The right to live or die in medical ethics
Currently there is a debate that exists among ethicists on whether the right to die or live is universal or it only applies in certain circumstances. A good example of this is the court in Montana currently found out that the right to die can only be extended to those with medical conditions that threaten their lives. On the other hand ethicists argue that any person has the right to end his or her own life. In most cases the issue of the right to live or die is related to the wish of the involved person that the care takers allow death, for example healthcare providers may not provide life support or important medications when they think that the recovery of the individual is almost impossible. Euthanasia is the process through which physicians kill their patients by omission of vital support for the benefit of the patient.
There are various types of euthanasia: Voluntary euthanasia is when the individual who is killed has requested it. Non-voluntary euthanasia is when the person killed had not requested it and did not know whether he or she would be killed. Physician assisted suicide is another type of euthanasia which takes place when a doctor gives information and guidance to a patient aimed at ending their lives for their own benefits. Euthanasia by action is when a person intentionally causes another person’s death by performing an action so as to end the other person’s life. Euthanasia by omission is when death is caused intentionally by omitting vital care or food. The debate between right to live or die has become very common with other people arguing that a poor quality of life is enough justification to end the life while on the other hand ethicists argue that we should allow death to take its course and not facilitating death.
The following hypothesis has been developed to aid in the research work:
H0: Each person has the right to choose the end of his or life.
H1: A person may be denied his right to live or die in some circumstances.
METHODOLOGIES USED TO GATHER INFORMATION
In selecting the appropriate methods to be used to gather the required information during this research, the following factors were considered: the cost of the research method, the time available to carry out the research and the accessibility of the information required for the research. Due to the sensitivity of the topic it is necessary to ensure that the information for the research work is collected from reliable sources. One of the methods to be employed in the research to aid in gathering information will be surveys. Surveys are preferred in most research work due to the fact that they are inexpensive and at the same time they give concrete information regarding the subject being studied. Surveys will be conducted on medical practitioners to find out the information they have regarding the right to die or live. Information will also be collected from legal experts to find out the laws that exist regarding the right to life and death.
Information will also be collected from ethicists to find out their stand on the right to life and death. Surveys will also be conducted on those patients who are in chronic medical situations to find out the information they have regarding the right to live or die. Information will also be collected from the general public by means of questionnaires and surveys. The questionnaires and the surveys administered to the different groups of people will provide the primary information required in the study. The study will also use the method of deliberate information gathering (Appendix B).
Secondary information is also important in any kind of research. This is the information collected from other studies that have been conducted related to the issues of right to live and die in the medical ethics. This information will be collected from different individuals and organizations that are concern with the issue of medical ethics and right to live or die. Information on the legal rights entitled to individuals in determining how they wish to live or die when their health is affected by a terminal disease will also be collected. Information on the moral rights of individuals in choosing how or when they want to terminate their lives incase of a terminal illness will also be collected during the research. After all the required information is gathered the researcher will then evaluate the information to come up with a conclusion regarding the right to live or die as related to terminally ill patients.
The term right to die or live has been seen by many individuals to be related to the decision made by individuals suffering from chronic illnesses to either continue living on life support or the individual should be allowed to die. In some instances it refers to the idea that a person with a terminal illness should be allowed to take his or life before death can occur. The debate among many religious, legal and medical organizations is based on who if at all anyone has the power to decide over the right to live or die.
In cases where the physician finds that it is impossible for the patient to recover from the medical condition, on some set conditions the physician may assist the patient to die. This is called physician assisted suicide. There are legal laws concerning the right to die or live but these laws differ from place to place. A legal document referred to as the Five Wishes gives a chance to a terminally ill patient to state in the order of priority any issues that they would like to be honored before the individual dies. The MDPOA (Medical Durable Power Of Attorney) assigns an agent in case the patient is incapacitated to make decisions at the end of life. The individual granted the power to make decisions on behalf of the incapacitated patient may provide written guidelines to be used in deciding how the patient wants to die or live.
Currently of all the legal documents related to the right to live or die in case of a terminally ill patient the MDPOA is regarded the most powerful document. This legal document offers interpretation to the healthcare providers and also to the court guardians who are appointed to deal with the case involving the terminally ill patient but other legal documents do not offer this interpretation. This legal document also ensures that the terminally ill patient gets information regarding the right to live or die from a person the patient trusts unlike other documents where the patient get the information from a stranger. The supreme court in the United States rejected the legal right to physician assisted suicide but some people feel that it is vital to deny the choice of an individual to die while others still feel that it is equally vital to deny the chance of an individual to live (Newman, 1992: 30).
