Physician Assisted Suicide Case Study Essay | nomrmasq.gq

 

physician assisted suicide case study

Physician Assisted Suicide Case study Essay - Diane: A Case of Physician Assisted Suicide Diane was a patient of Dr. Timothy Quill, who was diagnosed with acute myelomonocytic leukemia. Diane overcame alcoholism and had vaginal cancer in her youth. She had been under his care for a period of 8 years, during which an intimate doctor-patient bond. This is why so many veterans who returned from Vietnam had to undergo psychiatric examination and treatment. This is because killing by whatver name destroys one emotionally. Legislating physician assisted suicide will do more harm to the physician than to the patient. It will destroy the physician. This cannot be allowed to happen. Section 5. Case Study. Douglas Graudons. Case Study Module Title: The Velma Howard Case (Assisted Suicide) Description of the case: Mrs. Velma Howard, a year-old female, was afflicted with ALS (Lou Gherig's Disease) and starting to deteriorate rapidly.


Physician Assisted Suicide | Case Study Template


In her paper, The case for physician assisted suicide: not yet provenBonnie Steinbock argues that the experience with Oregon's Death with Dignity Act fails to demonstrate that the benefits of legalising physician assisted suicide outweigh its risks. Given that her verdict is based on a small number of highly controversial cases that will most likely occur under any regime of legally implemented safeguards, she renders it virtually impossible to prove the case for physician assisted suicide.

In this brief paper, we suggest some ways that may enable us to weigh the risks and benefits of legalisation more fairly and, hopefully, allow us to close the case for physician assisted suicide.

Because of a legal injunction, implementation of the act was delayed by almost three years. After multiple legal proceedings, including a petition that was denied by the United States Supreme Court, the Ninth Circuit Court of Appeals finally lifted the injunction on October 27, The Death With Dignity Act DWDA allows mentally competent, terminally ill patients who are over 18 years of age and residents of the state of Oregon to obtain a prescription for a lethal dosage of medication to end their own life in case their suffering becomes unbearable.

The prescribing physician and a consulting physician have to confirm the diagnosis and the prognosis. If either doctor believes the patient's mental competence is impaired, he must be referred for a psychiatric or psychological evaluation. The prescribing physician is required to inform the patient of potential alternatives to PAS, such as comfort care, hospice care, and pain control. Between andphysician assisted suicide case study, individuals died under the provisions of the DWDA.

In16 Oregonians used PAS, followed by physician assisted suicide case study in27 in21 in38 in42 inand 37 in Thus, PAS accounts for only one in 1, deaths among Oregonians.

Interestingly, about 36 per cent of patients who obtained a lethal dose of barbiturates from a doctor never used it, suggesting that all these patients sought was control over the manner and timing of their deaths.

Of the patients, died at home; only one died in an acute care hospital. Opponents of the act predicted that the patients most likely to avail themselves of PAS would be the poor, the ill educated, physician assisted suicide case study, and the uninsured who are without access to adequate hospice care. On average, 86 per cent of patients physician assisted suicide case study the act are enrolled in hospice care. As a matter of fact, it seems that the legal option of PAS may actually have contributed to the improvement of end of life and hospice care in Oregon.

As the Oregon Department of Human Services points out:. While it may be common for patients with a terminal illness to consider physician assisted suicide, a request for a prescription can be an opportunity for a medical provider to explore with patients their fears and wishes around end of life care, and to make patients aware of other options. Often once the provider has addressed patients' concerns, they may choose not to pursue physician assisted suicide.

The availability of assisted suicide as an option in Oregon also may have spurred Oregon doctors to address other end of life care options more effectively. In one study Oregon physicians reported that, since the passage of the Death with Dignity Act inthey had made efforts to improve their knowledge of the use of pain medications in the terminally ill, to improve their recognition of psychiatric disorders such as depression, and to refer patients more frequently to hospice. Although Bonnie Steinbock concedes that the dire predictions of a wholesale abuse of Oregon's DWDA have clearly been proven wrong, she remains sceptical as to whether aid in dying really physician assisted suicide case study a sea change in medicine and law.

