Rasmussen College Physician Assisted Suicide Comparison Essay Competency This deliverable will allow you analyze academic publications in various ways. I

Rasmussen College Physician Assisted Suicide Comparison Essay Competency

This deliverable will allow you analyze academic publications in various ways.

Instructions

Read both Physician-Assisted Suicide: Finding a Path Forward in a Changing Legal Environment and The Slippery Slope of Legalization of Physician-Assisted Suicide. In a 2-3 page comparison essay, address the following;

Determine the main point of each article.
Evaluate the arguments of both. Examine where they agree and disagree.
Compare and contrast the two articles. Show where the arguments are similar and where they differ.
Determine which of the two articles makes a stronger case and explain why you have reached this conclusion. Annals of Internal Medicine
EDITORIAL
The Slippery Slope of Legalization of Physician-Assisted Suicide
T
he American College of Physicians (ACP) position
paper on the legalization of physician-assisted suicide reaffirms the ACP’s opposition to this practice,
even though it is now legal in several countries and U.S.
jurisdictions (1). The ACP’s position deserves credit for
its clarity and courage.
Among other achievements, the ACP paper identifies “euthanasia” and “medical assistance in dying” as
euphemisms. These terms do what euphemisms are
supposed to do: make a distasteful subject palatable,
or at least discussable. The social process of change
in ethical and moral standards makes bold use of
such euphemisms. At one time, “mercy killing” and
physician-assisted suicide were both illegal and unthinkable. However, times are changing, and the
changes have followed a recognizable pattern (2). First,
the unthinkable becomes discussable although highly
controversial. After a while, it is seen as acceptable under certain circumstances. As it becomes more familiar,
it seems increasingly sensible and reasonable. Finally, it
is established as a legal right. In this way, what was
once unthinkable can eventually become policy, or
even a duty (3).
Space limitations permit only a brief consideration
here of arguments for and against medically assisted
suicide. The argument in favor that is based on “nonabandonment” ignores a conscientious physician’s
commitment to relieve suffering and to accompany
sick and dying patients to the very end. We all should
provide “medical assistance in dying” and not abandon
our suffering patients. This argument also tends to stigmatize those who object to suicide as a solution to
suffering.
The “slippery-slope” objection to medical suicide
and euthanasia may be dismissed as alarmist, but it is
not easily refuted. Euthanasia was legalized in the Netherlands in 2002, with multiple safeguards against
abuse. However, in 2015, the Dutch government reported that hundreds of persons were put to death
without their express consent or because of psychiatric
illness, dementia, or just “old age” (4). In addition, the
Groningen protocol has legalized infanticide in the
Netherlands. In view of these developments, it is laudable that Oregon, Canada, and other jurisdictions have
built safeguards into their end-of-life legislation. However, a slope still exists, and it may be fairly steep.
The argument based on intractable suffering appeals to a physician’s sense of empathy. However, if
hard cases make bad law, they also may produce unwise medical policies, and the argument surely greases
the slippery slope. If intractable physical suffering is a
justification for actively ending life, why should intractable existential angst, a severe sense of personal alienation, or the helplessness and hopelessness of severe
depression not be as well?
The principle of patient autonomy seems the
weightiest of the arguments in favor of medical euthanasia or suicide, and with good reason. It alone of the 4
pillars of medical ethics can survive Western society’s
transition toward a post-Christian antinomianism. Beneficence would now be defined as whatever the patient believes to be helpful. Nonmaleficence and justice
would be whatever the patient says they are, absent
external standards. Autonomy alone would stand unassailed and, by default, carry the day. Who is to say that
what I want for myself is the wrong thing?
A person might say it is wrong if he or she recognizes an objective moral standard, namely that human
life has intrinsic worth and dignity and that its value
extends beyond the individual to the community. This
might be true even if its owner doesn’t recognize it for
a time or if others believe that one’s life is “not worth
living.” Some hold that this moral standard (along with
many others) can be known from nature or discovered
by reason. Others reach it intuitively or find it in revelation, still others in all of the above. Of course, in a pluralistic society, not everyone believes in or will agree on
objective moral standards, or which one prevails when
they seem to conflict.
