Role for Physician-assisted Suicide in Cancer

A woman suffering from terminal cancer became the first person to die under the law of physician-assisted suicide in Oregon in 1998. The New England Journal of Medicine states that more than 4,000 doctors have approved of the physician assisted suicide law (The Anguish n.pag.). In just the United States, forty-two percent of people have had a friend or relative suffer from a terminal illness (The right n.pag.). Although cancer is the leading cause of death in terminally ill patients, many other illnesses destroy someone's quality of life. Most treatments for terminally ill patients are long, expensive and leave the patient and family in an intense amount of physical and emotional pain. Assisted suicide is frowned upon by some people, these concerns are usually rooted in religious beliefs. In the United States that practice is legal in Oregon, Vermont, Montana, Washington and California. Patients throughout the US with ALS, terminal cancer and paralysis should have the option to receive a lethal dose of prescription medication to die peacefully.

ALS is a complex disease that sends the patient into a slow cycle of physical suffering. The disease attacks the nerve cells in the brain and spinal cord. Sometimes early stages of ALS are hard to diagnose because the symptoms fatigue, nausea and muscle weakness can be easily diagnosed as other illnesses (Leveneand Parker n.pag.). Assisted suicide would not be optional for someone in early stages of ALS although each patient progresses differently. It usually takes about five years until patients are in the final stage of the disease. Patients who are considering assisted suicide should start planning when to do it in their third or fourth year. Doctor Lorne Zinman of Health Sciences center states ALS has sort of been at the forefront of the physician assisted death debate because of how awful the disease is(Zinman n.pag.). With the progression and severity of this disease other doctors can agree with Zinman that assisted suicide should be an option to patients with ALS.

Physical suffering progresses the later the patient is into the disease. By the final stages patients are usually paralyzed, unable to swallow and breathe on their own. Patients at this stage are usually living off of feeding and breathing tubes. The physical pain arising from complications of the feeding or breathing tube can sometimes cause more pain than the disease itself. Some complications can be UTIr's, pneumonia and even collapsed lungs (Zinman n.pag). Assisted suicide will benefit the patient before reaching the late stages and prevent him or her from suffering the complications along with ALS. These complications can be treated but include serious side effects. The most commonly used treatment for ALS is Ritalek, which has been connected to liver failure. The patient would therefore have a chance to end the suffering before any painful side effects. Many doctors who treat ALS patients have to watch their patient slowly deteriorate, eighty percent of ALS doctors believe that in the moderate-severe stages the patient should be eligible for physician assisted suicide (Zinman n.pag.). Physical quality of life may be the number one reason behind some patient requests for assisted suicide but they are also struggling through their emotions.

The social and emotional quality of life deteriorates for patients with this disease. Some doctors believe that the patient's quality of life is based on psychological factors(Zinman n.pag.). Along with two specialty doctors patients must also be seen by psychiatrists before they are eligible for assisted suicide. It is possible for the patient to have a bad hqol (health quality of life) but a decent QOL (quality of life) (Rummans, Botswick, Clark, n.pag.). Both of these play into the patient's needs for assisted suicide. The support system that the patient has plays a big role in the quality of life which can affect them emotionally.

This physical and social strain can deeply affect the emotional quality of a patient's life. Although ALS patients lose control of their physical and sometimes social abilities, their minds are still competent. Many patients either become over-emotional or not emotional at all. The feeling of not being able to express themselves can be deeply damaging (Weiss et all n.pag.). In this stage the patient may feel extreme loneliness or burdensome and all of this plays into the emotional quality of life. Giving them some kind of control will allow them to feel some peace while living before they pass away , without that control patients could easily start to feel anxious.

Anxiety is a common psychological problem developed in patients with ALS. Itr's caused by the feeling of the body slowly shutting down but not knowing exactly when they will die. Assisted suicide could help eliminate this problem by allowing the patient to plan the date of their death (Weiss et all n.pag.). Giving patients control when they die would deeply benefit them, especially since theyve already lost control of their bodies. Anxiety and lack of control can easily manifest into depression.

Depression in ALS patients is fairly common especially if the patient is under the age of forty (Cirino n.pag.). Psychiatrists are brought into evaluate the patient's depression just in case the patient was depressed before diagnosed although this is usually not the case (Zinman n.pag.). Under certain circumstances, depression can be caused by the profuse amount of medical bills.

Costs for terminal illness are extremely expensive and can deeply affect the patient's quality of life. For ALS alone, the annual patient cost is $31,000.. This amount is before the final stage where a feeding/breathing tube is introduced (Weiss et all n.pag.). It can be very stressful to the patient spending such an exorbitant amount of money on a terminal disease. Assisted suicide would reduce the costs drastically. A lethal dose of prescription medication for assisted suicide costs between $35-50, while a breathing tube can cost up to ten thousand dollars (Gardner n.pag.). By allowing the patient to receive a lethal dose of medication, the burden of medical bills would be almost nothing on the patient and their family.

