As the 2014 calendar year comes to a close, it is has been a memorable one in many respects. Yet it has been specifically important in the field of medical ethics where the idea of physician- assisted suicide came to the forefront with the case of Britney Maynard. Maynard, who died on November 1st, chose to end her battle with brain cancer by using physician-assisted suicide.
Cancer hurts. It is lethal, corrosive, and fatal. It mobilizes its army, viscously attacking glands, tissues, organs, and people. This destructive nature of cancer and its treatments prompted twenty-nine-year-old Brittany Maynard to surrender when surgery did not cure the brain cancer that invaded her body.
Earlier this year, Maynard and her family moved from California to Oregon, seeking a state with the implemented Death with Dignity Act. Enacted in Oregon in 1997, this act legalizes physician-assisted suicide in Oregon, Montana, Washington, New Mexico, and Vermont. The common protocol for physician-assisted suicide is the prescription of nine grams of secobarbital or ten grams of pentobarbital— both barbiturates that are usually used as an oral hypnotic in doses of one to two hundred milligrams. Once patients pick up their dosage from the pharmacy, they can keep it in their home until they choose to end their life. If they fall back on their decision, they can return the pills to a site designated by the government for the return of such drugs.
Statistics show that in Oregon in 2009, four-fifths of the prescriptions written were for patients with cancer, and sixty-two percent of the patient who received the lethal drug opted to ingest it. In total, four hundred and sixty people in Oregon terminated their life through this process.
An advocate for Compassion and Choices, a campaign which strives to enact the Death with Dignity Act in many other states, Maynard planned out her last few weeks of life and set a date to take the lethal pills prescribed by her doctor. She claimed that her decision to end her life was not suicide, and told People Magazine, “There is not a cell in my body that is suicidal or that wants to die. I want to live.” But since her body was deteriorating, and her cancer was incurable, she chose to escape the turmoil and pain on November 1st, 2014.
Stories like Maynard’s have sparked much debate.
Opponents of the law say that assisting patients in suicide poses a danger to society. Typically, the concept of prescribing pills to speed death is meant to apply only to those who are dying of incurable, fatal diseases. However, in Holland and Belgium, citizens suffering from chronic, but not fatal, conditions sought the right to end their life. For example, many people in Holland chose to end their life as a result of mental illness. And in Belgium, deaf twins decided to use the law to end their lives. Holland and Belgium are developed countries with quality healthcare, so it is not unreasonable to think that something like this can happen in America as well.
Ira Byock of the New York Times voiced this concerned: “When doctor-induced death becomes an accepted response to the suffering of dying people, logical extensions grease the slippery slope.” Therefore, the only solution is to rally against these laws, he believes. Doctors must not kill patients. “Principles” such as this “are the I-beams of civilizations’ architecture, designed to withstand the forces of social upheaval,” he asserts.
Another danger of The Death with Dignity Law is that it in essence supports suicide. Author Jane St. Clair cites a study showing that the suicide rate in Oregon has increased to thirty-five times the national average.
Thaddeus Mason Pope of the New York Times, a proponent of the law, says these dan-gers do not exist because Oregon has set guidelines. The patient must be a legal adult, live in Oregon, and be mentally stable. Two physicians have to have deemed the pa-tient’s disease as fatal within sixth months, and described all options of treatment and care to the patient. Moreover, patients need to voice their desire to carry out the assisted suicide procedure at two separate times, fifteen days apart, plus document their decision in writing with two witnesses. Moreover, no one is permitted to feed the drug to the patient: the patients must take it themselves.
Psychologist Dr. John M. Grohol says that “denying someone a peaceful death can be unethical.” He notes that since the primary job of doctors is to heal their patients, some physicians erroneously define healing as their sole purpose, and therefore deem it “contradictory” to assist their patients in dying. But reducing pain and suffering is also a form of healing. By allowing a patient to end his own life, the doctor will not only freeing the patient from the pain of the disease, but also from the emotional pain of “indignity and loss of independence,” which they would endure if doctors did not allow a patient to choose his own death date. Therefore, asserts Dr. Grohol, doctors can prescribe end-of-life pills and still be acting within the framework of medical ethics.
The law presents a dilemma for pharmacists as well, reveals Medscape. The Code of Ethics for Pharmacists does not discuss physician-assisted suicide, yet it does note that the role of a pharmacist is to be “dedicated to protecting the dignity of the patient.” Failing to dispense end-of-life drugs due to ethical considerations would, then, be a violation of the code. However, the America Pharmacist Association does reserve the pharmacist’s right to refuse to participate in the death of a patient by providing them with the pills. The addition to the Death with Dignity Act, which requires physicians to note the purpose of the pill on the prescription paper, guarantees pharmacists the ability to act in accordance to their moral consciences.
There is, and always has been, a fine line between what is moral and what is not. Ethics appears in almost every aspect of the medical world, and is especially relevant in the area of physician-assisted suicide. So far, only five states have legalized physician-assisted suicide. More states are in the process of legalizing the act. It is unclear what this will hold for the future of medicine. However, one thing is for certain: cancer hurts. But is that enough for patients to put their life in their own hands?