By Nonie Arora
Is it acceptable for patients to choose to die on their own terms? Can physicians assist them with their wishes? Where do we draw the line for euthanasia and end-of-life decision making? Faculty and students discussed these thorny issues at a recent Science & Society Round Table event, co-hosted by the Duke Undergraduate Bioethics Society.
This event was sparked by the recent events regarding Brittany Maynard. On November 1st, Maynard, a 29-year-old terminally ill cancer patient, chose to take a pill that ended her life.
During the roundtable, professor Dr. Jennifer Hawkins and paramedic Anita Swiman discussed this case as a launching point to delve into ethical issues regarding decision-making and “Death with Dignity” laws. Dr. Hawkins is a philosopher in bioethics and has studies quality of life issues and the nature of suffering. Swiman, an emergency medical technician, has insight into what it’s really like to deal with families who are making decisions about end-of-life care.
Because of her brain tumor, Maynard would have to undergo a very difficult process of death. She chose to relocate from California to Oregon to take advantage of their “Death with Dignity” statute. Previously, about 750 people – mostly elderly – had used the statute, but Maynard changed the discussion by being a young, vibrant woman talking about a decision to end her life, according to round table moderator, Michael “Buz” Waitzkin.
Dr. Hawkins described three main worries that come along with physician-assisted suicide. She said the first struggle is whether it can be in someone’s best interests to die. “Death is the enemy for most of us most of the time because we are healthy and have things we want to do,” she said. However, some people are suffering deeply. She questioned how can we distinguish between those that could be helped in what remains of their lives from those who cannot.
“Even if we can agree that sometimes it’s in a person’s best interests to die,” Dr. Hawkins explained, “We can disagree about the roles of physicians or other health care workers in this process.” Physicians generally operate by the code of doing no harm. Some people believe including physician-assisted suicide violates sacred codes of physician conduct.
Finally, Hawkins said that even if we can agree that sometimes it is in some people’s best interests to die, and we don’t have a problems with physicians helping them, we may still worry about the effects on society of such a policy that permits physician-assisted suicide. She said that some people are concerned about how such a policy could impact end-of-life decision making if elders feel pressured to choose this option, against their own wishes, to not feel like a burden on their families.
“Will we be able to keep the policy restricted to the terminally ill, those who request it, and those who are able to take the prescription on their own?” Dr. Hawkins asked the group. She questioned why we restrict the application of “Death with Dignity” laws to those who can ask for a prescription. Some people who are paralyzed or cannot take prescriptions for themselves are excluded.
Paramedic Anita Swiman provided a perspective based on practice. “As a health care provider in prehospital medicine, there are clear laws that we must follow. If a patient meets certain criteria, we know what we will do. We take our personal feelings out of the discussion. We (sometimes face) assault from family members who want something different from what their family member had written in their wishes.”
Swiman said that pre-hospital providers act as counselors as well. She described that while being receptive to what family members are saying, paramedics sometime have to explain, “This is what the person wanted. This is what the law states. I would like to fix the situation for you, but there is nothing that I will be able to do for you.”
Ultimately, scholarly work that addresses the nature of suffering or examines consequences of “Death with Dignity” laws in different states could further inform the difficult ethical issue of physician-assisted suicide.