Background of Assisted Suicide

              For many, assisted suicide is a very sensitive topic. Some believe that suicide itself constitutes a form of a crime, while others believe that assisted suicide is a lawful act that should be legalized in the entire United States of America. In Is Suicide Murder by William Mikell, Mikell states that, “In English law…the deceased [one who committed suicide] is here punished with forfeiture, not for the crime of taking his own life” (JSTOR). On the other hand, the opposite point of view must also be taken into account. Although America does not currently legalize assisted suicide in all fifty states, America stands with the belief that all of its citizens deserve utmost freedom. Would assisted suicide not provide the preeminent standard of freedom? “Supporters of legislation legalizing assisted suicide claim that all persons have a moral right to choose freely what they will do with their lives as long as they inflict no harm on others” (SCU).

The Case

              In this week’s reading, we have an ALS patient in the initial stages of the disease that wishes to be allowed the opportunity to commit suicide on her own volition when the time comes that she feels fit. The dilemma is that with ALS, the patient passes away when all organs fail to keep functioning and the heart stops beating. The patient’s solution to this problem is to ask to be provided with a device that she can have attached to her so that when the time comes, she can commit the action herself. In order to lawfully attach a device of this nature, Sue Rodriguez, a Canadian citizen, went to the Canadian court system to help her legalize this form of suicide. The courts denied her the allowance of this method of suicide. As a result, Sue when on to an anonymous doctor and had the doctor perform assisted suicide. Gloria Taylor, as second patient with ALS appealed to British Columbia’s court, and this time, the court could not make a decision, so appeals are currently in progress today.

Conclusion

              The main concern with this particular dilemma is that as humans, we “have an obligation to relieve suffering of our fellow human beings and to respect their dignity” (SCU). If a patient is incarcerated to a hospital bed with a terminal illness that is extremely painful, as humans, how can we morally justify allowing the patient to go through the extreme amount of pain?

Alternatively, we also have the moral principle of non-maleficence. As humans, we are expected as moral beings to minimize harm as much as possible. By assisting in a suicide, the reduction of harm is completely ignored.

In the end, the dilemma comes down to one question: Should we harm for morals (assisted suicide, or not harm for another form of morality (non-maleficence)? What ought we to do?

The answer is not concrete for every case, but must be analyzed separately, case by case. In this particular case, in my opinion, in order to minimize the suffering the patient will be incurring, assisted suicide should be allowed. Let’s remember that the patient is the one suffering and the one committing the act of suicide. We ought to allow the patient to decide the morally justified ground of themselves in this case.

Infamous ALS Patient

              Stephen Hawking is an astrophysicist with ALS. When he was diagnosed, he was told he had merely two years to live. That was in 1963. Hawking lives today, 52 years later, having given so much to this world.

Works Cited

http://www.jstor.org/stable/1109529?seq=1#page_scan_tab_contents

http://www.finalexit.org/assisted_suicide_laws_united_states.html

http://www.scu.edu/ethics/publications/iie/v1n1/suicide.html

http://www.hawking.org.uk/

Background

In this case you have a 40-year-old women named Sue Rodriguez how was diagnosed with amyotrophic lateral sclerosis in 1991 and in 1993 she was given estimation that she had roughly two-fourteen months to live. As her prognosis was that she would soon lose the ability to swallow, speak, walk and move with out assistance. In addition she would eventually lose her ability to breathe on her own with out the help of a respirator. As her illness progressed Sues abilities began to deteriorate, and she began wishing to maintain control over how and why she would die.   Ultimately, Sue petitions to allow a medical practitioner set up technological means which she might, by her own hand, at the time of her choosing, end her life.

Dilemma

This case raises multiple concerns. One would be addressing the if assisted suicide should be legal or not. That it is not legal discriminates against those who are dying but physically unable to commit suicide without assistance. As Sue’s illness has began compromising her quality of life her desire to end her life and maintain control over her body a doctor’s obligation to nonmaleficence. The bigger picture is the issue of whether a patient’s autonomy is more important than or maleficence.

