Focus on giving comfort and recognizing the patient's preferences
The debate over physician-assisted suicide has arisen largely because health care professionals routinely overlook patients' preferences, or fail to provide palliative care. Hospital patients often die in great pain, despite the fact that medications are available to ease their suffering. As physicians focus on taking every possible medical measure to keep patients alive, they often fail to relieve the pain and depression patients experience. Recognizing the patient's right to control the treatment they receive is a far better solution than encouraging physicians to supervise suicides.
What Should be Done?
Take additional steps to improve patients' comfort and quality of life, rather than helping to hasten their death. Allow patients to issue directives, not just preferences, about end-of-life care and treatment, and provide additional incentives for medical professionals to follow those directives. Improve training so medical professionals are able to provide relief from pain, and also the emotional support people need as they near death. Expand palliative care in medical facilities. Even acute care facilities should be able to provide as much comfort and pain relief as possible. Expand hospice care, both facilities designed specifically for this purpose and in-home hospice care. Remove barriers to effective pain management, such as overly restrictive regulation of narcotics. Provide mental health care for terminally ill patients, who are prone to suffering and depression.
Arguments For This Approach
Many hospital patients endure needless pain. If patient care were improved and additional measures taken to reduce pain and suffering, fewer patients would want to hasten their deaths. If medical professionals consistently honored the right to refuse treatment, which is already recognized, there would be less demand for physician-assisted suicide. Many terminally ill patients would be better served, at lower cost, by hospice care than by acute care hospitals. Health coverage should be expanded to include hospice care. Most suicidal people suffer from depression. If depression among seriously ill patients were treated seriously, fewer people would seek assistance in dying. Unwanted treatment of terminally ill patients wastes money and medical resources.
Arguments Against This Approach
If terminally ill people want to die, they have the right to do so. Some people would prefer to end their lives rather than lingering in a coma-like state induced by heavy sedation and opiates. Medicating patients to the point of death is a form of mercy killing, which skirts the central moral and legal issues in the right-to-die debate. By calling for more attention to patients' preferences about end-of-life treatment, this choice ignores a fundamental fact: physicians are the medical experts, and they are in the best position to determine when illness is terminal. Hospice care is strictly limited. It is appropriate only when patients have given up hope for a cure or treatment that might extend their lives. Short of terminally sedating patients, physicians cannot relieve the pain experienced by many patients. It's unrealistic to think that additional attention to pain relief would reduce the number of cases in which people seek assistance in dying.
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