Philosophy

Knowing that you are a burden is always painful. For the terminally ill patients, having knowledge that one is not going to recover and will be a permanent burden is also agonizing. The suffering becomes so much to the sick especially when the person taking care and bearing the burden is a loved one. This is because as we love and care for our loved ones, we would like to see them progress instead of being bogged down by our burdens. As everybody wants equality, being a burden to other people makes equality unachievable.

Some philosophers have argued that refusing life saving treatment and even opting for suicide can be accepted so as to evade being a burden to people. Others have argued that in extreme conditions, there is need to die. This issue of opting to die is not theoretical since people who have requested for physician assisted suicide claim that they do so as to avoid being a burden to people.  There are other several reasons which can make someone refuse to be a burden. Some people may opt to die because they are a shamed of being dependent, while others want to share their problems as little as possible. Caring for a terminally ill person poses many burdens to the family.

Most studies have revealed that majority of patients who die in the intensive care unit in the US do so in the process of withholding and withdrawal of life support and the administration of calming care. Removal or withholding of a life supporting treatment is the process in which medical treatments are either not given to the terminally ill patients or are withdrawn hoping that the patient will finally die from their disease. Palliative care involves administration of pain relieving medications and treatment of other kinds of conditions in serious sick patients. These medical practices are regulated by ethics, benefits, and autonomy.

In the US, withholding and withdrawal of life support treatment is justified by the law based on the principles of informed approval and informed refusal. According to these principles, treatment of a sick person cannot be started without their approval or of their surrogates in emergency situations, and that either the patient or the surrogate may refuse any or all the treatments intended. These principles were first applied in Quinlans case in which the New Jersey Supreme Court ruled that the patient had the right to refuse artificial breathing and since she was seriously ill and could not approve it, the parents were in a position to act as her surrogates and exercise her rights. The California court of appeal passed the same ruling in declaring a physician who had been charged with murder for withdrawing palliative care to a patient who was in a coma as a result of request from a family member who was acting as a surrogate. The physician was released for having not committed any crime.

The laws regulating the application of these principles vary from one state to another. There is need for evidence showing that the incompetent patient does not require the life supporting treatment especial if the request has come from the surrogate. The law also allows a competent person to refuse treatment and other palliative care and this right is protected by the Fourteenth Amendment of the Constitution. Although the Supreme Court supported the withholding and withdrawal of life supporting treatment under the principle of informed consent, it failed to tackle the principle of futility. It is not possible to quantify how ineffective a treatment can be. The principle of futility can also be interpreted differently by the physicians, patients and the surrogates. Physicians have been reported to cite futility in conditions where they want the treatment to be ignored. Studies have also revealed that some physicians have withdrawn or withheld treatment without consulting the patients or their surrogates when they considered such efforts as futile regardless of objection from the patients or surrogates.

In cases involving futility, almost all the courts have ordered continued treatments in solving conflict between families who want treatment to be continued and physicians who considered them useless. The judges have also been reported to be ordering continued treatment of patients in cases where advance withdrawal has been made. This is a clear indication that they do not want to cause death to sick patients. Reluctance has also been noticed among the judges and juries in punishing physicians who have acted professionally in withholding treatment they consider useless. There seems to be no clear rule on futility.

Physicians should always consult the patient or surrogate in situations where the patient cannot make informed decisions. The practice can be considered morally right if they are in line with professional integrity, which is the responsibility of every physician to follow the moral practice of medicine. Above all, independence remains the first ethical principle to be considered whenever there is need for withdrawal or withholding of life support treatment even though terminally ill patients exercise this right through their surrogates.  Ethics in this decision reflects the law since the patients informed consent or refusal is the basic primary principles governing this law. Physicians should also avoid deciding solely on such matters since it can lead to legal action.

When debating whether refusal of life saving treatment is a suicide or not, there is need to consider whether one has a right to die or not. There is no solid philosophical or even legal argument for a right to die. It has become common for sometime now for people to demand what they want in relation to their rights. In the past years, people have demanded for several rights some of which appeared weird like the right to abort and watch pornography.  The right to die emerged as a result of changed situations and growing concerns regarding the end of life. Medicine has made it possible to preserve and prolong life, and were it not for medicine, many people would have lost their lives. Technology has also contributed greatly in prolonging life like the use of respirators and other machines that can sustain patients in coma and other terminally ill patient between life and death. Of all the deaths that are reported in America yearly, some occur as a result of patients or physicians decisions to withdraw or to initiate medical treatments. Death in America has become a subject of choice.

