.. ind PAS intrinsically wrong. The standard which we adhere to leaves these considerations in the hands of the agent and physician. Central to the hypocratic oath is the principle of beneficance, which holds that the physician is obligated to act in the agents best interest. As technology has increased and advances have been made, what constitutes beneficance in any given action is becoming trivial; quality of life issues and painful but successful treatments have clouded what constitutes beneficance to the point that the 1960s saw the emergence of Biomedical Ethics as a field.
Indeed it is difficult to simply decide whether or not PAS should be considered universally a medical treatment or universally suicide. Rather than make this judgement, we hold that it is not a black and white issue, and that right action through policy requires consideration of all applications and scenarios. We further offer that causistry, or the evaluation of correct choice on a case by case basis, is essential to any approach hoping to yield just results. Requests to Withdrawl Treatment “[Any] person who is above [18 years old] and of sound mind has the right to exercise control over his/her body.”4(p.279). This implies a right to refuse medical treatment even if the deprivation of treatment results in death. The right to refuse treatment is fundamental to principles of autonomy such as privacy.
Therefore, this rule is not conditional, and all requests for treatment withdrawal are honored upon completion of an informed consent. This particular type of informed consent acts independent of any previous informed consent (particularly ones such as advanced directives which will be spoken about in the next section) and only pertains to the task at hand. The document affirms that the physician and the patient had a discussion about the consequences and benefits of withdrawing from treatment as well as those with proceeding of treatment. It will also affirm that the physician told the patient all possible alternatives to the situation and all the patient’s questions were answered and understood. Most importantly, the patient has a sufficiently clear understanding of the situation in its entirety. Upon association with our hospital, all competent persons are encouraged to fill out an advanced directive indicating “treatment directives (documents such as a living will stating the person’s treatment preferences in the event of future incompetence), proxy appointments (documents such as a durable power of attorney appointing a proxy decision maker), or both.”5 This hospital makes a continuing effort to educate patients about directives and, most importantly, to educate physicians in their obligation to honor them.
Because there is room for interpretation and the advanced directives are not always case sensitive, a decision regarding treatment withdrawal will be one that proceeds from a collaboration of the proxy’s views and the patient’s preferences stated on the advanced directive. In cases of incompetence where no advanced directives exist, the legal right of the patient to consent to any procedures is handed over to the next of kin. If there is no next of kin, the attending physician will use his sound judgement to assess the situation. Continuing Treatment When There is No Hope For Recovery It is the belief of this institution that mere quantity of life does not eventuate in quality of life. The desire to continue treatment when there is no hope for recovery is indicative of fear in the patient. Healing is key to the mission of our hospital. Therefore, diminishing fears in our patients, particularly fears involving such natural processes as life and death, is of surmounting importance.
In such cases, we will do everything possible through palliative care to assess the spiritual, emotional, and mental needs of the patient while we continue to respect the autonomous decision of the patient to continue treatment when there is no hope for recovery. In cases where the individual is deemed incompetent, the advanced directive of the patient should be honored if one exists. Otherwise, the decision will be handed over to the next of kin. This will be treated similarly to the previous competent-patient-decision process in that if the decision is fear-based then palliative care will be appropriated to ensure the most accurately desired procedure. A beating heart or a pair of working lungs does not assert an individual among the living, rather consciousness is what distinguishes an individual as alive.
Lawrence O. Gostin assesses the Cruzan case stating that, “when asked, very few people would choose to be kept physically alive when all conscious life is over.” Particularly in cases of perpetual vegetative state (PVS), where all consciousness is gone, our hospital does not agree with life prolonging procedures and therefore will perpetuate palliative care among decision makers, whether it is the next of kin, or the attending physician. Although each case is different and should be assessed individually, the general view of the hospital stands. REQUESTS FOR PHYSICIAN ASSISTED SUICIDE (PAS): In accordance with The Oregon Death and Dignity Act, terminally ill adult Oregon residents are permitted to request drugs from their physician with the intent to end his/her life. This act ensures the removal of any criminal penalties for qualifying physician-assisted suicides. All of the following strict guidelines are pertinent to a qualifying PAS: 1) physicians predict patient’s death within 6 months; 2) the patient makes 3 requests for PAS, 2 oral, and 1 written; 3) 15-day waiting period after requests; 4) second physician’s opinion; and, 5) counseling if either physician believes that the patient has a mental disorder or impaired judgement from depression.
It is our view that meeting this criteria, PAS has a stong case for legitimacy as a medical procedure and treatment option. Conclusion Implementation of PAS as a legal medical treatment in Oregon aroused the passions of so many. As the public debate continues, and as other initiatives work their way through state legislatures, it is clear that their is no answer that will apease both sides of this very difficult issue. As caregivers, it is essential to take a much longer consideration. In order to find what we believe to be the right approach to PAS by an institution, it was inevitable that we had to make a clear decision regarding what principles were to guide us. Compassion and beneficance are required.
They are also desired; every caregiver wants to help his patient, deliver treatment with excellence, compassion, and with the intent of beneficance. These principles in and of themselves require us to consider their purpose: the benefit of the agent. With this, we hold that autonomy is the expression of the human self. It is the manifestation of human rationality, and therefore, should be held in the highest regard. The right to self determination is the key to this. As we hold this as our central virtue, it follows that beneficance in any action is contingent upon upholding personal autonomy.
Violation of this constitutes deprivation of freedom, and is in turn, intrinsically wrong.