The ramifications of physician-assisted death legalization

It was very painful and almost unbearable to see my grandmother suffer from an incurable illness during the last few days of her life. She laid down on her bed, motionless and silent, and looked emaciated and vulnerable. The weak motion of her jaw as she gasped for air through the oxygen mask with each breath was the only remaining sign of her existence. Every night when I stayed up to take care of her, it frightened me to think that any breath would be her last one. One part of me wished to never let her go, but the other part of me prayed for her sufferings to end.

It’s very hard to let our loved ones go, but it is equally as hard to see them suffer through the pain from their incurable illness. Trudeau’s liberal government is proposing a plan to legalize physician-assisted death in Canada. Some positive aspects of this plan are as follows: (1) it is only limited to Canadians and permanent residents of Canada in order to prevent “medical tourism” of visitors from other countries seeking medical assistance in ending their lives; (2) it is for patients with a “serious and incurable illness”, which has resulted in “enduring physical or psychological suffering”, and this may help patients avoid prolonging of intolerable experience resulting from their illness; (3) two physicians must agree that “death has become reasonably foreseeable” after considering all the factors, and the patient must wait for a certain time period before proceeding for physician assisted-death. This ensures that the there is a valid reason for the request of physician-assisted death, and that the reason has been agreed upon by credible sources.

However, I think that the major shortcoming of the proposed legislation is that it is restricted to “mentally competent” patients. Simply put, mentally competent are those “who are capable of making decisions with respect to their lives”. Can this definition of “mentally competent”  be rightfully applied to patients suffering from a terminal illness? In terms of mental competency, are patients with a terminal illness different from those not suffering from a terminal illness? Can the terminal illness itself contribute to the aggravation of mental competence in such patients? One cannot be in the right state of mind when they are very sick, and thus it is difficult to determine whether they are mentally competent. For example, my grandmother, although a very intelligent women, was unable to speak because she was very sick. It would be unfair for patients who are unable to make decisions about their lives, as a result of the illness, to not be allowed the option of physician-assisted death. I believe that for patients with terminal or mental illness who are unable to make decisions about their lives, their families or caregivers should be allowed to make the decision on behalf of them. Sometimes patients do not anticipate their unfortunate circumstance, and therefore advance directives are not always sought. However, whenever it’s possible, advance directives that records patients’ choice on physician-assisted death in the event of terminal or intolerable illness should be utilised.  The Liberal Party’s proposed plan seems to discriminate against patients who are unable to make decisions for themselves, either as a result of their terminal illness or as a result of prior psychiatric condition. The definition of “mentally competent” needs to be revised in the context of legalization of physician-assisted death for those with terminal illness. Second, inclusion and exclusion criteria for “mentally competent” needs to be further explored.

The bill also challenges medical ethics. Physicians have a moral obligation to do no harm when delivering medical care to those in need. If the legislation is passed, then physicians will need to be trained to recognize situations in which deviating from the “do no harm” policy will become necessary in the context of physician-assisted death. Physicians will have to adapt to special set of rules and regulations which may require them to acquire new set of skills. Furthermore, the development of rigorous, yet user-friendly methods of specifically evaluating terminally ill patients’ mental competence may become necessary.

When the legislation is enforced, it will have influential consequences on the patients, families, and the medical community. Thus, it becomes necessary that the proposed plan is thoroughly explored in order to maximize its potential of having a net positive impact on the society.

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Reference of quoted text: I.A. (2016, April 14). Justin Trudeau Seeks to Legalize Assisted Suicide in Canada. Retrieved from http://www.nytimes.com/2016/04/15/world/americas/canadian-prime-minister-seeks-to-legalize-physician-assistedsuicide.html?_r=

 

 

 

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