Table of Contents
The contents of this recommended policy analysis are intended to examine the supported facts surrounding the legalities, moral impacts, and ethical dilemmas regarding physician-assisted suicide in United States. Physician-assisted suicide happens when a physician/ healthcare provider provides measures to assist a patient to end their life. Some of these measures may include instructions guiding the influence of remedies of deadly medications that will end the patient’s life without suffering Koenig, (1993).
At some point during the tenure of a physician/healthcare provider’s career, the news of someone’s imminent demise while have to be delivered to the patient/family member. In most cases the prognosis of the fatal illness is irreversible. As there may be a multitude of health conditions, all reacting at the same time causing a domino effect of incurable illnesses.
Yancik et al., (2007) refer to these fatal illnesses as multimorbidity which stops the body from performing its normal biological functions. In their research Boyd’s et al., (2008) have discovered a substantial number of patients experiencing multimorbidity that will increase over the next 20 years. There are no magical cures for the aging population, however, we have to recognize that the Baby Booming Era is here and is affecting a great number of the aging population who require extensive healthcare.
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The U.S. National Library of Medicine and the National Institutes of Health (NIH), have researched patients with incurable illnesses who may elect to proceed with an end of life (EOL) plans or continue the EOL process of nature. Respecting a patient’s decision provides them with a pro-choice of death or pro-choice of life much like in the case of Roe v. Wade, 410 US 113 (1973).
As these are EOL choices where women have the Right to end a pregnancy Kreimer, S. F. (1994), some may define a pregnancy as a living human being, allowing the Right to terminate life, so should be the Rights of a patient with an incurable illness. Here is where this recommended policy analysis can be an emotional resolution to support EOL choices for the terminally ill.
Hypothesis
Is assisted suicide legal for the terminally ill in the United States? The U.S. government oversees the 50 states, the District of Columbia, and U.S. territories which are divided into three branches: legislative, judicial, and executive. In 1997, the United States Supreme Court decided that there is no Constitutional justification whereby physician-assisted suicide is legal, leaving states allowed to pass laws explicitly disallowing it.
Currently, there are five states (Vermont, Montana, Oregon, Washington and New Mexico) that have legalized physician-assisted suicide for the terminally ill (perform by a physician/healthcare provider). There are many high regards leading to the discussion of physician-assisted suicide, as many other States remain on the fence between moral and ethical concerns.
These States are standing by their decisions not to legalize the much-debated issue. This is very surprising, since human society has become more adaptable to anti-discrimination laws identifying personal freedom choices.
Physician-assisted suicide for the terminally ill can be considered a dignified personal choice with the right to privacy. According to the Universal Declaration of Human Rights (1948) “Article 12-Freedom from interference” – no one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honor and reputation”.
Literature Review
The probability of the hypothesis question “Is assisted suicide legal for the terminally ill in the United States”? may be answered in the contents of this paper with cited literature review, an analysis, and recommendations.
Using Bardach, (2008) eightfold path to more effective problem solving will provide this policy paper with techniques on defining the problem, assembling evidence, constructing the alternatives, selecting the evaluation criteria, project positive or negative outcomes, simplify basic trade-offs, decisions of the policy alternative based on the analysis, and tell the story that supports the hypothesis.
Moving forward into the literature phase, let’s first examine the statistical data that collectively increases the potential for illness that may become fatal. There are many social-economical facts regarding the aging population who are rapidly approaching retirement age. In the United States the retirement age presumably is 65. But the Social Security Administration continues to increase the retirement age by marginal years.
These calculated administrative decisions may derive from the National Center for Health Statistics (2017) that indicate people are living longer with an average life expectancy of 78.6 years. Additionally, adding to the National Center for Health Statistics (2017), in the year 2000 the percentage of the aging population was at 12% compare to 1900 which was 4.1%. Also, predicting these percentages will increase over the next 20 years by at least 20% or more.
More notably as a result of the Baby Booming Era that now have increasing access to preventive healthcare. Yes, we’re living longer, but at what cost and who pays the health care bill that comes with aging? Health statistics continue to report Heart disease and Cancer as the two leading causes of death with other EOL illnesses are not far behind.
The discussion topic of physician-assisted suicide is not new and has been on the table for quite a number of years. Physician-assisted suicide comes with an expanded content of ethical ampleness in regard to the willful extermination of one’s self.
The agreed upon writing of such a document requires a dignified end goal shaping the open agreement that reflects the moral and ethical concerns surrounding physician-assisted suicide Rodriquez, (2001). In the United States, family physicians/ healthcare providers provide a multitude of services that are extended to the aging population.
Rodriquez, (2001) believes that legalized physician-assisted suicide would influence the manner in which American physicians/ healthcare providers practice prescription writing. A growing number of physician/health care providers seem to show very little concern regarding the matter of EOL choices for the terminally ill.
Though, the issue of enduring in people with constant and terminal disease can’t be disregarded. Sympathetic, compelling, psychosocial impacts and moral arrangements must be found as we approach this advanced age of disparity Rodriquez, (2001).
