Debbie was a 20 year old girl with a severe case of ovarian cancer, and was a patient of the gynecologic-oncology unit at her local hospital. She was having unrelenting problems with vomiting as a result of an alcohol drip that was being administered for her sedation. Her appearance was that of extreme emaciation, and her breathing was always very loud and heavily labored. Her condition led onlookers to pure shock and disbelief that a girl so young could look so old. She was receiving nasal oxygen, had an IV, and was obviously suffering from what could only be severe air hunger. Her medical chart noted that she only weighed eighty pounds. Debbie’s eyes were
sunken in and looked hollow, and she had suprasternal and intercostal retractions with her rapid respirations. It had been a full 48 hours since Debbie had either eaten or slept. She had shown absolutely no signs of improvement with her chemotherapy, and seemed to be worn and beaten by her struggle to survive. Debbie’s only words to the nurse administering her supportive care were “Let’s get this over with.”
Debbie’s mother was by her side on the night that the gynecologic resident was paged to Debbie’s room. The resident was expecting this late night page to be an elderly woman that was having trouble getting to sleep, and was amazed by what she saw when she arrived at the room—a middle aged woman standing next to the bed of what could only be her sister, or so she thought until the resident saw the patient’s age on her chart. The resident, after reviewing the chart of the patient, and having a discussion with the mother, decided that while she may not be able to give Debbie health, she could give her rest. The resident went to the nurse’s station, and asked a nurse to draw 20mg of morphine sulfate into a syringe—enough, she thought, to do the job. She took the syringe back to Debbie’s room, and told the two women that she was going to give Debbie something that would help her rest, and that now was the time to say good-bye. Debbie’s mother smiled and said her final words to Debbie while she was still alive, then gave the resident the OK.
The resident injected the morphine sulfate into Debbie intravenously, and waited for the signs that her calculations on the effect of the medicine were correct. Within seconds, Debbie’s breath slowed to a normal rate, her eyes closed, and her features softened as she finally seemed at rest. Debbie’s breath continued to slow, and with clock-like certainty, had almost completely ceased within four minutes. Her breathing became very irregular, then ceased completely. Debbie was no longer alive.
Identify and Discuss:
Should Debbie have been assisted by the resident in her suicide?
There are many things to consider when asking this question. First and foremost, what did Debbie want? By her saying “Let’s get this over with,” it can safely be assumed that Debbie was ready for her pain and suffering to end. While Debbie was at a very young age in her life, the ovarian cancer had led to her having to constantly be in a state of sedation via IV alcohol drip. She had excessive trouble breathing, and from her emaciated state, we can also assume that she was having serious problems with either ingestion or digestion, or both. Debbie had already tried chemotherapy, but it had failed thus far.
Another factor to consider would be the opinion of Debbie’s mother. While by Debbie’s bedside in the hospital, the mother seemed to agree with Debbie that it was time for the pain and suffering to end. Debbie’s mother was probably upset by seeing her daughter in such a horrible condition for so long, that she was also ready to use the last resort of ending Debbie’s life. The case did not say anything about Debbie’s father so his opinion is not able to be taken into account.
Next to consider would be the legality of the resident helping Debbie to end her life. The case does not specify where this hospital is located; however, in every state, with the exception of Oregon, physician assisted suicide is illegal. If this hospital happened to be in Oregon, then it was within the resident’s legal rights to assist Debbie in her death. However, if this hospital was not in Oregon, then the resident that administered the morphine sulfate was doing something illegal, and could be tried for murder.
Another consideration would be the professional values that deal with physician assisted suicide. According to the Washington School of Medicine, half of practicing physicians believe that physician assisted suicide is ethically justifiable in certain cases. An average of one in five physicians will at some point in their career get a request for physician assisted suicide, and about twenty percent of these physicians will go through with the PAS. (Braddock)
I believe that in Debbie’s case, the resident was ethically justified in administering the morphine sulfate. It is what Debbie and her mother wanted, so that Debbie’s pain and suffering would be alleviated.
The resident first and foremost respected Debbie’s autonomy by performing the injection. Decisions about time and method of death are very personal, and a competent patient such as Debbie should have the right to choose when and how they die. Debbie made that decision by stating “Let’s get this over with.”
Another justification for the resident was a combination of justice and compassion. All like cases should be treated alike, and with Debbie being in a state at which she was competent to make her own decisions, she could have refused treatment to hasten her own death. For some patients, like Debbie, death by refusal of treatment is not quick enough, and suicide is the only way, as they are experiencing unbearable suffering. This suffering for Debbie was apparently not alleviated by her alcohol drip, and chemotherapy had already failed to treat her cancer, so it was out of compassion that the resident administered the morphine sulfate injection.
There are some critiques of performing physician assisted suicide—the first being the sanctity of life. This argument points out strong religious and secular traditions against taking human life. It may be argued that the resident should not have performed the PAS, but the case said nothing of either the resident’s religious beliefs or Debbie’s.
Another critique could be the passive versus active distinction. The argument here holds that there is an important difference between passively “letting die” and actively “killing.” Some might argue that treatment refusal or withholding treatment equates to letting die and is justifiable, whereas PAS equates to killing and is not justifiable.
One more critique would be that PAS demotes the image of the medical profession. This argument points to the historical ethical traditions of medicine, which are strongly opposed to taking life. For instance, the Hippocratic Oath states, “I will not administer poison to anyone where asked,” and “Be of benefit, or at least do no harm.” Furthermore, major professional groups (AMA, AGS) oppose assisted death. The overall concern is that linking PAS to the practice of medicine could harm the public’s image of the profession. (Braddock)
Braddock, Clarence H. MD, MPH. Physician Assisted Suicide. Ethics in Medicine. University of Washington School of Medicine. http://depts.washington.edu/bioethx/topics/pas.html