Assistance in Dying and Hospice and Palliative Care

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Introduction

Assistance in Dying (AID) is based on the concept of a patient’s quality of life wherein it is considered preferable to be dead rather than live a life of agony due to a debilitating condition. While this is a particularly controversial subject, there have been numerous supporters of its implementation due to the limits of modern-day medicine and arguments focusing on the ethics of prolonging an individual’s suffering through artificial means. Examples of this can be seen in the cases of terminal cancer patients when cancer has spread to such an extent that no further treatment can be reasonably implemented. The end result is that the lives of these individuals are extended through a variety of artificial methods (ex: respirators, dialysis, chemicals, etc.), which prolong their suffering due to the sheer amount of pain that often occurs when cancer spreads throughout the body. Inevitably, due to the low quality of life that these individuals lead, it becomes preferable to simply wait for death. As such, this paper presents the assumption that: Assistance in Dying (AID) should be legalized in the United States since it is in respect of the patient’s autonomy and their right to die.

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Providing AID (Assistance in Dying) is similar to Hospice and Palliative Care

In the previous section, the concept of “quality of life” was touched upon as a means of justifying AID to terminally ill patients. Quality of life encompasses a wide variety of possible circumstances, yet, a generalized overview of such a concept can be boiled down to the capacity of a person to live a life that is relatively pain-free and enables them to go about their daily activities without considerable burden. Under such a definition, individuals who are unable to accomplish the basic tenets of such a concept can be described as having a relatively low quality of life. Such a case can be brought through a myriad of different circumstances (ex: cancer, disease, extensive physical trauma, brain damage, etc.), however, the end result is usually a person living a life that is far from what many would consider as “ideal”, and in most cases, they will not live for long. It is due to this fact that hospice and palliative care are often implemented to help improve the quality of life of such individuals. Hospice care is applied in cases where terminally ill patients have been given only a few months to live due to the limits of traditional methods of treatment. The main point of such a service is to make the patient as comfortable as possible (i.e. increase their quality of life) so that they can transition into death in the most humane way possible. Palliative care, on the other hand, is focused on providing relief to seriously ill patients by alleviating the pain and symptoms related to their current condition. Do note that this is not meant to treat their current illness; rather, it focuses on improving their quality of life by making their current experience less painful and more comfortable to endure.

Inevitably, it becomes immediately obvious to medical practitioners that utilizing artificial means of sustaining a person’s life is merely delaying the inevitable. However, do note that delaying what is inevitable, can place a person in considerable long-term pain and discomfort, which can be easily avoided by merely allowing them to die a natural death. Based on articles such as those published by the Nurses Services Organization, it is noted that as long as a patient is informed and wishes to do so, it is legally and ethically permissible to withdraw life-sustaining medical care. The basis behind such a decision is often related to the quality of life that is sustained by the treatments. Even if a method of sustaining a person’s life artificially is successful, it must be questioned as to whether or not it is the type of life that person would want to live. Some methods (ex: artificial respiration) can cause considerable amounts of discomfort while others such as those related to treating terminally ill cancer patients merely cause them more pain and prolong their suffering (Fraser and Walters 120- 123). Under such a context, AID may be applied if the method of sustaining a patient’s life causes them more harm or has no conceivable benefit. Thus, it can be argued that if a person’s quality of life has deteriorated to a considerable degree due to their current medical condition, then it is conceivable that they should have the right to end their suffering regardless of whether or not their life is currently being prolonged through hospice or palliative care.

Providing assistance in dying, when requested by the patient, is respectful of the patient’s autonomy

Autonomy can be described as the right of the patient to make decisions about his or her medical care. If the patient wants to try chemotherapy instead of radiology then they have the right to do so. If the patient in hospice or palliative care wishes to forgo life-sustaining therapy, then doctors should comply with their wishes. It is under such a concept that if a person should wish to end their life due to a painful medical condition, then under the concept of patient autonomy, they should have the right to do it in the most painless way possible (Andre and Velasquez 11). However, doctors within several states in the U.S. cannot simply assist a person to die due to current laws stating that such an act is equivalent to medical malpractice and even murder (Schüklenk, Van Delden, Downie, Mclean, Upshur and Weinstock 1 -5). While a patient may have the right to refuse treatments that can prolong their life, they cannot simply end it through medical means under current laws.

While there are of course other means of doing so, such as suicide, such acts often cause considerable emotional and psychological distress among the members of a patient’s circle of family and friends (Andre and Velasquez 11). The end result is that they can often feel an incredible amount of pain and distress. Thus, a certain level of hypocrisy in the current laws is evident wherein it is not ethical for doctors to end the pain of their patients, which prevents them from having a good quality of life yet it is perfectly acceptable to let a person endure in months of agonizing torture when their lives can be ended in a painless and comfortable way. When presented with a quick and painless death as compared to weeks or even months of extreme pain, most patients would go for the latter choice (Fraser and Walters 120- 123). Taking this into consideration, it can be seen that changes need to be implemented in present-day laws so that patients with terminally ill conditions can be given the choice to end their life in a controlled medical setting that maximizes their comfort and enables them to end things on their own terms. Not only does this reduce the amount of time that a patient suffers, but it also enables their friends and family members to come to terms with their choice which would enable them to move on from the death of the patient.

