Good Example Of Argumentative Essay On Human Euthanasia In 2015

Abstract

The debate today continues to rage over euthanasia and whether a physician should be in charge of ending the life of another person.  Students of history know that societies who devalue human life even in the smallest amount tend to devalue human life in greater proportions later.  While many religions hold different ideals and values, most of them can agree that physician-assisted suicide/euthanasia is something to be opposed.  The Hippocratic Oath itself forbids the administration of lethal medications, even if it is for mercy.  Different societies on our world are experimenting needlessly with euthanasia today, and have been for years, without apparent negative outcomes for anyone.  The alternative to euthanasia used by others, palliative sedation, is allowing patients to die naturally without any pain or discomfort whatsoever, physical or psychological, and allows the physician to honor their Oath and the nurses to do what nurses do best: Care for their patients and make them comfortable.

Introduction

Patients with terminal illnesses and severe pain, suffering, and/or discomfort may seek out physicians in order to help end their lives.  It is the physician's role to determine exactly what to do with this person.  Understanding the motivation is critically important to physicians because many of them have been asked for assistance in [physician-assisted suicide] (Pearlman et al, 2005).  In certain societies around the world where physician-assisted suicide is legal; how many of the people who undergo this medical procedure do it out of a feeling of duty?  No one wants to be a burden on their loved ones or a financial drain.  With the knowledge we have today, it is unnecessary for any person to have their life prematurely ended, even if that prematurity is only a couple of days.  Physicians have tools available to them to ease pain and symptoms of discomfort, and when all else fails, they have the ultimate solution of "palliative sedation."  If this level of care is necessary, the patient is made unconscious and becomes unaware of all the physical and emotional pain they were in, and are allowed to die naturally without having to be conscious or aware of it.  Palliative sedation has been proposed as an ethically acceptable alternative to physician aid in dying (Veterans Health Administration, 2006).  The patient's comfort is of utmost importance, and when our time comes, as it will for all of us, we will have available to us the medications that will ease our pain and discomfort, and if necessary, even our consciousness.

Physician-Assisted Suicide Yesterday and Today

There is a debate going on all throughout the world today over whether or not a physician should be responsible for ending the life of another human being because of hopeless circumstances, refractory pain and suffering, and a voluntary patient (or voluntary family members). The history of euthanasia sometimes is something most people would like to forget, and an area that many insist is the reason why the practice should be forbidden. Some countries around the world, and indeed states within the United States, have allowed the practice of physician-assisted suicide, and have reported their results. Churches from around the world have given their official positions whether or not they believe one human being should end the life of another. The decision over whether to allow physicians the responsibility, the duty, to take another human life continues.
Perhaps the most often cited argument against euthanasia is the "slippery slope" theory. The idea that once the lives of terminally-ill people are ended by physicians, then the next step would be the disabled, mentally ill, and/or criminals. The Anti-Defamation League (2006)'s article reported:
Dr. Leo Alexander, a medical consultant at the Nuremberg Doctors’ Trial, wrote in the New England Journal of Medicine a warning to the American medical profession:
Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually, the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the nonrehabilitable sick.
Extreme cases in the history of the debate include people like Dr. Kevorkian, who seemed maybe a bit too eager to assist his patients in suicide, or when the physician-assisted suicide group "Final Exit" assisted a man's suicide by instructing him to put his head into a hood filled with helium, except it turned out the man was cancer free and instead had facial deformities from the treated cancer.  The chronology of the debate for the U.S. begins as long ago as 1906 when a bill in Ohio to make physician-assisted suicide legal was defeated.  This debate is not going to end anytime soon.
The Netherlands, Belgium, Colombia, and Luxembourg have passed laws making physician-assisted suicide legal.  Switzerland even allows non-physicians to assist in suicide.  Oregon, Vermont, Washington, and Montana allow physician-assisted suicide.  It will soon be legal in Canada for a physician to aid in the death of a terminally-ill human being.  Judith Reitjens (2009) argues that after two decades of physician assisted suicide in The Netherlands, "it has been shown that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts” (Rietjens et al 2009).  It is notable that all of the countries and states who have engaged in physician-assisted suicide/euthanasia, no evidence has been presented of "slippery slope" outcomes, at least not so far.  It is also possible that 20 years along with only partial acceptance of the act by the society is restraining the ultimate, inevitable outcome of devaluing human life.  Churches across the world have made statements regarding physician-assisted suicide and euthanasia.  The United Church of Christ and the Unitarian Universalist Association both support the role of a medical doctor to end the life of a patient.  However, on the other side, numerous churches are opposed to the idea, including Judaism, Islam, Hinduism, Catholicism, The Mormon Church, Buddhism, and many more.  One aspect all the churches do seem to agree on is that extraordinary treatment to extend life need not be administered in the terminally-ill patient, and that even withholding medical treatments, and even hydration, in the dying patient is acceptable.  It is the act of taking the human life, no matter what the reason, that is the issue.  Based on the fact that churches are made up of people, a lot of people, it must be entered into evidence for this report, and their views are important.
Euthanasia and/or physician-assisted suicide may be legal in some parts of the world and even some parts of the United States, but the fact is that it is a violation of the physician's Oath, and an unnecessary medical procedure given the alternatives available.  Numerous religious bodies around the world oppose this practice.  Most notably, history has shown us what happens with a society devalues human life.  The role of the medical community is to ease pain and suffering and extend life, not to end it.

