Both non-maleficence and beneficence are concepts that are universal across our world, whether it is in everyday actions or in a healthcare setting. However, to what extent is non-maleficence and beneficence universally recognized? We can analyze this question by delving into the motives and virtues of multiple cultures across the world and we can compare and thus contrast the aspects of non-maleficence and beneficence.

As we can see across the United States and in most western countries, non-maleficence and beneficence across a health care setting derives from the relationship between the doctor and his/her patient. Across history, our doctor-patient relationship in the United States has changed towards greater respect for patient’s autonomy rather than a historically paternalistic ideology. There needs to be much more consent from the patient before any type of medical procedure is placed upon the patient. Even in bioethics class, we place the importance on the consent of the patient and the patient’s autonomous decision.

In the sense the word “beneficence” is a type of paternalism in which the doctor assumes what is beneficial towards the patient. In many other cultures beneficence is actually emphasized more than autonomy. There has shown to be correlations between the type of government and the power of beneficence over autonomy. Pellegrino and Thomasma’s article asserts that this could be as a result of many different factors, of which includes technology, religion, economy, and politics.

Accordingly, in Islamic medical ethics, there has been studies done on the works of Mawlana, a prominent Sufi theologian and philosopher, that showed that beneficence is prioritized over autonomy. We also see that religion is a major factor when considering the emphasis of beneficence with Confucianism in China. Beneficence is emphasized greatly as “A humane art, and a physician must be loving in order to treat the sick and heal the injured” (Kao, 2002). Politics also play in a major role when considering beneficence. The world’s “democratization” carries with it distrust for authority, and thus there seems to be a correlation between the United States of America’s democratic politics and the lowered respect for paternalistic beneficence of the physician in most healthcare settings. Technological advancements in our society is also something that can be greatly considered when thinking about autonomy versus beneficence. Technology in a sense brings about freedom within people. Having different cars, phones, and other forms of technology allows us to assume that we are autonomous beings who have great power in our own decisions. This in turn seems to be correlated with our western culture being more focused on autonomy.

Does looking into a cross cultural prospective of the principles and aspects of autonomy and beneficence in a bioethical lens helps us in a way? I would say that it helps us to generalize less about “an individual” and to realize that there are many complicated factors when considering balancing autonomy of the patient and beneficence of the physician. I would love to hear comments and thoughts about this topic.

Works Cited:

Pellegrino, Edmund. “The Conflict between Autonomy and Beneficence in Medical Ethics: Proposal for a Resolution.” Journal of Contemporary Health Law & Policy. N.p., n.d. Web. 12 Mar. 2017.

“Non-Maleficence and Beneficence.” The EIESL Project RSS. EIESL Project, n.d. Web. 12 Mar. 2017.

“Ethics – Definitions and Approaches – The Four Common Bioethical Principles – Beneficence and Non-maleficence.” Alzheimer Europe. Visual Online, n.d. Web. 13 Mar. 2017.

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

The concept of paternalism in biomedical ethics gives authority of people’s bodies and autonomy to qualified persons, and could lead to a serious abuse of power if used as reasoning for simply controlling patients or their families’ choices for a host of reasons.  As controversial and as it is, paternalism is needed in cases where it is truly in the patient’s best interests to forgo their wishes, but there will always be a gray area in determining what those interests are.

Intervention in suicide attempts are, necessarily, considered paternalistic.  In “Confronting Death: Who Chooses, Who Controls?”, Dax Cowart asserts that “The right to control your own body is a right you’re born with, not something that you have to ask anyone else for […].”  This commonly upheld idea of autonomy is the precise reason the principle of paternalism exists – to essentially ignore a person’s autonomy if the reason for doing so benefits the person in question. Paternalism regarding cases of suicide, however, involve the act of suicide as a moral right and the state of the person attempting it.  Psychiatrists often consider a suicide attempt as a sign of a mentally incompetent person, but in doing so they are singling out the act of suicide as justification for revoking a person’s autonomy. If suicide is a “human right”, how is it different than any other action a person does to change his or her life for the better or worse?  A way to approach this dilemma is the relativity of suicide to other tasks, momentarily ignoring the social stigma surrounding it. People with suicidal thoughts should of course be given options, assistance, and concern, but doctors do not necessarily have inherent authority to intervene in a suicide attempt when not asked or given consent (this source explains various philosophical principles of thought on this topic).

