AHS 107 Position Paper Part B

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Running head: PSA MORE THAN JUST THE ACT 20720631 Physician Assisted Suicide More Than Just the Act ZUZANNA WERONIKA BUKALA 20720631 November 16, 2017 AHS 107 University of Waterloo Instructor: Dr. Wade Wilson TA: Nicole D’Costa 1

PSA MORE THAN JUST THE ACT 20720631 Physician Assisted Suicide More Than Just the Act Physician-assisted suicide and euthanasia have been a very sensitive and controversial topic in today’s medical practice because it deals with the ended of a person’s life due to terminal illnesses with the help of the patient’s physician. It is not a simple black and white topic, there are a lot of grey areas due to the morality aspect of it. Like any topic, there are usually two sides that people take; either to support it or oppose it. Those who support it would argue that the patient is allowed to make the decision whether or not they are going through a lot of suffering and pain caused by the illness while those who are against it because they believe that one should not be able to choose when they die, leave it to natural causes. I believe that terminally ill patients should not be allowed to end their lives with the assistance from their physicians because of religion, stability and psychological issues. Religion is a big part of a person’s life, it is involved in everything that one person does on a day to day basis. Religion is more than just a set of rules that people must follow, it is a way of life that a person incorporates into their words and actions. Many people apply their faith to their professions, for example, a Catholic physician would apply the teachings of the Catholic Church in their practice. Religion is an important factor when influencing how a physician’s practice of end of life care, which opposes physician-assisted suicide. Curlin, Nwodim, Vance, Chin, and Lantos (2008) updated and extended a study done a decade ago and found that the physician’s ethnicity and religion will influence the end of life care that they provide their patients. In the questionnaire that was mailed out, it asked the participants if they opposed physician-assisted suicide and say if it is due to religious or non-religious reasons. Curlin et al. (2008) found that 69% of physicians opposed physician-assisted suicide and those with high religion motives (structure of their lives), had a 4.2 odd ratio to oppose physician-assisted 2

PSA MORE THAN JUST THE ACT 20720631 suicide. The data also showed that physicians that agreed their religious beliefs impact how they practice medicine, they had a 2.7 odd ratio to oppose physician-assisted suicide, and those who had no religion or were Jewish were less likely to oppose physician-assisted suicide with having odds ratios of 0.2 for no religion and 0.3 for Jewish (Curlin et al. 2008). Religion and the key roles it plays in a physician’s medical practice and they will not incorporate practices that go against their religion, which is why physician-assisted suicide should not be allowed. In life, people are faced with making decisions that can either have outcomes that are temporary or outcomes that are permanent. The decision of ending a life with the assistance of the physician is a permanent choice, you cannot bring someone back to life. People have a tendency to be indecisive with choices that we face in our day to day lives, from what you are going to eat, what you want to study for post-secondary education, etc. Often times, people can be indecisive when it comes to big life decisions. The stability of a decision over time and probability of changing one’s mind is crucial when it comes to physician-assisted suicide due to the permanence of the act. Blank, Robison, and Schwartz (2001) conducted initial and follow-up interviews and collected data for the 124 medically ill participants who partook in both interviews. They created hypothetical conditions where people consider physician-assisted suicide, and they had to meet specific requirements before taking part (Blank et al. 2001). They found a general pattern that most people changed their minds after agreeing to physician-assisted suicide, the instability ranged from 8 to 26% after the six-month period (Blank et al. 2001). There was a higher percentage of instability from the hypothetical situations that ranged from 12 to 18% of patients changing their opinions from being for it to against it at the follow-up interview, possibilities of these changes could result from many factors including the hospital environment, which can affect how patients make decisions when it comes to physician-assisted 3

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PSA MORE THAN JUST THE ACT 20720631 suicide (Blank et al. 2001). People’s inductiveness has to be an important consideration when it comes to physician-assisted suicide due to the possibility of choices being changed after a certain time period, which is why patients shouldn’t choose to end their lives with the help of their physicians. Mental health is just important to the physical health of a patient because of how it affects one’s thoughts and actions. One has to consider the psychological stability of a person and determine whether or not they can make decisions on their own without the influence of their particular mental illness. If a person is in a state where they cannot make rational decisions that will impact them greatly, then others who are capable will step in. For example, a high school student is in a poor mental state and they believe that suicide is the only option, the staff of the school such as guidance counselors will take control of the situation and take the steps necessary to keep the student safe. The psychological state of a patient is more important than the desire of physician-assisted suicide and should be heavily weighed when the request is made. Emanuel, Daniels, Fairclough, and Clarridge (1996) interviewed oncology patients to get the data on their views but they also interview oncologists and the general public to get a comparison, asking specific questions because previous studies had vague questions. All the participants were separated into three cohorts based on whether they were the general public, oncologists, and the oncology patients, in order to not cause emotional distress, they avoided using the word physician-assisted suicide (Daniels et al. 1996). In their data, they found that the patients with psychological issues such a depression were more susceptible to showing interest for physician- assisted suicide, 3-4% hoarded drugs, and 1-3% read the book Final Exit (Daniels et al. 1996). There is a positive correlation between physical illness such as cancer and suicidal thoughts, so the desire of ending their lives could be possibly due to psychological stability (Daniels et al. 4

