Research Rough Draft ENGL 215- Task 4

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Project Research Proposal: Physician Assisted Suicide Elizabeth Rabe Ivy Tech Community College ENGL 215 November 2, 2021

Rabe 1 Topic Physician assisted suicide is a widely controversial topic among various groups of people, and it is an illegal practice in many areas of the world. However, there is a lot of debate around whether or not humans should have the right to die and decide when they should die in certain circumstance. One of the topics that will be discussed is the way that physicians or those in the medical field would feel about physician assisted suicide in the United States. In a study done by Barsness, Regnier, Hook, and Mueller, it was stated that “Of 150 societies, only 8% have position statements on PAS and euthanasia” (Barsness, et al, 2020). PAS simply stands for “physician assisted suicide” throughout this article (Barsness, et al, 2020). Physician assisted suicide is illegal in many US states, and many physicians will most likely not outwardly support the physician assisted suicide. Another source that will be looked at in determining the opinion of doctors is a study done by Lee, Price, Rayner, and Hotopf in 2009. It is a much more dated study, but it is still useful in determining how physicians play a role in the concept of physician assisted suicide in the first place. There are a few places in the world that have laws that are legalizing physician assisted suicide and they are as follows: Oregon in the United States, Belgium, the Netherlands, Switzerland, and Luxembourg (Lee, et al, 2009). It is heavily debated in many countries about what exactly determines someone to be qualified for physician assisted suicide or euthanasia, because if the focus is just on the right to die, then anyone can request a physician assisted suicide. For example, in the US state of Oregon, they passed the “Death with Dignity Act” which allowed doctor’s or physicians to administer lethal doses of medication to patients that were terminally ill and requested it (Lee, et al, 2009). This is typically the similar debate amongst doctors, patients, lawyers, and outsiders in regards to physician assisted suicide, and I intend to use all of my sources to find the relationship between the controversy.

Rabe 2 Literature Review The first source is titled “Survey of doctors’ opinions of the legalization of physician assisted suicide” and it is a study that was completed by Lee, Price, Rayner, and Hotopf. In this study, the authors conducted a questionnaire for 1000 senior doctors in England and Wales on their opinions and standpoint of physician assisted suicide. The source spends much time discussing how the UK relates to other countries in their conversation about physician assisted suicide, and uses their survey of doctors to formulate a synopsis on the support in legalization of physician assisted suicide or changing laws to allow physician assisted suicide to take place in certain instances (Lee, et al, 2009). The second source I had looked it is titled “US medical and surgical society position statements on physician-assisted suicide and euthanasia: a review” by Barsness, Regnier, Hook, and Mueller published in 2020. This study focuses on analyzing position statements of medical professionals on their opinion or support of physician assisted suicide (Barsness, et al, 2020). Their methodology was to identify “150 secular US medical and surgical professional societies” and determine which of these societies had statements regarding physician assisted suicide (Barsness, et al, 2020). From this study, the authors were able to see how the doctors in the studied areas viewed the controversial of physician assisted suicide and whether or not they felt it should be legalized or it could be crucial in certain terminal instances upon patient request (Barsness, et al, 2020). The third source that was observed in research is titled “Ending Life : Ethics and the Way We Die” by Margaret Pabst Battin. In the introduction of the book, Battin states, “Underlying this debate is what I think of as the Stoic/Christian divide about the individual’s role in his or her own death: whether one’s role should as far as possible active, self-assertive, and resppnsible and

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Rabe 3 may include ending ones own life – “(Battin, p. 6). This is really the underlying theme of my entire research project, whether individuals have the right to determine their own fate in the instance of physician assisted suicide. Battin goes on to cover three different sections within her book, the first section is about the “dilemmas about dying” in which people have religious, moral, or ethical feelings about how death should happen or when it should happen or if someone should get to choose their own fate (Battin, p. 18). The second section discusses historical, religiousm and cultural concerns about physician assisted suicide, and the third section covers “Delimmas about dying in a global future” (Battin). My fourth source is titled “When My Time Comes : Conversations About Whether Those Who Are Dying Should Have the Right to Determine When Life Should End” by Diane Rehm. In this source, Rehm introduces the opinions and stances from a variety of people on the topic of physician assisted suicide. The first viewpoints given are those of a terminal cancer patient and a professor of medicine (Rehm, p. 16). The book covers many other professions, situations, and people who have been close enough to the topic to put in intellectual conversation about physician assisted suicide. The novel ends with the grandson of the author and his stance on physician assisted suicide (Rehm, p. 225). This source provides a wide stance and variety of viewpoints about the topic at hand. Targeted Audience The target audience for this project is physicians and patients and loved ones of patients that would be effected by a change in legislation for physician assisted suicide. Obviously, if the legalization of physician assisted suicide took place, then physicians would have to decide if that is something they would be okay with practicing in the instances that one of their patients requested that route of treatment. Also, the patients who suffer from terminal illnesses with

