This is one request every physician dreads to hear from a patient. No matter how hopelessly ill a person may be, even one dying from terminal cancer which has spread all over the body causing unabated pain and suffering, such a plea for mercy and final relief for the physician to prescribe higher dosage of intravenous pain killers and allow him/her to die with dignity, nonetheless causes severe anguish and conflict on the part of the physician.
Trained to respect and save lives, not to kill, to adhere to the Oath of Hippocrates and its precept of “primum non nocere” (first do no harm), and to alleviate pain and suffering, the physician in this situation faces a grave dilemma. As a scientist, he/she knows the hopeless nature of end-stage medical condition, that the quality of life at that point is dismal, and that the patient will only continue to languish in pain, with his loved ones suffering with him, day in and day out. Aware of these harsh realities and having compassion in his heart, the physician might be tempted to consider granting his patient’s request. His final decision will certainly be dictated by his personal philosophy, moral conviction, medical standard of care, and the law of the land.
The most controversial issue of euthanasia, which has landed Dr. Jack Kavorkian in jail, has been a subject of a recent survey among physicians in the United States .
Medscape Ethics Survey
“Doctors are sharply divided over the question of physician-assisted suicide,” reports Wayne J. Guglielmo in the Medscape electronic Exclusive Ethics Survey, covering August to September 2010, involving 10,000 US physicians of various specialties.
To the ethics question “Are there situations in which physician-assisted suicide should be allowed?,” 45.8% responded affirmatively, 40.7% said “No,” and 13.5% answered “It depends.”
Both ends of the spectrum of responses were quite direct, like stating “Kill yourself, but don’t involve me,” and “I am a healer, not an executioner.” The opposing group asked “Did you ever watch a patient die a miserable death day by day?” and “We treat animals more kindly than people. This should be an absolute right of a terminally ill patient.”
The report stated, “In between these 2 black and white extremes, physician respondents who are still uncertain about the issue expressed their continuing ambivalence in various shades of gray, a clear reflection of the competing ethical concerns they’re struggling to balance.”
One respondent stated: “As a physician, I do believe my job is only to keep a human being alive, but the quality of life is important as well.” Another said: “I think there are times when it may be justifiable, but I don’t think it should be legal.” Another asked: “There is a thin line between ‘comfort care’ and ‘physician-assisted suicide.’ Who draws the line?”
Although debated for more than a century, the practice of euthanasia is still rare in the United States . Only 3 states legally permit physician-assisted suicide (referred to as Death With Dignity option): Montana permit it thru a trial court, and Washington and Oregon , through statutory law.
Fundamental issue
This dilemma “not only raises fundamental questions about the nature of the profession itself but also about doctors’ ethical obligations to their patients at the end of life,” the report pointed out.
The survey revealed that “on one side, there are opponents of physician-assisted suicide who nevertheless draw a bright line between this practice and providing the palliative treatment necessary in order to alleviate a patient’s pain, even if that treatment ends up suppressing respiration and hastening death…all agree that patient comfort is paramount.”
The report further stated that in the United States today “physicians who under treat pain sometimes place themselves in greater legal jeopardy than those who treat pain aggressively, even to the point of hastening a patient’s death” among the terminally ill being given palliative care.
The law is clear-cut on the issue of “intent,” even among those 3 states where physician-assisted suicide is concerned.
Distinction
“Palliative care and withdrawing life-sustaining support are legally and morally distinct from physician-assisted suicide,” writer Guglielmo quoted Nancy Berlinger, PhD, Deputy Director and Research Scholar at The Hastings Center, an independent, nonprofit bioethics research institute in Garrison, New York. “While physician-assisted suicide is legal in only 3 states, palliative care is supported by a variety of measures in different states, where a legal and ethical consensus around its importance has formed,” she emphasized.
According to the Pew poll “Americans make a distinction between allowing a terminally ill patient to die and taking action to end someone’s life.” On the question of physician-assisted suicide, in fact, the 2006 poll found the public to be only slightly less divided on the question — 46% in favor and 45% opposed — than the current Medscape survey shows physicians to be, Guglielmo writes. The 2010 Gallup Annual Values and Belief Survey confirms the public’s ambivalence, noting a clear 46% to 46% split between those who find it “morally acceptable” and those who regard it as “morally wrong.”
Proponents of physician-assisted suicide are questioning why abortion (which terminates the life of normal healthy fruit of conception) is allowed in several countries, while helping to end the life of a hopeless and suffering terminally ill person in great pains is illegal. They point out that in the name of love and compassion, it is universally accepted as humane to put animals, usually pets, to sleep when they are suffering and no longer have quality life, and yet the same society does not allow people to be similarly humane and compassionate and provide comfort to their loved ones under the same dire circumstances.
“Dying with dignity, in comfort and in peace, surrounded by loved ones, and having the privilege of joining our Creator a bit sooner is certainly a more charitable and graceful alternative for the terminally ill,” says a colleague.
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Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email:[email protected]
