Heather Holmes

Project 2 Rough Draft

On October 27th, 1997 the state Oregon passed the Death with Dignity Act. The Oregon

Death with Dignity Act interestingly enough requires the Oregon Health Authority to collect data

and personal accounts from physicians and patients who participate in the Act; which then must

be published in a statistical report (oregon.gov). Today, six states within the United States

(California, Colorado, Montana, Oregon, Vermont, Washington, and our capital D.C), have

passed laws similar to the Death with Dignity Act(procon.org). According to the Journal of

Palliative Medicine 87% of patients who requested Physician Assisted Death were Cancer

patients, and 14% were either ALS patients or other. Out of the 52 patients surveyed, 83% of

them were placed into hospice care before considering Aid-

in Dying. Death with Dignity not only has become a hot

button issue in American households.

Countries around the world such as Belgium and

Canada have legalized their own forms of Death with

Dignity. But specifically the Netherlands have passed a law that regulates the ending of life on

explicit patient request, as well as accompanied suicide. The Dutch, uniquely also include mental

illness as a type of illness included in Physician Assisted Death. The Termination of Life on

Request and Assisted Suicide Act, which became effective in April 2002, allows physicians to

help terminally ill patients decide whether they should end their life. (dignitas.ch).

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 In the states that the Unites States have legalized

Death with Dignity, several steps are completed before

even considering PAD as an option. Several symptoms,

and quality of life are analyzed by psychiatrist and

physicians. These include the ability to feed oneself,

energy to do things, and control of surrounding are observed and graded by physicians.

Specifically at the end of ones life, specialized psychiatrists are asked to assess patients capacity.

Psychiatrists actually play a huge role in physician assisted suicide. Not only do they observe

patients when mentally incapable, they observe patients not so subtle body language and choices

to help decide whether death with dignity should be an option. (Ryan, Christopher). Within

Ryans article the concept of delirium is addressed in a way that hinders the benefits of Physician

Assisted Death. Delirium is when a patient can not fully speak or express what they truly want

due to extreme pain. Delirium is also compared to clinical depression in this article. According

to David W. Kissane, and Brian J. Kelly, there is a strong correlation between the desire for death

and depression. They used examples from patients with motor neurons disease to surely

distinguish between the feeling of hopelessness and depression (which they found to not have

any correlation). Their argument shows that hopelessness should be used as symptoms to help

patients decide whether they wish to continue with the PAD procedure. Later in their article the

state that the two reported cases of psychiatrists assisting in suicide of mentally ill where later

punished because they did not provide the proper treatment to their patients with the mental

illness. Their article did pose debate regarding the involvement of psychiatrist in PAD, but did

not analyze both sides of they death with dignity argument especially when considering patients

with severe mental illnesses. Contrary to popular belief, mental illness is a disease. That can ruin

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peoples wellbeing and livelihood. Medications are used to balance the chemical imbalances in

the brain. Through the research and actions conducted by the Dutch, Canada, and states residing

in the United States physician assisted suicide and death should be

considered in the United States for chronically mentally ill patients, and

chronically ill patients.

There is a significant difference between Physician Assisted Death,

and Physician Assisted Suicide. According to deathwithdignity.org,

PAD or death with dignity is the proper way to explain the procedure when it involves illnesses

such as cancer, or ALS. PAS or Physician Assisted suicide is what is used in the Netherlands with

patients using the procedure who have a diagnosed mental illness. This common misconception

fuzzies the importance of death with dignity for patients who are in hospice care. This fuzziness

also affects the physicians moral backgrounds. PAS or assisted suicide, is a heavy term than

PAD. Assisting in one suicide in any country, is morally unsound. But, when should a doctors

moral and religious background stop the

procedure of PAD? It it obvious there is a

clear line between PAD and PAS.

Like stated earlier, religious and moral

backgrounds do often stop PAD from being a

procedure in several hospitals around the United States, and even in hospitals around the world.