Rabe 4 seemingly no way out would also be interested in research regarding the standpoint on physician assisted suicide if that was they way they decided to go. The loved ones of those choosing physician assisted suicide will also be affected by the change in legislation and therefore they are included in the intended audience for that reason. Argument Often times, when a patient is given a terminal diagnosis, there is a moment where they feel helpless, and feel like there is no point in suffering until the end. In an article by Jyl Gentzler that was published by the Journal of Medicine and Philosophy, “What is a Death With Dignity” covers a vast array of what is actually means to die with dignity. In this article, Gentzler examines the varied ways in which dignity can be interpreted in legislation for the matter of physician assisted suicide, and from these legal arguments, the author draws conclusions on dignity and the right to die. Gentzler also looks at Aristotle’s ideology of dignity and what it truly means to live a life that is best meant to suit the individual. Gentzler structures an argument supporting death with dignity in this article, and it is done so by backing up claims with evidence of previous legislative arguments on the matter, as well as a historical philosopher’s notions on what life and dignity are truly about. From this gathered evidence and support, Gentzler concludes that individuals do have the right to die with dignity via assisted suicide if that is what they should choose. The Toulmin argument model focuses on claims being made, then supporting those claims with factual data, warranting statements, and other backing support needed in order to assure that the claims being made are accurate. In this article, Gentzler states that there are certain aspects of passing legislation for physician assisted suicide that appeal to those who would like to die with dignity, or feel they have the right to die. Gentzler then gives data on this

Rabe 5 statement by following it with “the Oregon statute that legalizes physician-assisted suicide in certain limited circumstances is called “the Oregon Death with Dignity Act”” (Gentzler, p. 461). This data is then followed by the warranted support of the Supreme Court hearing two cases in 1997 that discussed the right to die with dignity. This is just one of the first few explanations in which Gentzler makes a claim and then backs it with evidentiary support regarding the claim. Gentzler begins the argument of this journal by stating that their purpose for this research is to determine if individuals really have the right to die with dignity, and if death can ever be done with dignity. The beginning section of the article discusses Immanuel Kant, and his views on dignity and death. Gentzler states that according to Kant, dignity is found within individuals and it is not something that is gained overtime. He supports this claim by explaining the Kantian theory on dignity. He says, “One might think that, if one is faced with the certain prospect of living in a morphine-induced stupor, or in a persistent vegetative state, one is faced with the prospect of losing the basis for the Kantian dignity that one possesses – namely, the one’s capacity for autonomous action…. Kantian dignity cannot be earned and cannot be taken away” (Gentzler, p. 462). This supports that dignity is something that individuals need, however it is also a rebuttal because suffering or living life in a vegetative state will not eliminate your dignity in death, according to Kant. It is interesting that Gentzler begins the article discussing the rebuttal aspects of the Toulmin scheme before truly jumping in to the supporting arguments and the supporting ideas for his claim that individuals do, in fact, have the right to die with dignity. One of the following statements regarding dignity on the matter is that individuals should not have the right to control all of their own decisions or make all of their own decisions to simply do whatever they would like to do, but that if someone is acting in a way that does not effect anyone else, then they should have the right to make those decisions (Gentzler, p. 470).

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Rabe 6 Gentzler follows this claim with support from Joel Feinberg who argues that competent adults should not legally be prohibited from deciding to commit suicide or have physician assisted suicide be an open option to them (Gentzler, p. 470). He quotes Feinberg, “It would be an indignity to force … others to die against their will, but an equal indignity to force him to remain alive,… against his will. Human dignity is not possible without the acknowledgement of personal sovereignty” (Gentzler, p. 470). This warrant’s the claim that all individuals with terminal diagnosis should be allowed to decide to have physician assisted suicide as their end-of- life treatment option in order to sustain their dignity in death the way in which they feel is best for them. A large theme in this essay is the Aristotle view of dignity and how this historical concept of dignity should definitely be taken into consideration when discussing dignity in death and physician assisted suicide. Gentzler states that there is definitely argument to be had that human dignity is something that all individuals have a right to, and thus have a right to die. Aristotle’s view of dignity centers around human virtue and character and thought (Gentzler, p. 476), Gentzler states that although it is not a total definitional match, “our notion of dignity seems to correspond most closely to Aristotle’s notion of the kalos (the admirable, noble, or beautiful) whose opposite is the Aischoros (shameful or ugly). The virtues themselves are admirable, on Artistotle’s view, and that which is productive of, conducive to, or an effect of virtue is also admirable” (Gentzler, p. 477). Thus supporting the idea that the nobility of death with dignity is admirable and therefore should be honored under the Aristotle view of dignity and life of human nature. The authors audience is those interested in the legislation and legalization of physician assisted suicide, looking at the topic through the lens of death with dignity. The article centers