Since the aforementioned texts define suicide along the lines of a human right, should society approach physician-assisted suicide any differently? To some, it is considered acceptable to assist in somebody’s suicide based on the argument that it is more humane if the person will accept no other alternative. To do this, though, would be to classify suicide as an acceptable, maybe even untouchable, act under the terms of autonomy and a person’s right to his or her own body.

From these conclusions, there is an evident correlation between intervention in suicide and physician-assisted suicide. If intervening in a suicide attempt on terms of beneficence, even if a person is mentally competent, is considered morally acceptable, then physician-assisted suicide is ethically justifiable under similar criteria of beneficence. There must be much more discussion surrounding the relation of suicide intervention and physician-assisted suicide, as each of those topics pertains to restricting autonomy and the ever-growing presence of paternalism in society.

Sources:

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009, 2013. Print.

Cowart, Dax, and Robert Burt. “Confronting Death: Who Chooses, Who Controls?” The Hastings Center 28.1 (1998): 14-24. JSTOR. Web. 12 Mar. 2017. <http://www.jstor.org.proxy.library.emory.edu/stable/3527969>.

Kelly, Chris, and Eric Dale. “Ethical Perspectives on Suicide and Suicide Prevention.” Advances in Psychiatric Treatment. The Royal College of Psychiatrists, 01 May 2011. Web. 12 Mar. 2017. <http://apt.rcpsych.org/content/17/3/214>.

Image Credit:

http://sociologylegacy.pbworks.com/w/page/75297230/Paternalistic

In Principles of Biomedical Ethics, Beauchamp and Childress present a hypothetical situation in which a psychiatrist “informs all patients that he may not keep information confidential if serious threats to other persons are disclosed” (Beauchamp and Childress, 208). After “learning of his patient’s intention to kill an identified woman… the psychiatrist may now either remain aloof or take measures to protect the woman by notifying her or the police, or both” (Beauchamp and Childress, 208). What does the principle of beneficence demand of the psychiatrist in this situation?

In my opinion, the psychiatrist should contact the woman, the police, or both in an effort to protect the woman’s life. While the psychiatrist is under no obligation to act in this situation, the principles of positive beneficence overrides all opposing arguments. The “principle of beneficence refers to a statement of moral obligation to act for the benefit of others” (Beauchamp and Childress, 203). Conveniently, in this case the best interests of the patient and the woman are the same. By preventing the patient from causing any harm to the woman, the psychiatrist is acting in the best interest of the woman by saving her life, and the patient by preventing him from committing an act he will later regret.

Beneficence “is optional rather than obligatory;” however, there are some situations in which an individual is highly encouraged to act (Beauchamp and Childress, 205). One of the principles of positive beneficence, which holds an individual accountable in a situation, is  the duty to “prevent harm from occurring to others” (Beauchamp and Childress, 204). In this situation, the psychiatrist is responsible to prevent the harm that could potentially be caused to the woman and the harm that would be imposed on the patient if he followed through on his wish to kill the woman. An additional principle is the duty to “rescue persons in danger” (Beauchamp and Childress, 204). The woman in this situation is obviously in severe danger of being hurt, or killed, and as a result, the psychiatrist is under an obligation to circumvent the threat. The patient is also in danger of being imprisoned, most likely for the rest of his life. In terms of these principles, the psychiatrist is expected to act in this situation to protect the woman and the patient’s future.

“One of the most common ethical dilemmas arises in the balancing of beneficence and nonmaleficence” (“Beneficence vs. Nonmaleficence”). However, in this hypothetical situation, the principles of beneficence and nonmaleficence complement one another. If the two principles conflict with one another, like in Dax Cowart’s case, then you must decide which carries more weight in the situation and should be respected over the other principle. The principle of nonmaleficence means “to do no harm” (“Beneficence vs. Nonmaleficence”). By telling the woman, the police, or both, the psychiatrist is preventing any harm from occurring to the woman or possible harm to the patient that could arise as a consequence of his actions. In addition, the psychiatrist is obeying the principles of beneficence by taking actions that “help prevent or remove harms or to simply improve the situation of others” (“Beneficence vs. Nonmaleficence”). 

