Clive S. The Problem of Pain. New York, NY: HarperCollins, 2014. Print.

Orden, Kimberly A. Van, Tracy K. Witte, Kelly C. Cukrowicz, Scott Braithwaite, Edward A. Selby, and Thomas E. Joiner. “The Interpersonal Theory of Suicide.” Psychological Review. U.S. National Library of Medicine, Apr. 2010. Web. 27 Feb. 2017.

“Right to Life, Right to Die and Assisted Suicide.” Journal of Applied Philosophy. U.S. National Library of Medicine, 2004. Web. 27 Feb. 2017.