Physician Assisted Suicide Ethics

¶ … right to terminate artificial life-Support system a practical condition on the successful practice of medicine?

Terminating artificial life support is often viewed as being qualitatively and ethically different from physician-assisted suicide or aid-in-dying. Withholding treatment is sometimes referred to as passive euthanasia (Steinbock, 2015). When in a fully cognizant, possibly healthy state of mind a patient had provided express written directives that artificial life support be withdrawn under certain specific conditions (also known as an advance directive), physicians may withdraw the life support if those conditions had been met.

Unfortunately, most cases of patients on life support are less clear-cut. The right to terminate artificial life support should not be one taken lightly, as insurers could too easily abuse their power by mandating the termination of life support in some situations in order to save money. On the other hand, terminating artificial life-support makes sense in cases like that of Terry Schiavo, for whom a full recovery was deemed practically impossible. Extending life support in cases like these only extends the emotional, mental, and psychological burdens faced by the family members. In situations where a patient is on artificial life support, the physician should be competent enough to determine whether or not recovery would be possible and if so, how possible.

The practice of medicine can still be considered "successful" even if a patient dies. A medical team may have done everything within its power to provide care, support, and intervention. Artificial life support is occasionally a temporary intervention, but when it becomes the only means by which the person remains alive, it is more compassionate and even "practical" to withdraw support to permit a natural, dignified death.

2. The author points out that the Ninth Circuit ignores in its rulings two established "distinctions." What are these distinctions and why ignoring them can have a significant impact on health care law and medical ethics?

The Ninth Circuit held that terminally ill patients deemed mentally competent should be able to make clear decisions regarding end of life. Furthermore, the Ninth Circuit found no ethical or legal distinction between a doctor prescribing a drug that was specifically designed to end a life (single-purpose medical interventions) and dual-purpose interventions. Dual-purpose interventions are those that "increase the risk of death or hasten its arrival as a byproduct of efforts to control pain," (Kasimar, 1997). Yet the distinction between these two methods is clear. In the case with single-purpose interventions, the doctor assumes full responsibility -- legal and otherwise -- for the death of the patient. The doctor cannot claim that the medication that killed a patient was prescribed for something else, and the patient had either accidentally or intentionally overdosed for the purposes of committing suicide, thereby abnegating responsibility. In the case with secondary effects, the doctor can be absolved of responsibility, which raises a host of moral and legal questions. As one of the authors points out in the discussion over assisted suicide, patients have indeed died without having any say in the matter because a doctor had prescribed medications without full consent (Kasimar, 1997). Therefore, ignoring the distinctions can have a significant impact on healthcare law, medical ethics, and public policy.

3. What does the author mean by the "right to die?"

The term "right to die" has several meanings. At its most literal, the right to die refers to the fact that suicide itself is no longer considered a crime and therefore each person has the right to die if that is his or her choice (Steinbock, 2015). Of course, all types of interventions can be made to prevent unwarranted suicides that arise from depression and mental illness but ultimately individuals should be able to choose how and when they die -- for death is inevitable anyway. When "right to die" is used in the context of euthanasia, then the issue becomes more legally and morally complex. As Steinbock (2015) puts it, there is no logical distinction between a self-induced suicide and a doctor-assisted one; in both cases, the individual chooses to die. In fact, the physician-assisted version seems far safer in that the physician can decide whether or not the person is competent to make that choice and if the choice is a wise one given the situational variables. Switzerland remains the only country that allows full right to die, not even requiring a physician's input (Steinbock, 2015). Otherwise, right to die is usually framed as the "right to die with dignity." Dworkin (1997) points out that a person may have a fundamental right to opt out of severe, chronic pain through the relief of death. It is not as if the state is mandating that a person be put to death as with a death row inmate; on the contrary, the choice remains fully with the patient.

4. How does the U.S. Supreme Court defend its position that administering palliative drugs that may hasten a patient's death is not the same as assisted suicide?