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End of life decisions

There are many decisions we make in our lifetime that affect how we live our lives. We choose where we live, with whom we live, and how we live (education, marriage, children, career, etc.). Everyone knows that death is the inevitable end result regardless of those decisions; however we still attempt to control our circumstances. Death, however, has control over how and when it will occur. Of course, there are things we can do to facilitate its arrival, however in most cases death makes the decision. Why? Death should not be something that takes the dignity out of a person's life; it should be allowed to occur in a manner that suits the person's life, in terms of a patient who is dying of a terminal illness. There should not be a law that mandates suffering or pain for people who actively wish to die sooner rather than live longer in a manner that is not consistent with their normal life (i.e. Alzheimer's patients, some cancer patients, AIDS patients, etc.). There are both ethical and legal obligations that not only healthcare providers, but the government as well need to take into consideration in order to maintain a person's right to die.

Ethical responsibilities at the end of life

As a healthcare provider, it is critical that we behave in an ethical manner regardless of the situation we find ourselves in. Ethics are often thought of as concrete, no discussion principles, when in fact, they are oftentimes very dynamic and ever changing (AAPA, 2007). In regards to a patient's right to die, it is important that we look at four basic ethical principles and their impact on this incredibly difficult situation. First, there is the ethical principle of autonomy. Autonomy can be defined as a person's ability to make decisions for themselves and choose the path they intend on taking on their own (AAPA, 2007). In the case of a person's right to die, it is important that we take into consideration the fact that that decision is being made of sound mind and unsound body; but nonetheless by the patient (Hinman, 2007). There are many people who believe that a patient has the right to end their life rather than live their lives in a painful, debilitating state (AAPA, 2007). In 1991, 60% of American supported physician assisted suicide as a means to an end in terminal cases (AAPA, 2007). In 2007, Great Britain performed a survey of public opinions where they found 80% of the populous in favor of legalizing physician assisted suicide (Bennett, 2007).

Beneficence can be defined as doing what is right by the patient, what is in their best interest (AAPA, 2007). By regarding their autonomy and their wishes, healthcare providers can ethically perform their duties within the boundaries of their ethical obligations. It is important that the patient be the one requesting euthanasia on their own, not based on a suggestion by their physicians. Nonmaleficence is defined by not imposing harm to the patient or doing something that is unnecessary or will impose an unacceptable burden on the patient (AAPA, 2007). In this case, allowing a patient to continue to live in pain or agony is just as unethical as allowing them to die. This is where ethics can often straddle a fine line and it is extraordinarily important to talk to the patient to find out what their true intentions are. Another solution to bridge this ethical gap is terminal sedation or a procedure to increase comfort after a life sustaining device is removed from a patient (AAPA, 2007). By performing terminal sedation, the physician allows the patient to die in comfort instead of in the agonizing pain that can be accompanied by the removal of artificial life support thus eliminating the burden of death for the patient (AAPA, 2007).

Finally, there is the issue of justice. Justice is ensuring that all patients are being treated in the same manner and are receiving the same care as anyone else (AAPA, 2007). Court rulings have established the right of the patient to discontinue treatments such as respirators and artificial nutrition in order to allow patient's to die, yet not all who ask are granted the same permission (Public Agenda, 2007). This is considered justice to those who received the answer they wanted, but the decisions were only made concerning that particular case and didn't truly help other patients. To ethically achieve justice, there needs to be a decision reached that affects all patients in this situation, not just in one case.

"Every death takes place in a unique set of circumstances (AAPA, 2007)."

It is important that the law back the physicians and their patients in situations where assisted suicide is requested. In some instances, patients are going to end their lives with or without the help of their physician, so in some regards, it is just as well the law allow the physician to help the patient achieve dignity in their end. Although the law should provide for all patients, not just individuals; it is imperative that the law make specific regulations regarding who will be allowed to participate in assisted suicide. The plan outlined here calls for a five step approach to being granted permission to participate in assisted suicide.

Step 1: A patient who wishes to end their life should be allowed to petition the court to have a lethal dose administered.

Step 2: The court then should review the patient's medical situation, their request, and their mental stability prior to issuing a "court date" to take place within 30 days of the initial petition.

Step 3: The patient must find a doctor willing to either prescribe or administer the lethal dose prior to their court date. The physician must then be at the court date to take responsibility for the patient.

Step 4: The court date will discuss the judges ruling as well