Ethics of P-AS, Bloxham

DLaina Bloxham
Inst: Jeff Zealley
HS 2050-400
May 2, 2016
The Ethics of Physician-Assisted Suicide

Introduction
What would your plan of action be if you were diagnosed with an incurable disease and
your days were numbered? During that time you would be in excruciating pain, lose all your
faculties and have a very slow, painful death. Would you want to pick the time and way to die,
preserving your right to dignity and choice?
Physician-Assisted Suicide (P-AS) and euthanasia have been controversial methods for
centuries. P-AS dates back before the time of Christ, when the Hippocratic Oath was established.
The Hippocratic Oath was originally penned between the 5th and 3rd centuries B.C. stating that
doctors should preserve life and never provide means to end it. But in the 5 th to 3rd centuries the
Greeks and Romans were generally in favor of assisted death. In the 12 th century A.D.
Christianity had become accepted, devout Christians and Jews vehemently opposed prescribing
death for those with inadequate quality of life.
New York outlawed assisted suicide in the mid eighteen hundreds and many other states
adopted that law, making it criminal code (and) prohibiting "aiding a suicide and specifically
furnish[ing] another person with any deadly weapon or poisonous drug, knowing that such
person intends to use such weapon or drug in taking his own life (ProCon.org, 2013).
In the 1930s, at the time of the Great Depression, assisted death and euthanasia started to
become more widely accepted as quality of life deteriorated. 45% of the population was in favor

Ethics of P-AS, Bloxham

of assisted death. In the 1950s support of physician-assisted suicide declined. By the 1990s
support was on the rise and in 1994 Oregon was the first state to pass the Death with Dignity Act.
Conversely, the US Supreme Court ruled in that same year there is no right to die. In 1997
Oregon votes in favor of keeping the Death with Dignity Act.
Since 1997 four other states have adopted and legalized similar laws in their states.
Several more are considering introducing a Right to Die bill to their voters.

Figure 1: States that have legalized or are considering legalizing P-AS. Source: http://www.governing.com/topics/healthhuman-services/aid-In-dying-advocacy-group-girds-for-battles-after-california-victory.html

Thesis
There is heated debate about legalization of physician-assisted suicide around the
country. Physician-assisted suicide should be legalized so patients can make the decision for
themselves. It should be up to them to decide if their illness or ailment merits them the ability to
utilize P-AS with knowledgeable help of physicians and family. By looking at the case of
Brittany Maynard, I hope to confirm this statement through the support of the Paradigm Boxes.

Ethics of P-AS, Bloxham

Figure 2: Brittany Maynard, Nov 19, 1984- Nov 1, 2014. Source: https://en.wikipedia.org/wiki/Brittany_Maynard

Medical Indications: The Principles of Beneficence and Non-maleficence

Brittany Maynard, age 29, was diagnosed with Stage II Astrocytoma brain cancer. After
an unsuccessful surgery her diagnosis changed to Stage IV terminal Glioblastoma multiforme.
The goals of treatment could not be successful. Brittany was terminal regardless of any medical
or nursing care. No treatment would save her life and she moved to Oregon to be eligible for its
Death with Dignity Act. The Death with Dignity Act gave her the opportunity to choose the time
and place she wanted to die, in the company of her family. She was able to be cognitive and
aware of their support, to the end.
Many argue that Brittany should have exhausted all forms of treatment, not allowing
nature to take its course, prolonging life with no regard to quality. Treatment would have
extended her life by a few months while her body deteriorated. Financial resources would be
used up, life would be painful and treatment invasive. There was no cure for her condition.

Patient Preferences: The Principle of Respect for

Autonomy

Ethics of P-AS, Bloxham

Howard Ball states in his paper Physician Assisted Death in America: Ethics, Law, and
Policy Conflicts that people facing terminal health issues do not have many options and because
of autonomy can really only choose between three choices that will lead to their death. They can
choose to withdraw from the testing that may offer a few more months to live. They could
choose to manage pain through being heavily medicated and/or in hospice care. The above
options pose no ethical debate and are widely accepted. The third option is P-AS, which right
now is illegal in 45 states. Ball states that autonomy is key, Those who oppose it believe that a
more fundamental societal rightthe sanctity of human lifetrumps individual autonomy
(Ball, H. 2012).
Brittany Maynard was within her rights of autonomy to choose physician-assisted
suicide. She was informed to the benefits and risks, and had given consent. She was mentally
capable and knew what she was asking for. She was unable to cooperate with medical treatment
because the treatments would do nothing for her.

Quality of Life: The Principles of Beneficence, Non-maleficence, and Respect

for Autonomy
There is a debate that people who are terminally ill should use pain medication and
hospice care. Between the years of 1999-2001 there were 91 deaths in Oregon using P-AS, of
those 78% were already living with hospice care (Ganzini, 2002). That is a substantial amount
that were still did not want their illness to dictate their life and death. According to a survey
taken from hospice nurses in Oregon about their patients showed that those who filled their lethal
prescriptions wanted most to control the circumstances of death, a desire to die at home, the
belief that continuing to live was pointless and being ready to die, (Ganzini, 2002). Those who

Ethics of P-AS, Bloxham

choose P-AS do not want to die because they dont value their life or want to live; they want to
be in control of something that took control of them.
Brittany was very well educated, she knew the quality of her life, and did not want to lose
her independence as her illness developed. She should be the only person who could determine
that. The ethical issues of only wanting to keep her alive due to sanctity of life did not sway her
decision.

Contextual Features: The Principles of Justice and Fairness

The legal issues that arise from physician-assisted suicide stopped Brittany from being
able to die in her own hometown. She had to move to Oregon in order to have the law on her
side. As mentioned before because Brittany was terminal, the treatments that she could have had
would have been expensive and would not have cured her. By making this decision she gave
herself the freedom she needed to get the peace of mind of dying on her own terms. To be just
and fair no one else should make that decision.

Conclusion
In all of the Paradigm boxes Brittany was within her rights to end her life the way she
saw fit. Physician-assisted suicide is only one means to help a terminally ill person. Everyone is
different in how they view their own life and in ability to choose, when they get that diagnosis
that their illness is incurable. They should have the legal right to make their choice. Brittany
chose to end her life in a way that involved her family's support and Oregon's Death With
Dignity Act allowed her to make that decision. The best way to say this is: despite Maynards
having taken her own life, a brain tumor is the official cause of death on her death certificate
(Slotnik, 2014)

Ethics of P-AS, Bloxham

Works Cited
Ball, H., (2012, Dec 10). Physician assisted death in America: ethics, law and policy conflicts.
Cato Unbound, A Journal of Debate. Retrieved from http://www.catounbound.org/2012/12/10/howard-ball/physician-assisted-death-america-ethics-lawpolicy-conflicts
Ganzini, L., Harvath, T,. Jackson, A., (2002 Aug 22). Experiences of the Oregon nurses and
social workers with hospice patients who requested assistance with suicide. New England
Journal of Medicine.
Maynard, B. (2016, February 21). In Wikipedia, The Free Encyclopedia. Retrieved May 1, 2016,
from https://en.wikipedia.org/w/index.php?title=Brittany_Maynard&oldid=706161119
ProCon.org. (2013, July 23). Historical Timeline. Retrieved from http://euthanasia. procon.org/
view.timeline.php?timelineID=000022
Slotnik, D. E. (2014, November 3). "Brittany Maynard, death with D\dignity Ally, dies at
29". The New York Times. Retrieved April 30, 2016.