Analysis

I find it for religious reasons not acceptable for the doctor to support Sue’s wishes to end her own life. From a moral stand point I don’t believe it is the doctors responsibility to make the decision to aiding to helping an individual end their life. While the case discusses that assisted suicide is unwarranted because of accessibility to proper pain administration this presents a conflict with as if the doctor administers drugs that will result in death instead of pain med, the doctor is essentially causing more harm than healing. As discussed in Beauchamp and Childress, “Killing is unjustified when it deprives the person who dies of opportunities and goods. However, if a person freely authorizes death, making an autonomous judgment that cessation of pain and suffering through death constitutes a personal benefit rather than a setback to interests, then active aid-in-dying at the person’s request involves neither harming nor wronging” (Beauchamp and Childress 182). Which seems to justify Sue’s request, as Sue is competent and is making the autonomous decision to die. In conclusion, I do agree that that assisted suicide breaches human life standards and is not something that is to be compromised just because a human being request to terminate one’s own life.

Works Cited

Beauchamp, Tom L., James F. Childress. Principles of Biomedical Ethics. 7th ed. N.p.: Oxford University Press, 2012. Print.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.

When looking at physician-assisted death from a legal perspective, most governments would deem it is as wrong; there are only 5 out of the 50 states in the Unites states that allow such a practice. However, despite the law, from a moral standpoint, someone of full cognitive capabilities choosing to die should only be viewed as right. The reason for this goes back to the moral principles of autonomy and moral status.

As an autonomous person your, “personal autonomy encompasses self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice such as lack of understanding” (101). With autonomy you are capable of self-government as long as nothing is impeding your choices like an illness or a lack of understanding. I know I just mentioned illness and one might argue that individuals that opt to die by the hand of a physician are ill and cannot make that choice autonomously. To that argument, I would say it does not apply in situations where someone is fully in control of all cognitive capabilities but also happens to have a terminal disease. Also, it is important to distinguish between illness and disease. It is possible for one to have a disease and not be ill. Essentially illness is a subjective state of being that manifested from a disease. While a disease is the presence of a pathological systemic issue that can result in illness (Illness). Thus, when someone is merely diseased but not yet ill, their autonomy is not hindered by their mental state. In fact, in their capable mental state they are making the decision to not get to a point where disease transitions into illness. At that point, the physician has a moral obligation to respect a patients autonomous decision to avoid suffering leading up to their inevitable painful death.

In the stipulations for a physician’s assisting someone’s death, it mentioned that there should be a voluntary request and unacceptable suffering (Beauchamp 184). The aforementioned two stand out because they indicate a person’s consent as well as an indication they do not desire the quality of life that lay ahead. Beauchamp and Childress claim:

If a person freely authorizes death, making an autonomous judgment that cessation of pain and suffering through death constitute a personal benefit rather than a setback to interests, then active aid-in-dying at the person’s request involves neither harming nor wronging (182).

There is not moral wrongdoing when someone is of sound mind and sees more benefit in ending their life early instead of dragging it out to end with suffering. From the physicians perspective it is wrong of them to knowingly leave a patient to be in pain or a low quality of life against their will. Take for example to case of Sue Rodriguez, she felt the law compelling her to stay alive through her debilitating disease was hindering her rights to life, liberty, and equal protection of the laws. However, her requests were denied on the grounds that suicidal practices were not legal. That stated, those previously mentioned facts of the case are about laws and not morals. Morally, a physician has a duty of non-maleficence and a need to respect patient autonomy, if they are capable. A patient being forced to live in pain is a harm, which is keeping them from the goods of life. This may be part of the reason why when Ms. Rodriguez took her life neither of the parties that assisted her was punished. Regardless of what the law says, it’s the individual who should be in control of their life and how they want to die if diagnose with a fatal disease.

P.S.

One other thing that interested me outside of the moral standing of physician-assisted death was the discrepancies in judgment of the Kevorkian case. Most bioethics writers have condemned Dr. Kevorkian but the physician and friend in the Rodriguez case were not. Are these not very similar incidents? I am curious to know what people think.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New

York: Oxford UP, 2009. Print.

Illness, Sickness, and Disease | Primer on Public Health Population.” Illness, Sickness,

and Disease | Primer on Public Health Population. The Association of Medicine

Canada. Web. 13 Mar. 2015. < http://phprimer.afmc.ca/Part1-TheoryThinkingAboutHealth/Chapter1ConceptsOfHealthAndIllness/IllnessSicknessandDisease>.

Thomas, John E., and Wilfrid J. Waluchow. “Case 8:3 Sue Rodriguez: “Please Help Me

Die”” Well and Good: A Case Study Approach to Biomedical Ethics. 3rd ed. Peterborough: Broadview, 1998. Print.

