Contemporary Social Issue: Physician-Assisted Suicide

Contemporary Social Issue: Physician-Assisted Suicide

Introduction

Contemporary social issues refer to the undesirable conditions within a society that are opposed by a section or the whole society. They include social evil, social problems and conflict. Major social issues can range from gender, age, sexuality, crime, the judicial system, religion and marital status, among others (Purvis, 2012). In America, contemporary social issues are expansive, and America’s citizens are not shy in expressing their discontent about them. One particular social problem that has attracted a lot of attention in the recent past is physician-assisted suicide, also known as euthanasia. The division regarding physician-assisted suicide is evident within states. On one end, states including Hawaii and District of Columbia legalize assisted suicide (Sulmasy & Mueller, 2017). As a result, the statistics differ, given that it is optional to undertake assisted suicide. However, the conflict of interest is based on why physician-assisted suicide should be legalized and whether it stands to do the best with the least harm (Smith, 2017). The following report provides an in-depth discussion about the contemporary social issue, physician-assisted suicide and how it is regarded on the frontiers, the opposition and supporters. The report will also provide political, social, religious, and economic factors, and how these environmental factors help shape the social policy on physician-assisted suicide.

Background: Physician-assisted suicide

The moral issue regarding assisted suicide presents conflicting interest among stakeholders in America, including churchgoers. According to Davis (2019), their different terminologies used to define assisted suicide. They include euthanasia and contemporary assisted suicide. Davis (2019) defines euthanasia as the active processes in ending a person’s Life to stop them from suffering. It is the final deed undertaken on behalf of someone, also known as voluntary euthanasia.

On the other hand, Davis (2019) defines assisted suicide as the process of seeking help from another person in ending Life. In other words, it is the final deed undertaken by the person. However, there is the term, assisted dying, which can be categorized under euthanasia. Assisted dying is voluntary suicide, but, often refers to individuals under terminal illnesses (Davis, 2019). The ongoing debate is how people should use these terms, given the rampant increase in assisted suicide in America.

In practice, physician-assisted suicide is the prescription of lethal medications to a volunteer patient who has to self-administer the medication. Physician-assisted suicide can also comprise of voluntary suicide and involuntary suicide (Goligher et al., 2017). Voluntary suicide is defined as the patient’s consistent, and thorough request in assisted suicide whereas, involuntary suicide is when a patient neither consents or objects to euthanasia because of decisional incapacity (Goligher et al., 2017).  Despite several states indicating the legalization of physician-assisted suicide, there are myriad of reasons why some are opposed to the immoral Act, from their perspective. End-of-life, according to Goligher et al. (2017), is a critical aspect of care in the medical field. Physician-assisted suicide is often the last resort in cases where death needs to be expedited. From a patient’s viewpoint, there are several reasons to request assisted suicide. Among them is the loss of autonomy and fear of dying in pain. Assurances regarding excellent palliative care or lack of abandonment do not necessarily protect the patient from considering assisted suicide. Nevertheless, the pending moral question is whether the need for physician-assisted suicide is necessary and moral.

Political Factors

Physician-assisted suicide is legal in nine states in America as well as the District of Columbia. The optional law is given to states including New Jersey, Washington, Oregon, Vermont, Hawaii and Maine (Inc, 2017). In other states, it is required by law to seek the courts’ approval before undertaking physician-assisted suicide, including California and Montana. The framework of the law states that the patient has to have a terminal illness and a prognosis of at least six months to live (Davis, 2019). The specifics in each state dictate that physician should include a prescription from licensed practitioners approved by the state in which the patient should be a resident (Davis, 2019). The interesting aspects about the States laws are the consideration of terming the physician-assisted suicide as not ‘suicide’ but an act of mercy. As a result, in Oregon, at least 2 200 people were reported to have physician-assisted suicide in 2019 with 1 400 patients dying from court-mandated physician-assisted suicide (Davis, 2019). Similar statistics are reported in Washington. Vermont, Colorado and California report of significantly lower numbers given the strong opposition in these states regarding physician-assisted suicide (Davis, 2019). The evidence, therefore, suggests that physician-assisted suicide is steadily rising in America.