The family plays a crucial role into the patient's life during their illness. Death is hard on loved ones either way, but in many cases the lack of suffering assisted suicide offers the patient is merciful to the family as well. Many patients are required to have counseling sessions with their loved ones, to help with the processing of letting them go. In most cases the patient talks with the family and the family physician before requesting assisted suicide (Zinman n.pag.). Loved ones influence the patient's decision critically, but at the end of the day the patient still gets to decide.

Families often feel many emotions under these circumstances. In typical suicide cases families often experience anger and abnormal grieving, while in terminal cases assisted suicide often makes the grieving process easier on the family because they have a chance to say goodbye without seeing their loved ones suffer (Zinman n.pag.). Overall the disease takes a toll on the family because of how little the patient can do in the progressing stages.

Assisted suicide has been the right alternative for many ALS patients. Betsy Davis, a forty-one year old woman living in Southern California, was diagnosed with ALS and told with her progression she had about six months to live. She talked to her family and decided to exercise California's law to participate in physician assisted suicide. Betsy decided to embrace this opportunity to die on her own terms by celebrating with her friends and family in an end of life ceremony(California women n.pag). The party she threw had dancing, laughing and one rule: no crying. Betsy became an advocate for assisted suicide in ALS patients because she proved that patients and their families didn't have to spend their time in constant grief (California Women n.pag.).These circumstances are unlike any party you have ever attended before, requiring emotional stamina, centeredness and openness(California Women n.pag.). With this option, Betsy was able to take control of her illness and say goodbye in her own way on her own terms. Although ALS is a detrimental disease there are other terminal illnesses to which assisted suicide should be available.

Being diagnosed with terminal cancer is one of longest and hardest processes a patient endures. Each patient that is diagnosed with terminal cancer takes the news in a different and personal way. It's hard to imagine the thought process that a patient takes on knowing that s/he is going to die. Certain patients fall into a pit of depression, this is why psychological evaluation is required (Llevene andMichael n.pag.). The level of their depression is based on different factors, the patient's support system and family.

Depression is extremely common among terminally ill patients, especially those with cancer. Before their request for assisted suicide is approved psychologists work together to determine whether the depression is caused by their terminal illness or if the depression was already present before diagnosed. If a patient is suffering from depression due to his or her terminal cancer, a psychologist will try and help pull the patient out of the depression (Yun et all n.pag.). Some terminally ill patients are at higher risk for depression if they have a past of social stress, addiction, family problems or history of depression (Weiss et all n.pag.). Terminal cancer patients with depression go through different stages of emotions. Common ones include anger, bitterness, grief, loneliness, acceptance and for some peace. Baylor University Medical center states up to seventy-seven percent of terminal cancer patients experience some kind of depression (Cirino n.pag.). The grief and depression patients endure can cause more pain than they already have. With assisted suicide patients would receive comfort knowing that they will die in peace.

There is no cure for terminal cancer but there are many treatments and medications the patient can receive. The problem with these is that it causes pain medication resistance. Over eighty five percent of terminal cancer patients and oncologists believe in assisted suicide. Their number one reason being pain resistance (Cirino n.pag.). As cancer withers away the body, doctors prescribe more pain medication until they are unable to prescribe anymore and the patient builds up a tolerance to it. Ten percent of terminal cancer patients turn to street drug opiates such as heroin just to decrease their pain (Gardner n.pag.). Allowing the patient to receive a lethal dose of medicine before the cancer reached this stage would give the patient a chance to live without daily pain. Eighty percent of patients suffer in the last six months of their illness with severe pain but only twenty nine percent want to increase medications (The long n.pag.). This is caused by the fear of addiction, being drugged out and increasing tolerance. Overall, medication can be helpful in the beginning stages of terminal cancer. However, many patients would benefit from assisted suicide once they got to a certain point where medication was of no help.

The quality of life for cancer patients can vary from patient to patient. Over 75% of patients spend their last days on a morphine drip in the hospital (Gardner n.pag.). This is no quality of life the patient or the patient's family wishes. Radiation is another treatment that can prolong life but it comes with serious side effects such as skin irritations, muscle fatigue, nausea and sometimes even radiation poisoning (Rummans n.pag.). These treatments may prolong life two to three months but assisted suicide would be an alternative to patients who don't want to live their last moment in extreme pain.

No death is easy on family but with the assisted suicide law cancer patients are able to plan their death, where they want it and who they want with them. This would make saying goodbye easier. By dying in the comfort of their own home the patient would feel more in control and feel less bad for his or her family. Sister of Kay Schellenberg, terminal cancer patient was relieved when my sister finally passed because watching her suffer was the hardest part and knowing that she died in pain broke me (Schellenberg n.pag.). Kays family often believes that if assisted suicide would have been an option at the time both Kay and her family would have had an easier time saying goodbye.

