Joseph Park Medicine & Society 11/04/10 IMS Sac TA: Karen Chao A Case for Physician-Assisted Suicide

If you were to imagine the perfect situation in regards to end-of-life medical situations, the account of Diane by her physician, Dr. Timothy Quill, is a great example. Dr. Quill was able to incorporate multiple elements into the care of Diane that concluded in the patient having control of her own death. Physicians should be given the opportunity to indirectly help patients that want to end their lives. This preserves the patients autonomy, while providing a safe alternative to suffering. Assuming competence, the patient has the final say in all medical decisions. Initially, the author disagreed with Dianes decision to forgo treatment. He states, I had her repeat her understanding of he treatment, the odds, and what to expect if there were no treatment. I clarified a few misunderstandings, but she had a remarkable grasp of the options and implications. (Quill, 1997) Quill continued that he did not understand Dianes decision to give up on a 25% chance of long-term survival and choose certain death. But with time, Quill began to understand and ultimately agreed that Diane was making the right decision for herself. This came after multiple visits, including a second opinion and an appointment with a psychiatrist. Time helps to eliminate irrational decisions, and gives the physician an opportunity to better understand the patient. Quill discovered that Diane was not only competent, but was making a rational decision that was her own. One concern that Dr. Quill had was one of safety. He knew, that if he were not willing to help Diane with her decision, Diane would have to turn to other options. I feared the effects of a

violent death on the family, the consequences of an infective suicide that would leave her lingering in precisely the state she dreaded so much (Quill, 1997) In the end, Quill knew that Dianes family would have to live with the majority of the consequences of Dianes decision. With the overview of a physician, Diane was able to pass safely, leaving her family with no doubts that they had made the right decision. At the end, Quill states that Diane seemed peaceful. Can death be a better alternative to suffering? Hartocollis mentions Thomas Aquinas in his article in the New York Times. Even if there is a foreseeable bad outcome, like death, it is acceptable if it is unintended and outweighed by an intentional good outcome the relief of unyielding suffering before death. The principle has been applied to ethical dilemmas in realms from medicine to war, and it is one of the few universal standards on how end-of-life sedation should be carried out. (Hartocollis, 2009) For Diane, though the medication would lead to her death, she and her physician determined that it was outweighed by the opportunity to avoid suffering. To Diane, death was a better alternative. Quill concedes that the issue of physician-assisted suicide is still gray. He ends his article wondering what the effects Dianes suicide will have. He wondered about how she was in her last hour and whether her family would remember the meaningful, last months above all else. Other issues like medication used for terminal sedation, and if it shortens a patients life are areas of uncertainty. Despite these uncertainties, the physician must respond to the decisions before him/her. The decision to respect the patients autonomy especially if that decision is to avoid suffering and die peacefully, is one that the physician can easily make. A regulated method for physician to assist patients in terminally ill situations should be available. It provides safety, some peace of mind, and an alternative to suffering.