A Healer, or the Reaper?

BY BARBARA PUODZIUS

It is safe to assume the day after Halloween 2014 was spent recovering from a nasty hangover, munching on some candy or even celebrating Day of the Dead. For Britany Maynard, the day after Halloween was the day she chose to end her own life. She shared her moving story with the public, in which she recounted her struggle with a recurring brain tumor. While she had considered a myriad of different alternatives, from radiation therapy to end-of-life care in hospice, Maynard ultimately elected to receive a prescription for pills that would terminate her life. Physician-assisted suicide gave Britany Maynard a sense of autonomy, dignity, and most importantly, some sense of pride; however, most people do not have this option. In the United States — a country where 45 states have banned physician-assisted suicide — Maynard posed a fundamental question: “Who has the right to tell me that I don’t deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain?”

Oregon gave Britany Maynard the solution for which she had been searching. For over a decade, Oregon’s Death with Dignity Act has provided relief from suffering only to patients who, like Maynard, are terminally ill but still retain competency. However, this law comes with hefty stipulations as one may assume. These patients must formally request the prescription on two separate accounts with a waiting period of two weeks between each request and must be given information about alternatives to physician-assisted suicide. Oregon’s statute has served as a shining example for right-to-die advocates as well as a replicable model in Vermont and Washington, where similar legislation has been passed. More and more states are considering their own versions of Oregon’s Death with Dignity Act. In fact, 72% of students surveyed at UM believe physician-assisted suicide should be legalized in the United States. A consensus supporting physician-assisted suicide for the terminally ill is growing throughout the country.

An crucial proviso of Oregon’s law requires the patient to affirm his or her choice to end his or her life not once but twice over a span of 15 days so as to ensure that no outside coercion or pressure yielded the decision. Since a major argument favoring physician-assisted suicide is based on upholding autonomy, it is necessary to confirm that this decision is that which the patient truly desires. With the introduction of “voluntary” deaths in the form of physician-assisted suicide, a double standard regarding autonomy has surfaced. People are told to do as they wish, unless they wish to end their suffering the only way they view possible: through death. While society may consider such a notion as gloomy or defeatist, the decision to die — if reached through rational evaluation of circumstances which, in this case, usually include debilitating pain — should be treated as any other medical decision. To deny people the option of ending a life they consider unworthy of living denies them an escape from that which destroys their quality of life. These patients lose what may be the one piece of them left living — their dignity. Yet, politicians, families and doctors attempt to restrict the choices made by competent adults whose quality of life is irreparably ruined by suffering; they are trying to kill the one thing the disease did not.

How badly are terminally-ill patients suffering without the option to end their own life? Most patients who request physician-assisted death do not cite pain or suffering as their main reason. Most patients know that the very baseline of suffering — the physical discomfort or pain — can be allayed through end-of-life palliative care. Such care is currently rather effective through pain-reducing medications and specialty in dealing with the psychological and physical needs of patients who face incurable diseases. Legalization of assisted suicide would threaten the delicate relationship founded upon the trust between patient and health care practitioner — the very person who is expected to preserve life. This fundamental shift in patient-doctor relations is especially harmful to palliative care, which specifically aims to increase quality of life to the very end. One prime example appears in the case of Barbara Wagner, whose payment for pain medication was denied. She was left only with the choice of life-ending medication. Her situation blatantly displays how assisted death can not only limit personal choice, but also erode palliative care. Dr. Chukwuemeka Ikpeazu, an oncologist based out of the Sylvester Cancer Center specializing in lung, head and neck cancer, recommends palliative treatment for ameliorating symptoms and increasing survival. He has had no complaints with the treatment and claimed his patients react positively to it. Ikpeazu’s experience involving palliative care and his patients derail proponents of assisted suicide. He explained, “I have never encountered a patient who told me they wanted to commit suicide … very few patients will tell me they don’t want any treatment, maybe 1-2 percent.”

Even more vital to health care and treatment of patients with incurable disease would be the relationship between doctor and patient. Around 60 percent of doctors in Oregon support physician-assisted suicide, believing it preserves doctor-patient relations. The first well-known text to codify doctors’ treatment of patients is the Hippocratic Oath. The original oath, dating back to Ancient Greece, promoted doing anything for the benefit of the patient and explicitly bans administering drugs intended to kill the patient. However, this archaic version also forbids cutting patients, which would make modern medicine impossible. While the modern version of the Hippocratic Oath has removed the stipulation that would conflict with assisted suicide, the current physician’s oath still emphasizes the doctor’s role as healer with a priority to do no harm. The provision of relief to terminally-ill patients who wish to die falls under a doctor’s duty to heal patients, according to proponents of assisted dying. However, Ikpeazu personally believes that physician-assisted suicide violates the Hippocratic Oath by eroding the idea to preserve life, further destabilizing the doctor’s role of healer. Just a year before Oregon legalized assisted suicide, Dr. Lonnie Bristow, former president of the American Medical Association, aired similar views: “The American Medical Association rejects physician-assisted suicide as unethical and incompatible with a physician’s commitment ‘to healing and to life.’” As he explains, allowing physician-assisted suicide endangers the trust given to physicians by patients, which is vital to providing quality health care.

Despite a system that already has treatments in place for the terminally-ill, there are people who believe a peaceful death brought upon by pills is preferential. The topic is still controversial with a challenge between granting the ill an autonomous choice and relief from pain and the risk involved with dismantling the ethics of health care. For cases like Britany Maynard, in which her decidedly autonomous choice completely eliminated her pain, it seems like Oregon is graciously granting the right to dignified death. However, it may be a bit idealistic and naive to believe a system like Oregon’s, while well-intentioned, can prevent all potential harms — such as in Barbara Wagner’s situation. In Oregon, less than half of one percent of deaths are a result of physician-assisted suicide. Is it worth risking an entire system for the few instances where people may opt for a dignified death? Assisted death, while a good idea, opens up an existing system to uncertainty and attrition.

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