Realistic Alternatives with Better Outcomes

The argument for physician-assisted suicide and euthanasia is made because of an empathetic view that the patient is enduring intolerable pain and suffering, death is imminent, and it is the right thing to do to end the patient's life ourselves.  This is not the case.  In cases that involve patients with refractive pain not responding to traditional methods of opiates and symptomatic care, the solution is clear: palliative sedation.  Nurses and doctors are highly trained and capable of performing end-of-life care including this procedure.  Palliative sedation will allow the physician to keep their Oath and never administer a dose of medication that will end their patient's life.  With the advent of this end-of-life procedure, it seems the argument over physician-assisted suicide is at an end.
When the physician determines that life expectancy is just days or less and the pain the patient is in is intolerable and not responding to treatment, the patient can be sedated to unconsciousness and kept there until death (or, if condition improves, allowed to awaken).  For patients suffering from severe pain, dyspnea, vomiting, or other intrusive symptoms that prove refractory to treatment, there is a consensus that palliative sedation is an appropriate intervention of last resort (Veterans Health Administration, 2006).  Physicians treat pain and suffering in end-of-life care, and when all else fails and the patient continues to suffer, palliative sedation is the answer.
Doctors specifically trained in palliative and end-of-life care are capable of knowing when a patient is ready for palliative sedation, and the nurses who administer the sedative and care for the sedated patient are trained in this medical procedure as well.  The following algorithm has been proposed to help clinicians determine when a symptom is truly refractory: (1) Are further interventions capable of providing further relief? (2) Is the anticipated acute or chronic morbidity of the intervention tolerable to the patient? (3) Are the interventions likely to provide relief within a tolerable time frame?  If the answer to any of these three questions is “no,” then these are refractory symptoms for which palliative sedation may be considered (Veterans Health Administration, 2006).  When the patient meets the criteria, the physician will order the procedure, and the patient will be unconscious and not able to feel pain or suffer any longer, the ultimate act of kindness any human being can perform on another.  This allows the body to die naturally while allowing the person to escape the process, and maintains the integrity of the healer and caregivers.
Hippocrates said it best when he took his own Oath and passed it onto his students.  The Hippocratic Oath includes the unambiguous statement: I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.  The physician is unable to deliver the lethal drug necessary in physician-assisted suicide and maintain their word of honor, which, arguably, is the basis of being a trusted physician.  The sedative given during palliative sedation is not a lethal substance, it is a drug to make the patient sleep, to numb the patient fully from any and all pain, both physical and psychological.
There is nothing more to argue.  There is no real, justifiable reason to end a patient's life.  Physicians are healers and nurses are caregivers, not executioners and undertakers.  With the advent of palliative sedation, there is no pain too great to treat with medication, and keeping that in mind, there is no need to interfere with the natural course of life.  No more extraordinary means to prolong life, at the end, the only thing that matters is comfort, and when there is no comfort to be had, palliative sedation is the last resort.

Conclusion

History has shown us exactly what happens in a society that no longer values human life; it begins with mercy, the terminally ill and suffering, and then it grows.  Even the Father of Medicine, Hippocrates, could see the inherent danger his profession could bring, and in his Oath, his students had to promise never to give a patient a fatal medicine.  Governments around the country and the world have seen fit to legalize the practice.  Churches around the world stand against it, valuing human life to the end, acknowledging that we as human beings have no right to take another human life.  Euthanasia is an unnecessary practice to prevent pain and suffering.  There is no pain too great that can cause discomfort to a person who is unconscious.  With palliative sedation, the unconscious state can last as long as it needs to, either until death or until the pain passes and the condition improves.  People are not burdens.  We can never allow a human being to feel it is necessary for them to die so as not to be a burden to others.  Physician-assisted suicide/euthanasia should be a forbidden act.

