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Doctor Assisted Dying

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Recently the Western world has shown more support towards assisted dying. In many countries the idea is popular with large numbers of people.  Some European countries and a few states of the US, such as Washington, Oregon, Vermont, Montana, and California, have already legalized the practice. Albeit with strong safeguards.

The practice has a long history. Throughout the world it is common for doctors ignore the law and help their patients die. They do so by withholding treatment or giving excessive doses of painkillers. Occasional one may go too far, falling under investigation, but charges are seldom brought.

Some people support this practice of operating under unwritten rules. They believe it sets limits to doctor-assisted dying. All without the need to discuss the difficult moral dilemmas the practice requires.

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Unethical

Unregulated the practice is unethical. Even though it is often done with agreement from the patient and their family, the patient has no explicit choice.  The decision rests with the doctor, whose duty is to keep the patient alive.

It is hypocritical and impractical. Outward protest against the practice covers for support, as long as it remains hidden behind hospital walls. The system is without safeguards. Moreover, it is becoming unworkable.

Most deaths now take place under teams of doctors who are operating in more regulated legal and professional environments. Silent death by unspoken agreement is no longer good enough.

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Questions

The Netherlands (Holland) has allowed ‘physician-assisted suicide’ since the 1980’s, although its parliament only passed a law in 2002. The US approved the first euthanasia bill, the Death and Dignity Act, in the state of Oregon in 1997. Today, euthanasia is legal, in some form or the other, in 23 countries.

Enough time has lapsed since the legalization to clarify some questions.

Is it used as an inexpensive alternative to save on palliative (end of life) care?

Have rules slackened over the years?

Is the patient-doctor relationship harmed?

And does the act put pressure on the ill, particularly if they perceive themselves as a burden on their kin?

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Answers

It is true that as more and more people are becoming aware of the possibility, the number of people choosing assisted dying rises each year. Yet the total number of people that have opted for assisted dying is low. Since Oregon passed its law in 1997, only 1327 people have applied for assisted dying. A third of those didn’t take the final step.

The rules haven’t slacked either. 80% have been terminal cancer patients. Further, the relationship between doctor and patient seems to remain unharmed. A doctor must inform patients of the alternatives, including hospice care and pain-relieving medication. And another doctor’s opinion must be taken.

In total there have been only 22 cases where a doctor has been investigated for a breach of the rules, with no prosecutions for malpractice. Most involved issues such as failing to file paperwork on time.

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The Facts

The concern of abuse seems misplaced. The poor who can’t afford hospitals or insurance are not forced to make unpalatable choices. Nor are vulnerable patients taken advantage of by relatives or rogue doctors. Neither does a cash-strapped state seem to be doing away with expensive patient care.

In fact those who have used the option are usually educated and wealthy. Most were in hospices, considered the best type of end of life care.

Counselling sessions revealed that the loss of dignity and self-sufficiency as the primary reasons for people making their choice. Most cite a loss of freedom or an inability to do things that makes life enjoyable. Escape from pain is only relevant in a quarter of cases.

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Unsubstantiated

There seems enough data to back the claim that euthanasia works. Many advocates feel that their opponents are making unsubstantiated claims  of abuse, because the cases to back them up don’t exist.

One argument against is that if there were more hospice options or facilities available, less patients would opt for suicide. Recent research doesn’t support this train of thought. A sociologist at Brunel University in London, Clive Seale, arrived at the opposite conclusion.

Terminally ill patients in British hospices were more prone to opt for assisted dying than the patients in hospitals.

Patients entering a hospice are aware of their proximity to death and are already planning their curtain call. They often consider all their choices.

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Misplaced

There is also a fear that the medical profession will lose its position of dedication and trust. In fact, the opposite seems to happen. Doctors become more responsible when they have the legal power to take a life. Nor does assisted dying lead to a reduction in care.

Surveys show that doctors are equally trusted in countries with assisted dying as those without. The Netherlands and Belgium have some of the best end of life care in Europe.

It is true that in Holland 3% of all deaths are now assisted suicide, but this is unlikely to be an increase due to legalization. Instead, it’s a reflection of a long-standing practice finally coming to light. The visibility of a long unspoken tradition formerly operating out of the limelight.

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This essay draws on the work of physician Atul Gawande, particularly his New York Times Best Seller, Being Mortal: Medicine and What Matters in the End

 


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