C22H19N3O4
07-25-2006, 01:09 AM
WARNING: Very long post.
The recent arrest of Dr. Anna Pou and two nurses has forced me (again) to reflect on physician-assisted suicide (PAS), or as some call it, Death with Dignity. Link (http://www.kevinmd.com/blog/2006/07/dr-anna-pou-hurricane-katrina-and.html) The link will hopefully provide you with some insight from healthcare professionals.
Oregon is the only state that has legalized PAS. Now, you're probably wondering if euthanasia and physician-assisted suicide are the same thing.
NO. They are two legally distinct procedures for hastening death. In euthanasia, a doctor injects a patient with a lethal dosage of medication. In physician-assisted suicide, a physician prescribes a lethal dose of medication to a patient, but the patient - not the doctor - administers the medication. Euthanasia is illegal in every state in the union.
Can anyone in Oregon request PAS?
NO. The law states that, in order to participate, a patient must be: 1) 18 years of age or older, 2) a resident of Oregon, 3) capable of making and communicating health care decisions for him/herself, and 4) diagnosed with a terminal illness that will lead to death within six (6) months. It is up to the attending physician to determine whether these criteria have been met.
A brief legal timeline:
--On July 26, 1997, the U.S. Supreme Court unanimously upheld decisions in New York and Washington state that criminalized assisted suicide. These decisions overturned rulings in the 2nd and 9th Circuit Courts of Appeal which struck down state statutes banning physician-assisted suicide. Those courts had found that the statutes, which prohibited doctors from prescribing lethal medication to competent, terminally ill adults, violated the 14th Amendment. In striking the appellate decisions, the U.S. Supreme Court found that there was no constitutional "right to die," but left it to individual states to enact legislation permitting or prohibiting physician-assisted suicide.
--1997: President Clinton signs legislation barring use of federal money for doctor-assisted suicide or euthanasia
--Oct. 27, 1997: Oregon's law takes effect when federal appeals court lifts judge's injunction
--Nov. 4, 1997: Oregon voters defeat proposed repeal of law
--Nov. 5, 1997: Drug Enforcement Administration says federal law can be used to penalize doctors who prescribe drugs for patients to commit suicide.
--April 2, 1998: Clinton administration Attorney General Janet Reno reverses DEA position, saying federal law does not prohibit Oregon doctors from participating in assisted suicide. Legislation in Congress to block the Oregon law eventually falters.
--Nov. 6, 2001: Bush administration Attorney General John Ashcroft says assisted suicide is not a legitimate medical practice and he will use Controlled Substances Act to punish doctors who prescribe drugs to help terminally ill patients die.
--Nov. 7, 2001: Oregon sues to prevent federal government from interfering.
--Nov. 8, 2001: Federal judge blocks Ashcroft's order
--May 26, 2004: Federal appeals court orders Bush administration not to interfere with Oregon's assisted suicide law.
--Feb. 26, 2005: The Supreme Court agrees to hear arguments over the law on Oct. 5.
--Jan. 17, 2006 : Supreme Court Upholds Oregon Assisted Suicide Law
Georgia statute regarding PAS:
--16-5-5.
(a) As used in this Code section, the term:
(1) 'Intentionally and actively assisting suicide' means direct and physical involvement, intervention, or participation in the act of suicide which is carried out free of any threat, force, duress, or deception and with understanding of the consequences of such conduct.
(2) 'Suicide' means the intentional and willful termination of one´s own life.
(b) Any person who publicly advertises, offers, or holds himself or herself out as offering that he or she will intentionally and actively assist another person in the commission of suicide and commits any overt act to further that purpose is guilty of a felony and, upon conviction thereof, shall be punished by imprisonment for not less than one nor more than five years.
(c) Any person who knowingly and willfully commits any act which destroys the volition of another, such as fraudulent practices upon such person´s fears, affections, or sympathies; duress; or any undue influence whereby the will of one person is substituted for the wishes of another, and thereby intentionally causes or induces such other person to commit or attempt to commit suicide shall be guilty of a felony and, upon conviction thereof, shall be punished by imprisonment for not less than one nor more than ten years.
(d) The provisions of this Code section shall not be deemed to affect any of the laws, in whole or in part, that may be applicable to the withholding or withdrawal of medical or health care treatment, including but not limited to, laws related to a living will, a durable power of attorney for health care, or a written order not to resuscitate.