Bibliography

American Medical Association. (1991). Opinion 2.211 of the AMA Medical Ethics: Physician-assisted suicide. Last revised 1996. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page?
Anti-Defamation League. (2006). Nuremberg Trials 60th Anniversary - Medical Trial Judgment. Dimensions: A Journal of Holocaust Studies, vol 19. Web. Retrieved from http://archive.adl.org/education/dimensions_19/section3/judgment.html#.VS6PeXlOW8s
Pew Research Center. (2013). Religious Groups' Views on End-of-Life Issues. Retrieved from http://www.pewforum.org/2013/11/21/religious-groups-views-on-end-of-life-issues/
Alexander, Leo. (1949). Medical Science Under Dictatorship. The New England Journal of Medicine, vol 241(2). Web. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJM194907142410201
Chambaere, Kenneth, Stichele, Robert V, Mortier, Freddy, Cohen, Joachim, and Deliens, Luc D. 2015. Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium. New England Journal of Medicine, vol 372, 1179-1181. Web. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMc1414527
Claessens, Patricia, Genbrugge, Ellen, Vannuffelen, Rita, Broeckaert, Bert, Schotsmans, Paul. (2007) Palliative Sedation and Nursing: The Place of Palliative Sedation within Palliative Nursing Care. Journal of Hospice and Palliative Nursing, vol 9(2), pp 100-106.
Givens, Jane L. and Mitchell, Susan L. (2009). Concerns About End-of-Life Care and Support for Euthanasia. Journal of Pain Symptoms Management, vol. 38(2), 167-173. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782598/
Golden, Marilyn. n.d. Why Assisted Suicide Must Not Be Legalized. Disability Rights Education & Defense Fund. Web. Retrieved from http://dredf.org/assisted_suicide/assistedsuicide.html
Gholipour, Bahar. (2013). Should Physician-Assisted Suicide Be Legal? Poll Shows Divide Among Experts. Huffingtonpost.com. Web. Retrieved from http://www.huffingtonpost.com/2013/09/12/physician-assisted-suicide-legal_n_3913400.html
Humphry, Derek. (2006). Chronology of Assisted Dying. Death with Dignity National Center. Web. Retrieved from http://www.deathwithdignity.org/historyfacts/chronology
Norman, Gail V. (2012). The Ethics of Ending Life: Euthanasia and Assisted Suicide, Part 1. The Language of Ending Life. California Society of Anesthesiologists. Ed. Winter 2012, pp 78-82.
Pearlman, Robert, Hsu, Clarissa, Starks, Helene, Back, Anthony L, Gordon, Judith R, Bharucha, Ashok J, Koenig, Barbara A, Battin, and Margaret P. (2005). Motivations for Physician-assisted Suicide - Patient and Family Voices. Journal of General Internal Medicine, vol 20(3), pp 234-239. Web. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490083/
Pickert, Kate. (2009) A Brief History of Assisted Suicide. Time. Web. Retrieved from http://content.time.com/time/nation/article/0,8599,1882684,00.html
Rietjens, Judith A, van der Maas, Paul J, Onwuteaka-Philipsen, Bregje D., van Delden, Johannes J., and van der Heide, Agnes. (2009). Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain? Journal of Bioethical Inquiry, vol 6(3), 271-283. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2733179/
Verhagen, E and Sauer, P. (2005). The Groningen Protocol - Euthanasia in Severely Ill Newborns. New England Journal of Medicine. Vol 352, pp 2353-2355. Web. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJM200506023522217
Annotated Bibliography
American Medical Association. (1991). Opinion 2.211 of the AMA Medical Ethics: Physician-assisted suicide. Last revised 1996. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page?
The AMA's opinion is directly against the practice of physician-assisted suicide. The physician must not give up on the patient upon diagnosis of a terminal disease. End-of-life care is paramount and should include specialty consultation, hospice care, pastoral support, and counseling, along with other forms of care. Emotional support and pain control must be offered. The AMA is clearly opposed to physician-assisted suicide. This opinion is extremely valuable in the argument over physician-assisted suicide and euthanasia.
Anti-Defamation League. (2006). Nuremberg Trials 60th Anniversary - Medical Trial Judgment. Dimensions: A Journal of Holocaust Studies, vol 19. Web. Retrieved from http://archive.adl.org/education/dimensions_19/section3/judgment.html#.VS6PeXlOW8s
This article was extremely relevant to the research on euthanasia and physician-assisted suicide. The Anti-Defamation League compiled the information from the Nuremberg Trials after WWII about the medical experimentation and other crimes committed in the name of science. A code of ethics was generated from this trial regarding human experimentation, a positive from the terrible chapter in human history, and is part of the article. Otherwise, the quotations, warnings, really, from Dr. Leo Alexander are extremely informative and must be included in this research.
