Pas & Voluntary Euthanasia

Filed under: Uncategorized — subtleserpeant @ 8:47 pm

What to do….

What to do seems to be the major question that has many answers.  Philosophers, doctors,  patients and judges have all asked, “What to do and should we?”, so what is the ethical permissibility of physician assisted suicide [which I will abbreviate as PAS from here] or active voluntary euthanasia?  I hope to answer those questions, perhaps even voice an opinion that is rational, on a sometimes irrational subject.

There seems to be two major philosophical views on this subject, the first which states that we should hold the theory that we should do what maximizes the overall happiness, for the greatest number of good possible.  This is what is called Utilitarianism, which weighs the worth of the moral action versus the outcome, but you can only weigh that morality after seeing the consequences of that action.  John Stuart Mill termed it the “greatest happiness principle” and Jeremy Bentham in return, “pleasure principle.”

The other view, which Kant argued that we must act in the morally right way, while acting from duty.  He also argued that it was the motives of the action, by the person doing the action; that made them right or wrong, not the consequences.  This is called Deontological ethics, a normative ethical position that is action based on the actions of your duty.   Deontology, is sometimes referred to, in simple terms as an obligation based ethics, more so a sort of binding to your duty.  Kant claims “Nothing in the world-indeed nothing even beyond the world-can possibly be conceived which could be called good, without qualification except a good will.”

When he makes this statement I can only conclude that he is saying to a degree, that if we were to watch someone suffer, and we were to take pleasure in that action; morally/ethically things are made far worse than need be.

I will start off by differentiating PAS, and active voluntary euthanasia.  PAS, is the doctor assisting the patient in dying, here’s some pills to take at home, I’ll bet you a hundred bucks you wont call me in the morning.  Active voluntary euthanasia, is the practice of total control of the physician, a lethal dose of morphine administered by that physician.  The only meaningful difference in these two acts mentioned are one is taken in to the physicians hands i.e. pushing the syringe’s contents, while PAS is a doctor prescribing a pill(s) that the patient takes at home or in a park or maybe even in a subway at rush hour.  So what would permit either one, what is justification for it? Can we enforce laws to see that it is not done just for the sake of being done?  What of the monetary influence of all of these, will someone benefit from ones dying?  Let’s try and figure this out.

In the United States, three of its states Oregon, Washington and Montana allow PAS, but the rest of the lower 48 do not allow this act.  The majority of patients it is said in Oregon meet the criteria regarding the safeguards, but unlike Dutch law Oregon states that suffering is not regarded as a requirement.  The law also states that the patient must be of legal age, eight-teen, have a terminal illness, less than six months to live–those meet the safeguard issues.  I will get into the safeguards later on, but wanted to introduce something regarding the issue.  On the flip side euthanasia is not permitted under any circumstance in any of the States.  The main arguments against the actions of euthanasia are as follows, [1] because alternative treatments exist it is unnecessary. [2] you’re putting vulnerable people at risk or in danger, i.e. The elderly. [3] it goes against everything in which the medical profession stands for, the Hippocratic Oath [I will give no deadly medicine to anyone if asked]’  Then there are the religious fervor that I will get into later on because I think it pertains to both subjects, and is a more important bias than some think.

Lets start with the first argument, alternative treatments.  Now medicine and science have been able to eradicate numerous diseases, but what if the patient contracts one that is incurable?  There is no cure for ALS, but that is an easy one, lets stick with the big C.  Lets say the only other option left after numerous options used up, is the use of chemotherapy, namely Doxorubicin, also known as Red Death, or the kinder Red Devil.  Doxorubicin works by intercalating DNA, intercalating essentially is a way of inducing distortions in the structure of DNA, which makes it carcinogenic, it makes its way into DNA by forcing the strands to open and unwind.  Chemotherapy usually will take shelter in three separate spots in DNA.

The serious risks involved in this are in my opinion murderous.  Independent cell death, its reaction with oxygen that then reacts with iron, which cause permanent damage to myocytes (heart cells) which causes myofibrillar loss.  CHF, dilated Cardiomyopathy, neutropenia (decrease in WBC), etc.  Does this now fall into the category of what the medical profession calls the “double-effect” which says an action has two effects, one good, one bad?  Treating for the good of the patient, but in the end killing the patient.