According to Wallerstein, (1995), Erik Erikson, born 1902 and died 1994 was a personality clinician who created a standout amongst the most well-known and compelling speculations of advancement. While his hypothesis was impacted by psychoanalyst Sigmund Freud’s work, Erikson’s hypothesis focused on psychosocial advancement as opposed to psychosexual Cherry, (2017).
Erikson’s theory consisted of eight life cycle stages of development that ranged from Trust vs. Mistrust to Integrity vs. Despair. Each stage was presented with ongoing biological, social, and psychological affects as the body continued to age. As each passing phase developed, concerns of missed elements of growth would connect to present phase. Ultimately, attempting to reconnect with a piece of life that was not fulfilled at the previous phase.
For instance, Erikson refers to Trust vs. Mistrust as the first stage of his psychological study and the most important one. This stage begins at birth as an introduction to the world, it sets the stage for the nurturing of our personality. Missed elements of this phase such as, not being loved or held as child may cause negative growth of one’s personality leading into the next phase. As indicated by Erikson, our sense of self personality is always showing signs of change because of new encounters and data we get in our everyday communications with others.
The eighth and final stage of Erikson’s theory is Integrity vs. Despair. This personality stage generally begins around 60 years of age, here is where one begins to reflect on their life and contributions. The individuals who feel pleased with their achievements will feel a feeling of respectability. Effectively finishing this stage implies thinking back with few second thoughts and a general sentiment of fulfillment. These people will achieve insight, notwithstanding while going up against death Erikson, (1995).
With regards to death, the finishing of someone’s life, ought to be their choice to choose their destiny? Contentions of this is written in an article by, Fraser et al., (2000) Death – Whose Decision? Willful extermination and the Terminally Ill. The article addresses the general population about whose extreme choice should it be genuinely up to.
The article investigates the lawfulness, results, conclusions, and standards of fundamental life managing the theme. When seeing this issue, there are dependably factors, incredible one’s contrary to it that standout amongst the most powerful being religion. The article mentioned that Oregon is one of the main states where physician-assisted suicide is absolutely lawful with no regards to religion.
According to Oregon Health Authority Public Health Division, (2017), Oregon’s Death with Dignity Act (DWDA) permits a critical condition adult to acquire and utilize solutions from their physician/healthcare providers for self-directed, deadly dosages of prescriptions. Physician/healthcare providers can recommend deadly medicine that will enable in critical-condition people to take their lives.
There are quite certain means – including holding up periods and discharge frames – that must be pursued before the prescription can be endorsed. The Oregon Public Health Division is required by the DWDA to gather consistence data and to issue a yearly report.
Some of the data concludes that in 2016, 204 individuals got remedies under the DWDA and in January 23, 2017, 133 individuals had passed on in 2016 from ingesting the endorsed meds, including 19 solution beneficiaries from earlier years. Attributes of DWDA patients were like earlier years: most patients were matured 65 years or more established (80.5%) and had malignant growth (78.9%).
Quill et al., (2013) proposed clinical criterions for physician-assisted suicide. In their article, they are agreeable to the legitimization of physician-assisted-suicide however rather than simply gushing reasons of why they feel that way, the writers have proposed a way and criteria in which the therapeutic culture could enable in critical-condition people to be appeased of their torment.
One of the concealing issues that individuals and possibly the Government appear to have against physician-assisted suicide is that there is no set criteria model. The deciding factors and variables need to be in place for an individual to potentially surrender their life to ease the agony. These proposed criterions provide multiple platforms with respect to how one could characterize the kinds of people who ought to have the capacity to get this alternative.
A few criterions given are that the patient must get the choice by their essential specialist not simply somebody the patient realizes will give their choice a chance to occur, the patient must have a condition that is serious and related with extreme experiencing which results from their condition. Educating the patient on other conceivable options must be included in the criterions along with how to prepare an EOL plan.
Based on a National Survey of Physician-Assisted Suicide and Euthanasia in the United States uncovered ramifications of the information for the present discussion over the sanctioning of physician-assisted suicide. Initially, a generous number of physicians in the United States have gotten at least one solicitation for help with suicide or willful extermination.
Analysis
The technique of this proposed policy falls under the structure of private rights that support family law. The implementation of this policy analysis would influence the integrity of quality of life while subtracting the burden on economic health cost. Although struggles with ethical behavior among some maybe questionable, the policy analysis is reasonable.
Family law defines the problem that is stated in the hypotheses question: “Is assisted suicide legal for the terminally ill in the United States? The concluded answer to this question is reiterated that in 1997, the United States Supreme Court decided that there is no Constitutional appropriate to helped suicide, leaving states allowed to pass laws explicitly disallowing it.
Given the fact that only five state have legalized physician-assisted leaving the other states with the disregard for the Universal Declaration of Human Rights, (1948) “Article 12-Freedom from interference”.
