Critical analysis of an academic article

NURSING CRITIQUE ON LAW: LIFE, LIBERTY AND THE PURSUIT OF PALLIATION: RE-EVALUATING RONALD LINDSAY'S EVALUATION OF THE OREGON DEATH WITH DIGNITY ACT BY DURANTE (2009)

The objective of this study is to critique the work of Durante (2009) entitled "Life, Liberty, and the Pursuit of Palliation: Re-Evaluating Ronald Lindsay's Evaluation of the Oregon Death with Dignity Act." The Death with Dignity Act was enacted by the state of Oregon on October 27, 1997. This act enables patients who are terminally ill to end their lives by use of self-administration of medications that are lethal in nature and that the physician has prescribed to the patient for this express purpose. The work of Durante (2009) examines the claims of Lindsay on this subject and reports that the evaluation of the experience of Oregon with physician-assisted suicide of Ronald Lindsay is "a much needed counterpart to moral speculation." (p. 28) According to Durante, if the assumptions, both implicit and explicit on which Lindsay grounded his argument are flawed the result is the undermining of Lindsay's conclusions. The claims of Lindsay include that "Respect for autonomy is one reason to supporting legalization of assistance in dying" it is noted that Lindsay states that it is "not a sufficient reason." (Durante, 2009, p. 28) Durante (2009) reports that the argument of Lindsay is such that is "highly contingent upon a deep-seated concern for patient's autonomy." (p. 28) Lindsay reports that patients are kept alive against their will and the "importance of providing alternative options for coping with suffering, so that a patient can make an informed choice." (p. 28) The claims of Lindsay are that the "quality of palliative care has improved rather than diminished in Oregon as a result of the legalization of PAS." (p. 28) However, there is a failure on the part of Lindsay to make provision of a model or to describe what comprises "adequate palliative care." (Durante, 2009, p. 29) Durante holds that palliative terminal care must consider that for many individuals who are seeking PAS "death becomes a means of, or at least a substitute for, palliation and other means of palliative care that have failed or are not accessible." (2009, p. 29) Durante reports that palliative terminal sedation (PTS) is contentious but is an option and that those who oppose PAS do not necessarily oppose PTS and that PTS "may be argued to be a necessary component of -- although only as a last resort option -- an 'adequate' palliative care program." (Durante, 2009, p. 29)

The difference between palliative terminal sedation and PAS is that palliative terminal sedation does not "use death as a means of alleviating suffering. Rather, it utilizes sedation as a means of quelling suffering and might employ passive methods of allowing the patient to die." (Durante, 2009, p. 29) In addition, it is reported that according to the widespread use of PTS and the availability of PTS in the palliative care units in Oregon, that there is a need to "evaluate the effects of legalizing PAS and recommend that it be legalized elsewhere." (Durante, 2009, p. 29) Lindsay's argument is for self-determination on the part of the patient stating specifically as follows:

"Respecting the right of a terminally ill person to make his own decision about the course of his remaining days hardly seems to evince an attitude of diminished respect for life. Thus, a key element of the causal slippery slope argument is missing." (Lindsay, 2009, p. 19)

According to Durante, the observations of Lindsay in relation to compassion and respect to autonomy, may be on base, however, that which is described by Lindsay is not "so much a respect for human life, per se, but rather respect for various aspects of a particular vision of the good life, which again is founded upon the idea of autonomy and liberty. Respecting self-determination is not the same as respect life, it is respecting liberty." (Durante, 2009, p. 30) As such, Lindsay does not distinguish between the two and thereby fails in the comprehension of what PAS opponents believe is at stake. The argument exists that the Oregon Death with Dignity ACT, which constitutes respect for self-determination and liberty is such that "trumps consideration regarding the respect for life." (Durante, 2009, p. 30) The adoption of the view upheld by Lindsay appears to entail adopting a view that somehow the patient's life is no longer worth living and this means that alleviating suffering takes precedence over the respect for life. The Oregon Death with Dignity Act makes PAS an option for a patient who is terminally ill and who desires to end their suffering. Included in the options of this act is the use of PTS which effectively alleviates the suffering of the patient and ultimately offers a passive method of PAS to the patient.