AMA's stance on PAS:
--E-2.211 Physician-Assisted Suicide
---Physician-assisted suicide occurs when a physician facilitates a patient's death by providing the necessary means and/or information to enable the patient to perform the life-ending act (eg, the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide).
It is understandable, though tragic, that some patients in extreme duress—such as those suffering from a terminal, painful, debilitating illness—may come to decide that death is preferable to life. However, allowing physicians to participate in assisted suicide would cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks.
Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. Patients should not be abandoned once it is determined that cure is impossible. Multidisciplinary interventions should be sought including specialty consultation, hospice care, pastoral support, family counseling, and other modalities. Patients near the end of life must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication. (I, IV)
Scenario:
--You are terminally ill
--You have less than one year to live
--Your diagnosis has been confirmed by multiple physicians
--Your medical bill has exceeded six figures
--You can barely summon enough strength to eat. You fade in and out.
--You can no longer control your own bowel movements
--You must suffer the humiliation of someone bathing and feeding you
--Your family must endure watching you die a slow and painful death
--Your physical pain is so intense your teeth and gums throb.
You want to die peacefully surrounded by loved ones, but you can't. You must tolerate 6 to 12 months of this inhuman torture. The ball is in your court. What would you do?
A few things to consider:
--A few PROS:
---People should be able to control their own lives
---Some terminally ill patients are allowed to end their lives by refusing medical treatments; in all fairness, those who don't have that option should be allowed to choose death. * Death is a compassionate way to relieve unbearable suffering.
---Legal or not, assisted suicides occur, and it would be better if they were brought into the open
--A few CONS:
---Taking a life under any circumstances is immoral
---Assisted suicide has great potential for abuse. People without family support or adequate finances, as well as the depressed, could be pressured to choose death.
---Physicians can be wrong about estimating how much time a patient has left, causing unnecessary deaths
---The public will lose its confidence in the medical profession if physicians get into the business of helping people kill themselves
---Doctors take an oath to heal not kill
Is it moral or ethical? What are the religious repercussions? What is the psychological impact on the family? Is it about money? Would this feed the god complex beast of some physicians?
:D :D
The recent arrest of Dr. Anna Pou and two nurses has forced me (again) to reflect on physician-assisted suicide (PAS), or as some call it, Death with Dignity. Link (http://www.kevinmd.com/blog/2006/07/dr-anna-pou-hurricane-katrina-and.html) The link will hopefully provide you with some insight from healthcare professionals.
Oregon is the only state that has legalized PAS. Now, you're probably wondering if euthanasia and physician-assisted suicide are the same thing.
NO. They are two legally distinct procedures for hastening death. In euthanasia, a doctor injects a patient with a lethal dosage of medication. In physician-assisted suicide, a physician prescribes a lethal dose of medication to a patient, but the patient - not the doctor - administers the medication. Euthanasia is illegal in every state in the union.
Can anyone in Oregon request PAS?
NO. The law states that, in order to participate, a patient must be: 1) 18 years of age or older, 2) a resident of Oregon, 3) capable of making and communicating health care decisions for him/herself, and 4) diagnosed with a terminal illness that will lead to death within six (6) months. It is up to the attending physician to determine whether these criteria have been met.
A brief legal timeline:
--On July 26, 1997, the U.S. Supreme Court unanimously upheld decisions in New York and Washington state that criminalized assisted suicide. These decisions overturned rulings in the 2nd and 9th Circuit Courts of Appeal which struck down state statutes banning physician-assisted suicide. Those courts had found that the statutes, which prohibited doctors from prescribing lethal medication to competent, terminally ill adults, violated the 14th Amendment. In striking the appellate decisions, the U.S. Supreme Court found that there was no constitutional "right to die," but left it to individual states to enact legislation permitting or prohibiting physician-assisted suicide.
--1997: President Clinton signs legislation barring use of federal money for doctor-assisted suicide or euthanasia
--Oct. 27, 1997: Oregon's law takes effect when federal appeals court lifts judge's injunction
--Nov. 4, 1997: Oregon voters defeat proposed repeal of law
--Nov. 5, 1997: Drug Enforcement Administration says federal law can be used to penalize doctors who prescribe drugs for patients to commit suicide.
