Abstract
There are many people in our society who are profoundly uncomfortable with the legalization of physician assistance in dying, previously known as physician - assisted suicide. The End of Life Option Act is designed to help people who are dying, who have no realistic chance for meaningful improvement of their health, and who are senselessly suffering from their condition.
There are misconceptions regarding assisting in dying is the terminology itself. Article discusses the law, as well as, clarifies the vocabulary related to the topic.
In conclusion the article raises the question: Is neglecting suffering consistent with the healers ethics

Hausdorff, Malgorzata

English

Digital Commons @ CSUMB (California State University, Monterey Bay)

Culture, Society, and Praxis Volume 11 Number 2 Land of the Free, Home of the Brave Article 4 December 2019 Understanding Assistance in Dying: Arguments in Favor of the End of Life Option Act Malgorzata Hausdorff CSUMB Follow this and additional works at: https://digitalcommons.csumb.edu/csp  Part of the Social and Behavioral Sciences Commons Recommended Citation Hausdorff, Malgorzata (2019) "Understanding Assistance in Dying: Arguments in Favor of the End of Life Option Act," Culture, Society, and Praxis: Vol. 11 : No. 2 , Article 4. Available at: https://digitalcommons.csumb.edu/csp/vol11/iss2/4 This Main Theme / Tema Central is brought to you for free and open access by the Student Journals at Digital Commons @ CSUMB. It has been accepted for inclusion in Culture, Society, and Praxis by an authorized administrator of Digital Commons @ CSUMB. For more information, please contact digitalcommons@csumb.edu. Understanding Assistance in Dying: Arguments in Favor of the End of Life Option Act Cover Page Footnote Sources Footnotes: *Palliative care may involve physical, spiritual, emotional or legal assistance, explains the National Cancer Institute. Pain management therapies help patients cope with symptoms and side effects, while talk therapy and support groups provide emotional care. Some palliative care programs offer practical assistance to manage health insurance issues, advanced care directives, and wills and other legal paperwork. At the end of a patient's life, palliative care may be the only treatment available. However, patients can begin palliative care as soon as they are diagnosed with a serious illness, explains the National Cancer Institute. **The list of states, and their legal document, that legalized assisted dying. California 2015 End of Life Option Act https://www.deathwithdignity.org/states/california/ Colorado 2016 Colorado End-of-Life Options Act https://www.uchealth.org/colorado-end-life-options-act/ District of Columbia 2016 District of Columbia Death with Dignity Act https://www.deathwithdignity.org/states/district-of-columbia/ Hawaii 2018 Our Care, Our Choice Act https://www.deathwithdignity.org/states/hawaii/ Maine 2019 Maine Death with Dignity Act https://www.deathwithdignity.org/states/maine/ New Jersey 2019 Aid in Dying for the Terminally Ill Act https://www.deathwithdignity.org/states/new-jersey/ Oregon 1994 Oregon's Death With Dignity Act https://www.deathwithdignity.org/states/oregon/ Vermont 2013 Patient Choice and Control at End of Life https://www.deathwithdignity.org/states/vermont/ Washington 2008 Washington Death with Dignity Act https://www.deathwithdignity.org/states/washington/ References 1. Braverman, D., Marcus, B., Wakim, P., Mercurio, M., and G. Kopf. Healthcare Professional- s’Attitudes About Physician-Assisted Death: An Analysis of Their Justifications and the Roles of Terminology and Patient Competency. Journal of Pain and Symptom Management. 2017 Jul 14. (Epub ahead of print). 2. Brenan M: Americans’ Strong Support for Euthanasia Persists. Gallup. May 31, 2018. Avail- able at https://news.gallup.com/poll/235145/americans-strong-support-euthanasia-persist- s.aspx. Accessed June 27, 2019. 3. Bruce, S. D., Hendrix, C. C., Gentry, J. H., Palliative Sedation in End-of-Life Care, Journal of Hospice and Palliative Nursing. 2006;8(6):320-327 https://www.medscape.com/viewarti- cle/550666. Accessed June 29, 2019. p.324 4. Cassell, E. J., Rich, B. A., Intractable End-of-Life Suffering and the Ethics of Palliative Se- dation, Pain Medicine, Volume 11, Issue 3, March 2010, Pages 435–438, https://doi.org/ 10.1111/j.1526-4637.2009.00786.x 5. Christopher, M., Role of Ethics Committees, Ethics Networks, and Ethics Centers in Improv- ing End-of-Life Care, Pain Medicine, Volume 2, Issue 2, June 2001, Pages 162–168, https:// doi.org/10.1046/j.1526-4637.2001.002002162.x 6. Emanuel, E., Onwuteaka-Philipsen, B., Urwin, J., and J. Cohen. Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. JAMA. 2016. 