I. Statement of the issue:
The issue of euthanasia and assisted suicide present immense ethical importance and intense controversy.
There are laws that negate its use in the United States (U.S.), except in five states. Vermont, Oregon, and Washington have legal physician assisted suicide (PAS) legislation laws for residents. California intends to legalize PAS following state adjournment on healthcare. The legislation, in California, should take effect in the first quarter of 2016. Montana allows PAS through court ruling (Procon.org, retrieved December 7, 2015). Death with Dignity, End of Life Options, and Patient Choice and Control Acts (Procon.org, retrieved December 7, 2015) permit the prescription of lethal drugs to terminal patients, under certain circumstances, in the countries and states that permit them. In the remaining states, and countries, breaking this law is punishable under manslaughter, second-degree manslaughter, or class A, B or C felony, among other charges. One of the considerations, with which this issue is contemplated, falls within the relevance of the usage of precious resources.
These resources are seen as finite. Hospital bed space, skilled staff dedication, medical supplies, medications, and the financial expense of these resources, have defined boundaries. There are only certain numbers of beds available at any given point in time. Staff utilized to procure lifesaving methodologies are highly skilled, and in demand. Medical supplies are costly, require skilled technicians to implement and use, and can consistently present shortage. Medications are similar to medical supplies and require personal and computerized monitoring to ensure accurate dosage, interactivity with other medications, availability and reaction by patients. Medications must also be monitored for effectiveness. The cost for these resources are often supplied through insurance policies. However, out-of-pocket expenses left to family members have the audacity to add to the loss of a loved one. In this respect, it ultimately falls to hospitals to bear the burden of these costs when they are not covered. Therefore, cost of care, in terminal patients becomes a viable source of discussion in euthanasia and PAS.
II. Statement of position:
It is my position that financial constraints should be considered in making decisions regarding use of finite resources to extend terminal life. The reasons I believe this are 1) financial decisions made under emotional stress are not usually well considered. End-of-life decisions are emotional. Emotion tends to blur the lines of reality and sensibility. Decisions regarding the utilization of finite resources cannot reasonably be discussed during periods of heightened emotion. 2) Autonomy and quality of life are not typically enhanced through the extension of life. Death is inevitable. Terminal illnesses make the end-of-life more predictable. Technological advances in medical care have the ability to prolong life, but prolonging life does not usually promote the quality of that life. Loss of control is typically cited as a top priority in the choice to request PAS (Sjostrand, Helgesson, Eriksson, & Juth, 2013). 3) Suicide can be damaging when not met with competence. Physicians, as assistants in suicide, where legally permitted and personally accepted, can ensure the speed of delivery of pharmaceuticals to lessen the pain and extent of terminal illness. The expedience of lethal dosages can hasten impending death to preserve the control and dignity of the patient as they see fit.
III. Opposing arguments:
Arguments opposing euthanasia have the majority. Forty-five of the fifty United States have laws in place rejecting euthanasia and PAS. The violation of the ability to live, until life exists no longer, presents a right, which is considered an automatic and assumed understanding of human existence in the majority of the U. S. and other countries. The opposing opinion expresses how laws are in place to protect life. These laws also seek to prevent the slippery slope of consent to suicide by all who claim life is not worth the pain of living (Procon.org, retrieved December 7, 2015). One more reason for the opposition is the Hippocratic Oath, taken by all physicians, inciting the promise to ‘do no harm’ (translated by North, 2002). Harm is understood to represent anything that may prevent the continuance of living.
Living, then, begs the question of definition. Is it considered living when resuscitative machines are used to maintain respiratory movement of air into and out of the lungs? Is one living when the brain function ceases to continue? Are you alive when illness or disease consumes so much of your human function you are reduced to awareness with no ability to communicate? Are you living when pain persists in such excess, pharmaceutical coma is the only way to sustain presence? According to opposing arguments, living is defined as human animation. There are no exceptions to the continuance of life, until a heart ceases to beat.
In rebuttal to the protection of life, choice is the desired option of the free. The right to freedom, is of real value (especially in the U.S.) to most. Protection of choice, therefore, is the real consideration. It is in the best interests of people with definitive terminal disease to have the right to choose how they wish to be treated (Nordqvist, 2015). Prolonged suffering, diminished autonomy and lost dignity does not heed desire in most, without the potential recourse of recovery.
In regard to the slippery slope argument, patients with mental illness cannot claim to possess terminal illness, which is a requirement in the U.S., under all legislation that permits PAS. The state of Oregon has had PAS in place since 1998 and there is no evidence that points to the consequence of sliding into possibilities that would negate the basis of PAS (Procon.org, retrieved December 7, 2015).
To discuss the Hippocratic Oath, this oath is vindicated in opposition to euthanasia but it would be remiss not to recognize the ‘harm’ in prolonging a painful existence that lacks autonomy, quality and desire to live, without the recourse of possible healing. The oath has been amended in the past, to allow women to study medicine, and physicians to incise the skin (Procon.org, retrieved December 7, 2015), to effectuate the continuance of the validity of practice. It would not be a far stretch to seek a rendering of the oath that includes the autonomy of patients.
In conclusion, the extent of human emotion should not be implicated in decisions that utilize personnel, medical supplies, hospital rooms, and money. Whether these costs are covered through pre-paid medical policies, insurance, out of pocket costs or burdens to hospitals, the costs for irreplaceable resources cannot be recovered. The savings realized in time, energy, and the aforementioned resources could be put to better use in assisting patients with illnesses or diseases that can be healed to prolong viable life.
Nordqvist, C. (2015, October 15). Euthanasia and Assisted Suicide. Medical News Today, p. accessed: http://www.medicalnewstoday.com/articles/182951.php?page=3.
Procon.org. (retrieved December 7, 2015). State-by-State Guide to Physician-Assisted Suicide. Retrieved from euthansia: http://euthanasia.procon.org/view.resource.php?resourceID=000132
Sjostrand, M., Helgesson, G., Eriksson, S., & Juth, N. (2013). Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique. Medical Health Care Philosophy, 225-230.
translated by North, M. (2002). Greek Medicine. Retrieved October 30, 2013, from U. S. National Library of Medicine: www.nlm.nih.gov/hmd/greek/greek_oath.html