One may reply that the dignity and worth of human
life are not absolute values. For example, it is recognized that some life-prolonging treatments are disproportionate or even futile. However, as the ACP position
paper points out, neither is patient autonomy an absolute value. We do not always give patients whatever
they ask for: A futile treatment? No. An illegal prescription? No. We therefore find ourselves weighing different considerations with regard to assisted suicide.
Many will give considerable weight to the presumption
that human life is intrinsically valuable, especially in
view of what may happen if this value is held as less
compelling than autonomy, or utility, or health care
economics.
The weakest part of the ACP’s position against
medical suicide is its objection on the basis that such
provision lies outside the scope of medical practice. I
disagree. If assisted suicide and euthanasia are right
and good, physicians should willingly accede; if they
are wrong, they should not be done by anybody.
With clarity and courage, the ACP has reaffirmed its
opposition to physician-assisted suicide. Perhaps the
vote was close; the tide of opinion may be turning, and
the next iteration of the ACP’s position might be different. Autonomy and self-determination are ascendant,
and there are warnings of intolerance toward those
who object. Nonetheless, physicians opposed to the
provision of euthanasia and medically assisted suicide
should not be cowed by attempts to place them “outside the mainstream.” Where these practices are
legal, I believe that physicians should firmly decline to
participate.
This article was published at Annals.org on 19 September 2017.
© 2017 American College of Physicians 595
EDITORIAL
It is time to return to our duty at the bedside. Our
compassion calls us there, as Dr. Edward Trudeau is
credited to have said, “to cure sometimes, to relieve
often, to comfort always,” but not to kill or to assist in or
facilitate killing. With time, we will see whether our collective cultural conscience, including respect for the intrinsic value of human life, can keep us from sliding
down the slope. Otherwise, it will merely mitigate our
speed as we descend.
William G. Kussmaul III, MD
Media, Pennsylvania
Disclosures: The author has disclosed no conflicts of interest.
Form can be viewed at www.acponline.org/authors/icmje
/ConflictOfInterestForms.do?msNum=M17-2072.
Requests for Single Reprints: William G. Kussmaul III, MD,
5 Arrowhead Trail, Media, PA 19063; e-mail, w.kussmaul
@verizon.net.
596 Annals of Internal Medicine • Vol. 167 No. 8 • 17 October 2017
The Slippery Slope of Legalization of Physician-Assisted Suicide
Ann Intern Med. 2017;167:595-596. doi:10.7326/M17-2072
References
1. Snyder Sulmasy L, Mueller PS; Ethics, Professionalism and Human
Rights Committee of the American College of Physicians. Ethics and
the legalization of physician-assisted suicide: an American College of
Physicians position paper. Ann Intern Med. 2017;167:576-8. doi:10
.7326/M17-0938
2. Marsh L. The flaws of the Overton window theory: how an obscure
libertarian idea became the go-to explanation for this year’s crazy
politics. New Republic. 27 October 2016. Accessed at https:
//newrepublic.com/article/138003/flaws-overton-window-theory on
21 August 2017.
3. Stahl RY, Emanuel EJ. Physicians, not conscripts— conscientious
objection in health care. N Engl J Med. 2017;376:1380-5. [PMID:
28379789] doi:10.1056/NEJMsb1612472
4. Francis N. Netherlands—2015 euthanasia report card. Dying for
Choice Web site. Accessed at www.dyingforchoice.com/resources
/fact-files/netherlands-2015-euthanasia-report-card on 18 August
2017.
Annals.org
Copyright © American College of Physicians 2017.
EDITORIAL
Annals of Internal Medicine
Physician-Assisted Suicide: Finding a Path Forward in a Changing
Legal Environment
Imagine yourself with a disease that has recently become terminal. What kinds of treatments and options
would be most important to you? Almost everyone
would want to be sure their physicians had considered,
if not tried, all potentially effective disease-directed
therapy and best possible palliative treatments to maximize their quantity and quality of life. Many patients
would want to consider a timely transition to hospice
care if no acceptable disease-directed therapies existed, hoping to live as fully as possible for their remaining time, and then to die peacefully. On these points
we are completely in sync with the American College of
Physicians (ACP) position paper (1).
We also know that most patients would want to
know that they could refuse burdensome treatments
that may keep them alive but with a low quality of life.