Progressively throughout this course, I began to question, “Why do people value life so differently?” Social interactions, past experiences, upbringing and diseases/illnesses are only few of several factors that sculpt the way we view our lives.  Despite the struggles, hardships and obstacles we encounter, we are always told to keep going and never give up. Why? Wouldn’t it be easier to terminate our lives instead of enduring pain? Sometimes the easiest path isn’t necessarily the right path and we have to overcome obstacles to serve our purposes in our lives: to learn, to grow, to help others, to cure, to love, to nurture, to guide.

Background

The idea of legalizing, “physician assisted suicide” (PAS) has been a prolonged debate that entails several specifications that must be considered before siding with or against this option. “Oregon Death with Dignity Act” (ODWDA) enables physicians to write prescriptions for lethal drugs at the patient’s request.  Studies have shown that only one-third of the patients who are given the prescription, get the drugs. Patients who are granted this lethal medication are not “vulnerable to intimidation or abuse” and “have had, on average, a higher level of education and better medical coverage than terminally ill Oregonians who did not seek assistance in dying” (Beauchamp and Childress, 178-81). Those who oppose this option argue that despite the appearing competency of the Oregonian patients, they could possibly be depressed. If PAS is legalized, people suffering for serious or debilitating diseases will be erased from our societies which will provoke the issue of determining their value and quality of lives.  Healthcare is centered on the idea of protecting patients’ lives and protecting their right to life. As a result of legalizing PAS, it is feared that the quality of care for suffering patients will decrease.  Those who support PAS argue that palliative care is a form of restoring peace to a suffering patient and believe that the right to live is equivalent to the right to die. Nevertheless, as stated in Beauchamp and Childress, the moral dilemma “is not whether physicians are obligated to lend assistance in dying, but whether valid requests render it permissible for a physician to lend aid-in-dying.” (182)

I’ve always been the student who promotes prolonging of life and found myself strongly disagreeing with others who believed that death was a viable option for patients. However, for the first time, while questioning myself if I wanted to live after suffering from an accident that has dehumanized me and has made me “endure a loss of functional capacity, unremitting pain and suffering, and an inability to experience the simplest of pleasures”, I’ve encountered myself on the opposite side of the spectrum and decided that sometimes withholding or withdrawing treatments that hasten death may relieve acute pain. (178). Then I came across the famous case of Dax Cowart.

Case

In 1973, Donald, a pilot in Air Force, and his father visited a small valley that was unknowingly filled with propane gas and when they ignited the car, an explosion occurred which severely burned both men. When someone came to help, Donald asked the stranger if he had a gun because he already considered himself a dead man and wanted to put himself out of misery; however, the stranger replied gently that he couldn’t give him a gun.  While Donald’s father died on his way to the hospital, Donald was compulsorily treated for 10 months, which consisted of being immersed in a chlorinated bath and have bandages stripped and replaced almost daily. Despite insisting his desire to die, describing his treatment as being “skinned alive”, losing his ability to see, and losing more than 65-68% of his skin on his body, Donald was still treated until sufficiently healed. In 1986, Donald graduated from Texas Tech University with a law degree and subsequently opened his own practice. Because of his inability to see, Donald would feel embarrassed after mistakenly responding to his name when someone else was being addressed; therefore, he legally changed his name to, “Dax.” Then, Dax effectively sued the oil company responsible for the propane gas leak during his accident. He married twice and is currently still married to his second wife. This case is an example of preserving a man’s life against his wishes (despite having endured pain and suffering during treatment), who successively became a very successful and happily married person (“Dax Cowart”). Although not all stories result in such fantasy-like endings, it gives us hope that those who are genuinely suffering from unremitting pain and can only perceive death as their form of relief can be mistaken and become great leaders after treatment.

Discussion

When is the use of PAS morally justified? I believe PAS shouldn’t be legalized because we embark on a slippery downward slope when determining where the line should be drawn to permit physician to intervene in the natural trajectory of a human’s life. Even in the cases of terminally ill patients, such as Sue Rodrigues, who only have an estimated and limited number of months to live and would rather hasten their inevitable death than prolong their suffering, doctors have to be the reservoir of hope (Thomas and Waluchow, 214). Like Sue Rodrigues, Stephen Hawking, a world known physicist and cosmologist, was diagnosed with ALS and told he had only 2 years to live. He is currently 73 years old and is still considered one of the brightest men in the world (“Stephen Hawking”). My use of, as what some of you would describe, “miraculous” stories is not to portray the large probabilities of a well lived life after suffering from an accident or being told that you will have few days to live, but rather to enlighten the importance of hope for a better future. If a patient is severely experiencing pain then withdrawing or withholding treatment, and administration of prescribed pain medicine can be used; however, a physician must never prescribe or administer a lethal medication to end the life of any patient. A doctor’s duty is to prolong life and instill in people the will and strength to live because every life is valuable, regardless of disabilities and other disadvantages.