Lets say a patient twenty-five, is terminally ill with cancer, a rare cancer; on the brain stem called Fernd-Phi Cluster, the only things that can be done is treatment with Doxorubicin or pain management.  Lets start with pain management, lets administer high doses of Morphine, so as to numb the patient of their pain, which is excruciating pain like no other, but in the meanwhile the second effect of that double-effect is shortening the life of that patient, it is foreseen, but obviously not intended.  In this case it is deemed that the patients death is both ethical and legal, because you are doing what is in the best interest of the patient, nor causing harm.  When it comes down to Red Death, the results are usually never good. So if all alternatives have been explored or there are no alternatives, what is there to argue about, let the patient use the option of PAS or AVE, like Kant stated, if we somehow can find joy in the suffering then we make things far worse.  Make it a choice give the patient the option.

So what if the patient says, “No more Dr. Ball, I want to stop all treatment(s).”  This would fall under the category of passive euthanasia, but sometimes saying no or withholding certain treatments can be to the benefit of that patient.  Catch-22 if you like.  Is it the intention of the medical practice that deems it a good practice?  I think so.  Now that begs the question, if the patient is of sound mind to refuse treatment, and willingly die on their own accord, how does that differ from euthanasia?  The doctor after all cannot push medication, chemotherapy or any other lifesaving treatments on someone who willingly refuses.  The doctor has to respect the autonomy [self-govern] of the patient, autonomy is extremely important, but it is not unconditional.

Most say if euthanasia were to be legal, it could get to the point where someone who wants their pain in the ass sick mother gone?  Which leads us to the second argument, putting vulnerable people at risk.  Who ever says vulnerable people are going to be at risk shouldn’t be a doctor if you cant pick out the ones that are obviously helpless, I learned that in Anatomy 101.  Obviously if someone is without their faculties, Alzheimer’s, dementia, retardation, mentally ill and so on, we leave them be.  Another stance on that are people that cant communicate, say in a coma or cant speak.  You can get around the unspeakable, coma not so much.  If the person that cannot speak, but can communicate in other ways then we have to take that into account.

So what about the Hippocratic Oath, doctors do the wrong thing all the time sometimes willingly.  I just think that most of the doctors that are with the, “I will not give deadly medication even if asked” have alternate reasons to why they wont.

My disagreement with all three of these in short is that, we don’t always have alternative treatments at our disposal,  when we do more often then not they fail.  We obviously can tell when faculties are gone with FMRI or EEG’s even when the relatives seem to be a bit pushy about it, so we can test for vulnerability, and to say doctors take the Hippocratic oath seriously these days would be a farce.  They worry more about the bottom line due to the ever punishing insurance world.  If the patient is not in a vulnerable state, has all of their faculties and is left with no other way, hand me the needle, Ill help them out.

Some will argue that PAS is a safer alternative to euthanasia.  Truth is some patients are incapable of doing the deed themselves, and would need someone else to do it for them, PAS seems also to have failure rate–some don’t die–even when large amounts of drugs are administered.

Lets say a 30 year old male comes up with ALS, he has degenerated so fast within three months time that he needs a ventilator just so he can breathe.  He can still speak, and is of sound mind a PHD holder in Philosophy and Physics.  He knows the risks of ALS and knows he does not have much time left before he loses his swallowing capability.  At this rate he will die well before the average two to five year life expectancy, maybe within months.

So he is a Maryland resident, and it is illegal in the state of Maryland, nor can he take advantage of the three states that do allow it.  So that washes out any hope in America, so he travels to Zurich, Switzerland [Switzerland is the only country that allows outsiders to request PAS] and meets with Ludwig Minelli who is the head of Dignitas.  Mr. Minelli and a doctor go over his records and deem he is doomed, he is the rare of rare, they arrange for him to drink a lethal dose of Sodium Pentobarbital, which will lull him to sleep within four to five minutes, and be dead within thirty minutes.  Swiss law states that he must drink it himself, and it must be videotaped, he agrees to these terms.  While taping his death he is told by the attending doctor, “If you drink this you will die, do you understand this?”

