Euthanasia Not A Step Down The Slippery Slope
Physician-Assisted Suicide and Euthanasia Are Not Steps Down a Slippery Slope
Life and death, one can not exist without the other. No person can live without someday having to face death and no person can die without having lived. The following information should assist you to consider the rights, that as citizens of the United States, we should have when facing issues which surround the treatment that involves the end of life care. All people should be entitled to their beliefs and also should have the right to make individual choices that could affect them if they are faced with a life threatening injury or terminal illness.
The pro-choice stance regarding physician-assisted suicide and euthanasia is not about advocating death. These beliefs are more about striving for ways to make better end of life care available and the right to make decisions which pertain to our individual being. Legalizing physician-assisted suicide and euthanasia in all of our states would not become steps down a slippery slope.
Working as a nurse for twenty-five years, I have compassionately cared for many individuals at the time of their deaths. I realize that illness, injury, and death are never easy subjects to discuss, but the importance of talking about these issues can not be stressed enough. These types of discussions are important so that the decisions which face us in regards to these matters will be left in the hands of those to which these decisions pertain and to those persons closest to them. Not all the choices that I wish to discuss are legal at this time. The options of euthanasia and physician-assisted suicide need to be taken into consideration for the possible reformation of our existing laws which have to do with the end of life affairs. At this time in the United States, Oregon is the only state that has passed laws legalizing physician-assisted suicide.
Having a clear understanding of what euthanasia and physician-assisted suicide mean is important. Michael Manning, M.D. says in his book Euthanasia and Physician-Assisted Suicide: Caring or Killing, that physician-assisted suicide is, “A physician providing medications or other means to a patient with the understanding that the patient intends to commit suicide.” Euthanasia can be defined as bringing about a gentle and an easy death (“Euthanasia”). The act of euthanasia can be either voluntary or non-voluntary and it can also be considered a passive or an active act.
According to Thomas Fuchs, M.D., Ph.D. in an article he wrote for the journal, Medicine, Health Care, and Philosophy, voluntary active euthanasia means that a clearly competent person makes a voluntary request to be assisted in the dying process. An example of this type of euthanasia would be giving a lethal injection to a person at his or her request. Passive euthanasia entails letting a person die by withdrawing or withholding a life sustaining treatment, such as the act of removing a person from a ventilator or withholding artificial nutrition and hydration. The act is considered non-voluntary when a person can not actively express his or her wishes; this may be due to severe brain damage or because a person is in a persistent vegetative state (Fuchs).
Having a living will in place makes issues surrounding serious illness and death much easier on everyone because it makes our wishes about the type of health care we would or would not want known to others in the event of a terminal illness or a life threatening injury. The Ohio Department of Health states that a living will lets our doctor and our loved ones know the extent of treatment we would wish to receive should we be in a condition that has left us unable to communicate. A person can do this by putting in writing what is called an advanced directive. This can be done by obtaining the proper forms from a doctor, attorney, or there are also state specific forms available on the Ohio Department of Health website (Ohio Department of Health).
The reasoning behind the slippery slope theory usually entails the Hitler-Nazi Germany experience. Some people believe that euthanasia and physician-assisted suicide would lead to the possibility of this type of an experience reoccurring. However, according to Derek Humphrey, the founder of the Hemlock Society, there is no connection between these cases. The only commonality is the name euthanasia, which is the name that was used to describe what Hitler and the Nazis used their death camps for. In these cases the name stands for quite two different policies. The Nazi program of euthanasia was neither voluntary nor based on compassion. This program was motivated by the desire to remove specific groups of human beings that the Nazis considered to be useless, foul animals and to preserve the purity of the Volk and hence resulted in a vicious and racist ideology that was already firmly in place (Humphry).
Americans fought to stop the Nazis and the vile torture of these human beings. Our American society saw this racist ideology as incomprehensible and despicable. Citizens of the United States would never tolerate such appalling acts to take place in our country. Although, some people do believe that if physician-assisted suicide and euthanasia were legalized for the terminally and chronically ill, then the gradual extension of these practices would widen to other groups of patients, such as those individuals with developmental disabilities, the mentally ill, and the elderly.
If physician-assisted suicide and euthanasia were to be legalized throughout the U.S., there would have to be mandatory regulations put in place and over seen by a regulatory agency, as in the case with the Oregon Death With Dignity Act. This would insure that legislation would have to be voted on before anyone other than those patients who meet specific criteria could employ these practices.
As a heath care worker, I cannot stress enough how important it is to document and make known to our families and our loved ones the choices we would want if we were faced with a serious illness or injury. When determining the extent of treatment we would want to receive we need to consider our values, such as how important independence and self sufficiency are to us. According to an article written by the staff at MayoClinic.Com, we should ask ourselves the following questions: What would make my life not worth living? Do I want life saving treatment or life sustaining treatment? These are important key issues to address when putting advanced directives in place (Mayo Clinic).