Pew Research Center. (2013). Religious Groups' Views on End-of-Life Issues. Retrieved from http://www.pewforum.org/2013/11/21/religious-groups-views-on-end-of-life-issues/
This compilation of the official positions of different churches is valuable to the debate. While the vast majority of churches surveyed oppose physician-assisted suicide/euthanasia, they all seem to agree that extraordinary measures to keep the body alive are not necessary. It is the actual act of ending life that is against their views. Even removing hydration and other life-prolonging acts is seen as acceptable.
Alexander, Leo. (1949). Medical Science Under Dictatorship. The New England Journal of Medicine, vol 241(2). Web. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJM194907142410201
This article from the physician who gave testimony at the Nuremberg Trials was truly astonishing. His point of view is extremely important to the debate today. The diminishing value of life by a society is an important sign to watch for. Perhaps, based upon this man's testimony, it is time to reevaluate how we view life, the role of medicine and doctors, and how we care for those in our societies who cannot care for themselves, lest we go down a path we have been down before.
Chambaere, Kenneth, Stichele, Robert V, Mortier, Freddy, Cohen, Joachim, and Deliens, Luc D. 2015. Recent Trends in Euthanasia and Other End-of-Life Practices in Belgium. New England Journal of Medicine, vol 372, 1179-1181. Web. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMc1414527
This article was important to the research because of its statistical data and the very recent publish date (March 15, 2015). This was really a comparison between euthanasia rates in Belgium and The Netherlands, demonstrating that Belgium now has even higher rates of euthanasia than The Netherlands, including higher rates of requests and acceptances. The rate of (reported) euthanasia in Belgium jumped significantly between 2007 and 2013 as compared to 2001 to 2007, demonstrating a greater acceptance of the practice in the country.
Claessens, Patricia, Genbrugge, Ellen, Vannuffelen, Rita, Broeckaert, Bert, Schotsmans, Paul. (2007) Palliative Sedation and Nursing: The Place of Palliative Sedation Within Palliative Nursing Care. Journal of Hospice and Palliative Nursing, vol 9(2), pp 100-106.
Nurses have an incredibly important role when it comes to palliative sedation. The physician writes the order and determines the dose of medication but then it is up to the nurse to deliver the medication and keep the patient comfortable, clean, and cared for during the procedure. The emotional toll placed on the nurses is very large, as these people they are caring for so intimately in the very end of their life. The debate over physician-assisted suicide at times equates palliative sedation to physician-assisted suicide, so the nurse may have to deal with the psychological impact of what they are doing, actually administering the sedative. This is an interesting perspective and an important one to note in the research, what are the societal costs for the people who actually physically give the medication that may end the life of the terminally-ill person?
Givens, Jane L. and Mitchell, Susan L. (2009). Concerns About End-of-Life Care and Support for Euthanasia. Journal of Pain Symptoms Management, vol. 38(2), 167-173. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782598/
This article gives the statistical analyses of the study into end-of-life care and euthanasia based on a survey from 1998 that demonstrated an estimated 70.6% of respondents approved of euthanasia of human beings facing a terminal illness. Findings reveal that people were more likely to support euthanasia if they had concerns about making family members decide their medical decisions on their behalf, the burden of expensive care on their families, and lack of insurance coverage. Essentially, this article makes the case that euthanasia is the answer for people who do not want to be a burden to their family members or to society.
Golden, Marilyn. n.d. Why Assisted Suicide Must Not Be Legalized. Disability Rights Education & Defense Fund. Web. Retrieved from http://dredf.org/assisted_suicide/assistedsuicide.html
The vulnerable people who know history are voicing their opinions about the legalization of physician-assisted suicide and euthanasia. The people with disabilities feel that they could be endangered by laws like this and the embracing of euthanasia by a society. Today it is the terminally ill and suffering, could tomorrow be the elderly and disabled who cannot take care of themselves? This ultimately goes back to the "slippery slope" argument, but is valid nonetheless, as history as our witness.