There are many issues in medical ethics but of most important is the issue of euthanasia which involves helping a terminally ill patient to end his or her life in a more heroic manner. In the early 1990s a Gallup poll conducted in America to investigate the feelings of people regarding the right to die or live indicated that 85% of the people felt that they would opt for a withdraw of any kind of treatment in a case where they were to be put on a full life support system without the hope of recovering. 66% of the people interviewed felt that it was their moral right to withdraw any life support treatment if there was no hope of recovery. A poll carried out in Mumbai by the Society for the Right to Die with Dignity (SRDD) interviewed 200 doctors and out of these 76% believed that terminally ill patients should have the right to choose either to live or to die. The same poll revealed that 75% of the doctors interviewed believed that there is no need to extend artificial supports of life in cases where death is about to happen. Almost all the doctors interviewed believed that there was nothing bad with euthanasia and they said that it only means good death (Cristina, 2009).
Those people who believe in euthanasia say that it is a decisive act of democracy and that it is a human right. They also argue that the act taken to alleviate a painful death would increase the well being of the patient and hence lead to more good as compared to what a patient goes through during a painful death. The proponents of euthanasia also say that it is an act of kindness and it is also humanitarian. In a medical context there is no major difference between administering euthanasia and withdrawing life support from a terminally ill patient. Those people against euthanasia argue that most of the deaths are not painful and hence there is no need for euthanasia. They also argue that euthanasia may lead to an ethical issue in that unscrupulous medical personnel may use the issue to eliminate people they do not like. Medical practitioners may find it difficult in situations where they have to deny an individual a chance to live so as to relieve the financial burden and the distress on the relatives of the patient (Raphael, 2001: 121-126).
For many years in the past death was indicated by the lack of pulses or absence of breathing. The advancements in technology led to invention of life support devices like the mechanical respirators. These life supporting devices enable the physicians to maintain the functions of the lungs and the heart in an artificial manner hence the signs of death became unclear. As a result of the advancements in technology a challenge arose that of having to come up with a new definition of death and this spurred a lot of debate in the medical ethics sector in the late 1960s and early 1970s. In 1968 a committee in Boston came up with the issue of brain death which they defined as termination of all functions of the brain even if the body was maintained by artificial means. In 1981 an advisory group comprising of major bodies involved in medical; ethics issues was formed and it came up with guidelines on how to define death. The guidelines developed by this group defined death as complete and irreversible termination of respiratory and circulatory processes in the body. The guidelines also include the former guidelines on the function of the brain but this time they added that for some to be declared dead the brain must also encounter non reversible termination of all its processes. This definition of death has been adopted by many nations and therefore the medical physicians have the responsibility of ensuring that their patients do not die. Use of all the possible means available to prevent death has been seen as a violation of the right to die. Patients whose health is affected by terminal diseases have the right to determine the way in which they want to die or live. If the terminally ill patients cannot afford the life support equipments then the physicians may be forced to withdraw the support hence leading to the death of the patients (John, 1996).
There are certain situations where the medical practitioners may find it difficult to either allow death or sustain their terminally ill patients. Some of these situations are: If there is a patient who has gone into a constant vegetative state due to injury or due to pharmacological accident and the patient is in a condition to be sustained through medical technology. A good example of this was the case of Karen Ann Quinlan. A second situation is when a patient lapses into a condition of contented dementia due to an injury. Such individuals do not have the capacity to interact with people or growth; physicians are always faced with a challenge of determining whether an individual in such a condition should be treated for a life-threatening illness. If the individual in this case had earlier written a will requiring that this kind of treatment be withheld the physicians are then confused on the right action to take. The other situation is in the case of newborns that are born with serious defects, an example of this case is a child born with Down’s syndrome. Such situations raise challenges about the acceptable treatment and on the other hand the acceptable neglect of the situation. The last scenario is when life is full of high levels of pain. This is the strongest category for those who claim to be given the right to die (William, 1999: 19-22). The physicians in this case may help their patients to die without a lot of pain although the issue of physician assisted death has not yet been legalized by the law.