In the past, the law was against physician-assisted suicide. According to Davis (2019), the Supreme Court in 1997 ruled against state laws banning physician-assisted suicide. It has dissented that the regulations contradicted as well as violated the constitution in Washington v. Glucksberg (Davis, 2019). The final decision determined that the matter was the constitution of the right of the physician’s aid in dying patients to the states.

Consequently, Oregon State instituted that the Death with Dignity Act in October 1997. The law was passed with a majority (51%) votes in favour of the law which was delayed as a result of the Washington v. Glucksberg U.S district judge who issues an injunction regarding the matter unconstitutional (Davis, 2019).  Simultaneously, the Ninth Circuit Court of Appeals also ruled that it was unconstitutional as well as the Supreme Court. Nevertheless, Oregon state voted in favour of the Act and other states, including District of Columbia followed suit.

The social issue on physician-assisted suicide gained nationwide uproar after a televised physician-assisted suicide was aired on television. In 1998, as Davis (2019) narrates, an assisted suicide involving an advocate Jack Kevorkian aired on CBS 60 minutes showing the advocate videotaping the death of Thomas Youk. The Act prompted murder charges against Kevorkian rather than assisted suicide charges since Kevorkian injected the drug into Thomas, who has Lou Gehrig’s disease (Davis, 2019). Kevorkian was sentenced to 25 years in prison. As a result of this, the State of Washington passed the Death with Dignity Act in 2008 (Davis, 2019). Vermont decreed into law the Patient Choice and Control at the end of Life Act in 2013. Montana was declared through a Supreme Court ruling in Baxter v. Montana asserting the rights of the terminally ill Act protecting the physicians prescribing aid from liability (Davis, 2019). In 2016, California paved the way for the End of Life Option Act citing that patients should have the legal right to ask for physician-assisted suicide. Consequently, Hawaii instituted the Our Care Our Choice Act, Colorado the Death With Dignity Act and District of Columbia’s Death with Dignity Act was also instituted (Davis, 2019).

The legalization of physician-assisted suicide presents the general view of how states in America are politically inclined to influence the health sector. Politically, it is given that assisted suicide does not interfere with the sanctity of humanity.  The effect of political influence has emerged with studies including Purvis (2012) and Bostrom (2010) indicating that there is a growing mistrust on the medical field professionals including the competing claims on medical expertise and practice. In other words, from a political standpoint, researchers justify the need for political influence on the social matter giving more authority and autonomous rights to individuals choice and control during death (Purvis, 2012). However, political influence is seen to transcend into social factors, including religion. According to Purvis (2012), Oregon’s legislation of the Death with Dignity Act involved Catholic churches in influencing the public to support the bill. As a result, more than 60% of Oregon citizens ruled in favour of the bill allowing doctors to prescribe lethal medication to terminally ill patients (Purvis, 2012). The influence of the church highlights the political, social and religious climate in America segregating opinions about physician-assisted suicide given that State of California and Washington, religious-based institutions, did not vote in favour of the law. The mismatch between religion and politics presents a new factor of how religious plays the double-edged sword regarding the social problem.

Social and Religious Factors

            Religion plays a critical role in how legislators and social aspects discuss and determine physician-assisted suicide. It is said that spiritual, religious and existential factors are crucial to how Life is interpreted as well as death. On one end, it is showed that religion influences how patients view death. In most cases, patients request an interaction with someone regarding the belief about life and death according to the study report by Chakraborty et al., (2017). The study also reveals that difference in religious and spiritual beliefs play a role in how well terminally ill patients receive the religious and spiritual care they desire. Chakraborty et al., (2017) results from the study showed that patients who received religious and spiritual care from the medical teams decided to increase hospice care whereas, those who did not receive religious or spiritual intervention regarded physician-assisted suicide at increased rates. From a denomination perspective, the study Chakraborty et al., (2017) reported differences in perception of death. Catholics faithful were most likely to withdraw treatment while, protestants, Greek Orthodox and Muslims as well as Jewish were more likely to withhold from terminally ill patients (Chakraborty et al., 2017). The study, therefore, reiterates the aspects of belief and attitudes as major factors that contribute to the decision on whether to use physician-assisted suicide or not.