Taking everything into consideration, while the psychiatrist is under no obligation to act in this situation, due to the principles of beneficence and nonmaleficence, he should inform the woman, police, or both. The psychiatrist will suffer no risk or inconvenience by acting in this case. In addition, he is obligated to prevent harm and act in the best interest of the individuals involved.

Works Cited:

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

“Beneficence vs. Nonmaleficence.” Beneficence vs. Nonmaleficence. University of California Regents, School of Medicine, 2008. Web. 12 Mar. 2017.

The next principle of bioethics that is discussed is the concept of beneficence. The “principle of beneficence refers to a statement of moral obligation to act for the benefit of others” (Beauchamp and Childress 203). According to this statement, beneficence is all about acting positively toward creating benefits for others as opposed to the negative action of doing no harm as explained by the principle of nonmaleficence. With this in mind, there is another clear distinction between the two principles and that is “the rules of nonmaleficence must be followed impartially” while the “rules of beneficence need not always be followed impartially.” (Beauchamp and Childress 204). What this means is when it comes to nonmaleficence, every physician and healthcare professional has the obligation to not inflict harm on patients yet for beneficence, not every physician is obligated to provide beneficial aid to patients who need it. My question is why is it that all physicians are universally required to do no harm, yet not all physicians are required to “act for the benefit of others” and can even refuse to treat certain patients?

The concept of refusing to treat a patient directly contradicts with the principle of beneficence yet there are laws such as those within the American Medical Association which declare, “a physician shall in the provision of appropriate patient care, except in emergencies, be free to choose who to serve” (Hood). The AMA then went on to add to this decree that in the case of discrimination, the physicians’ right to refuse to treat is not allowed. Additionally, there have been other debates about physicians’ refusal to treat patients when not in the case of discrimination, which is why other reasons have been offered to justify this contradiction with beneficence. Some of these reasons are that there are a limited amount of resources so not everyone can be treated, the patient is seen as hostile, the physician’s personal religious beliefs contradict with the aid necessary, or the physician will be at risk (Hood).

The last reason explained by Hood of the physician being at risk is brought up by Beauchamp and Childress and is specifically described as “X’s [physician] action would not present significant risks, costs, or burdens to X,” and “the benefit that Y [patient] can be expected to gain outweighs any harms, costs, or burdens that X [physician] is likely to incur” (Beauchamp and Childress 207). Thus, there is a sensitive relationship established between the patient and the physician when dealing with treatment, so it is important to consider both sides of this relationship and how everyone is ultimately affected with the decisions made. Lastly, in light of my discussion, I believe as we begin to diverge into this new concept of beneficence, it is important to remember the previous concepts in which we have discussed that way we continue to question how they coexist with one another; without trying to understand the contradictions these principles have amongst each other, we will not be able to provide a moral balance in the new situations that arise.

Work Cited:

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

Hood, Virginia L., “Can a Physician Refuse to Help a Patient? American Perspective,” http://pamw.pl/sites/default/files/pamw_06_hood_pogl_en.pdf.

This article deals with the topics of patient autonomy and doctor interference with patient decision making and selectively sharing information. Patient autonomy is a common ethical issue in the medical field because there are so many exceptions and specific situations that may compromise the initial principles of patient autonomy. Doctors are expected to give all known information to the patient and patient confidentiality can also bring up a variety of issues within this field. The author, T. F. Ackerman, includes several arguments stating that illness can often greatly affect the patient’s ability to make a reasonable decision. There are many psychological and physical constraints that can affect the decision making process. Therefore, physicians should be able to participate in the decision making process, especially if the patient does not fully understand the illness or lacks the psychological wellbeing to make life changing decisions (Ackerman, 1982).

In the 19^th century, patients were expected to completely trust the judgements and decisions of the physician based on the beneficence model of the “golden age of medicine” in America. However, malpractice was common. Physicians could make controversial decisions such as declaring a severely disabled newborn as a stillbirth in order to prevent the parents from having a difficult decision to make or even withholding medicine from a patient. Ethical discussions did not take place often within the medical field. Because of this, many changes were made regarding the patient-physician relationship as time progressed (Will, 2011).