(In fact, most patients die having forgone some potentially life-sustaining treatment.) A substantial minority of
terminally ill patients also would want some assurances
about their ability to access or potentially activate a
physician-assisted suicide if their suffering becomes unacceptable (2). For many of these patients, the motivation is to maintain control over the manner and timing
of their own death (many have been making a series of
very challenging decisions throughout their illness and
see no reason not to stay in charge of the last phase).
Others fear the potential of unacceptable physical suffering in the last phase of their illness, perhaps on the
basis of experience. Still others might find that the prolonged debility and dependence that might occur during the dying process are unacceptable (3).
Knowledge about what “last-resort” options are
available (4), as well as which options one’s own doctor
can support, would be reassuring to these patients. It
would free their emotional energy for other psychosocial and spiritual matters potentially critical to this last
phase of life, and most patients ultimately will not need
a medically assisted death if they receive excellent end-
of-life care. However, even with the best possible palliative and hospice care, a small percentage of patients
eventually will want direct assistance with dying now.
Carefully exploring the why now for such requests and
redoubling efforts to palliate suffering are the next
steps, followed by an exploration of legally available
options for responding (2).
The legal landscape for patients who want to end
their life now is rapidly changing in North America and
western Europe (5). Both physician-assisted suicide and
voluntary active euthanasia have been legal in the
Netherlands, Belgium, and Luxembourg for many
years, and both recently were legalized in Canada.
Physician-assisted suicide is now legal in 6 states and
the District of Columbia (affecting one sixth of the U.S.
population), whereas it remains either explicitly illegal
or legally uncertain in the remaining states.
Most of the U.S. population favors legalization of
physician-assisted death, although support decreases
slightly when the word suicide is used in questionnaires
(5). The medical profession’s views are decidedly
mixed on the subject of legal access. Most U.S. physicians would want access for themselves, but a smaller
percentage would be willing to provide assistance to
their patients (6). Positions of professional organizations also vary on this subject. For example, the ACP
joins the American Medical Association in opposing the
practice (1), whereas the American Academy of Hospice and Palliative Medicine has a neutral position, and
the American Medical Student Association and the
American Medical Women’s Association are in favor of
legalization. How should individual physicians proceed
when opinions are so deeply divided?
We clearly support the steps outlined in the ACP
position statement with regard to “responding to patient requests for assisted suicide” (1). However, if requests persist and the unacceptable suffering continues, we believe all legally available last-resort options
Table 1. Last-Resort Options
Intervention
Ethical Consensus Regarding
Permissibility
Legal Status
Aggressive symptom management
Legally permitted
Physician-assisted suicide
Widely accepted in North America and
western Europe
Widely accepted in North America and
western Europe
Consensus if death unintended; controversial
otherwise
Some controversy, often depending on
religious views
Opinion about permissibility differs widely
Voluntary active euthanasia
Opinion about permissibility differs widely
Stopping or not starting life-sustaining therapy
Palliative sedation (potentially to unconsciousness)
Voluntarily stopping eating and drinking
Legally permitted
Probably permissible but never tested
Probably permissible but never tested
Legally permitted in 6 states and the District of
Columbia; legality uncertain in most other
states; legal in Canada
Illegal and likely to be prosecuted in the United
States; legal in Canada
This article was published at Annals.org on 19 September 2017.
© 2017 American College of Physicians 597
EDITORIAL
Physician-Assisted Suicide: A Path Forward in a Changing Legal Environment
Requests
Main reason
Acceptance rates
Refusal rates
Hypothetical future vs. now
tially life-ending medical practices. We need to support
an environment that both redoubles our efforts to provide palliative and hospice care to all seriously ill patients and enhances our imperative to listen and respond to those who still feel they may need an escape
from the last stages of this process. We currently have
an opportunity to learn about this process on a larger
scale with a more diverse population than ever before.
Let’s make sure our processes and safeguards are as
robust and responsive as possible, and let’s learn as
much as we can so that these new laws help us serve
our patients and families in the best way possible.