The discussion should continue. At present, the case for legalising PAS seems to me to be still—in the words of the Scottish verdict—not proven. Apparently, for two reasons. First, partisanship on the issue of PAS makes it extremely difficult to assess the Oregon data objectively. Proponents of PAS interpret the statistics in a strikingly different way from its opponents.

And second, there have been several reports about abuses of the Oregon DWDA, suggesting that the existing safeguards do not work. These cases of alleged abuse involve patients who might have been mentally incompetent or clinically depressed. We do not want to get into this debate. Let it suffice to say that the mere fact that most of the allegations of abuse come from the author of Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder3 should at least make us pause.

I think if there were any abuses in the law, we would hear of it. Although we agree with most of Steinbock's excellent paper, her overly cautious, if not outright disheartening conclusion calls for five critical comments. More specifically, it tacitly assumes that the legalisation of PAS may have put the terminally ill at greater risk.

What makes her think, however, that this physician assisted suicide case study really the case? Most likely, the highly controversial claims that there have been a number of abuses in Oregon.

Yet even if these allegations were true, we are simply in no position to make the claim that the terminally ill have become more vulnerable since the legalisation of PAS. To demonstrate that, we would need to have at least two sets of empirical data: data collected before and data collected after the passage of the DWDA.

Only then would we be in the position to determine whether the terminally ill have become more or less vulnerable. Given that there are no data on the incidence of abuse prior to the legalisation of PAS, we simply cannot claim that the terminally ill are now at a greater risk.

Second, given that her advice that other US states should wait for some more years before jumping on the PAS bandwagon is solely based on the highly controversial claims of abuse, it is simply unwarranted.

Does she really believe that physician assisted suicide case study for, say, another seven years will actually resolve the controversy over Oregon's DWDA? That is highly unlikely! There will always be claims of abuse. If no one else will, Wesley J Smith will make sure of it, physician assisted suicide case study. Personally, we hope that Vermont and California will follow Oregon's lead. These states might, however, indeed be well advised to implement some additional legal safeguards, such as a mandatory assessment by psychiatrists for all patients seeking PAS.

Implementing more stringent safeguards will by no means guarantee that there will not be any claims of abuse, but it may at least reduce the number of wrongful allegations. Third, by relying on dubious claims of abuse and by attempting to dissuade other US states from following Oregon's lead, Steinbock makes it virtually impossible to prove the case for PAS. Fourth, Steinbock appears to be inconsistent in applying her own approach.

As already mentioned, there is ample reason to doubt that the cases Steinbock highlights did involve any abuses. We do not deny, however, that abuses may, indeed very likely will, occur. No system is foolproof and no legislation without risk, physician assisted suicide case study. It is, of course, a tragedy if someone capable and desirous of enjoying life meets an untimely death as a result of abuse of PAS legislation, in Oregon or elsewhere; but discovery of such cases would not serve to demonstrate that the legislation is flawed, physician assisted suicide case study.

Abuses will occur under any legislative regime, whether PAS is permitted or not. Steinbock asks us to assess the need for and the risks of PAS. We endorse her call, physician assisted suicide case study. She, however, has not done this. Which brings us directly to our fifth and final critical comment on her paper. Let us say that among the cases physician assisted suicide case study PAS there have been five such cases.

Would these five cases outweigh the remaining cases? If not, physician assisted suicide case study, physician assisted suicide case study about 10 such cases? How many cases of abuse ought to be tolerated before we can say with certainty that the risks of PAS outweigh the need for PAS?

Unfortunately, we are not told. At least in theory, the answer to the question of how many abuses can be tolerated could go like this: we should tolerate the same level of abuse in PAS that we tolerate in forgoing life sustaining medical treatment FLSMT. Just as the poor, the elderly, the disabled, and the clinically depressed can be subtly pressured into PAS, so they can be subtly pressured into FLSMT. And just as physicians concerned about the costs of medical treatment can subtly pressure patients into requesting PAS, physician assisted suicide case study, they can subtly pressure patients into requesting FLSMT.

We do not, however, have any such data, physician assisted suicide case study. Also, establishing the number of deaths resulting from subtle pressures to forgo life sustaining medical treatment, it seems, is simply impossible, physician assisted suicide case study.

