Friday, June 3, 2011

Hippocratic or Hypocritical: Doctor assisted suicide

"For of all sad words of tongue or pen, The saddest are these: 'It might have been!' "

-- John Greenleaf Whittier

Dr. Jack Kevorkian, known as 'Doctor Death,' died this morning from age related complications. The moniker attributed to him stems from Kevorkian's willingness to challenge cultural norms in America by assisting terminally ill patients end their lives.

Kevorkian and his supporters believe that human beings should have the right to choose to end their own lives, provided they are terminally ill. History will need many years to assess Kevorkian's legacy, but this article will attempt to determine if Kevorkian was correct. Should terminally ill patients have the choice to end their own lives?

The concept of a human being choosing to end their own life is difficult to digest. Most humans have a self-preservation mechanism that won't allow them to commit suicide.

The few individuals who do willingly take their life are seeking an escape from some kind of pain -- mental or physical.

In terms of history, suicide is not new. In certain situations, ending one's life was done willingly, without any mental defect. In ancient Japan, disgraced samurai warriors participated in a ritualistic death known as seppuku where they used a blade to disembowel themselves. (Ironically, Japan has one of the highest suicide rates in the world today.)

In the United States, currently only Oregon, Washington, and Montana permit assisted suicide. Each of those states have survived legal challenges but the future of the issue on a national level is still in doubt.

The nature of American government and the lack of clear precedent on doctor assisted suicide make this policy area difficult to negotiate.

The Constitution permits freedom to citizens yet is extremely vague in certain areas. The Supreme Court has interpreted the Constitution to mean that patients have a wide latitude in determining what treatments they will receive. The Court has determined medical treatment to be a privacy issue, which is been inferred as a fundamental right of Americans (through the 3rd, 4th, 5th and 9th amendments). Included in those rights is also the right to decline medical treatment.1

However, the Court tackled the issue of physician-assisted suicide in the case, Washington v. Glucksberg (1996). In this case, the Court upheld a state law from 1979 which prohibited doctors from assisting in "mercy killings, lethal injection or active euthanasia."2

The challenge to Washington's law was based on the premise of the 14th Amendment's Due Process Clause, which states, "... nor shall any state deprive any person of life, liberty, or property, without due process of law ..."

The argument for striking down the state law included a patient's right to choose to end their own life being protected as a freedom under the term liberty.

A broad definition of liberty has been used to allow numerous freedoms, including a woman's right to have an abortion (Roe v. Wade) and the right of homosexuals to engage in intercourse (Lawrence v. Texas). So, wouldn't doctor assisted suicide fall under the same concept as being protected under the 14th amendment?

According to the Court, the answer to that question is a resounding 'no.' This policy area is different, because in their words,

"... examination of our Nation's history, legal traditions, and practices demonstrates that Anglo-American common law has ... disapproved of assisting suicide for over 700 years; that rendering such assistance is still a crime in almost every State; that such prohibitions have never contained exceptions for those who were near death; that the prohibitions have in recent years been reexamined and, for the most part, reaffirmed in a number of States ... In light of that history, this Court's decisions lead to the conclusion that respondents' asserted 'right' to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause."3

The Court's decision did not mean it was automatically illegal to assist in a suicide, but it did stipulate that a state could ban such an activity because it was not a constitutionally protected right.

Since this case was decided, Washington has changed state law to permit doctors to provide medication that would kill a patient. The state is under no obligation to do so, but they choose to allow such an option.

So, that settles the issue, right? Not exactly. Merely hashing out the legality of this issue is not enough. An emotional side of this argument exists that hasn't been fully explored. How does society expect a terminally ill patient to endure excruciating pain for months or even years? Do these citizens not have a right to die with dignity?

Patients who will not have a high quality of life also feel as if they are a burden on their families, both financially and emotionally. Those who know they are dying also wish to allow medical personnel to focus on other patients who need the attention of doctors.

How can the United States permit citizens to deny medical treatment (even life saving measures), but not allow doctors to give a lethal dose of drugs? Doesn't that seem hypocritical in a sense?

Moreover, we can't ignore that perhaps the Supreme Court is wrong. (They did, at one point, sanction slavery.) Is this a situation where future generations will look back at our society and wonder how foolish and barbaric we were? The right to choose death and assistance in seeking that end could be reasonably construed under 'liberty.'

In fact, a change in the Court's view of this issue is already taking place. Oregon passed legislation permitting doctors to assist in suicides of terminally ill patients. The federal government responded by threatening doctors who administered deadly amounts of drugs would be prosecuted under the federal Controlled Substances Act.

In this instance, the Court ruled the federal government could not use the Controlled Substances Act to punish a doctor acting under a valid state law. (See Gonzales v. Oregon.)

Though a difficult decision, I must conclude that doctors should not be permitted to assist suicides. Reasons exist that most Western societies have criminalized such conduct among physicians.

With respect to the freedom Americans enjoy, our liberty is not absolute, even with determining what choices to make with our bodies. A woman's right to choose to have an abortion can be greatly restricted depending on the trimester. People are not free to take drugs. Limits exist on all types of human behavior. Would it not stand to reason that the government has a compelling interest in preventing the loss of a life?

Ethically, allowing doctors to assist patients kill themselves is wrong. Although not formally part of modern medical tradition, the [Greek] Hippocratic Oath proclaims,

"I will do no harm or injustice to them. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan ..."4

Though critics may argue the greater injustice is allowing human suffering, I would disagree. If nothing else, doctors should not be allowed to assist in suicide because of death's finality. What if a patient was misdiagnosed? And can a person rationally choose to end their own life? That mistake cannot be undone.

The World Medical Association holds a similar position,

"Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient."5

Allowing caregivers to administer deadly amounts of medication also presents the danger of abuse. Would doctors take it upon themselves to determine who is or is not suffering and in need of relief? Where would society draw a line as to who could be 'euthanized?'

Additionally, doctors did not create life. On what basis would they be in a position to assist in ending life? Dr. Kevorkian helped well over 100 people end their lives. What might they have contributed to society or added to their own dignity had they lived? And for that reason, among others, I cannot support Kevorkian or his views.

Endnotes

1"Constitutional Law," http://www.justia.com/constitutional-law/docs/privacy-rights.html

2Washington State Legislature, 70.122.100, http://apps.leg.wa.gov/rcw/default.aspx?cite=70.122&full=true#70.122.100

3WASHINGTON ET AL. v. GLUCKSBERG ET AL - 521 U.S. 702, http://supreme.justia.com/us/521/702/case.html

4"The Hippocratic Oath," http://www.nlm.nih.gov/hmd/greek/greek_oath.html

5"WMA Statement on Physician-Assisted Suicide," http://www.wma.net/en/30publications/10policies/p13/











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