Works Cited

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

“Dax Cowart.” Wikipedia. Wikimedia Foundation, n.d. Web. 13 Mar. 2015. <http://en.wikipedia.org/wiki/Dax_Cowart>.

“Stephen Hawking.” Wikipedia. Wikimedia Foundation, n.d. Web. 08 Mar. 2015. <http://en.wikipedia.org/wiki/Stephen_Hawking>.

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: A Case Study Approach to Biomedical Ethics. 4th ed. Peterborough, Ont.: Broadview, 1998. Print.

Case 6.3 Tracy and Robert Latimer: “It Was Right to Kill My Daughter”

Background:

This case deals with two main discussions: 1) the decision Robert Latimer made to take his daughter, Tracy’s life and 2) the appropriate sentence for Robert Latimer’s crime.  Robert admitted to taking Tracy’s life by leaving her in the cab of his truck and closing in the exhaust fumes to let her pass from carbon-monoxide poisoning.  “Tracy had suffered from cerebral palsy and had been both physically and mentally disabled since the time of her birth.  At the time of her death [12 years old], she weighed no more than 38 pounds.  She had never been able to walk, sit up, talk, feed herself, or express her thoughts or wishes.  She had suffered a great deal of pain throughout her life and had undergone numerous surgeries to correct orthopaedic and musculoskeletal difficulties,” (Thomas, Waluchow, Gedge, 222).  Robert’s reason of committing the act was that to be phrased as “mercy killing.”  Robert was found guilty of second-degree murder and sentenced to life in prison with a possibility of parole after 10 years.  After a failed appeal, he appealed to the Supreme Court of Canada and resulted with a new trial on the grounds that the previous sentence was “cruel and unusual punishment.”  The new trial resulted with a sentence of one year in prison followed up by one year of house arrest.

Dilemma:

Was it appropriate for Robert Latimer to take responsibility of his daughter’s life under his hands (with respect to the principles of nonmaleficence and autonomy), ultimately with the decision to end it?  Also, is the heavily reduced sentence justified?/Was the original sentence too harsh?  What are the implications of the reduction in sentence?

Discussion:

The first discussion regards Robert’s decision to end Tracy’s life.  Obviously in almost every case, it would be fair to say that any man who would take his 12 year old daughter’s life is sinister, ill, a threat to society, unholy, overall a disaster of a human being.  However, in this case, all evidence has been shown – with acceptance by the Judge in the second trial – that Robert was not a threat to society, quoted by his family and Tracy’s doctors as being very loving, supportive father, and was very close to his daughter.  He was born and raised in the same town and is known throughout the community as being a responsible and hardworking farmer who never does anything unkind towards others.  The method of choice to end Tracy’s life was of the least harmful to Tracy and made the process easy and unnoticed.  Carbon monoxide poisoning causes no pain and is odorless.  Also, from the day Tracy was born, she had been feeling much pain her entire life.  She has had countless surgeries to cut her muscles in order to reduce pain, leaving her with limp limbs.  She only had control of her head and one arm.  Her body was so distorted she needed a steel rod down her spine to partially correct the shape.  She has never lived a normal day in her life, and was under total care.  Her quality of life was non-existent.  Every act of treatment was to reduce pain, not to treat the problem.  So was this an act of maleficence?  I don’t think so, after watching his daughter go through so much pain for so many years, knowing no amount of treatment would better her quality of life, it was possibly the responsible thing to do.  Regarding the principle of autonomy, she had never voiced her opinion in her entire life.  One of the great debates in this case was whether Robert and his wife should make the decision or should Tracy.  The decision of non-voluntary euthanasia made by Robert is justified because Tracy has never voiced her wishes or expressions at any point in her life.  Robert and his wife had always made decisions for Tracy in her best interest, not in her best wishes.  For all we know, Tracy could have rejected the idea of every having her countless surgeries, but we would never know.  At the time Robert felt it was necessary, he decided that, in her best interest, he should let her pass.  The Judge ruled this as an extremely rare case of compassionate homicide.  With the changing in the sentence, a question arises in a quote made by Aristotle: “once we disturb our disposition to fight death at all costs, it may become easier to sanction the actions of one who kills for compassionate reasons,” (227).  I read a comment on another post discussing the balance between morality and practicality and how they bump heads.  It is a difficult concept to wrap your head around, but with a case such as Robert and Tracy Latimers’, is our society changing its attitude and view about the withdrawal from life-support and euthanasia when it seems practical?  Is the balance between morality and practicality shifting?