During the early 1900s, the number of hospitals in the US and the availability of medical technology and knowledge increased. Medical malpractice litigation became more popular in the late 20^th century and there was even a “malpractice crisis” during the Nixon presidency. The Nuremburg Trials revealed many ethical issues with patient consent and autonomy. These issues brought about mistrust towards researchers and even between patients and their doctors. Because of these events, new discussions developed about ethical reformations in the medical field, bringing about new ideas of patient autonomy and consent (Will, 2011).

In my opinion, I agree with Ackerman’s point that the doctor should be a part of the decision making process to some effect. A research study published in 2005 about patient preferences for decision making showed that majority of their patient participants desired to share decision making with their physician. Furthermore, no matter what their preference was, participants mostly valued the physicians opinion in most cases (Mazur,Hickman, Mazur & Mazur, 2005). Overall, physicians are the most knowledgeable about the patient’s conditions and can provide the most helpful and specific information possible. It makes sense for the physician to be allowed to intervene in decision making processes. This does not mean that patient autonomy is overridden; however, it is the physician’s duty to prevent and to not harm the patient which may involve intervention.

References

Ackerman, T. F. (1982). Why Doctors Should Intervene. The Hastings Center Report, 12(4), 14. doi:10.2307/3560762

Mazur, D. J., Hickam, D. H., Mazur, M. D., & Mazur, M. D. (2005). The role of doctor’s opinion in shared decision making: what does shared decision making really mean when considering invasive medical procedures?1. Health Expectations, 8(2), 97-102. doi:10.1111/j.1369-7625.2005.00315.x

Will, J. F. (2011). A Brief Historical and Theoretical Perspective on Patient Autonomy and Medical Decision Making. Chest, 139(6), 1491-1497. doi:10.1378/chest.11-0516

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.

This brief blog post is unrelated to this week’s readings and the immediate ethical issues we discussed in class, but I thought it would be interesting to hear some feedback on this topic. While reading the Well & Good Case 6.3 “Tracy and Robert Latimer” and wrapping my mind around the pertinent ethical issues in the case, I couldn’t help but think about the sentence Mr. Latimer received for killing Tracy – a few years in prison and then parole – and the precedent it would set for future generations and trials. I understand that this specific case is filled with questions surrounding the principles of nonmaleficence, killing versus letting die, and the Mr. Latimer’s general intentions, but how does it look if this is his sentence for admitting to taking a human life?  I feel as if the court must be conscious of this and provide some explanation or exception to prevent murderers from receiving lesser sentences on the basis of their personal, “untouchable” morals and beliefs.  The Stanford Encyclopedia of Philosophy states that present generations “are obliged not to violate the rights of future generations.”  Does Mr. Latimer’s short sentence compromise the security or rights of future victims or the accused in the legal system? Do we have a right to protect future people under this concept of “intergenerational justice”? I’d love to hear your thoughts.

Thanks!

Elisabeth Crusey

Sources:

Meyer, Lukas. “Intergenerational Justice.” Stanford Encyclopedia of Philosophy. Stanford University, 03 Apr. 2003. Web. 27 Feb. 2017. <https://plato.stanford.edu/entries/justice-intergenerational/#Bib>.

Image Credit:

http://www.policyinnovations.org/ideas/policy_library/data/01667

Arguments regarding proper ethical actions in medicine tend to focus on preserving life and working towards improving the health of a patient. In many cases, the ethical decisions regarding an individual’s health may appear – at least superficially – to be linked with the volume or sophistication of medical care. However, these are inaccurate replacements for the primary focus of truly caring for an individual. The patient’s quality of life is the most ethically significant factor to both the physician and patient, and therefore should always be preserved or improved over the long run. Of course, many medical treatments reduce a patient’s quality of life in the short term while long-term benefits heavily outweigh these negatives. Unfortunately, there are extraordinary cases where the quality of life will likely never improve, only becoming worse with time. When the patient’s forecasted quality of life is not typical, the patient should not be treated or assessed as a typical patient.

Such is the case of Sue Rodriguez, whose quality of life had deteriorated substantially with the progression of amyotrophic lateral sclerosis (ALS). While Sue had made her intentions clear — to continue living as long as she could enjoy life — this presented the issue of requiring physician-assisted suicide if her condition progressed beyond what she could tolerate. This was in violation of Canadian law, where a physician could face up to 14 years in prison from assisting in suicide. While in violation of the Canadian legal code, the Charter of Rights and Freedoms ensured she would not “be subjected to any cruel and unusual treatment or punishment.”