Religious individuals, including medical officers, incline to refuse assisted suicide, whereas; non-religious individuals are more inclined to support assisted suicide. However, belief and attitude play a critical role in making this decision. Fundamentalists are more likely to oppose assisted suicide compared to non-fundamentalists (Chakraborty et al., 2017). It may explain why States such as Oregon were more inclined to support physician-assisted suicide regardless of the large Catholic setting in the region. It may also explain why States such as California and Washington are separated from this decision to use physician-assisted suicide (Purvis, 2012). The interesting aspect is that studies by Chakraborty et al., (2017) and Purvis (2012) show that individualism on religious and spiritual beliefs are critical determinants on whether a person chooses physician-assisted suicide or not. It is the American culture regarding assisted suicide. It is different between fundamentalists and non-fundamentalists.

To understand the impact of the social factor on physician-assisted suicide, the concept of ethics and morals is required. On one end, American people are concerned about the death process with physician intervention medication, including end-of-life care (Sulmasy & Mueller, 2017). On the other hand, some question the legal ramifications on physician-assisted suicide. Therefore, some American have advocated strongly about assisted suicide based on autonomy, whereby, practitioners should be given the legal mandate to carry out the Act (Sulmasy & Mueller, 2017). The study report by Sulmasy & Mueller (2017) shows the American culture on individualism factors in the relevance of medical intervention on the good end of life care. However, there is a difference in lethal medication and good medication. Society is divided upon this given that most States have legalized or through courts, physicians are allowed to use lethal medications. The social aspect in assisted suicide using lethal medication questions the care for patients and families psychological, emotional, financial and physical outcomes as a result of lethal induction of assisted suicide (Sulmasy & Mueller, 2017). The question is also on the concern on death, whether some receive the care needed during death or whether some do not receive it all. Inherently, the concern on end-of-life criteria is based on the medicinal scope and how it is addressed.

The main factor bases on the medicinal influence on unprecedented capacity to treat illnesses and ease the process of dying. Additionally, the question is whether patients are given the right care at the right time and the right place. Society inevitably struggles with giving the right care for the patients. Communities mandate the need for palliative care and hospice care but, with terminally ill patients, advanced medication to care for the patients is yet to be achieved in this century (Sulmasy & Mueller, 2017). The challenge, therefore, remains on how well the society is prepared in caring for the terminally ill patients and the elderly population has given issues on time pressures, care coordination and communication barriers (Sulmasy & Mueller, 2017). Hence, society remains undecided on whether physician-assisted suicide is necessary or not given the ramifications of individual beliefs and religious attitudes.

Economic Factor

The cultural bias against physician-assisted suicide expediently highlights the economic issue of physician-assisted suicide. According to the Supreme Court decision on Washington v Glucksberg, the dissent indicated that the autonomy and health of the patient to seek physician-assisted suicide compromise their financial status (Smith, 2017). The decision reiterated that it was ethically justifiable for physicians to assist in suicide to spare families of the substantial financial burden to end-the-life of their loved one on the premise of health-care costs (Smith, 2017). As such, the concerns regarding physician-assisted suicide on economic influence have raised a lot of questions. Among the questions is whether patients are coerced into agreeing to take on assisted suicide, given that palliative care or hospice care is expensive and burdensome to many (Smith, 2017). Most especially, it has been noted that most patients offer to take up assisted suicide as a means to relieve the burden from the younger family members. The provision of the law in some States or provision under the rule of the courts permits patients to make the autonomous decision to take assisted suicide (Smith, 2017). However, the ethical question in play is whether patients are making the decision by themselves or are being coerced into doing so. Hence, the premise of autonomy is no longer permissible in this scenario.