Gholipour, Bahar. (2013). Should Physician-Assisted Suicide Be Legal? Poll Shows Divide Among Experts. Huffingtonpost.com. Web. Retrieved from http://www.huffingtonpost.com/2013/09/12/physician-assisted-suicide-legal_n_3913400.html
This is a poll conducted by the New England Journal of Medicine among its readers that demonstrated 65% of 2,356 votes from 74 countries were opposed to the idea of physician-assisted suicide. The majority of physicians do not see their role in medicine as ending life. This article also questions whether or not the next step in physician-assisted suicide would be physician-assisted euthanasia, as history shows.
Humphry, Derek. (2006). Chronology of Assisted Dying. Death with Dignity National Center. Web. Retrieved from http://www.deathwithdignity.org/historyfacts/chronology
This chronology is a list of legal proceedings and notable facts throughout the past 100+ years or so involving the debate over physician-assisted suicide. 1906 saw the first bill in the United States to legalize euthanasia in Ohio and was defeated. Societies throughout the western world began appearing to support euthanasia. The legal challenges continue in the U.S., bill after bill being defeated all the way up to the Supreme Court, which also defeats the idea of physician-assisted suicide. The list is now up to 2013 and lists states within the U.S. passing laws legalizing physician-assisted suicide.
Norman, Gail V. (2012). The Ethics of Ending Life: Euthanasia and Assisted Suicide, Part 1. The Language of Ending Life. California Society of Anesthesiologists. Ed. Winter 2012, pp 78-82.
This article was about the legal basis for euthanasia and a brief history of selected cases in which physicians had been charged with a crime. Many definitions were presented that expand further the information in the legal debate. Interesting note, in Switzerland even a non-physician can legally assist in a euthanasia.
Pearlman, Robert, Hsu, Clarissa, Starks, Helene, Back, Anthony L, Gordon, Judith R, Bharucha, Ashok J, Koenig, Barbara A, Battin, and Margaret P. (2005). Motivations for Physician-assisted Suicide - Patient and Family Voices. Journal of General Internal Medicine, vol 20(3), pp 234-239. Web. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490083/
Knowing the motivation for patients who consider physician-assisted suicide is extremely important. This article discusses the study done on patients and family members who underwent physician-assisted suicide or contemplated it. The findings showed that patients and family members deliberated about this for long periods of time and the basis was not due to depression or hopelessness, but mostly about loss of sense of self and independence, dignity, fear of the future, and psychological suffering.
Pickert, Kate. (2009) A Brief History of Assisted Suicide. Time. Web. Retrieved from http://content.time.com/time/nation/article/0,8599,1882684,00.html
The extremely negative cases surrounding physician-assisted suicides are depicted in this article. While this type of article is not ideal for research, the extreme cases it discusses are important for the debate. Terry Schaivo, Dr. Kevorkian, and other similar cases are not representative of the whole argument, although the outliers show just what legalization would mean.
Rietjens, Judith A, van der Maas, Paul J, Onwuteaka-Philipsen, Bregje D., van Delden, Johannes J., and van der Heide, Agnes. (2009). Two Decades of Research on Euthanasia from the Netherlands. What Have We Learnt and What Questions Remain? Journal of Bioethical Inquiry, vol 6(3), 271-283. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2733179/
This article was very interesting in that it demonstrates that euthanasia/physician-assisted suicide exists and is simply unreported, for the most part. The government of The Netherlands simply legalized an existing practice. A benefit of this legalization was that it created criteria that must be met in order for a physician to legally participate in euthanasia, hopefully to standardize care and maximize the benefit to the patient. The authors were careful to point out in the abstract that "no slippery slope has occurred." This is good, of course, although it should have read "no observable slippery slope has occurred since the law legalizing euthanasia in The Netherlands in 2002."
Verhagen, E and Sauer, P. (2005). The Groningen Protocol - Euthanasia in Severely Ill Newborns. New England Journal of Medicine. Vol 352, pp 2353-2355. Web. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJM200506023522217
Euthanasia is not just for terminally-ill elderly people. There are cases in which newborns (at least in The Netherlands, and again, these cases were reported) who are in such dire condition that they undergo euthanasia as well. The protocol seems logical, everyone must agree, parents, physicians, and then after the fact the decision must be reviewed by the ethics board.