Second opinions
Who provides
Palliative care certification
Acceptance vs. refusal rates
Timothy E. Quill, MD
University of Rochester Medical Center
Rochester, New York
Practical aspects
Change in primary treating physician
Number of visits from initial request
Documentation
Actual methods
Robert M. Arnold, MD
University of Pittsburgh
Pittsburgh, Pennsylvania
Table 2. Representative Study Questions to Understand
the Effect of Legalization of Physician-Assisted Suicide
Cases
Numbers
Diagnoses
Second opinions
Presence of palliative care and/or hospice
Long-term effect
Family members
Participating clinicians
Participating consultants
Hospice workers
Stuart J. Youngner, MD
Case Western Reserve University
Cleveland, Ohio
Disclosures: Disclosures can be viewed at www.acponline.org
/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2160.
should be explored (Table 1). Clinicians should determine in advance which options they can and cannot
personally support (4). They should extend themselves,
if possible, to respond to their patients’ needs and requests without violating their fundamental personal values, regardless of the status of the law. If a patient desires a legally permitted option that the physician
cannot support and common ground cannot be found,
the patient should be given the opportunity to change
physicians in a timely way so that access is allowed.
Given the rapidly changing legal environment with
regard to physician-assisted suicide and voluntary active euthanasia, we are concerned that concluding a
guideline by stating “physicians should not do this” is a
problematic public health response. Even if one personally disagrees with the behavior, studying it might
tell us much about the state of end-of-life care and how
it can be improved. The Remmelink studies from the
Netherlands (5) and Oregon Health Department data
(7) provide examples of collecting meaningful information in an attempt to understand and improve practice.
The scale and diversity of a state like California and a
country like Canada warrant similar studies. Table 2
gives examples of areas that should be examined as
these large-scale implementation efforts are under way.
In addition, we worry that the ACP’s rigid opposition will prevent physicians who will practice physicianassisted suicide from sharing ideas about better policies and procedures. Given the diversity of opinions
and the legality of the procedure for so many people,
this response seems like a missed opportunity to educate clinicians and learn about best practices.
We should continue to debate the ethical and
moral implications of permitting or prohibiting poten598 Annals of Internal Medicine • Vol. 167 No. 8 • 17 October 2017
Requests for Single Reprints: Timothy E. Quill, MD, University
of Rochester Medical Center, 601 Elmwood Avenue, Box 687,
Rochester, NY 14642; e-mail, timothy_quill@urmc.rochester
.edu.
Current author addresses are available at Annals.org.
Ann Intern Med. 2017;167:597-598. doi:10.7326/M17-2160
References
1. Snyder Sulmasy L, Mueller PS; Ethics, Professionalism and Human
Rights Committee of the American College of Physicians. Ethics and
the legalization of physician-assisted suicide: an American College of
Physicians position paper. Ann Intern Med. 2017;167:576-8. doi:10
.7326/M17-0938
2. Quill TE. Doctor, I want to die. Will you help me? JAMA. 1993;270:
870-3. [PMID: 8340988]
3. Pearlman RA, Hsu C, Starks H, Back AL, Gordon JR, Bharucha AJ,
et al. Motivations for physician-assisted suicide. J Gen Intern Med.
2005;20:234-9. [PMID: 15836526]
4. Quill TE, Lo B, Brock DW. Palliative options of last resort: a comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia.
JAMA. 1997;278:2099-104. [PMID: 9403426]
5. Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and practices of euthanasia and physician-assisted suicide in
the United States, Canada, and Europe. JAMA. 2016;316:79-90.
[PMID: 27380345] doi:10.1001/jama.2016.8499
6. Meier DE, Emmons CA, Wallenstein S, Quill T, Morrison RS, Cassel
CK. A national survey of physician-assisted suicide and euthanasia
in the United States. N Engl J Med. 1998;338:1193-201. [PMID:
9554861]
7. Oregon Health Authority. Death with Dignity Act Annual Reports.
2017. Accessed at www.oregon.gov/oha/PH/PROVIDERPARTNER
RESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT
/Pages/ar-index.aspx on 18 August 2017.
Annals.org
Current Author Addresses: Dr. Quill: University of Rochester
Medical Center, 601 Elmwood Avenue, Box 687, Rochester,
NY 14642.
Dr. Arnold: 1232 North Highland Avenue, Pittsburgh, PA
15206.
Dr. Youngner: Department of Bioethics, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106.
Annals.org
Annals of Internal Medicine • Vol. 167 No. 8 • 17 October 2017
Copyright © American College of Physicians 2017.

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