In Physician Assisted Dying for Adolescents With Intractable Mental Illness, several statistics

regarding the Netherlands systems are thrown around, rightfully so. Consultation with other

physicians was extensive, but 11% of cases had no independent psychiatric input (Psychiatric

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Times). If PAS was thought to even be incorporated into our hospitals, extensive psychiatric care

and observation would be needed. We can take what has been done by the Dutch, and manipulate

it into something great.

This, is a long shot. Before assisted suicide can be passed, physician assisted death needs

to pass in all of the states residing in the United States. At the moment only six states have

legalized Physician Assisted Death, while the other forty four states have made it illegal.

According to Courtney S. Campbell and Jessica C. Cox, 88.2% of patients that utilized PAD

were indeed in hospice care. Several argue against patients using PAD especially in hospice care,

are under delirium and do not truly know what they want because of the extreme pain they are

in. Christopher Ryan, uses what he observed back in 2010. Patient Ms. P, with advanced multiple

sclerosis. She told doctors that if her condition worsened she would not want extraordinary

treatment. One day coming into the ER because of an infection requested to not have antibiotics.

Her state of delirium continued as she could not understand the different treatment options

being given to her. Ryan continues to go on by saying that physicians continuously overlook

delirium, and continue with treatments. Two things can be taken from his opinion regarding this

topic. One, physicians should be accompanied by psychiatrists when making decisions regarding

patient request for PAD. Two, delirium, needs to be considered but not extremely important in

hospice care individuals. In The Journal of Palliative medicine, categories such as ability to feed

oneself or ability to clothe or use the restrooms are all considered when PAD is considered as

a procedure. Of course 88.2% of hospice care patients are observed to see if they can do such

actions with ease. When actions, like the ability to eat, or even to enjoy life, why should a

physician tell an individual to continue on. Half the time, hospice care patients, are in extreme

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 pain for several months before they die. I believe, and

several others in Oregon and other states,, that a patient

or family should be able to request PAD.

Religions across the world have a set of rules that

the public should follow. In most religions, acts of

suicide is a form of sin. Attempting, and assisting in

suicide are both seen as being sinful. Physicians, and

psychiatrist, like the common population believe in several different things. Religion, especially

during times of death becomes incredibly crucial. Churches, and prayer rooms are built into

hospitals to help assist the sick and loved ones with the struggles of being chronically ill. But due

to religion being closely tied with death and illness, several individuals, especially physicians

find it difficult to assist in PAD. In The Pastor and Bioethics, the story of a doctor in Michigan

was under fire from the Catholic faith with helping a patient pass onto the other side (Hanford,

Jack). Dr. Kevorkian, is unlike many other physicians. He was under scrutiny by a religion he

was not a part of. Several religions, especially some forms of Christianity are taught to preach

the word of God. Sometimes, the preaching of the word of god becomes more forceful than

loving. But why should someone else religion prevent someone who is not apart of that religion

from certain actions?

Americans, constantly forget that the first amendment is truly still instilled in our

Constitution. Congress shall make no law respecting an establishment of religion, or prohibiting

the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the

people peaceably to assemble, and to petition the Government for a redress of grievances. Of

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course every American has the right of speaking opinions, but Congress should not prevent PAD

from becoming legalized because of religious shadowing. Religion of others should not inhibit

the decision of another especially regarding there life.

Of course, Medical schools around the country make their students recite the hypocratic

oath In this oath students state But it may also be within my power to take a life; this awesome

responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I

must not play at God (Johns Hopkins). It is a common misconception that several universitys

still recite the hypocritic oath. And on top of that, religion is once again addressed. The words

that are spoken during this oath can not be taken back. But, it needs to be remembered that these

words were written several years ago during Grecian times. An update to these words need to be

taken. Such advancements in modern medicine should also include the modernization of the

hpyocratic oath. The oath of course, is one of the main point that prevents several physicians

from wanting to be involved in physician assisted death. Their role as a physician of course is not

to play a God of any sorts. But Doctors, Nurses, and PAs are surrounded by death every day.