References:

Thomas, John E., and Wilfrid J. Waluchow. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Toronto: Broadview, 2014. Print.

Case 8.3 centers around Sue Rodriguez, a Canadian citizen living with ALS. At the time of this case, she was thought to have a life expectancy of between two to 14 months. According to the prognosis, she would soon lose the ability to swallow, speak, walk, and move without assistance, and could eventually lose the ability to breathe without the aid of a respirator. Knowing this, Sue asked to preemptively take measures to request means to end her own life using physician assistance, but with her own hand, once she stopped living life to her standards of quality and happiness.

The dilemma in this case is whether or not physician-assisted suicide should be legal, and under what terms this legality should exist. In Sue’s case, the courts denied her request for assisted suicide, stating that the laws are in place to protect the vulnerable, and that human life must be respected (Thomas 184).

There are multiple approaches to this dilemma. The first is the approach taken by the Canadian Government—that assisted suicide breaches human life standards. The case states the argument that assisted suicide is unnecessary because there is pain management and care techniques to help one live happily, and that assisted suicide conflicts with a physician’s duty to help heal, not to help kill.

However, there are also many arguments as to why Sue should have been allowed to perform assisted suicide. First, Sue was autonomous when she made these requests. She was competent, and thus should not have her autonomy stripped from her. She is also on the path to death. In my opinion, everyone has different standards of what makes his or her life worth living, and a government can’t define exactly what those standards are for you. Should an autonomous and sick person request means to end one’s life when it reaches a state that is not up to his or her standards, and should they request to do it by their own hand, that is their decision.

An important aspect to this case is that Sue would have ended her life with her own hand. This parallels the Oregon Death with Dignity Act, which states that a physician may not physically end the patient’s life, but may write a prescription for a lethal medication at the patient’s request and the patient must decide to use the drug. This takes the “killing” aspect out of the equation, since the physician is not the person physically ending the patient’s life—the patient is. Furthermore, according to Beauchamp and Childress, keeping in mind the patient’s best interest is critical: “(Killing) is unjustified when it deprives the person who dies of opportunities and goods. However, if a person freely authorizes death, making an autonomous judgment that cessation of pain and suffering through death constitutes a personal benefit rather than a setback to interests, then active aid-in-dying at the person’s request involves neither harming nor wronging” (Beauchamp and Childress 182). They also state that denying a patient such requests might be disrespect (B & C 183).

While both sides of the argument are valid, Sue’s autonomous decision—and her willingness to end her life with her own hand—should have been respected, and do not fall out of line ethically once her quality of life diminishes.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2013. Print.

Thomas, Tom L., and Wilfrid Waluchow. “131-138.” Well and Good. 3rd ed. Broadview. Print.

Beauchamp and Childress discuss moral issues that arise when banking samples for research. They discuss the case of the Havasupai Indians, which is also addressed by Thomas, Waluchow, and Gedge in case 9.1 in Well And Good (290-292). In the case of the Diabetes research conducted with the Havasupai Indians, miscommunication surrounding informed consent created a platform in which morality was clouded. In Well And Good, the authors raise the question of whether “Aboriginal communities have the right to dictate what type of research is performed on their data and materials” (292). I argue that researchers have the obligation to promote autonomy and nonmaleficence when encountering any community of competent individuals. Informed consent, however, cannot be gained without sufficient understanding. All participants involved in research should be informed of the extent to which their biological samples will be utilized. In cases such as this, if ambiguity exists concerning the understanding of the participants and their level of informed consent, researchers may be prompted to ask participants to verbally restate the study’s aims.