316(1):79-90 7. End of Life Option Act, California Department of Health Care Online, https://www.cdph.- ca.gov/Programs/CHSI/Pages/End-of-Life-Option-Act-.aspx#. Accessed July 01,2019. 8. Mayo Clinic https://newsnetwork.mayoclinic.org/discussion/tuesday-q-a-palliative-care-fo- cuses-on-providing-relief-from-symptoms-pain-and-stress-of-serious-illness/ 9. Oxford Textbook of Palliative Medicine, Fifth Edition, Cherny, Nathan I., Fallon, Marie T., Kaasa, Stein, Portenoy, Russel K., Currow, David C., Oxford University Press, UK, 2015. p. 314. 10. Sprung, Ch. L., Somerville, M. A., Radbruch, L., Steiner Collete, N., MD, Duttge, G., Piva, J. P., Antonelli, M., Sulmasy, D. P., Lemmens, W., Ely, W., Physician-Assisted Suicide and Euthanasia: Emerging Issues From a Global Perspective, First Published June 1, 2018 Case Report, Volume: 33 issue: 4, page(s): 197-203 Article first published online: June 1, 2018; Issue published: October 1, 2018 https://journals.sagepub.com/doi/abs/ 10.1177/0825859718777325 Accessed June 30, 2019. 11. Mayo Clinic https://newsnetwork.mayoclinic.org/discussion/tuesday-q-a-palliative-care-fo- cuses-on-providing-relief-from-symptoms-pain-and-stress-of-serious-illness/ This main theme / tema central is available in Culture, Society, and Praxis: https://digitalcommons.csumb.edu/csp/vol11/iss2/4 Culture, Society, and Praxis  	 Fall 2019, Vol. 11, Issue 2 	1 Understanding Assistance in Dying:  Arguments in Favor of the End of Life Option Act  Malgorzata Hausdorff  The California End of Life Option Act took effect on June 9, 2016, allowing the ter-minally ill to ask doctors for assistance in dy-ing.  It is a legal document, clearly defining and regulating the safeguards and procedures involved in physician-assisted dying.  At the same time there are many people in our soci-ety--27% of the US population (Brenan, 2018)--who are profoundly uncomfortable with the legalization of physician assistance in dying, previously known as physician-as-sisted suicide.  They argue that it is a slippery slope, that anyone will be able to “pull the plug” on them. They say that we should in-vest in end of life care and good pain man-agement rather than end lives due to discom-fort. Some are concerned that whoever suf-fers from depression will commit suicide in-stead of receiving treatment for their disor-der. (Cherny, Fallon, Kaasa, Portenoy, & Currow, 2015; Braverman, Marcus, Wakim, Mercurio, & Kopf, 2017; Emanuel, Onwuteaka-Philipsen, Urwin, & Cohen, 2016) These are real concerns that, unfortu-nately, come from misconceptions.  The End of Life Option Act is designed to help people who are dying, who have no realistic chance for meaningful improvement of their health, and who are senselessly suffering from their condition. (“End of Life Option Act,” n.d.) The most common misconception regard-ing assisting in dying is the terminology it-self.  The mass media bears a lot of responsi-bility for this, for they sometimes use the terms “Assisted Suicide” and “Euthanasia” interchangeably. These are two different things, even though they both have to do with ending life.  According to a leading palliative medicine* textbook, The Oxford Textbook of Palliative Medicine, Fifth Edition (2015), “euthanasia is defined as medical administra-tion of life-ending drugs at the patient’s ex-plicit request” (p. 314).  The result is the pa-tient’s death. The textbook goes on to clearly define the difference between these two enti-ties. “Physician-assisted suicide (PAS): in contrast to in euthanasia, the doctor is not the final actor in PAS but instead provides medi-cation for the patient to self-administer and overdose of barbiturates that suppress respi-ration” (p. 314).  In accordance with the law, you are the only person who can request assistance in dy-ing.  It cannot be a sudden emotional deci-sion. Firstly, the law only pertains to termi-nally ill patients deemed, by two physicians, to have a prognosis of less than six months. Your physicians are obligated to determine your ability to think clearly and rule out  any treatable causes of your desire to  end your life.  Undergoing psychological as-sessment is a prerequisite to further conver-sation, if there is evidence of a “mental disor-der” that may be affecting judgment. Your re-quest has to be made, and docu- mented by your doctor, at least three times  on separate occasions: twice made verbally, at least 15 days apart, and the third  request must be made in writing. There is the requirement of a private conference between the patient and physician to establish that no one is trying to influence or put any pressure on the patient to make the decision.  