While assembling the evidence factors, death is one of those factors whereas being terminally ill is likely when examining the national statistics. The National Center for Health Statistics, (2017) data shows life expectancy in United State to be approximately 78.6 years with the leading causes of death Heart disease and Cancer.
These data elements can be connected to patient wanting the options of physician-assisted suicide. The National Survey of Physician-Assisted Suicide and Euthanasia in the United States revealed that a generous number of physicians in the United States have gotten at least one solicitation for help with suicide or willful extermination.
Constructing the alternatives are supported by Fraser et al., (2000), article “Death – whose decision? Euthanasia and the terminally ill “. This article promotes less moral logical inconsistencies and more noteworthy safeguarding of respect permitting self-governance for the critically ill that encompasses choices. Quill et al., (2013) proposed clinical criterions for physician-assisted suicide.
They concluded that one of the concealing issues that individuals and possibly the Government appear to have against physician-assisted suicide is that there is no set criteria model. These criterions need to present features that identify specific individuals who could be afforded the option/alternative of physician-assisted suicide.
However, based on the National Survey of Physician-Assisted Suicide and Euthanasia in the United States, 54 percent of patients who were agreeable to physician-assisted suicide did not ask for it themselves. In some cases, the request was received from a family member wanting to end the suffering of their loved one.
The need to evaluate the criteria is crucial much like the Oregon’s Death with Dignity Act (DWDA) as the other four states (Vermont, Montana, Washington and New Mexico) have similar criterions regarding the extermination of life. The DWDA currently allow physician-assisted suicide by means of a deadly cocktail that is self-mistered with self-terminating instructions provided by the physician/health care provider.
But before the level of self-termination is discussed there are evaluating criterions that must be adhered to. First, the patient must have been diagnosed with an illness that is terminal. Second, the patient must be informed of other conceivable options. Third, a “Do Not Resuscitate (DNR) order must be in place along with a signed consent relieving the physician of responsibility.
At no time can the physician/health care provider assist with the injection or method of use if the patient become incapable to do so. Additionally, Oregon evaluates their data regarding physician-assisted suicide. This is done annually to determine if they are meeting the intended policies that are in place.
The positive projected outcome allows for patients to have the choice to their own demise while in the comforts of their home. Although, Erikson, (1995) in his theory identifies this as the eighth and final stage (Integrity vs. Despair) could be met with a positive or negative outcome depending on how the patient lived their life. A positive outcome would be having no regrets and they have had a fulfilled life.
A negative outcome would be just the opposite. While Erikson theory further explains how we age in life biologically, socially, and psychologically all of the interventions are simultaneously orchestrated. Therefore, a good healthy balance with the three allows for death to come with dignity. Erikson does not reflect on ethics in his studies he focuses only on the life cycle to be used as a guide of things to come.
Physician-assisted suicide is a simplified basic trade-off to our longer-aging population. Other trade-offs such as: lowering the financial burden on medical cost/insurance (if you have it) while additionally ending the potential hope of change on the family member.
As it is very costly to keep someone on life-support where death is the only possibility. According to the Washington Post end of care life-support costs between $2,000 and $4,000 a day. Prices may varies based on the level of care that the patient requires, in which case can easily escalate to $10,000 a day (Neuberg, 2009).
There are no further policy alternatives requirements to this analysis, however during this exploration of finding the answer to the hypotheses question “Is assisted suicide legal for the terminally ill in the United States? we know the answer is limited to five states.
Based on the numerous articles and books for and against the issue the two sides were presented with a wide range of purposes behind their convictions most being; ethical, governmental issues, religions, freedom of human rights, family convincing, mental state of the patient, and ending the agony.
As there are other opposing augments such as a person who is terminally ill but unable to make a choice for physician-assisted suicide due to not being conscious or mentally stable. However, much of the literature review revealed a growing support to sanctioning and execution of physician-assisted suicide as a possibility for the in terminally ill. As limited time was provided to prepare this policy analysis further research can be connected, if needed.
Policy Recommendations
Based on the research, this recommended policy analysis is presented with many challenges in regard to physician-assisted suicide. It appears that the public stigma may be more adaptable to physician-assisted suicide. Getting it through the remaining states legislation is questionable, although not impossible as many states have presented the argument and continue to do so.
Although, some physician/healthcare providers may find they have ethical dilemmas since they have signed a Hippocratic Oath stating that a physician’s obligation is first, do no harm. But on the contrary, physician/healthcare providers have an ethical obligation to honor a patients’ request for care, including an EOL plan. One may add that a DNR order may be considered a form of physician assisted suicide.
One additional recommendation for this policy analysis would be to mirror Oregon’s Death with Dignity Act as a platform model to gaining legalization to physician-assisted suicide. Patient’s must meet the criterions of being prognosed with a terminal illness, agreeable to an EOL plan, cognitive, and mentally stable.
The criterions will also include a care plan that includes a health care proxy, living will, power of attorney, consent for physician-assisted suicide, and a DNR order. These preliminary criterions will advocate for the patient’s EOL wishes and necessary when physician- assisted suicide becomes legal in states where it is not.