The case of the Havasupai Indians is not a matter of deception or intentional nondisclosure in order to gain information that would otherwise be biased. This is an example of exploitation of a group of individuals who are unable to fully grasp what they were consenting to, as a result of a language barrier and lack of definitive study parameters. The researchers neglected to fully inform the Havasupai Indians of the study’s intentions. Deception was not employed, but that does not negate the fact that understanding and clarity is fundamental in promoting morally justifiable research. If the consent form had been more specific, the participants in the study, as supported by their outcry against the study, would have objected to their samples being utilized to such an extent. This notion, however, does not morally justify using the samples for further study outside of Diabetes research. “Using samples or data to achieve goals other than those initially disclosed to subjects negates even an originally valid consent process and threatens the trust between subjects and investigators” (Beauchamp & Childress, 187). The broadly stated consent form was not explicit to the point where those involved had a clear understanding of what the research would entail. In this instance, the researchers have an obligation to adequately and clearly inform the participants in order to reduce the risk of harm. The Havasupai Indians may not have thought it necessary to pressure the researchers into expounding on what they meant by using the samples to “study the causes of behavioral/medical disorders” if they had no reason to believe the study would encompass research outside of the realm of Diabetes (Beauchamp & Childress, 187).

Beauchamp and Childress articulate that the challenge in banking samples “is both not to cause harm to personal and group interests and not to violate privacy and confidentiality” (186). This case did not avoid harm to personal and group interests and arguably violated privacy and confidentiality. Beauchamp and Childress state that, “The Havasupai viewed some of this research as offensive, insulting, stigmatizing, harmful, and provocative” (187). There was no sign of immediate physical harm as a result of the study, but emotional and psychological harm was clearly evident. The results of the study had cultural, religious, and political implications. The case does not address a breach in confidentiality, but various articles were published about the Havasupai without explicit consent from the tribe members. Not only were the Havasupai emotionally harmed by the findings, the “quasi-religious significance” of the tribe’s history was publicly contradicted, further contributing to the immorality of the situation (Beauchamp & Childress, 188). Taking all aspects of this case into consideration, it is obvious that a lack of understanding was exploited in a vulnerable population and the trust in research was greatly hindered regardless of the researchers’ intention (Beauchamp & Childress, 188).

A recent study conducted by Heerman, White, and Barkin (2015) attempted to increase the strength of a participant’s informed consent through the use of supplemental visual aids and graphics based on “enhanced communication techniques from the low health-literacy and health-communication literature”. While this study dealt with pediatric research, similar tactics could be utilized to promote understanding in vulnerable adult populations.

Works Cited

Beauchamp, T. L., and James F. Childress. Principles of Biomedical Ethics. New York:

Oxford UP, 2009. Print.

Heerman, W. J., White, R. O., & Barkin, S. L. (2015). “Advancing Informed Consent For

Vulnerable Populations”. Pediatrics, 135(3), e562-e564.                 http://pediatrics.aappublications.org.proxy.library.emory.edu/content/135/3/e562.long

Thomas, J., Waluchow, W., & Gedge, E. Well and Good: A Case Study Approach to Health

            Care Ethics. 4^th ed. Broadview Press Ltd., 2014. Print. 

Background:

In Case 6.2, “Sue Rodriguez: Please Help Me to Die,” the patient, Sue, is suffering from amyotrophic lateral sclerosis (ALS), which is also known as Lou Gehrig’s Disease. As per the ALS association, this disorder involves the progressive degeneration of motor neurons, which affects cells in the spinal cord as well as the brain. This degeneration results in diminished muscle movement, and the muscles atrophy. Symptoms include muscle weakness in the arms, legs, swallowing, etc. The average life expectancy for patients with ALS is two to five years after diagnosis although it varies from person to person. After being diagnosed with ALS, Sue has asked for a medical professional to help her with committing suicide before the disease takes her life.

Dilemma:

In Sue’s situation, one moral dilemma that is especially important to consider is, after the court ruled that doctors helping Sue were legally justified to do so, whether a physician should or should not assist her in committing suicide. While the physician knows that he or she is legally permitted to aid Sue with ending her life, the question involves whether the doctor is morally justified to participate. This issue revolves around the principle of nonmaleficence.