Another advocate that became the spokesgirl for assisted suicide was twenty-nine year old Brittany Maynard who was diagnosed with terminal brain cancer and a prognosis of six months to live. Her and her newly husband's life consisted of doctor visits, medical research and hospital stays which was no life brittany wanted (Griffin n.pag.). With four months left Brittany's doctors offered her the idea of full brain radiation that would give her maybe six more months, this did not appeal to her at all. Full brain radiation horrified her; she was told it would singe her scalp and she would be extremely sick with first degree burns all over her head. After talking with her husband she decided to exercise her right to assisted suicide, she traveled around the country for the next month until she got too sick. After being approved for assisted suicide by two oncologists and a psychiatrist she said goodbye to her family and died peacefully in her home with her husband (Griffin n.pag.). Terminal patients such as Brittany are often the front runners for assisted suicide but other patients that are suffering deserve the right to pass peacefully as well.

Patients that suffer an injury causing permanent paralysis go through a long process of learning to adapt to their new lifestyle. Every patient who suffers an injury like this is different. It depends on their personal resources such as home, family life, hobbies and coping style (Levene, Ilana, and Michael Parker n.pag.). For some patients becoming paralyzed is a struggle that they can overcome with a good support system but for others it's an ongoing struggle. Assisted suicide should be an option for adults with severe paralysis that have no treatments left.

Coping with the initial injury is one of the first steps after becoming paralyzed. Many patients need time to think and consider how their life is changed and if they can live like this, especially if they are considering physician assisted suicide. Paralysis is not a terminal illness but it puts some patients in the same position and mindset as a terminal patient may feel (Levene, Ilana, and Michael Parker n.pag.). Patients with paralysis face getting denied for assisted suicide more than terminally ill patients because they are technically not dying (Levene, Ilana, and Michael Parker n.pag.). Although these patients are not dying, assisted suicide should still be open to them due to the quality of life they are living.

Complications are extremely common among patients with paralysis. Some are UTIr's, autonomic dysreflexia, depression and infections (Levene, Ilana, and Michael Parker n.pag.). Before the initial injury, patients may have been healthy all their life. These complications add on to the costs which averages around seventy thousand a year for patients (Burns n.pag.). The burden of healthcare and complications can cause the patient anxiety and depression.

Depression in paralysis patients following the initial shock is extremely common. Obviously for some people, depression is part of the healing process and they work through the difficulties of this new life. Rates of depression differ from twenty to forty-four percent of patients depending on their situation. Some psychologists have presented that certain patients depression decreases when they know that they have the option to end life on their own terms (Yun n.pag.). The sense of relief when patients find out they can make a choice is what the option of Assisted suicide gives them.

Personal resources play a major role in the patient's feelings toward assisted suicide. This ranges from a wide variety of things such as family members, care facilities and the money to afford living as a fully paralyzed person (Levene, Ilana, and Michael Parker n.pag.). The simplest things such as bathing or using the bathroom becomes impossible. This causes the patient to rely on family members or friends which can be inconvenient and embarrassing. The feeling of being trapped inside a body unable to move is a nightmare to any healthy person. Nobody should take the right to die away from patients with paralysis.

Tony Nicholson, a fifty eight year old paralyzed man lost his case to assisted suicide. He was a former rugby player and after an accident he was unable to speak or move. His life was described as a nightmare and he described the feeling of being locked in(Burns n.pag.). Pneumonia was a complication Tony endured and although he was not pronounced terminally ill doctors said he would most likely not be able to defeat the pneumonia (Burns n.pag.). He desperately begged the court for the option to request a physician's help to suicide but when he was denied he felt devastated and heartbroken. If assisted suicide more available to patients with paralysis others like Tony would not have to suffer and could put their mind to ease peacefully. Although many people agree that Tony should have had the right to assisted suicide some believe it would have been unethical.

Some opponents of assisted suicide challenge the idea by saying doctors are violating the hippocratic oath when they are allowing and supporting the patient's wish to take a lethal dose of prescription medication. There are still many doctors today fighting against assisted suicide law by sticking to their hippocratic oath. In Washington DC at the international symposium Dr. Margaret Cottle spoke out, Euthanasia kills the patient twice once when we say, Yes, your life is not worth living, and then when we help him die(St.Clair, Jane n.pag.). Although doctors who believe in assisted suicide are technically violating the hippocratic oath no doctor believes their patients life is not worth living. The oath has been around for thousands of years and should be modified as new technology and diseases are understood (St.Clair n.pag.).. Doing no harm which is one of the first lines in the hippocratic oath does not necessarily mean death, harm can be suffering as well. Doctors number one job is to treat the patient but when there is no treatment left doctors must be able to understand and accept the patient's wishes for assisted suicide.

With the amount of suffering terminally ill patients go through, physician-assisted suicide should be an alternative for them. Death is a natural part of life, and patients should have the option to pass peacefully. Euthanasia has been an ethical issue since the beginning of western medicine but as new knowledge grows in the medical field, many doctors are realizing assisted suicide is the ethical option for patients. As human beings, we must put ourselves in the place of the patient or the patient's family before we judge someone who is terminally ill and chooses to go through with assisted suicide.

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