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Health care institutions are faced with many ethical and moral issues. It is a duty of practitioners and doctors to use the ethical decision making while they are being faced with certain issues during their practice. When there are fewer beds in the hospital compared to the number of patients that require the admission, it is the duty of nurses and other hospital staff to determine the patients which will be admitted to the particular hospital and the ones which can be treated as outpatients. Such decisions require nurses to have high ethical and moral standards. One of the issues bringing an ethical and legal dilemma on healthcare practice is the issue of physician assisted suicide. This paper focuses on some moral, ethical and legal issues facing physician assisted suicide. It also highlights a professional role of doctors and other medical practitioners on the issue of physician-assisted suicide.

Physician assisted suicide is the voluntary termination of the life of a patient through the administration of a lethal substance using the indirect or direct assistance from a physician. The proponents of physician-assisted suicide argue that it violates most of fundamental principles of medicine practice. They argue that doctors should not assist in suicide since it violates a critical role of doctors as healers. However, people supporting physician assisted suicide argue that it helps to end the suffering that patients might be going through. The next section of this paper summarizes the case of Terry Schiavo that had involved physician assisted suicide.

Summary of Terry Schiavo’s Case

The case of Terry Schiavo can be used to illustrate whether physician assisted suicide is moral, ethical and legal in healthcare practice. Terry died when she was 41 years old after 14 days when doctors had disconnected her feeding tube. This tube had kept Terry alive for about 15 years. On 25 February 1990, Terry suffered a cardiac arrest that was brought about by her eating disorder. Extreme hypokalemia triggered the cardiac arrest that she had suffered. Doctors conducted a scan on her brain; and they revealed that she had suffered a severe atrophy on her cerebral hemispheres. In addition, the studies also conducted on her brain showed that she did not have any functional activity on her cerebral cortex. She was in a persistent vegetative state. She experienced the reflexive responses to noise and light. In addition, doctors indicated that she had showed no swallowing responses. She did not exhibit any signs of emotions. In 1994, doctors started giving her the speech and physical therapy. This is because they believed that such therapies would return Terry to her initial state of awareness.

In 1998, Michael Sciavo, a husband of Terry, filed a petition to remove Terry’s feeding tube. Terry’s parents opposed this petition. Michael argued that Terry had been in pain. It was, therefore, necessary to remove the feeding tube. The physicians taking care of Terry informed the court that she had been in a persistent vegetative state based on the statues of Florida. The doctors argued that Terry did not show any signs of a voluntary action. Also, she was unable to communicate and interact purposefully. However, the court denied the petition since they found out that Michael might have made the decision to remove Terry’s feeding tube since he wanted to inherit her property.

In 2000, Michael presented a case before the Judge George Greer arguing that Terry would not have wished to be kept in a machine where her chances for the survival were very minimal. 18 witnesses participating in this case gave their testimony arguing that Terry would not have wanted to be supported by the machine. However, her parents challenged this case arguing that Terry was a devoted Roman Catholic girl. She would not go against the teachings of her church. Terry’s parents wanted the court to allow her to be given oral feeding since it would prolong her life. However, the decision was denied since medical reports revealed that Terry required feeding tubes as she was not responsive to swallowing tests. On October 2002, doctors conducted the CAT scan on the head of Terry. This scan revealed that Terry had a severe cerebral atrophy. Scans also revealed that she did not have any brain activity. Her feeding tube was removed on March 2005. She died on 31 March 2005 at Pinellas Park Hospice.

In healthcare settings, doctors and nurses may be faced with the dilemma on whether to commit a physician assisted suicide or not. A patient may be in a persistent vegetative state with no hope of the full recovery. The physician may be asked to give his/her opinion on whether the patient should be taken out from life support machines. Ethically, a doctor is supposed to protect the life of his patient. It is, therefore, not morally right for the doctor to assist in the suicide of a patient who may be in a persistent vegetative state.

