The ethical debate over legalizing physician-assisted death for geriatric patients

Geriatric Right to Die

The debate about whether geriatric people or terminally ill people should be given right to end their lives to avoid constant pain and sufferings is a long- standing debate ever since the idea was first identified in our society. The man kind have developed certain rules under the moral or ethical code to promote the freedom of an independent and his right to live on his own will but the right to die or often referred as rational suicide is the long-lasting and unresolved matter as the issue is not only ethically complex but also has several societal and religious connotations associated with it. Additionally, the dependent nature of many geriatric patients further complicate the issue as the older patients as a result of cognitive impairment and/or communication disorders are unable to express their preference regarding their health care matters especially the right to die or treatment termination. Right to die has become a complex issue of recent times, with forces wrestling from different cultures, origins having a variety of beliefs, values and ethical, social and religious factors all effecting a person's will to die legally. The objective of this paper is therefore to highlight various bills and legislations passed regarding this issue and also various ethical, religious, medicinal and socioeconomic implications to evaluate whether geriatric people are as free to have right to end their lives as free are they to live.

The paper aims to check the possibility of two different hypotheses on the basis of secondary research or literature review, which are:

H0: to give geriatric people right to die is beneficial for them and is correct.

HA: to give geriatric people right to die is unethical and is not correct.

Literature Review

Medical science has made many advances to increase longevity but unfortunately all long-lived people do not die peacefully. Some die with torturous discomfort and painful death. Also longevity is becoming a global reality as it was forecasted that 25% of world's total population will constitute the elderly over seventy five years of age by the year 2010, further increasing the issue of death with dignity. The issue is so significant that in most of the states in the U.S., Japan, Britain, right to die or voluntary euthanasia (doing something to terminate life of terminally ill people) in one way or another is allowed by law but under strict guidelines. However, in Canada, Germany, Mexico and most of the other countries aid-in-dying or Physician-assisted suicide are illegal and are against the law (Levett, 2011).

According to Rurup (2006) the geriatric care is subject to many social, ethical and economic considerations. Especially the decisions regarding treating patients who are near their end of life are fundamentally affected by various ethical and socioeconomic considerations. For example how health care providers should deal with issues regarding an individual patient's request for the right to die, issues such as physician-assisted suicide etc. The author suggests that complete guidance should be provided to either the patient or in case if the patient is physically or mentally incapable of making or communicating a decision a complete explanation should be given to his family members regarding such decisions for example end of life decisions, suspension of treatment of terminally ill patients to avoid pain, assisted-suicide decision where a physician assist in ending the life of a patient with his or her own consent. Although many states strictly prohibit assisted suicide, but a few has recently legalized assisted suicide that allows physicians to prescribe a fatal drug or dose to terminally ill patients who are likely to die within six months, based on the value of individual right to end his life and the right to control his own destiny to control how and when they should die. However, this act is prohibited by the opponents who believe that taking a life in any case is harmful (Gastmans & Lemiengre, 2007).

Political resolution

According to the modern law it is a legal right for the medically competent person to refuse any further medical treatment even if the refusal would lead to his/her death. In this scenario the medical treatment includes ventilation and feeding tube. The law is applicable for the patients who are conscious and able to communicate, furthermore they are mentally in the position to take decision on their own.

The legal issues become complicated when the patients are unable to communicate or are in unconscious state. In such condition there are two issues that who is going to decide for the patient and how does the person will decide. According to law in such scenario the patient's guardian have the responsibility to take the decision about the patient. The decision would certainly be taken by guardian on the basis of the patient's previous wish or keeping in mind his patient's conduct and religious belief. In a situation where it is impossible to jot down the patients wish then guardian has the right to take decision by considering what a hypothetical reasonable person have done in such case (Rurup & Pasman, 2006).

One solution of this issue can be that the closest most guardians is given the permission and right to take the decision about the life of the patient who is not able to communicate or express his wish. The guardian who should be responsible to take this decision should be the one who will be having direct impact of the death of the patient.

Community & Health Care Resolution

Different communities have varied opinions in regard to right to die for geriatric. Although few of the countries have legalized this matter and have given the right to patient to decide whether he wanted to live more or not, but still there are campaigns in those countries that do not support the way patients should be given death and is also considered another way of committing suicide. Communities think if the right is legalized it will give doctors the right do anything and will let them stand in the position of God deciding for the future of the patient himself whether they should live or not. Although this issue seems to be easy in the case when patient shows his willing to die because of his pain and suffering and no chances of survival (Kenny, 2007). However at the same time the issue is complicated when there is no significant chances that shows the patient will to die or wanted to quit his life when he is not in the state of consciousness (Lemiengre, 2008).

Though for health care specialists this issue seems to be simple as they believe the person's life should not be prolonged when there are no chances of survival for more than six months and moreover it is an act of sympathy by releasing the patient from prolonged pain and suffering. However at the same time it is the belief of most of the health specialists that if the right is granted to the doctors then it might be difficult for them to do justice with their profession as this might happen that doctor's decision would be conflicting in majority situations (Meijler, 2005).

The solution to this medical and community issue is that the right of deciding about the dead of such patients should rest with the patient or is he is not able to communicate then his guardian, as people can raise questions on the decisions taken by the doctors and this can result in conflicts and issues.

Conclusion

Various ethical propositions proponent to the idea of right-to die embrace diverse values such as patient autonomy, death with dignity. These values propose that as a person is free to live, he should be given right to die free as well, according to his own will, to avoid pain and sufferings if he is wrestling with death. But various religious values denote the idea of free will to die as playing with God, and hence consider it strictly inhuman or unethical and mortal. Although this issue is being debated over a long period but still this issue remains unresolved since there is no right dimension to prove whether giving the right to die to extremely ill person is appropriate or not. From the literature reviews that we did and from opinions from people of different background this issue remains unclear since all people have different opinions about this issue and nobody is certain that whether it should be legalized or not. Though in few of the countries the right has been given to certain extent but still the practice is not valid as this will give doctors the authority to become God of the patients by granting them life or death.

Although different people have different views in this regard, one solution can be that like people have right to live they should also be given right to die under the law if there are no chances of betterment in order to provide them relief from the unbearable pain and misery. On the other hand such laws should exempt those peoples who have religious conflicts with the topic under discussion. Moreover the right of the decision should be with the patient or with the guardians of the patient if he is not able to communicate and the decision should not be taken by the doctors as this will lead to several other issues and problems.

Reference

Gastmans C. & Lemiengre. J. (2007). Development and communication of written ethics policies on euthanasia in Catholic hospitals and nursing homes in Belgium (Flanders), Centre for Biomedical Ethics and Law, Faculty of Medicine, Catholic University of Leuven, Belgium. Vol 63, Issue 1. pp 188 to 195, retrieved March 16, 2011 from http://web.ebscohost.com/ehost/detail?sid=06716113-81ca-4db0-a772-51ae3b6dd9ca%40sessionmgr15&vid=1&hid=19&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&an=2009306329

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Lemiengre K. (2008). How do hospitals deal with euthanasia requests in Flanders (Belgium)? A content analysis of policy documents. Health Promotion/Education, retrieved March 16, 2011 from http://web.ebscohost.com/ehost/detail?sid=37d04412-5a09-4727-92f0-398ccb54533a%40sessionmgr13&vid=1&hid=19&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&an=2009908744

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