A large controversy in the medical field is the ethics of assisted suicide. Currently only 10 states (in addition to Washington DC) have legalized assisted suicide, or “medical aid in dying” (Colorado End of Life Options Act, 2021). Colorado passed the End of Life Options Act in 2016 (Colorado End of Life Options Act, 2021). I imagine that some established physicians find this plea odd because they took the Hippocratic oath that states “do no harm”. As future physicians, I think we can all agree that the thought of losing a patient under our care is daunting, but first we must better understand what assisted suicide is before we discard it as an alternative to treatment.
The process and requirements for assisted suicide or medical aid in dying differ depending on state, so this post will focus on Colorado’s law and their dictated requirements. The main requirements in this state are that the patients must have been given a diagnosis of 6 or less months to live, must have the mental capacity to make the decision, must be 18 years or older, and have made the request voluntarily (Article 48 end-of-life option title of, 2016). There is a lot more that does into the process, but it is not a quick rash decision. A lot of thought and consideration is placed into this decision. The patient then self-administers the prescribed drug.
The prescribed drug given most commonly is secobarbital which is a sedative that when given in high doses is lethal (Simpson, 2017). It is a barbiturate that works as a CNS depressant. It controls the GABAa receptor channels so that when GABA is present, they increase the duration of the channel openings (for Cl- to go into the cell) (Boron & Boulpaep, 2017). This helps for people with certain types of seizures but a side effect of it is that it is highly sedative. This means that when a patient receives it for medical aid in dying, they simply fall asleep and feel no pain.
As a physician you can legally deny partaking in any step of the process and can instead refer the patient to another physician. But we must remember as physicians, our goal is to better our patient’s quality of life, and sometimes their condition could cause more pain and suffering. We must also remember that they have autonomy over their medical decisions and assisted suicide offers a safer route rather than them attempting something of the sort without medical supervision.
Article 48 end-of-life options title of ... - sos.state.co.us. . Retrieved November 28, 2021, from https://www.sos.state.co.us/pubs/elections/Initiatives/titleBoard/filings/2015-2016/145Final.pdf.
Boron, W. F., & Boulpaep, E. L. (2017). Chapter 13 Synaptic Transmission in the Nervous System. In Medical physiology(pp. 325–327). essay, Elsevier.
Colorado - Colorado end of life options act. Death With Dignity. (2021, July 7). Retrieved November 27, 2021, from https://deathwithdignity.org/states/colorado/.
Simpson, K. (2017, December 15). Aid-in-dying medications can run from $500 to $4,000 in Colorado. The Denver Post. Retrieved November 28, 2021, from https://www.denverpost.com/2017/12/14/colorado-aid-in-dying-medications-cost/.
Hello Lix,
ReplyDeleteI was drawn to reading and commenting on your post as I have always had a passion for human medicine, and I believe that the quality of human life is valued and important. With that being said, I am strong believer in the legalization of euthanasia across the world. However, I recognize the many grey areas and unknows of how to make this process humane. I believe that the best way to better understanding many of these grey areas it to take a look abroad where euthanasia is legal such as in New Zealand who legalized euthanasia just this month (November 2021).
While many agree that euthanasia should be legalized across the globe, many also believe that it should continue to be illegal due to the many ethical issues associated with ending a human’s life. According to Euthanasia -Free NZ, it is a popular belief that the desire to end one’s life by assisted suicide (euthanasia) is linked to depression, a treatable condition. Due to depression, which often causes suicidal thoughts, a person is no longer in a clear state of mind to make decisions resulting in the termination of their life. Thus, encouraging that suicide is a just action for those with mental illnesses by deeming it okay. As a result, there may be an increased suicide rate, especially among the youth due to increased publicization. In addition, some religions don’t accept the act of euthanasia. Euthanasia, assisted suicide, is solely seen as suicide, which is ultimately frowned upon. This is because it is thought that if God gave you your life, God is that only one that can take it away when your time has come.
Furthermore, the legalization of euthanasia brings all legal acts and laws surrounding murder and suicide into question. The foundation Euthanasia- Free NZ claims that it “could still be difficult to distinguish between an assisted suicide and a murder.” This is especially important to consider when courts show mercy to individual cases based on circumstantial evidence. Everyone’s life matters equally and proceeding with establishing laws that legalize euthanasia would send mixed signals that the government deems that not everyone’s life is seen as equal and worth living. For certain groups of people like the elderly, disabled and mentally ill this is already the case with generic thoughts across societies of developed countries. These thoughts then become abusive to these selective groups of people who believe that they are/have become a burden. If euthanasia was legal, since these groups of minorities see themselves as emotional and financial burdens, it is estimated by Euthanasia- Free NZ that the “right to die” will become a “duty to die” increasing the rates of assisted suicides by pressure.
The ethical issues surrounding the importance and value of all human lives regardless of age, disability or illness make it evident that legal euthanasia (assisted suicide) should not be legalized. There are too many grey areas and repercussions for making assisted suicide legalized because it brings disvalue to human life, values, beliefs, and a positive stigma to suicide.
Jha, P. (2020, October 30). New Zealand euthanasia: Assisted dying to be legal for terminally ill people. BBC News. Retrieved November 29, 2021, from https://www.bbc.com/news/world-asia-54728717.
End of life choice act referendum election 2020. Euthanasia Debate NZ on the End of Life Choice Act Referendum 2020. (2020, October 30). Retrieved November 29, 2021, from http://euthanasiadebate.org.nz/.
Great post Lixlia!
ReplyDeleteYou bring up a very good discussion on the role of a physician in the case of assisted suicide. This seems to be a debate that very much intertwines politics and medicine and poses the question, what ought we to do? Bringing up the Hippocrates Oath, I had just read through the Oath in researching for my blog post. In it, Hippocrates states, “ I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.” This to me, means he would argue against the role of the doctor to perform such an act, but rather seek palliative care if no such treatment would work. The second part of your post brings up the legality surrounding assisted suicide, as to give rights to the patient to make a decision regarding their own life and offering protection to the doctor that assists. This led me to question, what do we hold to a higher standard, our own ethics, or the wishes of our patient? I would lean more on the side of Hippocrates, and value human life, and rather seek out options to alleviate the pain and burden of disease. Whether or not a procedure is legal, does it require a physician to act?
References:
Hippocrates of Cos (1923). The Oath. Loeb Classical Library, 147. 298-299. Retrieved from, https://www.loebclassics.com/view/hippocrates_cos-oath/1923/pb_LCL147.299.xml
Hi Lixlia! Great post! Euthanasia is a very controversial topic, however, there are many important aspects pertaining to it. I was very intrigued by your post due to personal beliefs. I follow Catholic faith and have always had a negative connotation about euthanasia. I believed God is whom should decide a person’s time to go. However, I came across an article by Santa Clara University explaining Mathew Donnelly’s experience with beliefs such as mine. In summary, Mathew was in severe pain and wished to undergo euthanasia however, he was denied. This resulting in his brother shooting him in the hospital to relieve his pain. I came to understand the selfishness behind denying a person’s autonomy. Despite the controversial beliefs incorporating faith and religion, a person should always be granted the right to decide what to do with their life.
ReplyDeleteAndre, C., & Velasquez, M. (n.d.). A right or wrong? . Assisted Suicide . https://www.scu.edu/ethics/focus-areas/bioethics/resources/assisted-suicide-a-right-or-a-wrong/