Further-more, there are witnesses to be present for the 1Hausdorff: Understanding Assistance in Dying: Arguments in Favor of the EndPublished by Digital Commons @ CSUMB, 2019Culture, Society, and Praxis  	 Fall 2019, Vol. 11, Issue 2 	2 written request, and the witnesses must not be involved in the patient’s medical care, and at least one of them must not be a relative of the patient.  The above is to assure that witnesses do not have an inappropriate interest in the patient’s death.  It is designed to protect the patient’s independence and safety. (“End of Life Option Act,” n.d.; Christopher, 2001) End of life care is an important topic.  Palliative care, a type of medical treat-ment that focuses on improving the patient's quality of life by lessening pain and discom-fort (Sprung, Somerville, Radbruch, Steiner Collete, Duttge, Piva, Antonelli, Sulmasy, Lemmens, & Ely, 2018), is without a doubt the least developed field in our country’s health care. Pain management, despite the endless array of drugs available, does not work out perfectly for everybody.  Physicians can control pain for the majority of people and provide reasonable and acceptable com-fort. Yet, there is a group of patients (most often the cancer victims) for whom the pain cannot be controlled fully while they are con-scious; therefore, physicians may have to re-sort to palliative sedation.  Palliative sedation is defined as “the monitored use of medica-tions to relieve refractory and unendurable symptoms by inducing varying degrees of unconsciousness-but not death-in patients who, given their disease state, progression, and symptom constellation, are expected to die within hours or days” (Bruce, Hendrix, & Gentry, 2006, p. 324; Cassell & Rich, 2010). Hence, this differs in a very important way from both euthanasia and physician assis-tance in dying, in that the intent is symptom management, and not death.  Death often fol-lows in this situation, but not always, and it is not the goal. There is another kind of pain that cannot be satisfactorily controlled with medication - psychological pain.  Can you imagine being comfortable with no control over your own deteriorating body, with no reasonable chance for recovery, or even temporary improvement?  We do not realize that it actu-ally happens until we experience it first-hand.  For example, imagine how you would feel having no control over bodily functions. Im-agine urinating or defecating in bed in the middle of the night, and waiting for a care-giver (frequently a complete stranger) to come and clean you up.  How would it feel to be aware of the smell and burning of your skin, while lying in a warm sticky mess, im-prisoned in your own body, and not being able to clean up?  How would it feel to have a stranger change your bed and wipe your most intimate parts clean?  How would it feel to experience it day after day until you die?  Might it cause legitimate psychological pain?  Should one have no choice but to ac-cept it?  We should have the basic human right to dignity and independence. We should have the right to end painful humiliation and discomfort if we are of clear mind, and choose to end it by the only way that would achieve it: ending our own life. Suicide is a word many associate with de-pression. Depression is a mood disorder man-ifested in a persistent feeling of sadness and loss of interest.  There are ways to treat it, and the End of Life Option Act is not intended for individuals who are suicidal due to depres-sion.  People who decide to commit suicide do not seek assistance.  They are not con-cerned with the legal aspects of their act.  They will find a way to commit suicide: jump off a bridge, hang themselves, take sleeping pills, cut their wrists, or legally buy a gun and shoot themselves. Suicidal people would not generally come to a doctor and ask for help.  If they do, doctors can evaluate their state and provide help.  Doctors are trained for this kind of intervention and can force-fully, if necessary, admit suicidal people to a hospital for treatment. The End of Life Op-tion Act is clear on who can seek help from the physician, and people suicidal in the heat of the moment are not eligible (“End of Life Option Act,” n.d.). 2Culture, Society, and Praxis, Vol. 11, No. 2 [2019], Art. 4https://digitalcommons.csumb.edu/csp/vol11/iss2/4Culture, Society, and Praxis  	 Fall 2019, Vol. 11, Issue 2 	3 The law includes many safeguards against coercion. It obligates physicians to fully inform patients of their treatment op-tions, and it not only gives the patient an am-ple amount of time and flexibility to make an informed decision, but it specifically requires 15 days between the oral requests to warrant time for rethinking. It allows for a change of heart at any time (“End of Life Option Act,” n.d.). It is not the law’s intent to challenge the religious beliefs of those for whom suicide is a “sin;” they will continue to be free to reject this option. Furthermore, they will never be offered it as an option.  