Patients and/or families deserve a clear and complete understanding of the proposed therapy options that are available to them should they be faced with terminal illness or a serious injury. During my career while caring for those faced with such difficult decisions, I have found that some patients and/or families will want to know all the details, while others will prefer to forego the details and rely solely on his or her physician’s specific advice. Life-sustaining treatment should be discussed in the following realistic terms: the problem the treatment will address, what the treatment or procedure will involve, what the prognosis will be with and without treatment, and what the benefits and the burdens of the treatment will be.
When inserting a feeding-tube in a patient who is in a persistent vegetative state, it will not prevent aspiration, it will not stop all the effects of malnutrition, nor will it improve survival or function. Insertion of the feeding-tube also causes a serious risk of infection as well as the risk of other serious complications. Like all procedures, a tube- feeding should not be considered an inevitable procedure, this is an optional choice. I have found that there are several misperceptions that are common among patients and/or families when they are making this consideration. A family may believe that a lack of appetite and poor oral intake is causing the current disability; they assume that, “if only Dad got more fluids and nutrition then he would be stronger or get better.” In cases that are doubtful, a monitored trial of hydration may well be warranted. However, artificial hydration may worsen physical symptoms such as edema, breathlessness, diarrhea, vomiting or incontinence in someone who is terminally ill.
Near the end of life I have found that patients and families may be concerned that the lack of fluids and food will cause suffering. Through the knowledge that I have gained at seminars on caring for seriously ill patients, I now know that dehydration is a common and natural part of the dying process. Offering good mouth-care may be a better solution then attempting to give oral fluids. Trying to reverse a natural process often leads to substantial discomfort, and the outcome will remain futile. When a patient is not hungry or thirsty then providing artificial fluids and nutrition will not relieve the symptoms and may actually end up causing more problems Some patients make a conscious choice to stop eating and drinking. This choice is a natural part of the dying process in someone who is terminally ill.
According to Richard J. Ackermann, M.D., a professor of family medicine at the Mercer University School of Medicine, performing cardiopulmonary resuscitation (CPR) on hospitalized patients is usually an ineffective measure. Only 6 to 17 percent of patients usually survive to discharge. Many of these survivors die during the next few months or are left with a poor quality of life. Patients with malignancy, sepsis, pneumonia or renal failure have even lower survival rates. More than 90 percent of all hospital deaths now occur without CPR being performed. Dr. Ackermann feels that all physicians should review the overall medical condition of a patient and the context in which CPR is being discussed with the patient and/or the family. He feels that engaging in a discussion that focuses only on the CPR and the do not resuscitate (DNR) status may leave the patient and/or the family confused and anxious.
Dr. Ackermann says he explains these procedures in clear and understandable language to his patients by asking them: “If you should die despite our current therapy, do you want us to use extreme measures? Do you want CPR performed? Do you want us to press on your chest and put a tube in your lungs to try to get your heart and breathing started again?” This doctor says that by discussing CPR initially as “starting the heart” or “putting on a breathing machine” implies a false sense of reversibility, or suggests that those heart and lung functions are isolated problems. These practices need to be discussed in context with the patient’s medical condition and prognosis. Patients and their families need to know that in patients with advanced illness, circulation and breathing stop because of the relentless progression of disease (Ackermann).
As technology has increased the capacity to sustain life, it has created the need for critical examination of when such treatments are and are not appropriate. The assumption that health care professionals have an obligation to prolong life is a misconception. Doctors and nurses have an obligation to their patient to relieve suffering which does not have anything to do with prolonging the dying process. It has become increasingly recognized that patients and families have an essential role to play in their health care decision making. The concept of informed consent includes the right of the patient to refuse treatment, even life sustaining treatments. Yet the decision to forego life sustaining treatment, particularly a decision to withdraw a treatment that may be already sustaining the patient’s life, poses significant psychological difficulties for providers, patients and families. The bottom line is that we need to plan ahead so that these decisions are not left to be made during a time of tragic circumstances, which is an especially difficult time to make such types of decisions.
No matter how difficult it is for a patient or family to hear a prognosis that says a serious illness or injury will not end in a recovery, I have always felt that they have the right to know the truth. I have cried many times along with my patients and their families as this reality has sunk in. In the cases of serious injury, such as that of a head injury, a person can be left brain dead or in a persistent vegetative state. This does not mean that their life has to become fruitless. The end of one life can save the lives of many others through organ donation.
The decision of organ donation is another important matter we should all discuss with our loved ones if it is a choice we would make for ourselves. A person can also have his or her decision to be an organ donor put on their driver’s license, but it is still a good idea to talk about these wishes with those closest to us. After being counseled on the severity of a brain injury and given a patient’s dismal prognosis, a family may choose to withdraw mechanical life support. A family may also then choose to have the patient’s organs donated.