In any discussion of death with dignity, the main center of attention is on the right of the patient over his or her body. The main issue is whether life should be preserved at any cost or not. In this debate, two strong opinions emerge and they include sanctity of life and the need to maintain it as something very precious. This opinion was put forward by Christians and the Jewish. According to these people, life is considered precious and should not be taken away at will. The other opinion is mainly focused on the autonomy of the patient and his or her right to come up with a decision of whether to continue living or not. This opinion was put forward by liberal thinkers. According to this opinion, death with dignity will include time of death and the way to die. They argue that people should be in a position to control the process of death through respect of their independence and dignity.

People who support sanctity of life view refusal of treatment as a suicide. They argue that nobody has the powers over life therefore decision of whether to continue living or not cannot be made by man. People who think this way are mostly religious people, who are also supported by secular thinkers who see inherent value in life and fear any eventualities that may lead to termination of life even when the patients are still willing to live. Those in support of autonomy of an individual do not view life as being intrinsically important. They believe that through life, one is able to achieve some goals therefore when an individual decides that life has lost meaning, they should have the right to put it to an end.

Both views are driven by the desire to uphold and protect human dignity. Those advocating for sanctity of life argue that choosing death in certain situations does not respect human dignity while those in support of autonomy argue that consideration of human dignity might lead to thinking that at times life is not pleasurable. The subject which usually comes out clearly in such a debate is the quality of life one is leading. It is claimed that patients should have an option of forgoing their lives if it has lost quality and is not worth living. Life is not important, but what we do with life is the most important.

People against the sanctity of life argue that the position taken which is based on the belief in the intrinsic value of life has ethical dilemma. Take an example of a person who is in a lot of pain and wants to die. Believers in sanctity of life would object such a persons desire to die despite the suffering he might be going through. Their stand ignores the autonomy of the individual concerned. Life cannot be intrinsically valuable regardless of the interest of the person concerned. Alternatively, we can say that people have the right to die because their dignity has value.

In order to qualify refusal of treatment as either suicide or not, there is need to define the word suicide. It is the act of intentionally taking ones own life. It can also mean any intentional action with possible life threatening results, like overdosing with drugs or intentionally crashing the car, or even consuming poisonous substance. It is associated with emotional instability, bipolar disorder, and schizophrenia. Suicidal behaviors are usually seen in situations which are overwhelming, like loss of a loved one, advanced age, unemployment, and drug addiction. People who are attempting suicide usually talk about it before making the attempt.

In some countries, an act or aborted suicide attempt is considered as a crime. If a party who assisted in the attempt survives, he is likely to face criminal charges.  In countries like Brazil, if the assistance is offered to a minor, then the charges are doubled and are not taken as a homicide. In Italy and Canada, leading someone to suicide attempt is considered as a criminal offence. In Christian views, suicide is considered as a sin. In philosophy, some people view suicide as a legitimate matter of individual choice and a human right.  Such people maintain that people should not be forced to endure suffering against their will. Suffering can be as a result of incurable diseases, terminal illness, mental illness which does not have possibility of ending.

Suicide and refusal of treatment are more or less the same since they both result in death and are also instigated by suffering. The difference only arises from the legal acceptance of the practices. While refusal of treatment is legally accepted in patients who are terminally ill, suicide is not recognized by the law and it is considered as a crime. Any assistance to commit suicide is also considered as a crime and anyone found guilty of such offence is likely to face criminal charges. Most of the suicide cases are always as a result of emotional disturbance and mental illness.

In conclusion, refusal of life saving treatment cannot be considered as a crime because it is accepted by the law. It is incomparable to suicide since it is normally done to patients who are terminally ill and have no chances of survival left. Physicians are also allowed review the patients condition and give a proper advice concerning any decision that the patient may decide on.