--April 2, 1998: Clinton administration Attorney General Janet Reno reverses DEA position, saying federal law does not prohibit Oregon doctors from participating in assisted suicide. Legislation in Congress to block the Oregon law eventually falters.
--Nov. 6, 2001: Bush administration Attorney General John Ashcroft says assisted suicide is not a legitimate medical practice and he will use Controlled Substances Act to punish doctors who prescribe drugs to help terminally ill patients die.
--Nov. 7, 2001: Oregon sues to prevent federal government from interfering.
--Nov. 8, 2001: Federal judge blocks Ashcroft's order
--May 26, 2004: Federal appeals court orders Bush administration not to interfere with Oregon's assisted suicide law.
--Feb. 26, 2005: The Supreme Court agrees to hear arguments over the law on Oct. 5.
--Jan. 17, 2006 : Supreme Court Upholds Oregon Assisted Suicide Law
Georgia statute regarding PAS:
--16-5-5.
(a) As used in this Code section, the term:
(1) 'Intentionally and actively assisting suicide' means direct and physical involvement, intervention, or participation in the act of suicide which is carried out free of any threat, force, duress, or deception and with understanding of the consequences of such conduct.
(2) 'Suicide' means the intentional and willful termination of one´s own life.
(b) Any person who publicly advertises, offers, or holds himself or herself out as offering that he or she will intentionally and actively assist another person in the commission of suicide and commits any overt act to further that purpose is guilty of a felony and, upon conviction thereof, shall be punished by imprisonment for not less than one nor more than five years.
(c) Any person who knowingly and willfully commits any act which destroys the volition of another, such as fraudulent practices upon such person´s fears, affections, or sympathies; duress; or any undue influence whereby the will of one person is substituted for the wishes of another, and thereby intentionally causes or induces such other person to commit or attempt to commit suicide shall be guilty of a felony and, upon conviction thereof, shall be punished by imprisonment for not less than one nor more than ten years.
(d) The provisions of this Code section shall not be deemed to affect any of the laws, in whole or in part, that may be applicable to the withholding or withdrawal of medical or health care treatment, including but not limited to, laws related to a living will, a durable power of attorney for health care, or a written order not to resuscitate.
AMA's stance on PAS:
--E-2.211 Physician-Assisted Suicide
---Physician-assisted suicide occurs when a physician facilitates a patient's death by providing the necessary means and/or information to enable the patient to perform the life-ending act (eg, the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide).
It is understandable, though tragic, that some patients in extreme duress—such as those suffering from a terminal, painful, debilitating illness—may come to decide that death is preferable to life. However, allowing physicians to participate in assisted suicide would cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would pose serious societal risks.
Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. Patients should not be abandoned once it is determined that cure is impossible. Multidisciplinary interventions should be sought including specialty consultation, hospice care, pastoral support, family counseling, and other modalities. Patients near the end of life must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication. (I, IV)
Scenario:
--You are terminally ill
--You have less than one year to live
--Your diagnosis has been confirmed by multiple physicians
--Your medical bill has exceeded six figures
--You can barely summon enough strength to eat. You fade in and out.
--You can no longer control your own bowel movements
--You must suffer the humiliation of someone bathing and feeding you
--Your family must endure watching you die a slow and painful death
--Your physical pain is so intense your teeth and gums throb.
You want to die peacefully surrounded by loved ones, but you can't. You must tolerate 6 to 12 months of this inhuman torture. The ball is in your court. What would you do?
A few things to consider:
--A few PROS:
---People should be able to control their own lives
---Some terminally ill patients are allowed to end their lives by refusing medical treatments; in all fairness, those who don't have that option should be allowed to choose death. * Death is a compassionate way to relieve unbearable suffering.
---Legal or not, assisted suicides occur, and it would be better if they were brought into the open
--A few CONS:
---Taking a life under any circumstances is immoral
---Assisted suicide has great potential for abuse. People without family support or adequate finances, as well as the depressed, could be pressured to choose death.
---Physicians can be wrong about estimating how much time a patient has left, causing unnecessary deaths
---The public will lose its confidence in the medical profession if physicians get into the business of helping people kill themselves
---Doctors take an oath to heal not kill
Is it moral or ethical? What are the religious repercussions? What is the psychological impact on the family? Is it about money? Would this feed the god complex beast of some physicians?
:D :D