Difference between Assisted Suicide and Treatment Withdrawal.
Michael Doe, a twenty-four-year-old male, has ben brought to the hospital by a friend. Previously in good health, Mr. Doe is experiencing a severe headache and a stiff neck. Based on physical examination and laboratory tests, the emergency room physician makes a diagnosis of pneumococcal pneumonia and pneumococcal meningitis.
The physician informs Mr. Doe that he should be hospitalized immediately and given antibiotics. He refuses treatment and says he wants to go home. The physician explains the severe danger of going untreated and the minimal risks of treatment. (Without treatment, there is a likelihood of death of 60-80 percent, with survivors generally having major and permanent neurologic damage. With treatment, there is a greater than 90 percent chance of full recovery.) Mr. Doe persists in his refusal. There is no evidence ot compromised decision making due to an altered mental State (although the patient's high fever might lead the physician to suspect some incapacitation)." Further, Mr. Doe does not explain his refusal of treatment in terms of a personal belief, for example, a religious objection to antibiotics. Mr. Doe simply refuses and will provide no reason for the refusal. (One might conclude that physicians should impose life-sustaining treatment on Mr. Doe because he has given no reason tor his refusal and that this case simply illustrates that the right to refuse life-sustaining treatment requires a competent retusal. A small change in the facts could respond to this point. For example, assume that Mr. Doe would need artificial ventilation for a few days in addition to antibiotics, and he refuses the ventilator because he does not like the idea of being on a ventilator. From now on, I will refer to Mr. Doe as a "curable" patient.)
Jonathan Poe' was hospitalized and placed on a ventilator in December 1990, at the age of sixty-seven, because of difficulty breathing. This was his second experience with artificial ventilation. In 1936, nearly twenty years before the discovery of the polio vaccine, Mr. Poe had developed polio and spent six weeks in an "iron lung." He recovered completely, but his need for a ventilator in 1990 resulted from "post-polio syndrome," a condition in which a person's polio becomes reactivated and causes the same symptoms as with the original infection. During the few weeks after his 1990 hospitalization, it became clear that Mr. Poe would be ventilator dependent for the rest of his life. For Mr. Poe, having to live with continuous mechanical ventilation, with the consequent inability to speak, made his quality of life unacceptable. Accordingly, he asked that the ventilator be withdrawn. He was seen by a psychiatrist and two medical ethicists, all of whom agreed that Mr. Poe was making a carefully considered decision. Mr. Poe persisted in his wishes, and, on February 25, 1991, his ventelator was withdrawn. He died in fifty-three minutes, with thirteen family members and friends at his side. (From now on, I will refer to Mr. Poe as an example of a "permanent-ventilator" patient.)
Vincent Foster was a White House lawyer who died by a self-inflicted gunshot at the age of forty-cight, seemingly at the pinnacle of a life in which he went from one success to another. A friend of President Bill Clinton snce their childhood days in Arkansas, Mr. Foster had starred as an athlete in high school, finished first in his law school class, and become a leading partner in one of Arkansas's most prestigious law firms. When Mr. Clinton assumed the presidency in January 1993, Mr. Foster moved to Washington, D.C., to become the president's close and trusted legal adviser. Only six months later, however, Mr. Foster's body was found in a park just outside of Washington, after he shot himself in the mouth. According to friends, difficulties at work had taken a toll on Mr. Foster, and he had been showing signs ot depression during the last month of his life. He had just started to take an antidepressant medication and had obtained the names of local psychiatrists, but apparently he was overcome by his despair. (From now on, I will reter to Mr Foster as an example of a "depressed" patient.)
Jane Roe" was a sixty-nine-year-old retired pediatrician who was diagnosed with cancer in 1973. Treatment subdued the cancer until the fall of 1988, when it came back. By 1993, the cancer had metastasized throughout Dr. Roe's skeleton. Although she tried and benefited temporarily from various treatments, including chemotherapy and radiation, the cancer became untreatable. In June 1993, Dr. Roe became almost completely bedridden, and she began to experience constant pain, which was especially sharp and severe when she moved. Medications could alleviate her pain, but could not relieve it fully. In addition to the pain, Dr. Roe suffered from swollen legs, bed sores, poor appetite, nausea and vomiting, impaired viSion, incontinence of bowel, and general weakness. She did not, however, have any loss of mental competence. When it became clear that even hospice care could not relieve her pain and other suftering, Dr. Roe decided that she wanted to end her life by taking a lethal dose of prescription drugs. Because the law in Washington state, where she lived, prohibited physicians from assisting their patients suicides, Dr. Roe asked a federal district court in Seattle to find the law unconstitutional. Dr. Roe was joined in her lawsuit by two other patients, five physicians and an organization, Compassion in Dying. Although the trial court and the court of appeals ruled in Dr. Roe's favor, the Supreme Court ultimately rejected her argument in June 1997. In the meantime, in February 1994, before the trial court issued its ruling, Dr. Roe died. (From now on, I will refer to Dr. Roe as an example of an "end-stage cancer" patient.)
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