A more practical way to determine an acceptable level of risk in physician assisted suicide is by relying on comparisons of the incidence of withdrawing or withholding life sustaining medical treatment without the patient's explicit request WTWER.

This lack of involvement even occurred in cases where the patients were conscious and could have participated in the decision. Perhaps an open debate physician assisted suicide case study a tolerant policy are not that bad after all. Although we do not have comparable data for Oregon, it is not unreasonable to assume that legalisation of PAS may have appreciably reduced the number of doctor's decisions to WTWER.

If so, we certainly have to take this into account when balancing the benefits and risks of legalising PAS. Let us conclude by advancing some additional suggestions as to how the case for PAS might possibly be proven.

As already indicated, assessing PAS is a comparative matter: we need to know what potential there is for abuses under a particular legislative regime, as compared, not only to other legislative regimes that permit PAS, but also to others that ban it. All means of regulating end of life medical treatment have their risks of abuse. Doctors may collude with one another, or maverick doctors may act alone; incompetent patients may pass for competent, and relatives and others might attempt to coerce patients into a premature death.

We know that PAS occurs even in jurisdictions that forbid it, but we have little idea of how often it is abused indeed, how often involuntary euthanasia, or murder disguised as PAS or involuntary euthanasia occurs, physician assisted suicide case study. Since we do not have these comparative statistics—they are, by their nature, difficult to gather—we are not in a position to assess the risks of PAS.

Nor are we in a position to assess the risks of not having PAS. We note, however, that it is at least possible that legalising PAS reduces the number of abuses, for several reasons: because patients are able to remain rational longer when they do not fear losing control over the timing and manner of their death recall that more patients request and receive lethal barbiturates than actually use them ; because the stricter oversight reduces the potential for abuses, and because doctors respond to requests for PAS by improving end of life care.

Thus, answering Steinbock's call for an assessment of the risks of PAS requires more data than we have. Moreover, even if we are able to gather the relevant data, there remains hard conceptual work to do, physician assisted suicide case study, in weighing the risks against the benefits of the legalisation.

How do we go about assessing the risks? What weight are we to place on the loss of hours, days or weeks of life, when we are talking about the life of an incompetent, perhaps delirious, patient who is suffering from pain or depression all of which are sufficient to make PAS illegal? This is an extremely difficult question; we note here only that anyone who believes that it is appropriate to take quality adjusted life years into consideration in making decisions about medical treatment seems committed to thinking that these kinds of physician assisted suicide case study do make a difference here.

Against the loss of lives, we need to weigh the benefits gained by PAS, measured in peace of mind, enhancement of autonomy, and forgone pain and suffering. Once again, we have little idea how to quantify these things.

Yet assessing the risks and benefits of PAS requires that we have answers to these questions. Steinbock is right to hold that attention to heart wrenching cases is not sufficient to make the case for PAS.

Yet she does not provide us with any suggestions for proceeding. Here we have provided a few such suggestions. Assessing PAS requires a great deal of work, both empirical and conceptual. In the physician assisted suicide case study, we have no evidence at all that it is riskier to permit PAS than to forbid it. WTWER - withholding or withdrawing of life sustaining medical treatment without the patient's explicit request. National Center for Biotechnology Informationphysician assisted suicide case study, U.

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Case Study Velma Howard Case

 

physician assisted suicide case study

 

Physician Assisted Suicide Case study Essay - Diane: A Case of Physician Assisted Suicide Diane was a patient of Dr. Timothy Quill, who was diagnosed with acute myelomonocytic leukemia. Diane overcame alcoholism and had vaginal cancer in her youth. She had been under his care for a period of 8 years, during which an intimate doctor-patient bond. This is why so many veterans who returned from Vietnam had to undergo psychiatric examination and treatment. This is because killing by whatver name destroys one emotionally. Legislating physician assisted suicide will do more harm to the physician than to the patient. It will destroy the physician. This cannot be allowed to happen. End of Life Ethics: Euthanasia and Assisted Suicide Case Study by Dennis Sullivan, MD Steve Crossley is a year-old engineer living in Grand Rapids, Michigan. After a vigorous professional life, he has been looking forward to retirement. Just six weeks ago, he began to notice that his clothes were fitting.