Providing Care against the Will of the Patient is Inhumane

One of the current arguments in favor of AID is the view that many terminally ill patients no longer have the physical capacity to take care of themselves. Their respective illnesses will undoubtedly take their lives in the future, however, it should be noted that prolonging a patient’s suffering just for the sake of extending their life can be considered inhumane (Washington State Department of Health 2012 Death with Dignity Act Report Executive Summary 422). While it may be true that it is a doctor’s prerogative to safeguard the life of the patient, it must be questioned whether the life they are saving is truly worth it. There are cases where patients are suffering from unbelievable pain due to cancer or some form of degenerative disease, yet it will take weeks if not months for it to actually kill them (Fraser and Walters 120- 123). Within this span of time it is common for patients to willingly ask for death due to the suffering they are undergoing, yet doctors, despite having the capacity to end their pain, choose to merely prolong their life since that is what the law says they should do. Removing life support or methods of prolonging a person’s life is sometimes inefficient since not all conditions are reliant on artificially keeping a person alive.

For instance, some degenerative bone cancers can enable a person to continue to breathe and digest food yet they will be unable to move and will be living in constant agony. It is due to such situations that patients ultimately want their sufferings to end and often ask their doctors for whatever means possible (Ubel 1). Physicians ultimately need to follow the decision of the patient since their choice regarding the type of treatment that they receive is under the concept of patient autonomy that physicians must follow. In the end, it all boils down to the concept of allowing patients to have an informed choice regarding their current situation and whether or not they would opt to die peacefully and with their dignity intact rather than forcefully prolong their life through artificial means, which often result in considerable pain and suffering (Ubel 1). Patients should be given the right to end things on their own terms, rather than let an outside party decide on whether or not they should continue living. Unfortunately, some terminally ill patients are so physically weak that they do not have the capacity to bear their own life and end up isolated in a hospital room in incredible amounts of pain (Washington State Department of Health 2012 Death with Dignity Act Report Executive Summary 422).

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Conclusion

Based on what has been presented in this paper, Assistance in Dying (AID) should be legalized in the United States since it is a respect of the patient’s autonomy and their right to die. Through legalization, doctors will be able to present terminally ill patients with the option to end their life which would prevent months of suffering resulting in a much better quality of life for them.

Works Cited

Andre, Claire and Manuel Velasquez. “Assisted Suicide: A right or wrong?” Issues in Ethics 1:11. Markula Center for Applied Ethics, Web.

Fraser, Sharon and James Walters. “Death-Who’s Decision? Physician-assisted dying and the terminally ill.” Western Journal of Medicine 176: 120-123.

National Center for Biotechnology Information. Web.

Schüklenk, U., Van Delden, J. M., Downie, J., Mclean, S. M., Upshur, R., and Weinstock, D. “End-Of-Life Decision-Making In Canada: The Report By The Royal Society Of Canada Expert Panel On End-Of-Life Decision-Making.” Bioethics 25.(2011): 1-73. Print.

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Ubel, Peter. “Death with dignity should not be equated with physician assisted suicide.” Forbes, 2013 Web.

“Washington State Department of Health 2012 Death with Dignity Act Report Executive Summary.” Washington State Department of Health, DOH 422-109, 2013. Web.

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NursingBird. (2022, April 11). Assistance in Dying and Hospice and Palliative Care. Retrieved from https://nursingbird.com/assistance-in-dying-and-hospice-and-palliative-care/

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NursingBird. (2022, April 11). Assistance in Dying and Hospice and Palliative Care. https://nursingbird.com/assistance-in-dying-and-hospice-and-palliative-care/

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"Assistance in Dying and Hospice and Palliative Care." NursingBird, 11 Apr. 2022, nursingbird.com/assistance-in-dying-and-hospice-and-palliative-care/.

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NursingBird. (2022) 'Assistance in Dying and Hospice and Palliative Care'. 11 April.

References

NursingBird. 2022. "Assistance in Dying and Hospice and Palliative Care." April 11, 2022. https://nursingbird.com/assistance-in-dying-and-hospice-and-palliative-care/.

1. NursingBird. "Assistance in Dying and Hospice and Palliative Care." April 11, 2022. https://nursingbird.com/assistance-in-dying-and-hospice-and-palliative-care/.


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NursingBird. "Assistance in Dying and Hospice and Palliative Care." April 11, 2022. https://nursingbird.com/assistance-in-dying-and-hospice-and-palliative-care/.