Exploration of a Supporting Theory

Ethical decision-making can be used to explore whether physician assisted suicide is accepted by the medical ethics or not. Researchers argue that physician assisted suicide falls into four categories. These categories include active involuntary suicide, active voluntary suicide, passive involuntary suicide and passive voluntary suicide (Hawkins 2002). When a physician engages into active involuntary suicide, he/she kills the patient intentionally without receiving consent from the patient. In case a doctor engages into active voluntary suicide, he/she kills the patient after following the wishes of the patient. In the passive voluntary suicide, the doctor lets a patient die by not intervening in order to fulfill the wishes of the patient. When a physician engages into passive involuntary suicide, he or she allows the patient to die by not intervening in any way, which is contrary to the wishes of the patient. In the case of Terry, the doctors were engaged into the passive voluntary suicide. They removed the feeding tube since the court declared that Terry had made oral statements that she would have liked her life to be discontinued in case her life was under a machine support. Medical ethics do not allow active involuntary suicide, active voluntary suicide and passive involuntary suicide.

People are against suicide due to several reasons. They argue that suicide is morally wrong even if it is conducted on a patient being too ill. This is because it amounts to a self-murder even if it is done to end the suffering of another patient. Physician assisted suicide should not be conducted in order to eliminate the pain of patients since the advancement in medicine has introduced drugs that are able to reduce pain patients may be experiencing (Kopelman & Ville 2001). It is also wrong to conduct physician assisted suicide since religion condemns this act. According to Saint Augustin, it is never illicit to kill another one even if he/she wishes this. Catholics argue that if a patient requests for physician assisted suicide, he/she does this because he/she hangs between life and death (Carr 2010). This feeling is brought by the fact that the patient begs for his/her soul to be released from its bonds. Catholics, therefore, believe that a doctor will be ethically wrong by engaging in physician-assisted suicide. They will be going against the teachings given by religion. According to Christians, God gave them the commandment, “Thou shall not kill”. If doctors commit physician-assisted suicide, they will be breaking the commandments that God had given them. Thus, this is a sin. Terry’s parents were the strict Catholics. They believed that disconnecting the feeding tube that supported the life of Terry was an act of murder. It was, therefore, not ethically right that the doctors had removed the feeding tube since they took away the life of Terry.

It is also unethical to conduct physician-assisted suicide since it gives doctors too much power. Patients put too much trust on doctors when they seek medical services from them. In case a patient is in critical conditions, the families of the patient trust on the judgment that the physician taking care of the patient gives them. In some cases, the physician may have made a wrong diagnosis. In such cases, the physician would be participating in the suicide of a patient who could have been saved. Physician assisted suicide is also unethical since it undermines the value of human life. Life is sacred. That is why people mourn when a person dies. Physician assisted suicide also contradicts with a medical principle of autonomy. According to the principle of autonomy, patients have the right of making their autonomous decisions without being coerced by anybody. In addition, patients should have the full knowledge and understanding of the particular issue affecting them so that they are able to make the correct decision regarding their health. This principle helps to move the provision of health care services from a paternalistic approach to a client centered approach. Due to this, a patient is able to play an active role in his/her wellbeing and personal health. When the physician engages in physician assisted suicide, he/she may be going against the principle of autonomy. This is because some patients undergoing this form of suicide are in the persistent vegetative state. It is, therefore, not possible for the patient to decide that they want to undergo physician assisted suicide.

Physician assisted suicide is also against the Hippocratic Oath of doctors. According to this oath, doctors should act in the best interests of their patients. It means that whatever decision a doctor arrives at should be centered towards the recovery of the patient. This oath also states that doctors should always strive to correct all the injustices that might be causing harm to their patients. Doctors are also not supposed to give a drug that is deadly to anyone. By practicing physician-assisted suicide, doctors break this oath since they sometimes use lethal drugs in order to end the life of the patient. Physician assisted suicide gives doctors the right of killing patients. This is contrary to their oath that requires them not to harm their patients in any way.

Other people argue that most patients who request for physician-assisted suicide are medically depressed. Due to this, they may seek physician-assisted suicide so that they may be able to overcome the pain they might be feeling. If doctors apply the proper medical and psychological techniques, they may be able to convince the patients not to consider an option of undergoing suicide. Researchers have established that patients who seek for physician-assisted suicide mostly suffer from such conditions as severe body wasting, urinary and bowel incontinence, total dependence and immobility (Hawkins 2002). Such conditions can be managed medically; therefore, eliminating the need for a patient undergoing physician assisted suicide.

