What is the right to die, euthanasia and Physician assisted suicide? Is there a difference?
We have the right to die with dignity.
Intractable pain could be a reason to choose death over life.
Almost all pain can be managed but a patient may have to take so many drugs that they are not coherent
Being bedridden is not the way most people chose to live their lives.
Is this what the patient wants?
Can medicine help the patient?
Terminal diseases is a reason to end one’s own life
1. What is the prognosis?
2. Will science be able to cure the disease?
a. Is the cure worse than the disease?
We have the right to chose what becomes of us.
Quality versus quantity
My Grandfather, a true story.
Karen Quinlan and the families battle to do what is right.
Laws affecting the Quinlan case
Family response to the outcome of the lawsuit.
What are the laws in Oregon related to death with dignity?
Who is and what is Jack Kervokian’s role in physician assisted suicide
Rules for selecting patients that may opt for death.
The right to chose death is a solution to an unbearable terminal illness.
The right to die is as basic as the right to live and as natural as being born. It is a part of life. Doctors have the ability to keep a body alive without taking into consideration of how the person will live out their life. The right to live or die is a personal choice. The act of killing one’s self by the use of drugs when the quality of life has become unbearable and there is no hope for recovery is called euthanasia. The problem today is not the right to die but the acceptance that modern medicine cannot solve all problems. The medical state of mind is saving the body at all cost. It is moral and ethical to decide take one’s own life when the hope for quality over quantity using modern technology is beyond hope
Euthanasia means good death. From the Greek eu “good” and thantos “death” The right to die refers to the active or passive act of opting for death when an injury or illness prevents one from living a life they choose to. Active euthanasia is the act of helping someone die by injecting or giving them drugs that will allow them to peacefully pass away. Passive euthanasia is the withdrawal of treatment that will lead to the death of the patient. This may include the removal of the feeding tube, removing a respirator, or disconnecting a dialysis machine. The difference is that active euthanasia someone is doing something, injecting drugs or an overdose of sleeping pills. In passive someone is not performing a lifesaving function. If a person has a heart attack and the doctors do not resuscitate them then this is passive euthanasia.
There is voluntary and involuntary euthanasia. Voluntary euthanasia is when the patient tells their doctors they want to die with full knowledge that it will end their life. Involuntary euthanasia means taking the patient’s life without their consent or knowledge. This usually happens when the patient in unconscious, unable to communicate or too ill to be able to make decision on their own. Active voluntary euthanasia and passive involuntary euthanasia will have the same effect there is a huge difference between the two. In active voluntary euthanasia the patient decides that the treatment of their disease or the quality of life is unbearable and is able to make the decision to end their life peacefully. Passive involuntary euthanasia another person decides the patient’s life is no longer worth living and has them killed. While both of these are, by definition, euthanasia there is a big difference in them.
Physician-assisted suicide is a form of euthanasia. The physician prescribes the drugs and means to end the patient’s life but does not administer them to the patient. The patient must inject or ingest the drugs themselves. Some in the medical profession believe that assisting a patient to die goes against the everything that physician believe, others believe it is within the scope of the profession to help patient to die with dignity.
While it may be very controversial physician-assisted suicide has been legalize in three states, Oregon, Washington, and Montana. The doctors, following very strict guidelines, are allowed to prescribe drugs to the patients to terminate their lives. It bears repeating that physicians may not directly administer the drugs themselves. Dr. Kevorkian was arrested in Oregon for assisting a patient who was physically unable to take the drugs himself. He was charges with second degree murder and served 8 years of a 25 year sentence.
There are many reasons why a patient may choose death over life. If the treatment of their disease is worse than the treatment or the treatment does not add any significant time of quality to the patient remaining time on earth. As an example, Sara was diagnosed with lung cancer which had already spread to the lining of her chest and her lymph nodes. Her oncologist started her on a drug called Tarceva which targets the cancer cells commonly found in female non-smokers. Typically 85% of the patients respond to this treatment. Sara had an allergic response to this drug and needed surgery to remove fluid that was building up in her lungs. Eventually a permanent drain was put in to help get rid of the accumulated fluid. It was found that the cancer cells were not responding to the Tarceva, and the tumors had grown. Sara was put on a new chemotherapy regiment which she had a violent allergic reaction to. She was switched to a new drug which she tolerated. Several months later it was discovered her tumors were growing, the chemo had failed. The doctors once gained changed her medication to a drug which held promise of extending her survival. In reality the drug only, on average extended life by an average of two months, but that was in patients who responded to traditional chemo therapy.