PSA MORE THAN JUST THE ACT 20720631 1996). The psychological stability of a patient that can impact their judgment is crucial when physician-assisted suicide is discussed because of the negativity that comes from mental issues such a depression, which is why patients shouldn’t have the option to end their life. A possible counterargument for my position as a whole is what circumstances people think are acceptable to perform physician assisted-suicide, such as on patients with terminal illness and continual pain. Daniels et al. (1996) found that the majority of the three cohorts agreed that physician-assisted suicide should be acceptable when the patient is in constant pain and physical weakness as a result of their illness. Even though some may consider certain circumstances make it okay to perform physician-assisted suicide, it still goes against what physicians are meant to do, keep their patients alive. On the American Medical Association website, the definition of physician-assisted suicide is when a physician makes their patient’s death possible by making available or letting them know of what is needed to perform the act (American Medical Association 1995-2017). Physician-assisted suicide is going against the Hippocratic Oath which makes the physicians say that even if the patient asks, they will not distribute any medications that will cause death and the physician will not propose the idea to the patient (Prioreschi 1995). The way to no violate the oath is to let the patient die from their illness, people cannot choose when they want to die the same way we cannot choose if we get a terminal illness or not. Physicians are not meant to help a patient die, but provide them with the best end-of-life care possible until the day where the patient can no longer fight the battle. Religion from the physicians, stability and psychological state of a patient are reasons why terminally ill patients should not be allowed to request for physician-assisted suicide. Religion is an important part of a person’s life, the instability that you will stay with a previous choice made and the mental health of patients with the thoughts are factors that need to be taken 5

PSA MORE THAN JUST THE ACT 20720631 seriously for this topic. Instead of having this option available to patients, better end-of-life care options need to be available for those who have a terminal illness or have physical suffering from their illness. 6

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PSA MORE THAN JUST THE ACT 20720631 References A. (n.d.). Physician-Assisted Suicide. (1995-2017). Retrieved November 15, 2017, from https://www.ama assn.org/delivering-care/physician-assisted-suicide Blank, K., Robison, J., H., & Schwartz, H. I. (2001). Instability of attitudes about euthanasia and physician assisted suicide in depressed older hospitalized patients. General Hospital Psychiatry, 23 (6), 326-332. doi: 10.1016/s0163-8343(01)00160-8 Curlin, F. A., Nwodim, C., Vance, J. L., Chin, H.H., & Lantos, J, D. (2008). To Die, to sleep: US physicians religious and other objections to physician-assisted suicide, terminal sedation, and withdrawal of life support. American Journal of Hospice and Palliative Medicine, 25 (2), 112-120. doi: 10.1177/1049909107310141 Emanuel, E., Daniels, E., Fairclough D., & Clarridge, B. (1996). Euthanasia and physician- assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. The Lancet, 347 (9018), 1805-1810. doi: 10.1016/s0140-6736(96)91621-9 Prioreschi, P. (1995). The Hippocratic oath: a code for physicians, not a pythagorean manifesto. Medical Hypotheses, 44 (6), 447-462. doi: 10.1016/0306-9877(95)90505-7 7

PSA MORE THAN JUST THE ACT 20720631 Final Letter Dear Nicole. I want to thank you for your feedback on Part A of this assignment. I heavily took it into account when writing part B. To revise my paper, I made sure to only put the running head on the first page and avoided contractions. The part I especially worked hard on was finding two new arguments that had primary sources that I could use to enhance my argument, which proved to be difficult until I realized that the least amount of words possible are better when searching on websites such as PubMed and Google Scholar. Once I found the supports to my arguments, my confidence in my paper grew. If I had more time and energy to work on the paper then I would have looked even deeper into each of my arguments, but due to the limitations on the assignment, I know that it’s best just to be succinct. I am excited for you to read my arguments on my position but I am also slightly concerned about your thoughts on my religion argument. I am just excited about this position paper because it is my first time writing this kind of paper and I really enjoyed learning to how construct a position paper which will help me in my future. Regards. Zuzanna Bukala 8

AHS 107 Position Paper Part B

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