Rabe 7 around topics of dignity and the varied ways dignity has been defined over the years in order to support physician assisted suicide as well as oppose it, but the audience intended would be to reach those individuals interested in the concept of dignity in regards to legislation on physician assisted suicide. Whereas the purpose of the article is to examine what exactly people mean when they say “death with dignity” or in regards to physician assisted suicide they say individuals have the right to die with dignity. The purpose is examine what exactly is human dignity, and how the idea can change depending on who you as, what time frame you evaluate, and the nature of the action being claimed to be supportive of dignity. Interview Notes Abbeigh Johns - Responded via Email - Nursing Student at Valparaiso University 1. Is physician assisted suicide something that patients should be able to decide for themselves? I definitely think there is a good argument to be made for the individual decisions regarding Physician Assisted suicide. If a patient falls under the qualifications for terminal illness, then I definitely think the decision should be their own to make. 2. Should family support systems be considered when making a decision regarding physician assisted suicide? Yes. Absolutely. The family or support system is vital to the care and the medical healing that someone does. Therefore, they should be taken into consideration when a patient decides to add PAS to their care plan. However, I do not think family disagreement with the decision should change the mind of the physician, as it is the patient's right to choose their own plan of

Rabe 8 care. 3. Would legislation on passing Physician assisted suicide make the decisions easier or harder? I think that it would make the decisions for both patients and their families if there was laws passed on legalizing physician assisted suicide. However, I think it would create more difficulty between patients and family than the issues that may already occur. 4. From a professional standpoint, is physician assisted suicide something that your agency or line of work has ever had to discuss or work with? No, we do not discuss it often or at all. PAS is something that we do not offer in our facility so it doesn’t get discussed in too much depth. However, We have had patients ask if that was an option as a plan of care but the answer is no as it is not legal in the state. 5. From a representative standpoint, is physician assisted suicide a topic that you personally have ever had to endure in life or environments? My aunt, a few years ago, had stage four cancer, and although it is not the same as Physician assisted suicide, she made the decision to quit treatments that would prolong her suffering. It teeters on the same line of PAS, and as a family member we all understood her decision. It did not make it any easier though. 6. How will physician assisted suicide effect the relationship between physicians and patients in the future and the present? I think there are a lot of physicians that would choose to not offer that as an option. As a doctor, you feel your job is to help people heal, not to help people die. So I think there would be a lot of existing relationships with physicians that could be strained.

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Rabe 9 7. Should the criteria for determining eligibility for physician assisted suicide be very blatantly outlined in the instance that legislation is passed? Yes. Absolutely. There are certain criteria that patients have to have or possess for any form of medical treatment, and this should be no different. Legislation should do as much as it can to eliminate any uncertainty about patient qualification for that route of care. 8. How do you feel (professionally or personally) that an individuals ability to make that decision should be or could be measured to ensure they are in the right space to make such a decision? Competency for sure, as well as mental health. Even for medical decisions that we practice every single day, if an individual is not competent enough or healthy enough to make their own decisions, then someone else makes them. 9. Should legislation passed on physician assisted suicide outline the possibility of familial intervention in an instance that the family feels the decision is not made correctly? Yes and no. I think if the family may feel strongly enough that a patient is not competent or well enough to make that decision, then they should have the ability to have it reviewed. However, they should not be able to just change the decision because it is not one they agree with. 10. Should a physician be able to refuse to offer physician assisted suicide in the instance that legislation would be passed on the subject. No. I think a physician can choose whether or not they offer that service in their practice,