Patients die, especially in hospice care. Physicians, especially the ones involved in Katrina saw

how inhuman keeping a patient alive is when they are in so much pain (Fink, Sheri). A form of

euthanasia was used to allow the patients to die with dignity. During Katrina patient care was

altered because of medication running out, and power being cut from the storm. The physicians

involved in the euthanasia were tried in court for committing murder. After reading the book, it

was clear that even after the patients were transported they were not going to recover. If

physician assisted death was passed before the horrible events during Katrina, the legal action

taken could have been avoided. The patient suffering could have also been prevented.

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 Several articles have been written, arguing

and debating whether PAD or PAS is an

ethical move. But ultimately, the decision for

PAD boils down to the patient and the patients

family. Religions preference, physician

morals, even government regulation should

not prevent someone from wanting a certain

form of treatment. Because ultimately thats what PAD and death with dignity is. Treatment. The

studies that have been conducted in the Netherlands, need several more years to develop. Before

creating an argument against Physician Assisted Suicide more people than the amount being

tested need to be collected. This of course, is referring to PAS for mentally ill patients. Before

PAS can be passed, PAD needs to be passed. And here is why.

Timothy E. Quill, a primary care physician, had assisted in many patients comfortably

during death. He clearly states that these patients of course did not want to die, but also did not

choose to have such severe illnesses. He also continues saying that he never truly assisted them

in dying, and even admitted them into the hospital even when they advised him against it.

Excellent palliative care should be the standard of care for all dying patients, and no patient

should be medically assisted with a hastened death because she/ he is nor receiving the standard

care(Quill). I agree to the full extent that every form of treatment should be attempted before

coming to any decision regarding assisted death. It is the medical fields duty to make sure that

every patient being cared for is being properly cared for, and in the best hands. But when it

comes to a patient who has been through several rounds of chemo, and the cancer has spread

even more, PAD should be considered an option.

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 Instead of having physician assisted death options, American have created something

different. Potential Last Resort Options, include increased opioid dosage, stopping life

sustaining therapy, voluntary stopping of eating and drinking, and palliative sedation. According

to Quill a small percentage of dying patients will still experience suffering that can become

intolerable and unacceptable, and a subset of those will want assistance helping death come

earlier rather than later. Sometimes palliative patient care does not help the patient enough.

Some forms of chronic illness cause a form of pain that can not even be hindered by pain

medications. If physician assisted death is to be passed for one reason, this should be the reason.

Sometimes, even in the modern society we live in, pain still exists. Why should someone suffer

so severely? Why should their wishes be ignored?

After acceptance of this form of PAD can be passed to be legal, steps should be taken to

allow PAD to be legal in all cases regarding chronic illnesses. Limits although, need to be set.

Like the hypocrite oath and religious rules, Physician assisted death should have limitation to it.

Patients that are enduring emotional and physical pain should be allowed to explore this

treatment method.

Physician assisted suicide on the other hand needs more regulation to it then PAD or

death with dignity. Patients with a severe mental illness to prove to their physicians and

psychiatrist that they can not function any longer, even with the usage of medication and therapy

methods. Severe clinical depression should be a mental illness considered for PAS. Patients with

clinical depression, are born with a chemical imbalance in their heads, causing emotional pain as

well as physical. Allowing PAS for these patients, is not a gateway for other patients to commit

assisted suicide. Several steps will be needed to be instilled before PAS can even be passed in the

United States.

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 Physician Assisted Death

though, at the moment should be

heavily considered into the

American legislation. PAD for

chronically ill patients not only

would save money on medical

costs for families, but would

allow individuals in huge amount of pain to finally not feel pain anymore. Like stated earlier,

several things prevent this from being passed. Religious and moral outcomes from helping

someone to death are widely used to prevent physicians from helping in assisted death. Also,

delirium is also seen to be a preventive factor to PAD. Several physicians are said to not

understand this delirium. This is why psychiatrist should be present in the process of patients

coming to the treatment plan of PAD. Once these steps are instilled into a program, PAD should

be legalized. Common misconception of PAD skews the importance of physician assisted death.