Jordan Rashba
31 May 2018
Professor Cela
Applied Ethics
The issue I am discussing is the ethics of assisted suicide and end of life decisions. Many people who are afflicted with an illness that is incurable and irreversible must think of the way in which they want to die, or if they want to keep trying everything to survive. On the other hand, many people dislike the idea of assisted suicide for numerous reasons. Some of the reasons could be religious or perhaps these people feel that there is still a chance they could survive. Regardless of the reason, it is still very difficult to be responsible for the decision of ending someone’s life.
Many people have changed where they wish to go or have loved ones go when faced with terminal illness. The research shows that more people die in a hospital or other medical center as nearly 60% of people choose these locations whereas 16% more people choose either a nursing home or a hospice ("THE APA WORKING GROUP ON ASSISTED SUICIDE AND END-OF-LIFE DECISIONS," 2000). It is interesting to note that most of the deaths in a hospice are a result of a cancer diagnosis. Because of the potential to extend someone’s life, all 50 states of the United States have acknowledged the use of “end of life” methods by either legalizing some aspects of end of life decisions or by creating an alternative to it . In 2002 at a social work leadership summit for Palliative Care, attendees discussed the need for a collaborative effort in social work as it pertains to palliative care and end of life decisions. The National Association of Social Workers, or NASW, developed standards for how to address issues as they relate to palliative care. The result of the summit was the publication of a guide of requirements for social workers. Social workers involved in palliative and end of life care must understand both the ethics and the actual health and medical factors involved in such a difficult decision ("NASW standards for Palliative and End of Life Care," 2004).
When treating patients who are terminally ill requiring palliative care, there are many ethical issues at play. The ethical principles to be considered are: autonomy, beneficence, nonmaleficence, justice, and fidelity ("Ethical Issues at the End of Life," 2001). These ethical principles are critically important in treating people who are terminally ill. Physicians need to be aware constantly about following all these principles. There is no doubt that the patient has the autonomy to decide what kind of treatment they want; however, it is the physicians’ responsibility to inform the patient of the risk factors associated with the decisions they make. While physicians must face very difficult situations regarding the end of life, the patient may have a family member make the decision to end the person’s life. This person is referred to as a proxy, much like the physician the proxy also needs to honor their wishes ("Ethical Issues at the End of Life," 2001).
While it is also the physicians’ job to care for the patient until they pass away, the physicians also must respect the patient’s wishes such as in instances of DNR (do not resuscitate) even if they disagree with the patient, as difficult they may find it. Nevertheless, what many physicians have difficulty with is performing is a “self-beneficence duty,” which is when a physician needs to decide based on the good of the patient. In addition, another ethical principle that physicians must follow are “advanced directives.” These directives are much less complicated for physicians morally since the patient is competent enough to design their own treatment plan. Additionally, there are other ethical issues which the medical community faces, particularly pertaining to incapacitated individuals, such as when the patient is unable to consent to any plan and the family makes the decisions relating to end of life.
If I were a social worker or a health care professional, I would have a very difficult time with honoring a patient’s end of life decision due to my personal beliefs about ending someone’s life. I would also find it very challenging if a patient had a DNR specification on file because I prefer to cling to “hope.” I wouldn’t only have a hard time with it from a moral stance I would find it difficult if I had gotten to know the patient well.
References
Ethical Issues at the End of Life. (2001, October). Retrieved from http://jaoa.org/pdfaccess.ashx?url=/data/journals/jaoa/931962/616.pdf
Ethical Issues Surrounding End-of-Life Care: A Narrative Review. (2016, May 5). Retrieved from http://www.mdpi.com/2227-9032/4/2/24/pdf
Ethical Issues Surrounding End-of-Life Care: A Narrative Review. (n.d.). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934577/
NASW standards for Palliative and End of Life Care. (2004). Retrieved from https://www.socialworkers.org/LinkClick.aspx?fileticket=xBMd58VwEhk%3D&portalid=0
THE APA WORKING GROUP ON ASSISTED SUICIDE AND END-OF-LIFE DECISIONS. (2000, May 1). Retrieved from http://www.apa.org/pubs/info/reports/aseol-full.pdf