ndorsed the principle of the double effect, the Court did not directly apply the principle to the practice of writing drug prescriptions. The logic of the opinion supports the conclusion that physicians can continue to write prescriptions for medically indicated drugs even with the knowledge that the patients might use the drugs to commit suicide, as long as the physicians intent is to prolong the patients life and prevent suffering. The dismissal of physicians ability to use their own discretion on determining who is and who is not a candidate for euthanasia has maintained a legal loophole for physicians. The theory that is the framework for terminal sedation is that it is appropriate for physicians to treat the pain and other suffering of patients aggressively, even if doing so is Tierce, 7 likely to bring about death. On a closer examination however, terminal sedation can at times be equal to euthanasia, or a variety of slow euthanasia.
Terminal sedation equates to assisted suicide, in that the sedated patient dies from the combination of the unconsciousness and the withholding of food and water.Without these two interventions on the part of the caregiver the patient would live longer before weakening to the illness. Thus in its fundamental actions terminal sedation bears a greater resemblance to euthanasia that to mere mercy killing. The withdrawal of life-sustaining treatment has been invariably allowed, because the patient dies from the underlying illness, not from the active applied interference of a physician or of a chemical substance. A person who is in a persistent vegetative state dies when a feeding tube is withdrawn, because the patients condition is responsible for their inability to eat and drink. That, however, is not the case in terminal sedation accompanied by the denial of nutrition and hydration. Assisted suicide requires the active participation of the patient; terminal sedation, however, can be induced without the patients knowledge thus making it more difficult to monitor and to maintain standards of procedure. Tierce, 8 As it stands now, patients have the right to be sedated for the relief of pain, but once sedated, they would lose the right to have nutrition and hydration withheld or withdrawn.
Now that the courts have essentially left open a back door for the perpetuation of terminal sedation, many have abandoned the movement for legalized assisted suicide. However the distinctions between the two cases are more symbolic than factual, and the hazards posed by terminal sedation far outweigh those which would be posed by physician assisted suicide. The hazards and indignities imposed by terminal sedation are still fundamentally unnecessary when one looks to assisted suicide for comparison. Terminal sedation serves fewer of the purposes of a right to die law than assisted suicide or euthanasia. And although terminal sedation ensures a painless death, it forces patients to accept a dying process that is prolonged when compared with what it would be in the instance of assisted suicide or euthanasia. Terminal sedation requires that patients linger in a condition that may profoundly compromise their dignity as well as destroy the memory they would choose to leave behind.
Terminal sedation also prevents patients from maintaining control over when and how they will die. Essentially terminal sedation is not giving solution to these Tierce, 9 problems which the right to die movement originated in order to protect. Under the courts ruling it appears that terminal sedation can be limited to appropriate cases. So similarly is it not possible that the government should be able to limit assisted suicide to its appropriate cases? Whatever regulations that physicians apply when deciding that terminal sedation is an appropriate therapy, can also be used to decide when assisted suicide is also appropriate treatment. The courts decision for terminal sedation and against assisted suicide implies that it cares as much about the reasons a patient desires to die, as about how the patient physically attains death.In approving terminal sedation regardless of the fact that it often amounts to euthanasia, the court is in essence saying that the right to die primarily reflects a concept of morality which states that people who are dying, as well as suffering intolerably, should be allowed to die simply through refusal of life-sustaining treatment. Although the debate for and against physician assisted suicide is far from over, the recent legal conclusions leave a rather vague understanding of the Supreme Courts intentions for the future of physician assisted suicide, euthanasia, and terminal sedation.
In their rejection of a constitutional right Tierce, 10 to physician assisted suicide, the Court has preserved a long-standing tradition in the distinction between the withdrawal of life-sustaining treatment and assisted suicide and euthanasia. The Court has, however, undermined such a distinction by sanctioning terminal sedation. Though terminal sedation seems consistent with traditional medical care, it is often carried out as a form of euthanasia.
The practice of terminal sedation is ethically more problematic than assisted suicide or voluntary euthanasia because it can be perpetrated without the explicit consent of the individual being sedated.The Court seems to be implying that within the Constitution there is something to the effect of a right not to suffer at least when death is approaching. Although progress has been made, the Court has not truly broken new ground in the decisions affecting physician assisted suicide. Their concurring opinions can, however, be read as a warning to the individual stated that they should not attempt to adopt any restrictive statutes that would prohibit instead of inhibit physicians from doing everything in their medical power to prevent suffering. Clearly the legalization of physician assisted suicide rather than terminal sedation is the better choice for the United States. The United States should follow the example of the Netherlands and establish certain guidelines associated with physician assisted suicide in order Tierce, 11 to make the process less painful and less apt to commit any wrongdoing throughout the process.The patients who undergo terminal sedation are required to embrace a form of death that is less expedient and that is more vulnerable to abuse, and they are being placed in situations of possible peril by a government whose supposed intention in creating such an environment is to afford greater protection to them.
This question and other questions like it will have to be answered in future attempts to bring this movement to the forefront of Americas conscience. Bibliography Works Cited Annas, George J. The Bell Tolls For a Constitutional Right to Physician Assisted Suicide, The New England Journal of Medicine. 337, 1997, 1098 Hoeffler, James M.Deathright: Culture, Medicine, Politics, and the Right to Die Movement. Westview Press, 1994. Humphrey Derek and Ann Wickett.
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