The Right to Die

(See here)a wonderful piece on the subject of euthanasia written by Michael Tam that appears on his blog virtualis' Medical Rants.

I describe this piece as being wonderful because it represents the moral dilemma that every decent Doctor faces on the subject.

However I am not a Doctor. When I deal with the medical system, I am only forced to deal with this system as a patient. So I am going to attempt to explain this thing from a patient's point of view. If you want the Doctor's point, read what Michael Tam has to say. If you want the patient's viewpoint, read on.

I am going to preface this with the understanding that every human being really does enjoy the right to die. Perhaps this right would be denied you if you ever visited a psychiatrist and were evaluated in a manner that this right should be withdrawn, however, absent this occurrence, almost every human being enjoys this right within certain exceptions.

All "normal" people can take advantage of their right to own firearms and place the firearm to their head and end things. Absent the firearm, they can run their vehicle into a concrete buttress on the freeway. Many choose to jump off of bridges.

"Normal" people enjoy the right to end their lives any time they wish to.

But what happens to "Joe Average" when he places himself into the "loving hands" of the medical care system?

Joe Average walks into his Doctor's office because of a persistent cough. Joe's Doctor does an X-ray and informs him he has lung cancer. Joe is informed that if he undergoes chemotherapy and radiation therapy he might have a 30% chance of life.

Now Joe has a decision to make. He can forgo the "life-saving" techniques and savor the few remaining weeks he has left, or he can place his life into the hands of modern medical science.

But there is a problem. As long as "Joe" remains in control of his life, he can walk into his back yard and blow his brains out. Until he places his life in the hands of the medical "do gooders" he remains in control. He has the "right to die", that is until he signs over this right to those who will try to save his life.

Once "Joe" decides to give up the "right" to end his life when he chooses, he is in it for the long haul. No matter how unbearable his existence might become after his decision, he decided. He is no longer in charge, now all the Doctors make the decisions for him. (Not quite accurate, he still maintains authority in his treatment, however he still might be forced to face suffering during his journey to death.)

Why must the patient be forced to decide to exercise his "right to die" before he even gets to see if "modern medical science" might be able to save him?

All humans have the right to die (until they put the Doctor in charge). However they do not allow you to bring your handgun into the hospital. Once you enter the hospital, you surrender your "right to die" to the hands of the medical system. They might save you, however the "treatment" might entail insufferable pain while the outcome becomes increasingly grim.

What is so sacred about hospital sheets that suicide is not allowed? Are Doctors trying to motivate people to engage in suicide only in their own bedsheets or something?

Look, if Doctors do not want to prescribe what is necessary to end things, then just allow patients to bring handguns into the hospital when they seek treatment and allow the handgun to be within easy reach.

Even Doctors should not have the ability to deny the "right to die".


Blogger Michael said...

Good points Little David.

As I stated early in my article, there would seem to be a strong civil liberties argument for the right to choose death (and as you pointed out, there are many methods to suicide for the "intrepid").

I think perhaps you have hit the nail on the head. We as medicos do not "fear death" as such for our patients. You don't have to be working very long to be dealing with dying patients (there is a 100% mortality rate to life!) However, there has always been a moritorium on assisted suicide on the part of the medical profession. It is part of our ethical code.

The reason for this is simple. Doctors are humans. We make mistakes. Within the ranks of our profession is the spectrum of saint to demon. The various ethical restraints we put on ourselves are to protect the public with a limitations on what is considered acceptible behaviour.

I'll use another situation as an analogy. Doctors are generally forbidden to enter into sexual relationships with current patients or ex-patients. Now, you make ask, where is the harm in two consenting adults entering into an intimate relationship if they agree to terminate the doctor-patient relationship?

The answer is that there is probably no harm in the well intentioned setting, BUT, there can be plenty of harm for the unscrupulous.

With regards to euthanasia, it isn't so much that "well meaning" physicians would do a bad job, but rather, it creates a difficult to monitor and police pathway for the psychopathic (e.g., Harold Shipman).

At the end of the day I do not believe that there is clear consensus within most Western societies on what is allowable and what is not allowable in the context of euthanasia. As I mentioned in my article, there are often many hidden players and pressures in end of life decisions. The choice of death necessarily removes all possibility of a change of mind (unlike, a "choice of life") and thus must be a very well considered decision.

Michael Tam

2/10/2007 05:26:00 AM  
Blogger Little David said...

I believe you make valid points in regards to how this argument must take into account the Doctors themselves and how current practices and laws were not adopted arbitrarily.

However, at least here in America, some compromises seem to have been reached. As an example, it seems to be generally acceptable practice to give a patient suffering from severe pain enough medication to cause him to become unconscious (although not enough to cause death). Even this practice is not universally acceptable to all Doctors however. I read of a poll of American Doctors which showed a significant minority of them opposed such a practice and would not engage in such a practice themselves. However a similiar portion of those polled also felt removing life support from a terminal patient was also unacceptable.

Again, I understand the need to control "unethical" medical practitioners. However I feel the "rights" of the patient also need to be taken into account.

I myself firmly believe in the "right to die". However, I also acknowledge that my beliefs are probably in the minority on this issue. It is my understanding that the United States Supreme Court has ruled there is no such right.

2/11/2007 05:44:00 AM  
Blogger Michael said...

The US is a little bit funny in this regard in that there is a clear undercurrent of Christian conservatism in many policy areas.

This is not the case in Australia or much of Europe.

I believe that a recent poll in Australia showed that 70% of the population believed in the "right to die" (though not necessarily legalised euthanasia).

With regards to palliation to the point of unconsciousness (or at least, significantly sedated), that is rarely needed to keep someone comfortable.

In any case, I would be surprised of any medical practitioner who does not agree that this practice is entirely compatible with their moral obligation of relieving suffering (without causing death). I can see no religious justification opposing this.


2/12/2007 03:18:00 AM  
Blogger Little David said...

Well, in America, some cracks are starting to appear.

In the state of Oregon, assisted suicide of terminal patients by attending physicians is now legal. It is pretty strongly regulated, I can no longer recall all of the details, however I seem to remember that they had to have been evaluated as being within 6 months of death. Some consideration (I do not remember if a formal psychiatric workup was required) as to the patients mental condition, etc.

It is my hope that the practice eventually spreads to my own state, however I am not going to hold my breath. Oregon is a rather liberal state while Virginia (my own) is at least more moderate, if not slightly right of center. It would have to be adopted state by state because, as I said, the Supreme Court has ruled there is no "right to die" so the states can not be forced to adopt the practice by the federal government.

2/12/2007 08:47:00 AM  

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