Discussion:

The first objective should be to determine whether the physician is violating the principle of nonmaleficence. Beauchamp and Childress present the obligation of nonmaleficence: “One ought not to inflict evil or harm” (151). By participating in a procedure that directly leads to the patient’s death, the physicians are clearly inflicting harm. The next topic to address is whether this violation of nonmaleficence is justified. Sue would be requesting this assistance when she believes it is the right moment for her: “The dilemma she faced was that “by the time she no longer [was] able to enjoy life, she [would] be physically unable to terminate her life without assistance.” In light of this, Rodriguez petitioned the courts for an order “which [would] allow a medical practitioner to set up technological means by which she might, by her own hand, at the time of her choosing, end her life”” (Thomas et al., 214). Overall, Sue’s decision would be entirely autonomous, and the physician would only be helping her achieve her goal. In addition, unlike the case with Tracy Latimer in which Tracy did not explicitly express her wishes to die, Sue has clearly declared that she would be ending her life. Furthermore, the alternative to respecting Sue’s wishes would most likely only slightly prolong her life, and consequently, her extensive suffering after which she will inevitably pass away. One could argue that by causing Sue to suffer with the symptoms instead of allowing her to take life, the doctor is also inflicting harm. Therefore, this situation, for a doctor, does not involve a decision where one option leads to inflicting harm whereas the other results in the physician not causing harm. Ultimately, the violation of the nonmaleficence principle is justified, in this case, despite directly leading to the patient’s death, and the physician should assist Sue with ending her life on her own terms.

References:

ALSA. “What Is ALS?” The ALS Association. N.p., n.d. Web. 10 Mar. 2015.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2013. Print.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. New York: Broadview, 2014.

Image Link: http://www.visembryo.com/images/ALSneuronMuscle.gif

**For Blog period 3**

Two very similar cases were mentioned in our reading for 3/18: that of the Havasupai Indians and that of the Nuu chah nulth Nation (Beauchamp and Childress 187-8; Thomas et al. 289-91).  I will be focusing on the former case.

Background

The Havasupai Indians live in the Grand Canyon, and several scientists at Arizona State University obtained consent from about 100 representatives of the Havasupai in order to “study the causes of behavioral/medical disorders” using the Havasupai’s DNA samples (Beauchamp and Childress 187).  Whereas the Havasupai understood this as consent to conduct diabetes treatment, the scientists took it as a license to conduct various types of genetic research, including research on schizophrenia and inbreeding, and the results were made available to the public.  The Havasupai attested that they never consented to research on their samples aside from the diabetes research, and they sued the university and won the lawsuit (Beauchamp and Childress 187-8).

The Dilemma

The dilemma in this case is whether the scientists had obtained the proper consent to conduct additional research on the DNA samples of the Havasupai, aside from the research on diabetes, or if additional measures should have been taken to obtain proper consent.  This case involves the principles of autonomy, nonmaleficence, and beneficence.  The scientists made an effort to respect the autonomy of the Havasupai by having representatives sign a consent form.  The form was made basic to accommodate the limited English proficiency of the tribe members, but it was also made broad (Beauchamp and Childress 187).  The broadness of the consent form and a possible lack of effective communication between the scientists and the Havasupai representatives contributed to the harm of the tribe members.  There is no evidence that the scientists’ goal was to expose shameful or harmful aspects of the Havasupai to the general public.  By publishing the results, the scientists likely thought they were acting in beneficence to the general public by looking at the effects of inbreeding and at schizophrenia, as research is necessary in making progress in the remedy of certain conditions.  However, when findings were made beyond the research on diabetes, harm inadvertently resulted to the Havasupai.

Reflection

The scientists acted extremely irresponsibly in this case.  They did conduct the diabetes research that the Havasupai expected to be conducted and they likely conducted the research on mental illness to make progress in the field and to help those suffering from such conditions.  However, the scientists took advantage of the poor level of understanding of the Havasupai and clearly did not make sure that the representatives understood exactly what they were consenting to.  Although the Havasupai did legally consent to the “study [of] the causes of behavioral/medical disorders,” they obviously were not clear on what that entailed, and it is the scientists’ ethical responsibility to ensure proper understanding of the subjects of the implications of their consent (Beauchamp and Childress 187).

It would be virtually impossible to predict all possible consequences of the research, but a more comprehensive understanding would aid in the Havasupai’s evaluating the benefits and costs and making an informed decision.  Instead of writing up a vague consent form and giving it to the representatives to sign, the scientists should have explained in detail, both verbally and in writing, what they were planning to do and make it clear that they would likely be looking at factors beyond diabetes. To ensure proper understanding, the subjects should be asked to repeat what they are consenting to in their own words.  If the subjects make it clear that they only want the diabetes research to be conducted, their autonomous decision is to be respected.  The benefit to society of medical research is crucial, but it should not be done at the expense of the autonomy of and potential harm to anyone.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009. 187-8. Print.