To exercise the right to assistance in dying one has to voluntarily, by one’s own request, initiate the process.  Assistance in dying is help in ending unnec-essary suffering at the end of life.  Assistance in dying harms no one who has no use for it, and it aids the few who otherwise have no better option. It is an undeniable fact that 100% of us will face our own death.  There is no knowing how and when.  The End of Life Option Act (see Table 1) is designed to provide a choice for terminally ill who experience unbearable suffering, without a chance of a meaningful recovery, to end life on their terms. It is a purely personal decision.   Footnotes: *Palliative care may involve physical, spiritual, emotional or legal assistance (“Palliative care,” n.d.). Pain management therapies help patients cope with symptoms and side effects, while talk therapy and support groups provide emotional care. Some palliative care programs offer practical assistance to manage health insurance issues, advanced care directives, and wills and other legal paperwork.  At the end of a patient's life, palliative care may be the only treatment available. How-ever, patients can begin palliative care as soon as they are diagnosed with a serious illness.   Table 1: States and their legal documents that legalized assisted dying. California   2015 End of Life Option Act https://www.deathwithdignity.org/states/cal-ifornia/ Colorado 2016 Colorado End-of-Life Options Act    https://www.uchealth.org/colorado-end-life-options-act/ District of Columbia  2016  District of Columbia Death with Dignity Act https://www.deathwithdignity.org/states/dis-trict-of-columbia/   Hawaii    2018  Our Care, Our Choice Act https://www.deathwithdignity.org/states/ha-waii/ Maine   2019  Maine Death with  Dignity Act https://www.deathwithdignity.org/states/ maine/ New  Jersey      2019  Aid in Dying for the Terminally Ill Act https://www.deathwithdig-nity.org/states/new-jersey/ Oregon     1994  Oregon's Death with Dignity Act https://www.deathwithdignity.org/states/or-egon/ 3Hausdorff: Understanding Assistance in Dying: Arguments in Favor of the EndPublished by Digital Commons @ CSUMB, 2019Culture, Society, and Praxis  	 Fall 2019, Vol. 11, Issue 2 	4 Vermont    2013  Patient Choice and Con-trol at the End of Life https://www.deathwithdig-nity.org/states/vermont/ Washington  2008 Washington Death with Dignity Act 	 https://www.deathwithdignity.org/states/ washington/ 	References  Braverman, D., Marcus, B.S., Wakim, P.G., Mercurio, M.R., & Kopf, G.S.  (2017). Healthcare professionals’ attitudes about physician-assisted death: An analysis of their justifications and the roles of terminology and patient competency. Journal of Pain and Symptom Man-agement, 54(4): 538-545. Brenan, M.  (2018, May 31). Americans’ strong support for euthanasia persists. Gallup. Retrieved June 27, 2019 from https://news.gallup.com/poll/235145/americans-strong-support-eutha-nasia-persists.aspx  Bruce, S. D., Hendrix, C. C., & Gentry, J. H.  (2006). Palliative sedation in end-of-life care. Jour-nal of Hospice and Palliative Nursing, 8(6): 320-327. Cassell, E. J., & Rich, B. A. (2010).  Intractable end-of-life suffering and the ethics of palliative sedation. Pain Medicine, 11(3): 435–438. Christopher, M.  (2001). Role of ethics committees, ethics networks, and ethics centers in improv-ing end-of-life care. Pain Medicine, 2(2): 162–168. Emanuel, E.J., Onwuteaka-Philipsen, B.D., Urwin, J.W., & Cohen, J.  (2016).  Attitudes and prac-tices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. Journal of the American Medical Association, 316(1):79-90. End of Life Option Act.  (n.d.)  Retrieved July 1, 2019 from https://www.cdph.ca.gov/Pro-grams/CHSI/Pages/End-of-Life-Option-Act-.aspx Oxford Textbook of Palliative Medicine. (2015).  Cherny, N. I., Fallon, M. T., Kaasa, S., Portenoy, R. K., Currow, D.C. (Eds.) Oxford: Oxford University Press. Palliative Care in Cancer.  (n.d.)  Retrieved November 2, 2019 from https://www.can-cer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet Sprung, C. L., Somerville, M. A., Radbruch, L., Steiner Collete, N., Duttge, G., Piva, J. P., An-tonelli, M., Sulmasy, D. P., Lemmens, W., & Ely, W.  (2018).  Physician-assisted suicide and euthanasia: Emerging issues from a global perspective. Journal of Palliative Care, 33(4): 197-203.   		  4Culture, Society, and Praxis, Vol. 11, No. 2 [2019], Art. 4https://digitalcommons.csumb.edu/csp/vol11/iss2/4

Understanding Assistance in Dying: Arguments in Favor of the End of Life Option Act

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Understanding Assistance in Dying: Arguments in Favor of the End of Life Option Act

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