The first case scenario is that physicians and other health care providers are faced with financial incentives to reduce health care spending among patients. Hence, the autonomy to request assisted suicide by the patient on these grounds (Smith, 2017). It is mandated that physicians can carry out assisted suicide to save employers money to retain profit in spending on fewer premiums (Smith, 2017). On the other hand, physicians may feel obliged to care for the interests of the society in encouraging the patients to take the less costly alternative of assisted suicide. It is a phenomenon known as bedside healthcare rationing. Another factor to consider is that hospitals and other medical institutions are under economic stress (Smith, 2017). As such, they have management plans to ensure that the patients in palliative or hospice care get the best outcome. Therefore, the roles of the patient’s families are of significance to choose assisted suicide to avoid spending more money on the patient.  Hence, the economic factor on physician-assisted suicide justifies the political, social and religious factors on choosing physician-assisted suicide.

Impact on Social Policy Development

The factors, political, social, religious and economic have a profound influence on the social policy development on physician-assisted suicide. From a social and economic perspective, the necessity to develop the policy relies on the life-sustaining treatment financial burden and accessibility in prolonging Life. The political impact has created a justification for its involvement (Purvis, 2012). The reason is based on the medical loss in on criteria of the dying process. Americans feel that there has to be a way and a proper way at that in caring for their terminally ill patients and the elderly when they decided on retracting from medications. As a result, public policies on physician-assisted suicide have increased on both ends: prolonging Life and the decision to take up physician-centred care (Davis, 2019). From a social perspective, the influence of social policy develops gravitates towards the improved identity of the rights of patients and family members. The social policies regard for the personal ethical, moral and religious beliefs in people (Sulmasy & Mueller, 2017). For these reasons, social policies give an option for patients to decide on whether they would like assisted suicide or not.

In the United States of America, support for physician-assisted suicide is at 73% as of 2015 (Inc, 2017). Liberals are more supportive of physician-assisted suicide which allows doctors to voluntarily end the Life of a terminally ill patient if the patient requests it. The statistics may explain why five states in America passed a law regarding physician-assisted suicide citing it as a moral duty (Inc, 2017). Churchgoers, on the other hand, are strongly opposed to physician-assisted suicide claiming its contradictory Act to a higher power’s authority and command.  Alternately, a large percentage of Americans are divided on the social issue given that some state the need to have physician-assisted suicide in the Intensive Care Unit while others state it is possible to have if a patient requests it (Goligher et al., 2017). The following part of the report will delve into evaluating the political, religious, social, environmental and economic factors that affect physician-assisted social policy.

Conclusion

An in-depth analysis of the social policy perspective influenced by political, economic and social as well as religious factors is succinctly discussed in the report. American culture is described as the most influential factor and has a powerful impact on how social policies are made across the States. It may explain why different States are neutral in legislating physician-assisted suicide while others are in support of physician-assisted suicide. The social factor presents a two-fold argument whereby, the American society is more concerned about the care taken during assisted suicide for their families and on the other, the type of assisted suicide administered. For the political factor, the issue of administering a lethal injection is debated. California and Washington states are reluctant in providing a law on assisted suicide, but, it willing to accept court-mandated suicide. On the other hand, nine States, including Oregon, have legislated the assisted suicide by physicians using lethal injection. The ethical premise of using lethal is not regarded from a political perspective, but it is from a social conscious. Also, the paper has discussed in detail the religious factor and how individualism on belief and attitude influences support or opposition to assisted suicide. Nevertheless, the paper concludes that the growing support for physician-assisted suicide is rampant with a majority, 73% reported to favour the process. Hence, physician-assisted suicide is a social problem given the conflicting ideologies on factors of political, social and economic influences in choosing physician-assisted suicide.

References

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Sulmasy, L. S., & Mueller, P. S. (2017). Ethics and the legalization of physician-assisted suicide: An American College of Physicians position paper. Annals of Internal Medicine, 167(8), 576–578.