Thomas, John E., Wilfrid J. Waluchow, Elisabeth Gedge.  Well and Good. a Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview, 2014. 289-91. Print.

This week’s readings about end of life palliative care decisions and the struggle of their authors to morally define and establish ethical norms left me thinking about the recent media coverage of Britney Maynard. This past fall, it was difficult to walk into a grocery store without seeing Maynard’s face splashed across a tabloid or lifestyle news magazine cover. Brittany Maynard was a 29-year-old woman diagnosed with terminal stage IV glioblastoma multiforme brain cancer in January 2014. After her initial surgical treatment proved unsuccessful and her tumor returned, Maynard decided to forgo additional treatment of chemotherapy and radiation. According to her editorial for CNN, Maynard and her family reached the conclusion that all remaining treatments could not save her life and would destroy the months she had left to live. Maynard instead chose to establish residency in Oregon in order to gain access to a dosage of lethal barbiturates under Oregon’s Death with Dignity Act, passed and put into effect in 1997.

This law allows competent adults with a physician-diagnosed terminal illness the right to request lethal prescription drugs and use them to die should they voluntarily wish to do so. Individuals cannot qualify for the drugs solely based on age or disability status, nor can they receive them if they are deemed to have a psychological or psychiatric disorder, such as depression, that could infringe on their ability to make an informed decision about death (Oregon Death with Dignity Act). Once a person has received their prescription, they can choose to use or not use the medication at will. The law still forbids physicians from ending a person’s life in patient assisted suicide through “lethal injection, mercy killing or active euthanasia” and protects the patient’s death (should they choose to use their prescription) from being classified as “suicide, assisted suicide, mercy killing or homicide, under the law”.  Brittany chose to end her life surrounded by family members on November 1^st, 2014 by ingesting her prescription.

Brittany’s passing left me unsettled and I realized that Beauchamp and Childress and Thomas et al. do little to provide a moral code for judging end of life cases. Their writings detail the necessity for evaluating morality on a case-by-case basis for end of life decisions. Their frameworks for “killing” versus “letting die” and “active” versus “passive” measures explain the beliefs of the medical profession, but they decline to confirm or deny that these frameworks are logical or morally right.  On the other hand, Mcintyre, in her discussion about the principle of Double Effect, makes it clear that she would support “deliberate hastening of death” in circumstances where it could “relieve great suffering” (72).

Nevertheless, a decision like the one made by Maynard makes us uncomfortable because of preexisting personal convictions and values that differ beyond the “common morality” we generally use to evaluate ethical situations. Diversity in faiths and upbringings will always create minute differences in the value and purpose of physical life. As Beauchamp and Childress say, it’s not so much what causes death that results in the debate of whether a death is unjustified a “killing” or justified as a “letting die”. They state: “The validity of the authorization—not some independent assessment of causation—determines the morality of the action.” (Beauchamp and Childress 177). Different backgrounds mean people will place validity in the hands of different individuals.

Some may place the validity of the authorization of death only with god, while others may believe it lies with the ill individual alone. In the case of Brittany Maynard, I personally believe that the acceptance or disagreement with Maynard’s decision and Oregon state law comes down to the sanctity of life versus quality of life debate that Thomas et al. describe (210). Those who believe that quality of life is more important than the sanctity of life will choose to honor the principle of autonomy over the non-maleficence/beneficence of prolonging life. And, those who choose sanctity of life as more important will see the prolonging of life as an act of beneficence that is more important than personal autonomy in Brittany’s case—regardless of Oregon law.

Works Cited

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2013. Print.

 “Death, Dying, and Euthanasia.” Well and Good: A Case Study Approach to Health Care Ethics. 4th ed. Peterborough, Ontario: Broadview, 2014. 208-14. Print.

Maynard, Brittany. “My Right to Death with Dignity at 29.” CNN. Cable News Network, 02 Nov. 2014. Web. 11 Feb. 2015.

Mcintyre, Allison. “The Double Life of Double Effect.” Theoretical Medicine and Bioethics 25.1 (2004): 61-74. Web.

United States of America. Oregon Health Authority. Public Health. The Oregon Death with Dignity Act: Oregon Revised Statutes. N.p., n.d. Web. 28 Feb. 2015. <http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/statute.pdf>.