Physician-assisted suicide (PAS) has gained acceptance globally especially in the United States and Canada. The practice differs from Euthanasia because it is the prescription of lethal medication to be administered voluntarily by a patient (Goligher, 2018). On the other hand, Euthanasia is the causation of death directly by a physician. Therefore, to understand the implications of the PAS to the parties involved; a study of the vignette case presented by Spence et al (2017) is necessary.
The Vignette case involves Mrs. J.F. Vignette, a 56-year-old woman with stage II breast cancer. According to Spence et al (2017), Mrs. Smith later developed sternal and hip pain that resulted in her physician prescribing Lestrazole and Goserelin therapy. However, Mrs. J.F refuses the Lestrazole prescription citing adverse reactions to the medication. She requested the physician for a PAS as a backup plan because all the initial therapies had failed but the physician refused. As such Mrs. J.F. consulted a second oncologist. The latter physician went through her medical history and initiated an alternative treatment plan; involving Fuvestrant therapy and irradiation of the spine and ribs (Spence et al 2017). The treatment failed and Mrs. J.F. requested the doctor for PAS. At first, the physicians were reluctant, but after a period of one year, the oncologist granted Mrs. J.F her wish and prescribed secorbabital 10g.
The case above as presented by Spence et al (2017) presents an ethical dilemma faced by most health professionals attending to terminally ill patients. The CNN Editorial Research (2020) points that while the practice of physician-assisted suicide is accepted in some U.S states such as Washington and California; the practice is still widely shunned by the majority of the population as being morally unethical. According to Sulmasy and Mueller (2017), health practitioners have to abide by the stipulated code of conduct that promotes beneficence, maleficence, and justice in healthcare delivery. As such, the ethical factors that should be considered when deciding on a PAS option may result in three different outcomes.
Implications of the Case
From Mrs. J. F.’s case; the first response would be a physician’s rebuttal to the patient’s wishes. Some health practitioners fear engaging in a PAS due to the laws governing human life. For instance, the states of Massachusetts, Alabama, and West Virginia have common laws that prohibit physician-assisted suicide (Kumaravel, 2018). In such states, the practice of PAS is viewed to undermine fairness and social justice hence the law is used to control physician’s authority to end life. Therefore, the first physician may have considered the legal jurisdictions guiding the physician’s healthcare practices before refuting Mrs. J. F.’s wishes.
The second response that can result from the case would be granting Mrs. J. F.’s wishes. By agreeing to engage in a PAS, the physician will be acting as per the ethical principle of promoting patient autonomy. The American Medical Association (2019) stands on the principle of medical ethical support that a PAS is acceptable if the practice promotes patient autonomy. Since Mrs. J. F. was in a stable state to make a decision about her healthcare, then by taking Mrs. J. F.’ request into consideration, the physician’s actions are therefore aligned with the APA code of conduct. As such, the patient is at liberty to end her pain voluntarily while the physician acts within acceptable workplace behavior.
The third possible response that could be obtained from the case is for the physician to inform the patient of the pros and cons of either agreeing or refusing a PAS. For instance, by accepting to engage in a PAS the physician will end the patient’s pain at the expense of her life. Contrastingly, by disallowing a PAS, the physician will help in preserving life at the expense of the patient’s pain. Hence the physician can change the mind of the patient since some patients impulsively request the PAS option without prior background knowledge. For example, Spence et al (2017) note that after obtaining a prescribed lethal medication from the second oncologist, Mrs. J. F was reluctant to use the medication, and instead kept them as a backup plan. Informing the patient also helps the patient to make an informed decision. Grant (2015) portrays the importance of informed consent in solving legal-ethical frictions as witnessed in cases such as Nancy Cruzan and Schiavo. Therefore the physician takes a neutral stand in the PAS option selected while the patient makes an informed decision.
The most ethical response for Mrs. J. F.’s case would be to grant the patient her wishes. The physician will be acting within the accepted APA code of conduct by agreeing to Mrs. J. F.’s request. The APA code of conduct as explained by so emphasizes patient autonomy, beneficence, and maleficence in promoting patient-centered care. Furthermore, the act shows that patient was involved in decision-making since her informed consent was obtained prior to the prescription of the secorbabital medication. Therefore, the act upholds the three key principles (beneficence, maleficence, and autonomy) governing the provision of patient-centered healthcare. Most health providers support that PAS promotes patient’s autonomy despite the practice being seen as being morally unethical because it involves ending lives.
American Medical Association. (2019). Chapter 5: Code of medical ethics. Retrieved from https://www.ama-asssn.org/systems/files/2019-06/code-of-medical-ethics
Goligher, E. C., Ely, E. W., Sulmacy, P. D., Bakker, J., Raphael, J., Volandes, A. E., Patel, M. B., Payne, K., … & Downar, J. (2018).Physician-assisted suicide and euthanasia in the intensive care unit: a dialogue on core ethical issues. Critical Care Medicine, 45(2), pp. 149-155. DOI: 10.1097/CCM.0000000000001818
Grant E. R. (2015). Cruzan at 25, Schiavo at 10: Legal fiction is it time to outgrow. Center for Bioethics and Human Diversity. Retrieved from https://cbhd.org/content/cruzan-25-schiavo-10-legal-fictions-it-time-to-grow
Kumaravel, A. (2018). Physician aid-in-dying: practical considerations. The American Journal of Psychiatry: Resident’s Journal. DOI: 10.1176/appi-rj.2018.130802
Spence, R. A., Blanke, C. D., Keating, J. T. & Taylor, L. P. (2017). Responding to patient requests for hastened death: physician aid in dying and the clinical oncologist. Journal of Oncology Practice, 13(10), pp. 693-699. DOI: 10.1200/JOP.2016.019299
The CNN Editorial Research. (2020). Physician-assisted suicide fast facts. CNN. Retrieved from https://amp.cnn.com/cnn/2014/11/26/us/physician-assisted-suicide-fast-facts/index.html