At this point in this patient’s treatment there must be a decision made. All of treatment have failed and have not improved the quality of Sara’s life. The question is what should the doctors do? For that matter what would you want the doctors to do? If you had metastatic cancer of congestive heart failure with no more options of treatment that help with the quality of life, would you want the doctors to be honest with you? Sara put up with pain, surgeries, and life threatening allergic reaction to the medicines that were supposed to cure her. It is time for her doctors to rethink the treatment plan and help Sara be comfortable and accept no treatment.
Another issue at hand has become very important in the past few years. With the rise in managed health care plans and the need to cut cost in the medical field the treatment of terminally ill patients is very expensive. As Atul Gawande reports “Twenty-five percent of all Medicare spending is for 5 per cent of patients who are in their final year of life” (Gawande, 2010) most of that money is spent in the last few months with little or no benefit to the patient.
Medical spending, for cancer, typically follows a pattern, in 2003 it cost about 54,000 dollars to diagnose, treat with radiation or chemo as needed than the cost taper off. But with a patient with a fatal form of the disease the cost of treatment escalates in the final months rising to a cost of 63,000 dollars during the last six months of life. Doctors have no problem with eight thousand dollar a month chemo treatment, five thousand dollar an hour surgeries and three thousand dollar a day ICU stays. All of this without the benefit of adding quality time to the patient’s life. There is not only the economic cost; there is the emotional cost to the family. I, for one, would rather spend the last six months of my life at home relaxed, comfortable and be with my family.
According to a report from Sixty-Minutes it cost Medicare 50 billion dollars in 2008 for patients last two months in the hospital. In is a known fact that 100 percent of the American population will die, but medical science has now made it very difficult and expensive to do this. It is law that Medicare cannot reject treatment based on cost. They will pay $55,000 for patients with advanced breast cancer to receive chemo even though it will extend their life one month. They will pay $450,000 for a 68 year old man to have a liver-kidney transplant even though the doctors say he is too weak to have the surgery done. Doctors must speak with the patients and families to tell the truth about their conditions and the quality of life.
There comes a time in some people’s lives when they cannot, for various reasons, make an informed decision about what happens to them. My grandfather is a perfect example. When I was young I would spend my summers in Ocean City NJ with my grandparents. My grandfather would spend the summer with me boating in the bay, fishing at the club, biking on the boardwalk, walking all over town and always staying busy. I do not remember a time when we sat still for very long. In 1980 my grandfather had a series of small strokes. He was no longer able to walk or talk. He was unable feed himself or to use the toilet. He did not recognize his wife, daughter or grandsons. My grandfather lived in a skilled nursing facility until 1985 when he finally passed away. I think I knew him well enough to say that he did not want to live the remaining years of his life in a vegetative state. I, out of the love and respect, would have opted for euthanasia for my grandfather. I know he would have understood. Some people would question why I would have my grandfather killed, my grandfather died in 1980, it was just that his body did not know it until 1985. Before the strokes he was an active man who loved being with his family and living life how he wanted to. He would have not wanted to live the way he was.
Another case involving the right to die is Terry Schiavo. In 1990 Terry Schiavo went into a vegetative state due to a potassium deficiency which caused her heart to stop. Terri did not have a living will and it was her husband who maintained that Terri told him she did not want to live by artificial means. Her husband wanted to remove the feeding tube but her parents said she was responsive and sued to keep her alive. Her feeding tube was removed several times and replaced because of lawsuits by her parents. The federal government got involved only to be blocked by the Supreme Court. Terri Schiavo finally passed away on March 31, 2005. Her autopsy revealed she had massive and irreversible brain damage and was blind. There were no signs of abuse or neglect. Terry Schiavo starved to death in an act of passive euthanasia; wouldn’t it have been more humane to allow someone, maybe her husband, to give her a lethal injection to give her a little dignity in her death?
People can live for years in vegetative states without the hope of a better life. The cost both monetarily and emotionally, the lack of dignity when people are forced to live out the rest of their days in drug induced comas. How can we say we live in a progressive society when we force our citizen and families to endure the financial burdens and emotional burdens placed on us by the medical and legal professions in this country? Simple and honest laws like they have in Oregon would prevent the astronomical cost and the humiliation of lying in bed year after year with no hope of recovery. We have the right; some may say an obligation, to end our lives if an accident or illness leaves us in a condition where the quality of life ends. When we cannot live and do the things that make life worth living why are we subject to a battery of painful test and endless weeks hooked up to machines that can breath for us and feed us. It would be better if we let our families and healthcare professional know what our final wishes our. We have a right and an obligation to our families and society to know when to die. As medical science progresses and doctors are able to keep our bodies alive longer but does not allow us to do what makes life worth living, then we or our advocate must say enough is enough and prepare for the final stages of life with dignity and respect.