The physician's responsibility toward hopelessly ill patients: a second look

Article Abstract:

The increased awareness of the rights of dying patients has been translated into new laws; a patient's right to refuse medical treatment has been upheld in numerous court decisions. Popular attitudes about the rights of dying patients have changed, often in advance of the attitudes of health care providers, legislators, and the courts. Physicians must have timely discussions with patients about life-sustaining treatment and terminal care, and become familiar with patients' personal values and wishes, documenting them as they document information about medical history. Dying at home can provide the opportunity for quiet, privacy, dignity, and family closeness that may make death easier for the patient and provide consolation for the bereaved. Home care should be guided by the physician and implemented with the help of well-trained personnel from hospice units that now serve many communities. Care of the dying demands constant adjustment to pain control, fear and suffering. If pain cannot be controlled with the commonly used analgesic drugs more potent narcotics should be prescribed. Even as death approaches, and curative techniques are not required, sensitivity and responsibility to the patient and their family, are needed. With compassionate care patients will be less likely to commit suicide which differs from euthanasia in that the act of bringing on death is performed by the patient, not the physician. The physician who considers aiding a patient's suicide must determine first that the patient is indeed beyond all help and not suffering from a treatable depression, common in those with terminal illnesses. Even though suicide itself is not illegal, helping a person commit suicide is a crime in many states. No physician has ever been prosecuted in the U.S. for prescribing pills in order to help a patient commit suicide. Euthanasia, is being widely discussed in the U.S., but the prospect of criminal prosecution deters even the strongest physician advocates of this practice.

Analysis, Evaluation, Discipline, Terminal care, Medical protocols

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Morals and moralism in the debate over euthanasia and assisted suicide

Article Abstract:

In June 1990, a woman named Janet Adkins took her life with the aid of a 'suicide machine', designed by Dr. Jack Kevorkian, in an episode that aroused the nation's interest and fears about legalized mercy killing. Mrs. Adkins, having been diagnosed with Alzheimer's disease (a progressive neurological condition leading to complete loss of cognitive function) made the decision to die and flew to Michigan to obtain Dr. Kevorkian's aid. The physician's participation was universally condemned by physicians, lawyers, and ethicists, usually with fairly predictable comments regarding the need for medical professionals to avoid taking lives. In spite of some unsavory aspects of that case, the issue needs to be understood in its full complexity. Although Mrs. Adkins was in good health, many patients suffer profoundly, and it is likely that numerous deaths are planned in some way by patients, their families, and physicians. With many people expressing the belief that physicians should be able to assist patients in taking their own lives, insistence by the medical profession to refuse to participate may ignore patients' wishes. In fact, a more open process for deciding when to assist patients could promote accountability, rather than erode it, as is commonly feared. Doctors, no less than other segments of our society, do not want to accept death, which often leads to the prolongation of dying, without regard for the concept of death with dignity. Medical schools should teach moral reasoning to prepare physicians for these choices. Constraints to prevent abuse of physician-assisted suicide must be maintained, but the issue deserves examination with an open mind. The public appears to want more control over dying, and it is to these people, the patients, that doctors must listen. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Physician and patient, Physician-patient relations

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Care of the hopelessly ill: proposed clinical criteria for physician-assisted suicide

Article Abstract:

A set of clinical criteria may enable the legalization of physician-assisted suicide with a minimum risk of wrongdoing. Some terminally ill patients may ask their physician to help them commit suicide. The first criteria for physician-assisted suicide should be that the patient is suffering from an incurable condition and is in extreme discomfort. The physician should make sure that the patient's request is not a result of inadequate care for pain and discomfort. The physician should also ensure that the patient's judgement is not distorted and that the request is being made of the patient's own free will. The physician and the patient should have a meaningful doctor-patient relationship, and a second opinion should be obtained before the patient's request is fulfilled. The patient's condition should be documented thoroughly in case the request is reviewed by others.

Laws, regulations and rules, Column

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