What purpose does it do if we as a species cannot allow people who are in the utmost suffering, to let go.  What is so unethical about someone who is terminally ill and says, “I have had enough, I don’t want to be here anymore!”  If they are of sound mind and the doctor agrees to perform it, and all of their mental faculties are there, then why not?  Some say age is important, maybe.  There is a boy who is nine years of age in Michigan, his name I do not recall, has had multiple brain surgeries on a terminal brain cancer that his parents wished to try.  That child has now officially said NO MORE TREATMENTS!  His parents and his physician and oncologist have agreed, they will abdicate.  Is this the age that now sets a precedence?

Peoples views of so-called morality in this country just disallows any form of either activity.  You cant play God, they say….okay, so why is it acceptable to try to give a premature baby any or all medical treatment to save it’s life, or better yet why is it okay to give someone a new heart, or any other organ transplant?  Does this fall under the category of the sanctity of life, perhaps maybe, but who says life is sacred?  The old saying is that dead people care less about the sanctity of life, that then do living persons.  The idea that life is sacred is a man made, biased selective point of view.  So if you cannot try to save a patient from suffering by ending their life, shouldn’t you stop trying to save lives?  Are we not playing God in both circumstances?  We can’t have it both ways.

I think we need both of these instituted, and here is why….people suffer enough sometimes in this world, why should human beings, suffer to the point of wanting to die only to be told, nah we cant kill you because you want to go, thats not a good reason.

Why should one have to suffer anymore than need be, so to safe guard this from getting out of control we need to set an age, what age should we deem appropriate?  The Michigan boy now sets the bar at nine in America; Holland says twelve–Oregon says eight-teen.  Okay, so do we meet it in the middle say at….sixteen?  That is up to the law makers and physicians, maybe give parental consent under sixteen, base it on maturity of that minor I would say also.  If you can hold a job, drive a car and a little while later sign up for the make believe draft, then you are mature enough mentally.

We could also institute that the patients usual physician, the family doctor is the commander in chief, who would know the patient best than someone who has been with that patient for numerous years perhaps from their birth all the way to sixteen.  Everything runs through his primary physician, the oncologist, or neurologist reports to him/her. The patient and their primary care have the last word.  Should there be a waiting period of six months?  What if the patient is like the ALS case mentioned above and he is going to drop like a bag of rocks within weeks (even sooner than the fifteen day wait in Oregon), should we give special dispensation and move up his waiting time?  What if he gets past the point of voluntary swallowing, do we say sorry buddy, we ran out of time or do we institute euthanasia, that I think is a case where we could and should implement that.

So we need to see if the patient is of sound mind, maybe we should get the best psychiatrist and neurologist to test each patient and see what their state of mind is, see if through a FMRI while the psychiatrist is asking questions, see what lights up on the scan, see if there could be any misfiring on the part of the brain.  Just to make sure it is a rational human being.  I don’t think we should base things on age, and I don’t think withholding information is the right thing to do, after all how will the patient make a well informed decision on how to base their last days on this planet.  Certainly we should stipulate guidelines against euthanizing the elderly that cannot think for themselves, retarded people should also be safe from this as well.

People can get depressed when told of impending death, sooner than we wish for, some embrace it just so they can be with Jesus, but those people shouldn’t be deemed anything but insane.  The fact of the matter is we all grow older, some very old and we die.  The cycle of life, we die the minute we are born, but if we can control how we die in certain situations why not embrace it?  Facts are facts, we become worm food, our atoms become one with the universe again.  Let the flora feast upon us, like we feasted upon it.  If given the choice to do it with dignity, then why not?  There is no shame in dying anyway you want to look at it.  We all get to do it….eventually.

My view is I would do it, I would want to do it.  I believe it is the duty of the doctor to help his or her patient at any cost.  When it is done with malicious intent then there is something to disagree with.  If I were a doctor, and a patient came in and it was proved that he is beyond suffering, with no life ahead of him and was going to die with any treatments being deemed useless it would be immoral of me to not help him end his life.  Ill end with this scenario, your loved one is bitten by a zombie, you and they know that is it.  Pain will set in and soon they will die horribly are you to let your loved one convert to being a zombie and dying horribly without helping them?


Sean Michael Beasley

Summer 2012

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