Some doctors argue that it is ethical to perform physician assisted suicide. They argue that it should be granted to any patient who may be suffering from a fatal, painful or degenerative condition. Such conditions would make it hard for these patients to enjoy their lives as normal and healthy people enjoying their lives. If the patient does not have any possibility for recovery, doctors and other medical practitioners have a duty to end the life of such patients in order to eliminate the suffering such patients may be going through (Jeffry 2008). In the case of Terry, medical doctors had tried all forms of speech and physical therapy in order to try pulling her from a persistent vegetative state. After Terry suffered the cardiac arrest, Michael Schiavo took her to the University of California so that the experimental nerve stimulation could be performed on her. Although the treatment had taken several months, it was unsuccessful. In 1994, she was transferred to Sabal Palms Skilled Care Facility and received the neurological testing, the regular occupational therapy and speech therapy. During these tests, Terry contacted a urinary tract infection. Since there was no hope for the recovery of Terry, it was necessary to end her life so that the suffering that she might have been undergoing through could be ended. All reports from the doctors revealed that Terry was in the persistent vegetative state. She did not show any voluntary action.

Medical practitioners argue that it is conduct physically assisted suicide to a patient with no hope of survival. It helps the family of patients to save high medical costs. According to the research, terminally ill patients consume 40 percent of their total health care costs in the last months of their lives compared to other medical costs (Paterson 2008). It is expensive to pay for the medical costs of the patient whose life is being supported by machines. Such patients require the constant medical care and attention leading to the inflation in their medical costs. Families end up borrowing huge loans in order to support the life of a terminally ill patient. It is, therefore, ethically right for a doctor to end the life of such a patient so that he can help the family of the patient in saving huge costs that they incur while taking care of the terminally ill patient. Dying patients incur huge costs caused by many X-ray reports, lab tests and other hospital overheads. Patients supported by machines may end up incurring high medical costs that may range between $50,000 to 100,000. It would be ethical for this money to be used to save another patient with the hope of survival.

Some doctors support physician assisted suicide since they argue that it allows a patient to die with dignity. Patients being terminally ill and under the support of machines may lose their ability of taking care of themselves. They may constantly vomit on themselves, drool or even urinate on themselves. In such cases, doctors find it ethically right to end the lives so that they are able to die in dignity. In some instances, doctors conduct physician assisted suicide in order to save vital organs that a dying patient may be having. Long waiting lists exist for such organs as livers, kidney and hearts. If physician assisted suicide is conducted, such organs are saved. These organs can be donated to patients from a waiting list that may be requiring them urgently.

In the United States, physician assisted suicide is illegal in most states. According to the laws of most states in America, Americans do not have the right of refusing or ending life with sustaining methods of treatment such as feeding tubes and ventilators. It is, therefore, illegal for a doctor to disconnect feeding tubes of a terminally ill patient. Laws in most states of America also emphasize on the importance of controlling pain for dying patients. According to the Laws of Kansas, it is a crime when a doctor assists a patient to commit suicide. It is also wrong for a physician to provide any physical means that will help the patient to attempt to commit suicide. Recently, Washington passed laws that allowed physician-assisted suicide. The laws of this state allow patients being mentally competent and terminally ill to obtain the prescription of doctors in order for them to get a dose of lethal medication. In 2009, 63 patients filed for the prescriptions of legal medication. 36 patients died after taking the lethal medication. Some of the patients that died from the legal medication were suffering from cancer.

In 1997, Oregon passed the Death with Dignity Act. According to this Act, terminally ill patients being mentally competent can request the prescription medicine to hasten their deaths. Before a citizen qualifies for physician assisted suicide, he/she must be eighteen years or older, a resident of Washington or Oregon and be capable of communicating and making healthcare decisions for him/herself. Such patients should be diagnosed with the terminal illness that may cause them to die within six months (Snyder & Caplan 2002). The physician-assisted suicide of Terry was legal. According to the laws of Florida, a person may allow another person to die if the conditions of the case let this. Terry had stated that she would have liked to die if her life was supported by medical machines.

The professional values doctors require that they take care of patients in order to ensure that they do not suffer due to the medical conditions affecting them. By carrying of out physician assisted suicide on patients that may be in the extreme pain and suffering due to terminal illnesses that they might be facing, the doctors will be committing suicide to their patients. In addition, doctors are required to fulfill the wishes of patients and trust the decision that the patient has arrived at. If the patient wishes to engage in physician assisted suicide due to suffering that he/she may be going through, then the doctor should fulfill this duty.

Code: Sample20

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