Rabe 10 but I do not think that refusal can be made on a patient-by-patient basis. 11. How often do individuals given a terminal diagnosis refuse treatment? And is this refusal technically a step towards assisted suicide since patients are allowed to refuse service? Both personally and professionally, I have experienced an individual stop treatments or refuse treatment for an illness that can be deemed terminal. This could be a step towards PAS or a step away. It just depends on how you view it. Because refusing treatment or stopping a treatment does not end life immediately. It is still a “Natural” death or death caused by illness. However, PAS is simply ending the life of someone immediately and not letting the disease deteriorate their quality of life. 12. Is physician assisted suicide a taboo topic avoided in hospitals, and if so, what would you say is the reason for this? I think because of the legality of it, it might seem taboo or controversial. However, it is not entirely out of the realm of possibility for PAS to be discussed on a non-taboo agenda. Although in my field and place of work, we do not often discuss this treatment option because it is not legal, but again, I have had a few experiences with individuals wanting to go this route. The primary reason really is that death is a touchy subject for a lot of individuals, it makes people uncomfortable. 13. Is physician assisted suicide ethical in terms of medical ethics and your knowledge of medical ethics?In what ways could it be ethical and could it be seen as unethical? I think that it could be ethical if legalized. It would be another treatment plan with characteristics and a treatment plan. However, it could be unethical from some

Rabe 11 points because again, many physicians feel their job is to save lives and not end them no matter the circumstance. 14. In terms of ethics, are they certain aspect of Physician assisted suicide that are ethical and other aspects that would need to be tweaked with legislation? What aspects? I think this is similar to the last question in the sense that it could be ethical with legislation hard outlining the core characteristics and qualifications needed in order to even be eligible to choose PAS as a treatment route through your physician. 1. Is physician assisted suicide something that patients should be able to decide for themselves? a. Yes. The elderly especially. Their quality of life can diminish so much that dying seems dignifying and fair. If they feel they can make that decision, then absolutely. 2. Should family support systems be considered when making a decision regarding physician assisted suicide? Yes and No. Familial support systems are highly important. However, the families are not the one with the illness so they shouldn’t get to dictate how someone gets their treatment. 3. Would legislation on passing Physician assisted suicide make the decisions easier or harder? Definitely easier. If there was legislation legalizing PAS as a treatment method, than many individuals wishing to choose that route would have a much easier time deciding that they feel safe and comfortable with end of life treatment.

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Rabe 12 4. From a professional standpoint, is physician assisted suicide something that your agency or line of work has ever had to discuss or work with? Yes, absolutely. Working with the elderly in hospice can be hard because at that point, they feel they are just waiting to die and it can be sad and it can be extra painful. Many of them have asked to just be let go. It is truly heartbreaking to see some of these individuals struggle, and they discuss PAS in looser terms all of the time. 5. From a representative standpoint, is physician assisted suicide a topic that you personally have ever had to endure in life or environments? Never personally been through making the decision myself, and never had anyone close to me either have a terminal diagnosis where PAS could have been an option. However, personally working in Hospice can allow me to experience other individuals wishing to make the decision to have all treatments halted or simply just made comfortable. They can definitely feel their dignity is being stripped. 6. How will physician assisted suicide effect the relationship between physicians and patients in the future and the present? I think it will allow people to feel more secure with their physicians, and comfortable in discussing end of life treatment options. Definitely with the elderly again, they would create stronger bonds with their physicians as this is the person they are trusting to assist them in their suicide, technically. 7. Should the criteria for determining eligibility for physician assisted suicide be very blatantly outlined in the instance that legislation is passed?

Rabe 13 Yes. No doubt. There should not be any wiggle room for someone unqualified to make the decision. PAS should be about preserving the dignity of an individual and their right to die when necessary. The eligibility and outlining criteria should be absolutely strongly worded to avoid any confusion or loopholes. 8. How do you feel (professionally or personally) that an individuals ability to make that decision should be or could be measured to ensure they are in the right space to make such a decision? This can be harder to determine, because the elderly especially would be deemed unfit to make their own medical decisions, but at the same time, they are the ones suffering. So I think it could be determined on severity of their diagnosis and their terminal prognosis. 9. Should legislation passed on physician assisted suicide outline the possibility of familial intervention in an instance that the family feels the decision is not made correctly? Again, including family can be hard because although they are effected, it is not their life, their body, or their decision. So yes and no. Family support isn’t always huge with the elderly demographic anyway, so it would definitely be one of those scenarios that circumstances need to be considered. 10. Should a physician be able to refuse to offer physician assisted suicide in the instance that legislation would be passed on the subject. No. If a physician is not comfortable offering PAS then they need to be fully transparent when accepting any new patients and transparent with the patients they already have. Outward refusal is a misuse of their license, in my opinion. 11. How often do individuals given a terminal diagnosis refuse treatment? And is this refusal