I have gained a personal insight into how difficult this type of tragic situation can be. My twenty seven year old nephew, Michael, sustained a severe traumatic brain and spinal cord injury that the doctors assured us would leave him in a persistent vegetative state. Although, he was not considered to be brain dead because he was still left with some brainstem functioning. The brainstem regulates functions such as heartbeat, respiration, and temperature. We were told by the doctors that he would more than likely be paralyzed from the neck down and that he would never regain consciousness. He was left with virtually no chance for recovery from his injuries.
Michael’s parents and brothers, after several hours of heart wrenching discussions, finally decided to have the life support machines removed and to donate his organs. This is what we all believed that Michael would have wanted. The protocol for this to take place required that my nephew would have to stop breathing within one hour of being removed from a ventilator in order for his organs to remain viable. The doctors explained to us that if he were actually brain dead then he could have been left on the life support until the organs were taken, but this was not the case in Michael’s situation. Our family was told that it could take Michael anywhere from a couple of minutes to a few hours to stop breathing on his own. This form of organ donation is known as non-heart-beating organ donation. Michael was removed from the ventilator and we waited for him to die as we prayed that he would go quickly and his struggle would end.
Our family was told after one hour that Michael had continued to breath on his own and his organs were no longer viable for donation. Michael was returned to a room in the ICU where we continued to wait for his imminent death. There are no words to describe how it felt to sit helplessly as we watched Michael’s every gasping breath as he seized continuously and sweated profusely. He was given large doses of morphine and we assured that he was in no pain. As a health care professional who knew that the seizures and the sweating were being caused due to Michael’s head injury, it was still very hard for me to convince myself that he was not in pain. How would we ever really know how much he could feel? Another hour and twenty minutes passed before Michael took his final breath.
After witnessing Michael’s demise and watching other patients throughout my nursing career who suffered relentlessly until the moment of there deaths, I can only say that I believe there should be a quicker and more humane alternative to a death that is so inevitable. Michael was going to die, that was inevitable, whether it was two minutes or two hours should have made no difference. Had there been a choice available to give Michael a medication to immediately stop his heartbeat and his breathing there would have been no reason for him to struggle to for breath as we watched and wondered if he was in pain. If Michael had been left on the ventilator, he could have lived for years in a persistent vegetative state that would have left him to suffer the inevitable complications that this condition brings with it. Ultimately the outcome would have been the same and possibly this could have been done in a time frame that would have left his organs viable for donation.
Great strides have taken place in dealing with the end of life issues in regards to pain control and providing optimum comfort measures for the dying. Hospice organizations have been pioneers in this area and they provide a wonderful service to those patients who want it. After many years as a nurse, I have found that not all pain and suffering can be medically controlled. Also, who is to say that everyone would want to live in a drug induced state in order to control their suffering? I have been told by several patients that I have cared for that they would rather not be in a state that has left them unaware of their surroundings and to have other people left caring for their most personal needs. All people and should be left with alternatives as to when their suffering should end.
Due to the rapid advancement of medical technology and capacities to extend life, the issue of physician-assisted suicide is much more pressing then it has been in the past. A poll done by the San Francisco Chronicle in March of 2006 showed that 69% of registered voters said they believed that incurably ill people should have the right to ask for and receive life-ending medication. This poll conducted over a two week period ending February 26, 2006, found support among virtually all political, ethnic, and social groups. This included groups who identified themselves as major religious organizations (San Francisco Chronicle). Yet, Oregon is the only state that has passed a law to making physician-assisted suicide legal. According to the Oregon Department of Human Services, the Death With Dignity Act was passed in 1994 and reaffirmed in 1997.
This Act allows a doctor to prescribe a lethal dose of medication to a terminally ill person who has been found of sound mind. The person must be an adult (18 years or older), a resident of Oregon, able to make and communicate their health care decisions, have a terminal illness that will lead to death within six months, this diagnosis must be made be the physician prescribing the medication and then the diagnosis and prognosis must be confirmed by a consulting physician. If either physician believes that the patient’s judgment is impaired than the patient must be referred for a psychological evaluation. The prescribing physician is also required to inform the patient of all the feasible alternatives to assisted suicide such as comfort care, hospice care, and pain control (Oregon Department of Human Services).
The physician takes an oath to preserve life. Medical technology has now progressed far beyond its readiness to deal with the ethical issues it has now presented us with.There are also many types of pain and suffering that at this time can not be relieved. Such an oath in essence than becomes an oath to preserve the suffering of many patients when there is no hope for recovery or relief from agony.
The debate over physician assisted suicide will continue to evolve rapidly over the next several years. It is my hope you will use the information which I have presented to assist you in making an informed choice regarding such personal health care decisions. Physician-assisted suicide does not advocate death as suggested by the slippery slope theory. This pro-choice stance is more about striving for better alternatives pertaining to the end of life care issues and the right of all individuals to make decisions that affect any aspect of our private lives.