When sanctity of life conflicts with individual autonomy, the decision of the individual must take precedent over the sanctity if the decision was made logically. It is worth noting that anyone in this condition will be unable to act with full rationality, as the extreme degenerative state of the disease compromises an individual’s ability to comply by normal standards. Essentially, the degenerative state is a highly coercive influence over the patient’s wellbeing and should be recognized as having an impact. The patient can, however, act logically considering the realities and possibility of their predicament. The possibilities of improvement, in Sue’s case, were merely hypothetical while the impending deterioration was inevitable by all realistic assumptions. It is reasonable of Sue to assume that her condition would only deteriorate and that assisted suicide would be the only viable option in that case. Such an assumption, even by a person with diminished mental and reasoning capacity, should be treated as a valid decision, as the rational behind the decision is of sound logic and respects the realistic outcomes regarding the future of her quality of life.

As long as the autonomy of the individual is respected, allowing for physician-assisted suicide does not present a threat of progressing into more malicious uses of euthanasia or eugenics, as detractors often propose. The decision ultimately remains with the patient, not the physicians, hospitals, or legislature. There are rigid cultural and social taboos regarding this as well, with numerous organizations existing to prevent physician-assisted suicide from being further adopted legally (Physician Assisted Suicide). However, trends in medicine and law indicate an easing of the laws prohibiting this, allowing for more nuanced ethical and moral discussions to take place regarding end-of-life care and patient autonomy. Also, once adopted by Oregon in the United States, patients can cross state lines if their resident state does not allow for this procedure (Battin). This renders the local bans useless and goes to demonstrate that systems respecting the autonomy of the patient will be popular amongst the target demographic (i.e. deteriorating quality of life patients).

Sources

1. Physician Assisted Suicide Violates ADA, accessed 26 Feb 2017. <http://www.adapt.org/newsletter/1997v31n1/22ndy>
2. Battin MP, Heide A, Ganzini L. Legal physician assisted dying in Oregon and Netherlands: evidence concerning the impact on patients in “vulnerable” groups. Journal of Medical Ethics. 2007. 33(10) 591-597.

Sue Rodriguez had ALS, a progressive degeneration of the motor neurons of the central nervous system, leading to wasting of the muscles and paralysis. Rodriguez knew that she would “soon lose the ability to swallow, speak, walk, and move about with assistance (and then later), lose the capacity to breathe on her own without the help of a respirator” (Thomas et al., 214) previously deciding that she would not like to continue her life if she was not enjoying life in the capacity she wanted to, she petitioned the courts to allow he to obtain physician-assisted suicide. They denied her plead and she ended up taking her own life later on. A second case arose from Gloria Taylor with the same disease as Rodriguez who also wanted to petition the courts to allow physician-assisted suicide. Although Taylor further in court than Rodriguez did, there were still many opposing arguments. The important question of this case is: Should the courts should allow physician-assisted suicide and at what cost.

Arguments Against Legalizing Physician Assisted Suicide:

One of the main concerns of legalizing physician-assisted suicide is that there are going to be increased cases of involuntary acts of this type of suicide. Pressure from different kinds of sources will play a role in making this a problem. Family who is not able to fully financially support the patient or feel as if they are doing everything just to watch the patient die, may have more reason to pressure him/her to hasten their death. Physicians who feel as if the patient is very likely to die and is using up many resources to keep him/her alive in the meantime could also feel inclined to pressure the patient to make that decision sooner than wanted. This is comparable to Case 5.1 with the decision to treat Baby Q who had a small chance to live and if she did live there was a large chance of severe mental disabilities. The Resident of the hospital argued to not do the treatment and let Baby Q die as she claimed, “We are always being told how expensive this unit is, and look at how much it will cost if this baby is kept alive and requires long-term institutional care!” (Thomas et. al., 187). A further pressure would be the actual patient due to the fear that they are a burden on their family and friends and that it would be easier for the family if they ended their life. In this sense, legalization can become dangerous if handled incorrectly.