A good example in this case is in the case of Karen Ann Quinlan in 1975, she was a 21 year old lady who went into a permanent vegetative state due to intake of a mixture of alcohol and tranquilizers. Her parents believed that their daughter would have wished to be discontinued from the life supporting devices and they therefore requested for it. Discontinuing the lady from the life supporting devices would mean denying her the right to live. The medical practitioners who were very sympathetic to the parents could not agree to the move of the parents and this resulted to a long court battle. Lastly the case was settled by a New Jersey court and the young lady was discontinued from the life support system but unexpectedly she started to breath on her own and lived for another ten years.
Cristina Alarcon, (June, 2009), Right to die? How about right to live, National post journal, retrieved from: http://network.nationalpost.com/np/, on 23rd July 2009, at 10:42
Ed Newman, (1992), Ethical issues in terminal health care: Local perspectives on the right to die debate, retrieved from: http://www.cpinternet.com/~ennyman/DAS 3.html, on 23rd July 2009, at 12:26
John La Puma, (June 1996), Whose right to die? Assisted suicide and managed care, managed care magazine, retrieved from: http://www.managedcaremag.com/archives/9606/MC9606.ethics.shtml, on 22nd July 2009, at 13:42
Raphael Cohen-Almagor, (2001), the right to die with dignity: an argument in ethics, medicine, and law, New Jersey, Rutgers University Press
William Grey, (1999), Right to die or duty to live? The problem of euthanasia, journal of applied philosophy, Vol. 16, No. 1, U.K., Blackwell publishers.
APPENDIX A: SUPPORTIVE EVIDENCE
Marshall Klavan was once a very prominent physician in Philadelphia but currently he is living on a nursing home. The former physician cannot talk, or communicate by any other means; this means that he is unable to make his own decisions. The physician had signed a will some years back that forbade doctors from resuscitating him incase he became terminally and irreversibly ill. His current lawyer is now in a case that he is suing the doctors who saved Klavan’s life and the lawyer claims that the doctors should compensate for the expenses incurred by Klavan in the nursing home. Klavan spends all his days on a wheelchair because his right side is paralyzed and therefore he is helpless. The case on Klavan will shed light on other patients who would wish not to have odd medical care practices incase they became terminally ill. For many years doctors have been ignoring the wills of their patients anticipating that if they failed to try and save a live they would be liable to litigation. The case on Klavan is among many other cases that are to shed light on the fact that doctors could also be sued if they did not follow the wishes of their patients. This case has shed light on physicians because they have now begun to understand that the only way that they get to problems is if they do against the wishes of their patients, said George Annas, chairman of the department of health law in Boston University. Klavan wrote his will in 1993 and in his will he directed doctors to withhold any medical treatment that may in any way prolong his dying process incase he fell irreversibly ill. Klavan chose his wife to act as his legal substitute if by any chance he could not speak by himself.
The way Klavan became ill is what makes his case more complicated because he was found unconscious in his Upland hospital office on the morning of April 30th 1997. Around the scene where he was found there were many pills and suicide notes. Klavan was then taken to the hospital where all efforts were made to sustain his life. By May 4, Klavan went into a continuous vegetative state and there was no hope of him recovering. At this point the doctors who were in charge of him agreed to lower his level of treatment thereby obeying his directives. When his condition became worse the doctors disobeyed his directives and resuscitated him without informing his wife. The wife then went ahead and sued the physicians who resuscitated Klavan claiming that everyone had a right to either accept or reject any type of medical care even if the act would lead to one’s death. This case shows that in some cases a patient should be given the right to die while in other cases the patient may be given a chance to live even on life supporting machines.
APPENDIX B: MEANS OF GATHERING INFORMATION
Deliberate information gathering (DIG) is a method of collecting information that was developed by Todd Holder. It is a straightforward manner of collecting information and uses the interpersonal skills of the researcher to facilitate high levels of interaction with the respondents in a research. This method ahs been widely accepted in social work interviews and also in the counseling exercises. The method requires the researcher to dig deeper for information he or she needs so as to completely understand the respondent. The DIG method requires that the researchers is very much deliberate during gathering of the information required and at the same time behave in a natural way. This means that the way the researcher conducts himself during the collection of information process should make the respondent feel as if the exercise is just a normal conversation.
DIG identifies the following techniques to be used by researchers when gathering information on very sensitive areas: Attending behavior means that the researcher should focus his or her attention on the respondents instead of the agenda of the questions in the research. Open questions are also preferred in this method because they remove the researcher from the responsibility of carrying out the interview and therefore they establish a good quality of the conversation. Encouraging is using phrases that are chosen carefully so as to encourage the respondent to continue with the interview. Looping of the conversation is another technique and it involves the researcher identifying a general issue of discussion with the respondent.