Rabe 14 technically a step towards assisted suicide since patients are allowed to refuse service? Hospice is basically end of life comfortability, And can definitely be seen as a refusal to continue quality of life. However, it can be argued that at that point, their quality of life has diminish to a point that they cannot preserve their dignity. So I have experienced the shift in accepting that death is the easiest way. 12. Is physician assisted suicide a taboo topic avoided in hospitals, and if so, what would you say is the reason for this? No and yes. It can be seen as controversial because it is illegal or not legal and not offered as open practice in the state of Indiana. But again, in the line of hospice care, it is discussed often where patients just would like to go and not prolong their suffering and pain and sadness. 13. Is physician assisted suicide ethical in terms of medical ethics and your knowledge of medical ethics?In what ways could it be ethical and could it be seen as unethical? I definitely think when practice correctly it can be ethical. Individuals should have the right to make their medical treatment decisions despite how someone else may feel about it. This comes back to the patient body/patient choice of it all. If a patient feels that end of life treatment would be better than prolonging life that will end anyway, then they should be able to make that decision without any push back or concern. However, it can be unethical because physicians are meant to save or cure or treat patients instead of helping them die. So I am not entirely sure on the ethics of it all entirely.

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Rabe 15 Conclusion Based on all of the research covered here, individuals absolutely have the right do die in the way in which they would like. Dignity can be defined in so many ways that it is unfair to give the sense of dignity one meaning and one point of view. There are so many opinions on Physician Assisted Suicide, and not a lot of fact supporting it because the locations in which PAS is legalized or made allowed to take place are very limited. There are a variety of accounts from family members, researchers, and those who have been given a terminal diagnosis that it can be hard to draw a solidified conclusion behind the varied experiences. However, based on the research and argument, I feel that it is not up to outside opinions to make the decision.

Rabe 16 Bibliography Lee, W., Price, A., Rayner, L., & Hotopf, M. (2009). Survey of doctors' opinions of the legalisation of physician assisted suicide. BMC Medical Ethics , 10 , 2. https://link.gale.com/apps/doc/A198432694/OVIC?u=ivytech7&sid=bookmark- OVIC&xid=b3d73bee (Links to an external site.) Barsness, J. G., Regnier, C. R., Hook, C. C., & Mueller, P. S. (2020). US medical and surgical society position statements on physician-assisted suicide and euthanasia: a review. BMC Medical Ethics , 21 (1). https://link.gale.com/apps/doc/A642290270/OVIC?u=ivytech7&sid=bookmark- OVIC&xid=e284ffae Margaret Pabst Battin. (2005). Ending Life : Ethics and the Way We Die. Oxford University Press. https://web-p-ebscohost- com.allstate.libproxy.ivytech.edu/ehost/ebookviewer/ebook/bmxlYmtfXzE1MDA4N19fQU41? sid=216948b8-3145-4413-adb0-3b94102fb3b1@redis&vid=0&format=EB&rid=1 Diane Rehm. (2020). When My Time Comes : Conversations About Whether Those Who Are Dying Should Have the Right to Determine When Life Should End. Vintage. https://web-p- ebscohost- com.allstate.libproxy.ivytech.edu/ehost/ebookviewer/ebook/bmxlYmtfXzIxMTc1MzhfX0FO0? sid=df055076-67dd-4f78-8573-bd2a13c3e1bf@redis&vid=0&format=EK&rid=1 Gentzler, J. (2003). What is a death with dignity? The Journal of Medicine and Philosophy , 28 (4), 461–487. https://doi.org/10.1076/jmep.28.4.461.15968

Rabe 17 Meier, Diane E., Emmons, Carol-Ann, et. Al. “A National Survey of Physician-Assisted Suicide and Euthanasia in the United States.” April 23, 1998. The New England Journal of Medicine. DOI: 10.1056/NEJM199804233381706. https://www.nejm.org/doi/full/10.1056/NEJM199804233381706 Thomson, Judith Jarvis. “Physician-Assisted Suicide: Two Moral Arguments” April 1999. The University of Chicago Press. Vol. 109, No. 3, pp. 497-518, https://www.jstor.org/stable/pdf/10.1086/233919.pdf? casa_token=bRYAyP8DYNcAAAAA:DfOnP0i3eIsU0s1obwZYwGeEnyloxbvnGwRPp5 EhGczx_mKYW0Jx3o7Pe- ZQpR9Uuvv4mxVZQajwWu8DYvW7wv2ZDUZYOgShaUxTSJlt8m_43hlEhgA Pearlman, Robert A. Et Al., “Motivations for Physician-assisted Suicide” May 2001. The Society of General Internal Medicine. https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1525- 1497.2005.40225.x

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Research Rough Draft ENGL 215- Task 4

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