Arguments for Legalizing Physician Assisted Suicide:

Although there is room for misconduct in legalizing medical suicide, the arguments for the legalization outweighs the arguments against. In Rodriguez’s case, and in many other related cases, the quality of life that she had envisioned for herself had been taken away by the detriments of her illness. Rodriguez saw no value in continuing a life that is inevitably going to become harder and is going to cause her to suffer longer due to the degeneration effects of ALS. Not legalizing physician-assisted suicide goes against the autonomy of the patient by denying “individuals the right to control areas of their lives fundamental to their dignity” (Thomas et.al., 216). Furthermore, it is said that, “to impose unwanted treatment on a competent patient is to commit a battery against him, which would be condemned in both law and morals” (Thomas et.al., 219). People against physician-assisted suicide argue that there are other ways to commit suicide including “refusing to eat or drink,” which would cause even more pain and suffering. And also the problem is not that there are other ways to commit suicide, the problem is that patients who are dying do not have the capacity to commit suicide on their own. That is why there is a need for this legalization.

In my opinion, the government should legalize physician-assisted suicide because if not, it goes against a person’s autonomy. People have the right to refuse medical treatment and it is wrong for the government to make them endure a longer period of suffering against the patient’s wishes. Also, if the patient is competent, they should be able to make that decision and have it respected without major backlash.

Works Cited:

Thomas, John E, et al. “Case 6.2: Sue Rodriguez: ‘Please Help Me to Die.’” Well and Good: A Case Study Approach to Health Care. 4th ed. Canada: Broadview, 2014. 214-22. Print.

Thomas, John E, et al. “Case 5.1: Should Treatment Be Withheld from Patients with Severe Cognitive Disabilities?” Well and Good: A Case Study Approach to Health Care. 4th ed. Canada: Broadview, 2014. 186-92. Print.

Sue Rodrigues, a Canadian citizen, has amyotrophic lateral sclerosis. Sue decides to enjoy life as she can. However, as the time has passed and she began to experience difficulty  to physically enjoy her life, she began to explore the possibility of suicide. She is determined in physician assisted suicide and she bring this case to court which demands the physician to set up certain “technological means” for determining her terminated life. As Sue argued to the higher court, as suicide itself is not a criminal, her determination to end life should be considered legal as well. But lawmakers and physicians obviously still held in doubt about this issue for reasonable causes: First, the act of “aid or abets a person to commit suicide is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years”. Second, there a few guideline existed with relevance to this topic.

It is important to honor her autonomy rights and human dignity. From a patient’s perspective, Sue made the decision based on her own self interest. As she has stated in her conscious state, she wish to have control over when she died and spare herself from the pain she is destined to experience. She made the rational decision which consisted of her careful planning. As a physician and law maker, it is important to respect individual’s decision. As the medical care professional, they could request Sue to revisit her decisions by poses her more open ended questions. Sue should also always keep in mind her given informations, like: her health condition, her family member’s well being, her influence on other people and her funeral arrangement.

With the given guideline for assisted-suicide, it is far less enough. From the perspective of court and physician, it is hard to kill. As stated by Hippocratic Oath, “Thou shalt do no harm”, it is against ethics to kill or harm people not only as a physician but also as another human being on earth. For the court, it is hard to make decisions because every single cases are so different. Its ruling would insist on the given law because once the law is broken it is hard to know the boundaries. And it is hard to predict if there are going to be cases which used the allowance of assisted suicide as a criminal method. Fear also appear that the individual might be influenced over the process of her decision making. For example, the patient would not want her/his family to be broken because of the illness dragged along. I personally know a relative who jumped off the hospital window because he wish not burden his family further. This tragic event is a reflection of the lack of managed system which cause more trauma to the family and public than ever.

In Sue’s case, I believe we should respect the individual’s decision more than evaluating the current legal system. While it is important to acknowledge the concern of the court and physicians. Individual’s decision should be prioritized. As Sue has made such clear statement about her situation, it is important to support her as a friend, family and medical care professionals. There could be definitely more assessment and guidelines to be developed in the future years. It is important not to follow blindly of the patient’s interest but it is not right to secondize their needs or determination. After all, it is Sue’s life and it deserved to be respected and dignified.

Citation:

Valente, Sharon M. “End-of-Life Challenges.” Cancer Nursing 27, no. 4 (2004): 314-19. doi:10.1097/00002820-200407000-00008.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well and good: a case study approach to health care ethics. Peterborough, Ontario: Broadview Press, 2014.